Whats Next For Nursing?
Just when I thought the nursing profession was at an all time low on morale levels, then comes the RaDonda Vaught verdict.
A Nurse Can go to Prison for an Accidental Error?
If you are unfamiliar with this case, RaDonda Vaught is a registered nurse who in 2017, made a fatal med error. She gave the wrong medication to a 75 year old patient who was in the hospital, Vanderbilt Medical Center, originally admitted for a brain bleed. Her condition was improving. She went for an MRI and was ordered to get a sedative, Versed, but RaDonda pulled a paralyzing drug, Vecuronium, and administered the wrong medication.
If you are not familiar, in nursing and healthcare it is stressed often to report errors, including medication errors. Administrators and educators often state that this reporting is for improvement of care and systems and not to be punished; I’ve heard the words “just culture” and non-punitive so many times. RaDonda made a med error, many nurses make med errors, unfortunately, RaDonda’s patient died. But here is where the scenario gets messy.
Major Medical Cover-up
The cause of death reported to the county Medical Examiner was “natural” and related to the brain bleed, no mention of the med error. Therefore, nothing triggers an investigation. The error is never reported by Vanderbilt to state or federal officials or The Joint Commission, a hospital accrediting organization that most nurses hate. Joint Commission, where TF were you in 2020 when we were rewearing N95 masks for 5 days and carrying them around in paper bags and wearing garbage bags when PPE ran out. My hospitals Joint Commission survey meant for spring 2020 and was, of course, cancelled. Not safe for them to come into the hospital (insert eye roll). Ok, let me get back on track… Next, Vanderbilt settles with the family out of court ($$$) and inserts a condition that the family cannot speak publicly about the error…SHADY. RaDonda is fired. Understandable. The Tennessee Department of health, responsible for licensing and investigating medical professionals, decide not to pursue disciplinary action against RaDonda.
But THEN, an anonymous tip about the error gets to the Centers of Medicaid and Medicare Services (CMS), a government agency who are responsible for much of the payments hospitals get for care, so they are pretty important. CMS pops up to Vanderbilt for a surprise inspection and discover the error. They threaten to suspend payment to the hospital for Medicare and Medicaid patients, which would severely cripple the hospitals revenue. A hospital could not sustain without payments from CMS. So what does Vanderbilt do? Throw the scapegoat, I mean nurse, under the bus.
More Pressure, More Patients, Same Paycheck
Don’t get me wrong, RaDonda Vaught made a series of mistakes. Overriding medications from an electronic med dispenser happens everyday. I read, at the time of the error, the hospitals electronic systems were down and you actually had to override your meds. I’ve seen many med errors happen, even in labor and delivery. I have overrode a medication. Usually IV pain medicine before the pharmacy releases it to the Pyxis, to prevent my patient having to wait while in severe pain. Won’t do that anymore. Sorry women in labor. RaDonda was only a registered nurse for approximately 2 years at the time of the error. That is quite new, especially for the fact that she is an ICU nurse. I’ve been a nurse for 13 years and I have never given Versed and never even heard of Vecuronium. Nurses are given more and more duties, more and more pressure, and more and more patients. Oddly, our paycheck stays the same. Funny how that works, right?
What’s Next for Nursing?
Fast forward to 2022. The nursing profession has changed exponentially since the start of the pandemic. Hospitals are so short staffed, and many of the nurses working as travel nurses that make triple per hour what the staff nurses make, so what happens next? Those staff nurses leave their loyalty at the door and embark on a new chapter in their career as a travel nurse. Travel nurses are given about a 3 day orientation to the unit and let loose to fly solo. A scenario just asking for more errors.
On March 25th, RaDonda Vaught was convicted of negligent homicide and is facing up to 8 years in prison. After the verdict was announced, nurses held their breath. Could this happen to me? The long hours, short staffing, minimal pay doesn’t seem worth it with the possibility of being criminally convicted for making an accidental mistake. This decision sets in motion dangers for patients ahead; nurses are going to be less likely to report errors, as they see the concept of “just culture” can go out the window along with their nursing license and possibly their freedom. Reporting errors, near misses, and good catches help patient safety in the long run. If we spot a trend, then we can see if there is a contributing factor to these errors that can be resolved.
“We are deeply distressed by this verdict and the harmful ramifications of criminalizing the honest reporting of mistakes.
Health care delivery is highly complex. It is inevitable that mistakes will happen, and systems will fail. It is completely unrealistic to think otherwise. The criminalization of medical errors is unnerving, and this verdict sets into motion a dangerous precedent. There are more effective and just mechanisms to examine errors, establish system improvements and take corrective action. The non-intentional acts of Individual nurses like RaDonda Vaught should not be criminalized to ensure patient safety.
The nursing profession is already extremely short-staffed, strained and facing immense pressure – an unfortunate multi-year trend that was further exacerbated by the effects of the pandemic. This ruling will have a long-lasting negative impact on the profession.
Like many nurses who have been monitoring this case closely, we were hopeful for a different outcome. It is a sad day for all of those who are involved, and the families impacted by this tragedy.”
Statement in response to RaDonda Vaught guilty verdict from the American Nurses Association
A Bug’s Life
I wish, we as nurses could see and utilize our power. I think of the movie “A Bug’s Life”. Remember that Pixar movie? The ants worked tirelessly year after year to gather food for the winter, enough for the thousands of ants and enough for the few angry grasshoppers that forced them to do the foraging for them. The grasshoppers were bigger, they were louder, but there were only a few of them. At the end of the movie, the ants realized they outnumbered the grasshoppers by the hundreds and thousands and that they had real power if they came together. Nurses are the ants. According to the American Medical Association, there are 10 nurses for every 3 doctors. California nurses get it right. Numerous times, they come together as a union, declare they are not taking the crap anymore, and guess what? California nurses are the highest paid, have mandatory breaks that are actually enforced, and get paid time and a half after working only 8 hours. It is harder to do that in North Carolina. NC is a “right to work” state. That limits the power of a union. We cannot strike, we would just be fired.
What do the Heroes do Now?
I thought that the pandemic finally shined a light on nurses and healthcare workers, and how hard we work, the stress we are under, and how important we are to the public and the healthcare system. That respect and adoration was short lived. Check out my previous post detailing how I feel about being a “Healthcare Hero” https://mentalmommynurse.com/are-we-still-healthcare-heroes/
The RaDonda trial and verdict was a dagger in the gut after an already tumultuous few years in the nursing profession. This decision will continue to ripple outward. Nurses who are burnt out and already thinking about leaving the bedside will be pushed over the edge, further depleting a nursing staff that is stretched thin by the pandemic.
The American Nurses Association (ANA) is the premier organization representing the interests of the nation’s 4.3 million registered nurses. ANA advances the profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all.
ashley
Mental Mommy, RN
