This guest blog was authored by Sandra Y. Walker, EJD, MS, RN, FAADN, Dean of Technical Studies at Central Ohio Technical College. Dr. Walker serves on the board of directors for the OADN Foundation and is a Fellow of the Academy of Associate Degree Nursing

 

Many nurses have been following the news related to former nurse RaDonda Vaught who was charged with reckless homicide in the death of a patient because of medical error.  The timeline of this case may be found at https://www.tennessean.com/story/news/health/2020/03/03/vanderbilt-nurse-radonda-vaught-arrested-reckless-homicide-vecuronium-error/4826562002/  Recently, Ms. Vaught was found guilty of the lesser charge of criminally negligent homicide and gross neglect of an impaired adult, and sentencing is pending.

This was a difficult case as many nurses can empathize with the challenges nurses face in providing care in today’s often stressful healthcare environment.  Readers may also question precisely why the authorities elected to prosecute Ms. Vaught – this post will not speculate on this; however, prosecutorial documents are available for review at the tenessean.com link above.

The challenge for the prosecution was to prove the elements of negligence, which is defined as “a failure to behave with the level of care that someone of ordinary prudence would have exercised under the same circumstances.”  https://www.law.cornell.edu/wex/negligence

There are four elements that must be proven to establish a clear case of negligence (https://www.law.cornell.edu/wex/negligence ):

1. the existence of a legal duty that the defendant owed to the plaintiff (the injured party)
2. defendant’s breach of that duty
3. plaintiff’s sufferance of an injury, and
4. proof that defendant’s breach caused the injury (typically defined through proximate cause

Nurses are guided/regulated by their state’s nurse practice act.  The National Council of State Boards of Nursing (NCSBN) advises “Safe, competent nursing practice is grounded in the law as written in the state nurse practice act (NPA) and the state rules/regulations. Together the NPA and rules/regulations guide and govern nursing practice.” https://www.ncsbn.org/npa.htm  The nurse practice act is a good source to clarify the professional nurse’s duty as articulated in rule and law.  Expert witnesses who speak to standards of care may also help establish the nurse’s duty.

In this case, the facts of the case were not in dispute.  Ms. Vaught stated that “she allowed herself to become “complacent” and “distracted” while using the medication cabinet and did not double-check which drug she had withdrawn despite multiple opportunities”.  https://www.npr.org/sections/health-shots/2022/03/25/1088902487/former-nurse-found-guilty-in-accidental-injection-death-of-75-year-old-patient  This leaves the jury little choice but to compare the nurse’s actions against the required elements of negligence.  One cannot ignore the nurse’s duty and the acknowledged breaches of that duty, or the fact that a patient was harmed.

That being said, there is a larger systemic issue that must be acknowledged.  The healthcare system has worked to establish multiple patient safety initiatives, yet error and patient harm remain a major concern.  Medical errors have been identified as the third leading cause of death in the United States, claiming 250,000 to 400,000 lives every year.  https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html  Obviously, more must be done, and healthcare leadership must lead the charge.  It is critically important that leaders create an environment where direct care providers are supported, and systems are in place to prevent bypassing safety protocols.  It should never be the norm, as was stated in this case, that nurses routinely override the system to access needed medications.  Nurses in particular must be supported as they are often the last checkpoint before medications or treatments are provided to a patient.  For example, nurses must be comfortable questioning orders that seem out of line with standard protocol and there should be no retaliation for any nurse who does so.

Critically important is the role of nursing education in the prevention of patient harm.  It is vitally important that nurse educators teach about duty and accountability for one’s actions, the importance of patient safety, and adherence to standards of care.  Education about just culture should be a part of every healthcare provider curriculum – not solely as a reaction when harm has occurred, but more importantly to prevent said harm from ever occurring.  An ISMP analysis identifies multiple points at which the system failed:  https://www.ismp.org/resources/criminalization-human-error-and-guilty-verdict-travesty-justice-threatens-patient-safety  Nurse educators should not shy away from cases such as this – separate from the debate about where to lay blame, much can be learned, and patient harm could be averted.

In the Vaught case, although it is without question that the nurse administered the wrong medication, there was certainly more that contributed to this unfortunate outcome.  It is to be hoped that a full root cause analysis has been conducted and all points at which the system failed are being examined.  The entire healthcare system owes that to our patients.