HUGE thanks to the team over at Dr. Levin Jubbal's channel for making this video possible and providing me with ALL of the details and research to make this video. Go check out his video as well! ua-cam.com/video/XW5oMCVb5S0/v-deo.html
She killed someone... You think you are above the Law just because you are Doctors and Nurses! When you kill someone due to your Next, that's Man Slaughter, but what she did was so out of line, one could easily think Murder! And you think the Courts are going to let someone Guilty of Manslaughter and maybe even Murder just gets to Walk, just because you've been told your whole life you are the Greatest and Beyond Reproach, as 100s of 1000s of Americans die every year due to medical malpractice! And if more of you want to Jail and Prison, than 100s of 1000s would become 10s of 1000s! Personally it sounds like something so out of line to do I'd vote guilty for Murder!!!
Sounds like all these masses of Medical Doctors like you on UA-cam are engaged in a Conspiracy to Spread Propaganda to Condone a Murder! Which was her Crime she was Found Guilty of, which was Murder! Suspicious that the Medical Community on UA-cam is so inline with one line of Rhetorics in their Favor for a Murderer! Very Suspicious Indeed! Oh wait weren't you guys just refusing people treatments, putting them in medically induced comas, pills to crush the kidneys, and High Pressure Ventilators destroying the Lungs, and you don't think you didn't make Millions of Enemies! We are cracking down on you Doc! Get Use to It... Traitor!
Hhmmm... How many Doctors in Hospitals Refused people's personal doctors orders for treatment backed by a Court Order to Impose those wills, and after all that you still refused, and put people into Medically Induced Comas and Killed Them! And some how you Doctors are so high and mighty but mostly Brainwashed you don't think the Courts aren't going to Crack Down On You! Like Huck You Traitor!
You said wait around in the pt room for awhile after med administration and take vitals? I said lol @ u but looks like my comment got deleted. At any rate what med Surg floor are you at that's fully staffed with nurses and techs with a normal 4 to 1 rn to pt ratio where you can hang out in the pt's room for a half an hour after med administration and take vitals? And that's morning meds, afternoon meds, and anything the hospitalist or a myriad of consulting doctors add in-between. I mean get outta here dude
I'v been a nurse for 17 years, and the best thing that ever happened to me was exiting this profession during COVID19, I can say this with absolute certainty, because I am no longer on blood pressure medications, I sleep good at night, my stress level is low, etc...
So if every nurse decides to take your lead and quit, who is going to take care of you when you are sick. Listen the job is not for everyone. I'm glad you found peace now but maybe you were not meant to be a nurse.
I totally agree with you. I was a travel/strike/perdiem ICU nurse of about a decade. Trauma certified sub specialized in NEURO. It’s unfortunate where legislation and administration is taking healthcare. I would always tell my colleagues that they had to do what was best for themselves and not put others before them and travel and not stay staff with facilities that would throw them under the bus at the soonest chance they had. I retired from nursing too in 2020 when COVID hit. I was telling my family to stock up on masks before the nationwide shut down because it was so obvious, watching COVID spread in Asia and Europe, that it would make its way here. Anyway I say this to say the entire healthcare system is not the responsibility of nurses. Administrators and politicians should probably make changes in legislation and policies if they’re concern is for the people of this great country. It’s no one nurses responsibility to be concerned with every sick person in the country. So congratulations on your retirement and your improving health!
louis Kwaku it is very stressful . Especially, when people are quitting and the others need to pick up the slack.. You get so called “ Mandated.” Which means you must work or get disciplined.. it’s sad but true.. accidents happen…. But, not at work..
It’s nice to hear from the point of a true medical professional instead of the true crimers. Coming from healthcare administration, I am confused as to why the nurse manager didn’t get charged somehow for not reporting
@@DrCellini administration getting peoples attention off of them...saving their money/self/brand by having a scapegoat. Happens all the time. I have been pulled into the office with a CEO and Lawyer before because they thought I reported externally. The system of capitalistic gain in human healthcare is disgusting. I'm sure many other countries look at these issues and go... "duh"
"It’s nice to hear from the point of a true medical professional instead of the true crimers" lol. It's nice to hear from a true medical professional... who manages to explain the situation in such a way that conveniently enough goes out of its way to not state the actual reasons for this prosecution. True crimer types are all silly goose types, what with watching cases and reading the transcripts and all that silly 'wanting to know the facts' stuff. Unlike the good doctor here, who has an opinion and bizarre ability to give the appearance he understands the facts of the case while managing to avoid, at all times, mentioning the facts that explain why this woman was prosecuted. The nurse was not prosecuted for a mistake that any random healthcare worker might make. Among the reasons for the prosecution, and one of the most important, is that she was orally instructed by staff that they cannot administer the medication or monitor patients who are sedated; the nurse has to do that. This nurse acknowledged that, injected the patient and then left her for dead in a place she knew, and acknowledged she knew, she would not be monitored by anyone. She literally swabbed, jabbed, withdrew and just left. Further, she did not document that she administered the drug. Since she did not annotate what was done, those trying to save the patient's life had no chance at all in reversing the effects. Sometime after the code was called, Vaught returned and then informed the people failing to revive the patient that she had administered Vecuronium to the patient. The response from the code team was, "I'm so sorry.' So, she didn't give a medication by mistake, thinking one thing was some other thing. She knew what she had administered. She knew no one would monitor her patient for her; that she had to do that. She administered the medication, spared not even a second to observe the patient after doing so, left the patient alone and didn't even bother to tell anyone what she'd done or make an entry in the chart so the next person would know what had happened. Oh, and the whole time she was doing this, she was busy flapping her gums with some guy named Darren and that she thought, at the time she was doing all of that, it struck her as a really odd. But she decided to do it anyway and then just leave. The patent. Alone. She was prosecuted for reckless homicide, not negligent homicide. Reckless homicide is a conscious disregard of a substantial and unjustifiable risk that causes death. The good doctor here notes what she was convicted of, but omits the charges filed... while disingenuously claiming that he was going to go through exactly what happened. Good thing no crime folks around these parts to disrupt a good bit of delusional fluff with the hammer of what actually is up in this case. Protip: get medical advice/information from a doctor, not crime information. They're typically utterly incompetent in the latter, what with having approximately 0 seconds of education in the subject and all.
@@integralmath Wow! That explains it all better! I sensed that there was something wrong with this. Your comment should not be under other comments where it is hard to find. Also, still do not need to be rude about it, but sharing of *CORRECT* information under this video should be done!!!
As a retired Rn of 44 years this is terrifying. Yes mistakes happen and I’ve carried my own malpractice insurance for decades knowing that my employers would NEVER have my back, no matter how loyal you are/were with them. Telling the truth about errors is paramount. The good people understand.🙏
You realize that malpractice would no have protected you from criminal issues. Vanderbilt did protect her financially…they settled with the family on her behalf as well.
@@sallycinnamon5370 what OP is saying about her own protection is different from what happened in the true story. Yes, there is criminal negligence but there is also just plain unfortunate mistake that isn’t criminal. That insurance would be useful in the non-criminal situations. As for the hospital settling the case, they weren’t doing it on behalf of that nurse. They were covering up the whole situation because they wanted to cover their own asses. So in that regard they were motivated to cover the nurse’s ass because it helped them too. If covering up for the nurse wouldn’t help the hospital, I bet you they would throw her under the bus.
@@SL-lz9jr are you reading my mind ??? please stop :-) . There was a case, where several babies were overdosed(did not die) due to a dosage mistake: the drug is available in two different concentrations..The vials (its an injection) were identical. The babies ended up getting the high concentration and not the diluted form. they nearly bled out. Who is was at fault ?
I have seen pharmacy put the wrong drug in the Pyxis drawer & nurses not look at the vial label when making up an emergency drip. Always check 3 times.
@@SL-lz9jr Oh, I am more distressed about the hospitals than I can truly express. And VB was definitely covering their own ass and the nurse was just included. I’m just saying that malpractice insurance, I think, is generally to cover civil damages. Malpractice insurance would not likely make a difference in this case as she wasn’t pursued civilly. Although I don’t know if it is possible that they would cover the cost of a criminal defence? I don’t know. i don’t carry independent malpractice insurance. In the event of legal issues I would be covered by my union likely.
I'm a retired nurse of 25 years experience in Canada. This nurse made a bad medication error, but it seems to me that there was a problem with the system. Why was this high level sedative medication so easily accessible, why wasn't there a 2 nurse sign off, or an administration checklist or protocol? This sets up a "trap" for any nurse who is having a bad day. If nurses can be prosecuted and go to jail for errors, nobody will want to do their job anymore. Stay in a job where an error does not send you to jail.
Why this, why that? Can’t you simply accept that an inept colleague made a castrophic error despite numerous warnings that would have given my cat pause? DO BETTER!
@@thehonesttruth8808 And unless ALL the things leading up to the error are identified and looked at, nothing would ever change. In Canada -- at least in the province I practiced for 30+ years - there are "incident" reports. An incident report is not used to assign blame, but to identify all issues and make the necessary changes to policy. This type of evaluation was taken from the airline industry. No one is immune from errors. While what might seem obvious to you watching the video, might not be so obvious in the work environment. I can tell you one thing: no one goes to work planning on making an error. IMO, the hospital administration are the ones who are ultimately responsible because it seem that they didn't have safeguards in place to start with. The employer also has the responsibility to report the nurse to her registering body for a separate investigation if appropriate, but they also have the responsibility for developing policy and making changes to the system that caused the nurse to make the error. Using this method the employer can also identify what in the nurse's world is going wrong, if there are previous errors, etc. Perhaps there might be a need for remedial training. Shouting at someone to "do better" is not an answer. Essentially, that is what this hospital administration did by firing her. Tossed the nurse under the bus and as far as this story is concerned we have no idea if changes were made to procedures and if not, there is potential for a repeat. And worse, it discourages medical/nursing coming forward when errors are made.
I’m a nurse of 30 years and NO hospital can pay me enough to go back to bedside nursing! I have been on the other side for the past 15 years and it’s very disheartening especially if you stand up for your staff! What this case did is to say nurse are not valued and are easily replaced because schools are popping them out every 6 to 18 months. This is a very very bad standard for the future of bedside nursing. I would not encourage any of my daughters or granddaughters into hospital base nursing!! My heart broke for this young lady who was used as a scapegoat 😤
Good. Please stay out of medicine if you think what this nurse did was acceptable. She must either be one dumb *** woman, or she did it on purpose. Those red flags that the system are there FOR A REASON. She ignored, not just one, or two of them, but ALL of them... on a ROUTINE medication that she is USED to giving to patients. She ignored the warning label, failed to monitor the patient, and didn't even double check the medication she was administering to the patient. And as a RESULT, the PATIENT **DIED**. THen to top it all off, the hospital tried to cover it up and bribe the family with money. The thing is, this case is just one of MANY that have happened, but most of them are probably covered up. How shameful and disgraceful of you to defend this person. You all in medical care have no overseers. No one who holds you accountable and it's disgusting. Why even was she being taken for a PET scan in the first place. After hearing the details of this case, I am so glad she was convicted. An ape would not have made that mistake, and it's my belief that it's even possible she did it intentionally. Again, please STAY OUT OF MEDICINE. If you have that much of a callous disregard for human life then you don't have a right to treat patients.
I agree with you Marlene. I have been a nurse for 20 years and a nursing professor for 5 years. It is scary how badly nurses at the bedside are treated by administration. Nurses are the scapegoats for everyone's mistakes including their own. Nurses work 12 hour shifts and go above and beyond to help out, but they get thrown under the bus even with the slightest mistakes by administration who do not appreciate them. Nursing schools nowadays are not spitting out qualified nurses, because the bar has been lowered. The new nurses no longer want to critically think, they just want NCLEX questions and answers and that us promotes by school administrators. COVID-19 showed us how those in politics and the world elites think about health care workers, we are not as appreciates as the basketball players and entertainers until they find themselves in a sick bed reflecting on what's important in life.
She didn't work in nuclear medicine or radiology. She was called down to the unit to help a patient who was from her original unit, though not her own patient (most units don't give Versed outside of OR or radiology). Next, the hospital was changing to a new system (Epic) and nurse's had been having to override medications a lot in that time. Even if not, there is often a delay in when a med is ordered and when it shows in the pyxis which is why it didn't show up in the patient's name. However, she didn't seem to know the generic name which is how the meds are found in the med dispensing system. Versed is a brand name and she searched by it. She obviously didn't closely look at the med however and so definitely negligent here. Next when she got down to radiology (where she didn't work), there was no scanner to scan the med and the patient. She did attempt to find one but time was running out and supposedly radiology was threatening to send the patient back up stairs without the test. It was the day after Christmas and the patient was anxious to get home to her family. So, big mistake, she gave the med without scanning the patient which would have alerted that the med wasn't on their med list. Lastly, she had a student or preceptee with her which added distraction. I'm not excusing what happened, but the hospital did not provide the tools for her to do her job as well as possible. Per her there was no warning that came up and her preceptee agreed to that. They were also being asked to go to the ER to help there and radiology said there was no need to stay and monitor and so she left. I'm not saying it's OK that this happened, but charging her and not addressing the systemic issues that helped create it, make it easy for this to just happen again.
Sounds she just happened to be at a wrong place and wrong time. If that was me, if I wasn't able to find the right med as prescribed then the patient can either go ahead with a scan without it or she can choose to reschedule. Better safe than sorry.
Very much so the Swiss cheese effect. You’re dead on. We use Versed all the time in ICU but we closely monitor the patient. I’m really surprised they didn’t monitor this patient in such a closed setting.
I agree with the fact that majority of nurses just do not know the generic names of drugs which is standard for any electronic medication cabinets because those are the real names of the drugs. I, as a nurse, prefer to remember drugs by generic or chemical name. It annoys my coworkers and pharmacists but that’s how I operate.
@@chrisgurl3043 she worked on a neuro ICU. I’m not shocked that paralytics it would be present on ICU’s. I’m shocked out how much outsourcing of checking to the computer system. I work in a system that has an electronic ordering system but not one that checks our meds for us. What she did was walk into a room and grab a random V medication then gave it. I think the fact that they are trying to implement the independent double of the medication via computers is a good thing.
Turns out the DA has ties to Vanderbilt along with the Board of Nursing. When Vandy found out they were going to be investigated by CMS, they needed a scapegoat. It’s the biggest conflict of interest but those that would otherwise have overseen that, are involved. Later we found out that her defense should have caught something like this but turns out he also contributed to the DA’s campaign. It’s a whole mess.
i think the DA plays golf with billionaires and the billionaires want to go back to doctors burying their mistakes. A lot more cost-efficient for the billionaires than setting up and upgrading safety protocols at their hospitals. If no health care employees admit any wrongdoing, the families do not need to be paid millions. just a thought.
I hope she is able to appeal to the highest courts and wins. She’s already lost everything , but then to realize it was handled SO egregiously, with conflicts of interest at every corner…..it turns my stomach even more. Prayers for nurse RaDonda, that her case is either overturned on appeal, or at the least, given a new trial, with new evidence forced to light. I’m just sickened and saddened that a system I believed in and gave more than half my life to, has become so degraded and vile, both in the way they operate, and the way they treat others, especially one of their “own”.
Can a driver that accidentally kills/ maims another driver/ pedestrian be held criminally liable? Yes. This is no different. It was a grossly negligent series of events. No intention (intention = murder), but this was extremely abnormal incompetence. Trust, I am among the first to tell you how stupid the naming system is for drugs.
@@cameronno6039 Using your example, the hospital spilled ice on the road and told their driver he needs to deliver on time. What changed my mind was that Vanderbilt instructed nurses to use overrides when getting certain meds. So on a daily basis, there was a culture of nurses overriding the warning signs BY THEMSELVES on the floor. There is no 2 nurse system for high risk meds (really weird). Why was there Vecuronium next to the PET scan in the first place? Most importantly, the family directly forgave RV.
@@Backyard_Brouhaha the family forgiving someone is the least important manner. If the DA wished to prosecute will Smith, they could. Family wishes are irrelevant to prosecutorial discretion. My logic is based on actual precedent, not tomfoolery. Why vecuronium is available at the PET scanner is likely why is available everywhere in the hospital... in case a patient crashes. If you've noticed my actual logic, i put very little weight on the process she used to obtain the vecuronium. I put the majority on the fact she had to reconstitute it (required her to read the bottle) and that she immediately left afterwards (also little weight but still important). The reconstitutuon is a huge red flag for negligence.
I am a Registered Nurse myself, this could happen to anyone of us. I watch the story in detail, my heart goes out to her. God is in the detail, it's great to see so many people supporting her
Considering all the dancing around and obnoxious preening I've had to endure from nurses while the government destroyed my entire life over Covid because you people supposedly couldn't keep up with it, I have no sympathy for you at all. Here's the good news, though, I've rebuilt. Things are back to normal for me. But you'll always have this sword of damocles hanging over you. That makes me smile.
@@thisisaname5589 there’s a lot of anger behind this post….I’m sorry you feel that way about nurses. I’m a nurse and covid pretty much messed up my life for 2 years too. Maybe not to the extent that u have, but we have all suffered. Glad that things are going better for u 👍
@@angiemansfield9381 It's not your fault necessarily, but surely you understand why I'd be absolutely furious at the way nurses' whining about their jobs was used to justify destroying our lives. I risk getting electrocuted every day. If I lean a few inches in the wrong direction and touch a busbar, that's it, I'm dead. But society had to be ground to a halt for years, because your jobs are hard.
@@thisisaname5589 try not to paint everyone with the same brush. I do understand what u are saying and i do know that for 2 years life has been pretty different for ALL of us. Our jobs have ALWAYS been hard. It just got harder. And the work load increased far more than our bodies could handle. But though we may say the job has been hard, that doesn’t mean we are whining. It’s just a fact. And a lot of times when i would tell someone it would be in a distant way, that far off look people get in their eyes when they think about it. Because there is no way to really convey what we go thru. Most of us are not in it for the glory. We do what we do, go home exhausted, and get up and do it the next day too. We have families and lives too. But it’s our chosen profession and we just do it. But we did not ask for society to be put on hold. Nurses are the worker bees….we do the bidding of the Boss. We didn’t have a choice when they told us people had to shut down their businesses and lose their incomes and homes etc….I’m guessing maybe ur a lineman or something? I have tremendous respect for these men and women who do that. And i personally have friends in that profession. But i don’t blame them when the power goes off. When our town got demolished by a tornado in dec 2021, some folks had no power for weeks….frustrating yes, but the evidence showed that these men an women were out there working day and night trying to put the poles and lines back up. We had to learn to live without some things during that first few weeks. And 4 months later our town is still visibly and emotionally different. So we all just do what we gotta do. This crazy shut down in the last 2 years came from the nutty professor hired by the clown in the White House. With all due respect we have all just been surviving sir.
As a medical student, I am concerned that this could happen to any of us since we are prone to make mistakes with long-hour shifts, especially during residency. Imagine long hours of study and years of training to be placed in court as a criminal is something I can not even comprehend.
I don't think we have 36 hour shifts anymore, which is a great improvement. But when you are working 12-14 hour night admission shifts for 6-14 days straight you will be very tired. My advice, (been out of my training for 7 years now) even when you are 4 admission behind and constantly distracted by pages and needing to stop your work to see sick patients on the floors, always take a moment to reflect if you are making the right decisions. Your attendings may be unhappy with you being slow one night and long board times in the ED, but it is better than making a mistake that harms someone or jeopardizes your career.
Personally, I understand the fear that you could be charged for a mistake, but you took an oath and owe your patients perfect decision making. Lots of people have been citing that this was a "mistake" and "accident" , that there was no intent to harm, and therefore the nurse should not have been charged. But we charge people all the time for causing harm to others without intent. Its the difference between manslaughter and murder. My 0.02 is that the extended shifts in nursing, are a moral dilemma in and of themselves. I understand there aren't enough nurses to fill all the slots. Maybe the hospitals should raise their rates for nurses to increases the pool of nursing talent and incentivise it as a career going forward. But in the meantime, staff must be held accountable for their actions on those shifts too. If someone drives home tired from a double shift at a coal mine and hits someone on the way home, they would get charged. Tired is a reason, but it isn't an excuse. I do extend my sympathies to this nurse. It does not bring me pleasure that she is being charged and convicted
Just tried pulling Vecuronium from our Pyxis and yup, there were warnings and big orange labels around the vial and cubbie, but no two-nurse verifications, didn’t need to override it (in the ED albeit not in the orders) just shows how the system really has the potential to allow these errors to happen on possibly your worst day ever
There are more warnings now with this case. But she still had alerts that went off. Both hospitals I’ve worked at have a two-nurse dual sign off on this med so not sure why this hospital didn’t. I have so many questions…
Why people try to justify this because a computer didn't do 100 percent of the thinking for her blows my mind. This wasn't an emergency situation. She herself admitted she wasn't overwhelmed, etc at the time of administration. Those big orange labels and warnings you mentioned should be enough. Had she paid attention to just ONE of those things this would not have happened. SHE WAS CRIMINALLY NEGLIGENT. You have to READ what you're giving and know what it is. That's med administration 101. The only thing that bothers me is that the hospital administration involved in the attempted cover up weren't charged as well
This scenario happened at one of the ERs I worked at. The nurse pulled out and gave Norcuron, instead of cardizem, fortunately; the patient was quickly intubated, thanks to the monitor and us quickly noticing AMS changes. Management did some changes to prevent this from happening again.
@@Carima72 i understand your impulse but we shouldn't back down because of one drawback. The people are loud on this case and there's no telling what it may change in the future. People aren't sleeping on this so we can push through
Do not worry. I have been an RN for seven years. Just make sure you scan the meds, pay close attention to detail when passing meds, as that is our job. It honestly is VERY hard to do so many overrides and make the error she did, even though no one wants to say that.
@@ericafitzgerald Okay sure maybe not the exact same mistake. But what if it's something else? Who knows what will be taken as prosecutable next? This opened up a whole can of worms that makes the whole field far riskier to get into.
Hey there are some things you got wrong/may not know. 1)she wasn’t specifically a radiology/nm nurse. She was a ICU nurse who came down to admin the medication as a favor to the patients assigned nurse that day. 2) There also was no scanner in the NM department and that part of radiology. This means she could scan the patient and the drug. 3) At the time of the incident the policy at Vanderbilt was if only versed was being given no monitoring was necessary. 4) She pulled that med from the upstairs med drawer from the ICU. 5) The doctor who determined COD stated it was a brain bleed. Indicating a cover up attempt (on behalf of himself and Vandy likely) and apparently he had done it before 5)The reason why she was able to override the med was because Vanderbilt at the time was switching EHR systems and was having issues with meds not being able to be pulled despite it being ordered and in the EHR chart so nurses were having to override meds until it could get fixed (and this is what they were specifically told to do; they were told until it gets fixed they needed to override if necessary). 6) That DA has ties to Vanderbilt by the way. He is up for re-election too and Vanderbilt has a lot of sway. Therefore by charging and convicting it clears Vanderbilt name and then they will still support that DA. The DA also has ties to the nursing board.
Like so many tragedies, it's the accumulation of events that coalesce to create the dire event. Wrong medication, sloppy procedures in effect, working out of usual role doing favor in unfamiliar setting. Sh*t rolls downhill. Management is never willing to take the blame when they can find line staff to take the blame.
Well said. In a similar case that happened a long time ago in Colorado, the DA found out about the case because his wife, who was a nurse in the hospital where the even occurred told him about it. It would not surprise me if something similar occurred in this case. Wha is troubling to me is that as an ICU nurse she should be familiar with Vecuronium since it is given as a premed before intubation or to intubated patients who need to lie still and are unable to such as person with a brain stem contusion or a patient with a neck fracture. Note: in addition to being given a paralytic to prevent movement they are also heavily sedated, so they are comfortable. So much about this case doesn't make a lot of sense yet I feel that jail time is not warranted because there was no criminal intent. At the worst she should be given a suspended sentence and I agree she is also being scapegoated by the hospital. In theory one could also go after the physician who falsified the cause of death on the death certificate unless he was unaware of the drug administration. I am a retired RN and loved my career but if I were young today, I would never pursue medicine or nursing as a career choice because of all the risks involved and the unrealistic expectations of both the government and society. It is not just me: a lot of doctors and nurses are leaving the profession because of all the difficulties that get in the way of doing their jobs. While this is an extreme example, there have been cases where medical staff have been sued when referring to a patient using the wrong pronouns. In one state criminal prosecution was considered for this offense in a bill before the legislature. These types of expectations only increase the risk of medication and procedure errors.
As an anesthesiologist, I can tell you this was not a simple med error, (not going to go into the fact that elderly patients, and especially Neuro critical care patients who have SDH should NOT EVER GET BENZOS) This nurse put forth an enormous effort to kill this patient. Forcing her to reconstitute a drug would give anyone pause, overriding 5 paralyzing warnings in the pyxis, not reading med label. In fact while reconstituting she would have had to read the vial where it says vecuronium and paralyzing agent to see how much saline is needed to reconstitute. Idk what went on in her head during this but if criminically negligent homicide exists this is it. She took 100 steps OUT OF HER WAY to kill this patient. If it was a liquid maybe people could give the benefit of the doubt of this being a med error but no way in hell can you say this was a simple med error when she had to reconstitute.
You seem to think that "this could have happened to any of us" means going through the EXACT same steps with the exact same med errors. No, he means any institution could have covered up any medical error and then later decides to make somebody a scapegoat after covering it up for over a year. The second they went out of protocol and decided not to report a sentinel event like this, this stopped being about Radonda and started being about the a heavy amount of corruption with the people involved.
I was a med surg bedside nurse for about 3 years. I already had intentions of quiting due to how we were being treated but Radonda's case proved to me that I made the right decision in leaving nursing. It was truly the best decision I ever made. Which is sad because it just shows where Healthcare is headed..
This is terrifying! As a nurse, I have made mistakes and self reported. When I worked in the hospital, if needed I could be assigned extra patients, above the set nurse to patient ratio, and I could not refuse. In addition, I couldn’t walk out or I could be charged with abandonment. Why isn’t the administration being held accountable? We are human. We all make mistakes and now we need to worry about going to prison too.
This doesn't sound like just a common mistake since she actually entered in the medication name rather than stopping when she couldn't find versed. She also could have googled the medication when she read the bottle. And was stopped to monitor the patient regardless. That's pretty serious incompetence. At minimum she should have lost her license.
She lost her license after the incident. I’m not trying to defend her actions and it’s a tragedy that this happened. What most people don’t understand is that nurses are so overwhelmed, it is a recipe for disaster. All medications have a minimum of two names. I personally am not familiar with the medication she gave. That being said, how are we supposed to know every name? When I worked in the hospital, I rarely had time to go to the bathroom much less google something. Please understand I am not trying to minimize her mistakes. I am simply saying she self reported and subsequently lost her license yet the administration didn’t do what they were supposed to do and they are not being held accountable. As nurses, we self report in order to improve processes to prevent similar mistakes. Now nurses are going to be afraid of going to prison if they say “I made a mistake”. I almost gave a patient a super high dose of insulin because they were on an insulin I wasn’t familiar with. It turned out that for what would normally be one unit of insulin, it was 5 units of insulin. The patient was the person who told me it wasn’t right. I called the pharmacy and the pharmacist came up to the unit. We then put a process in place that the pharmacist would draw up this insulin so this particular bottle would not be on the unit because I guarantee someone else would have made the same mistake and the patient might not have said it wasn’t right. I would never want to harm someone even by accident. Administration is supposed to work with nursing staff to improve patient safety however; that is not how it always works.
EXACTLY. I’m a nurse too. I’ve made mistakes also. Nothing this big. But, it happens. You get overrun. There are shifts when I go to the bathroom one time in 13 hours. It’s too much !
As a nurse of 7 years, Dr C, I want to thank you for the beautiful speech!!!! Totally agree. I’m still a baby in comparison to the OGs in this field but it’s scary for anyone working in healthcare 👍👍👍👍👍
I appreciate your analysis of the situation. There is so much more to the situation than what you discussed here. I 100% agree with your opinion though. During this time at Vanderbilt they were in a transition phase from their previous EMR to Epic. There was an issue with medications crossing over from the EMR to the Pyxis/omnicell. When the physician entered Versed into the EMR it did not cross over and show up in the Omnicell. This was a reoccurring issue with all patients at Vanderbilt during this time. There were major systemic failures at the hospital. This one patient had over 20 to 30 overrides under her name for medications during her stay at the hospital and she had only been there a few days. Also the prosecution liked to point out that she did not scan the patient & the medication before administration which was hospital policy. However they failed to mention that the radiology department did not have a computer with a scanner installed. There was no access to one. Why would Vanderbilt install a medication Omni cell in the radiology department but never install a scanner for medication administration? I have carried medication into a patient’s room before and the only thing that stopped me from administering it was the fact that when I scanned the patient and then the medication I was alerted that that medication was not on that patients EMAR. She was unable to do this. Being a Nashville nurse I have followed this case closely and I have friends who worked at Vanderbilt during the time that this happened. They have told me that the transition to the new EMR epic was a complete nightmare. They say that nothing was working correctly at that time. I also know a nurse who knew Radonda and he says that she was a wonderful nurse and when she realized her medication error she immediately spoke up and told everyone and did not hide anything. This entire situation is horrible and there is still so much more involved in this situation. The district attorney, Glenn Funk, who chose to prosecute her is also a Vanderbilt law professor. Something does not sound right about that since this incident happened at Vanderbilt University. Radonda’s sentencing hearing is May 13th in Nashville and I have heard that there are nurses from all over the country flying in to be there. I’m interested to see if there will be a few hundred there or a few thousand. There is also a change.org petition that has almost 200,000 signatures on it asking for clemency for her. www.change.org/p/grant-radonda-vaught-clemency
@@MissGold888 this wasn't murder. Murder requires intent. For all the different views I'm seeing on this case, including those who argue that Radonda deserved to be convicted of a more serious offence than she was, no-one is stating that she deliberately set out to kill her patient. That is the actual definition of the difference between murder and manslaughter - did the perpetrator actually plan to take the person's life and then take actions in the full knowledge and intent that these actions would probably end their victim's life? If not, its not murder. And I don't see any evidence that Radonda wanted or intended for her patient to die, however negligent she may have been.
@@MissGold888 this wasn't murder. Murder requires intent. For all the different views I'm seeing on this case, including those who argue that Radonda deserved to be convicted of a more serious offence than she was, no-one is stating that she deliberately set out to kill her patient. That is the actual definition of the difference between murder and manslaughter - did the perpetrator actually plan to take the person's life and then take actions in the full knowledge and intent that these actions would probably end their victim's life? If not, its not murder. And I don't see any evidence that Radonda wanted or intended for her patient to die, however negligent she may have been.
All nurses need to refuse to "over ride" the med dispenser. The hospital needs to have enough pharmacists on hand to make sure those orders are processed timely and correctly. Further those medications should only be referred to by their generic names. Looking up by a brand name should be a separate lookup. When these agents are administered it should be understood that the administering nurse is now required to monitor for some set period of time.. They are not to by punished for not doing other things, like they usually are. Lastly, all nurses should immediately start invoking the 5th amendment when questioned about past actions. Their replies should simply by, "All actions for a patient are charted, please check it for answers to your questions. I'm invoking my fifth amendment right's with regards to additional questions."
Thank you I couldn’t understand why she would override the system. Is this is what hospitals intended you to do when the medication isn’t available and process and orderly fashion?
@@mydillweed It is. Especially in ER and ICU settings where timing is critical. They don't want to have to wait for it to be routed through the pharmacist. But they also critically understaff their pharmacists so even regular routine orders can take HOURS to process. So when you have a patient in pain who just heard the Dr. tell the nurse he's ordering something they kindve expect it sooner rather than hours later.
I was FORCED to over ride in the many ER and ICU I worked in 30 years. I was nursing before PYXIS. Every ICU I worked in had their own satellite pharmacy,LAB,, back before BUUDGET issues. I am still a RN BSN CCRN, recently retired .I miss my patients!! Not the system .
@@kznsky14 Yes! Challenge "the system" and force changes. Nurses and doctors need to come together and advocate for their patients and themselves. Hospitals aren't going to listen to patients, but nurses and other staff have some leverage.
@@hmrobert7016 Hospitals don't listen to nurses or doctors either. They've been saying this for years. Nurses and Doctors need to start making the hospitals pay for this crap by refusing to do things they know are unsafe or against policy. Patients need to start enforcing this stuff by REFUSING to be treated substandardly and taking that concern to the Admins and ultimately refusing to pay if not treated properly. If I hired a contractor to fix my plumbing and it still leaked when he left because he used substandard parts, did the bare minimum of cleanup, and didn't double check his work cause he was rushing to the next job no one would think twice about not paying him. Why should healthcare be any different?
I am glad I am retiring soon, nursing has changed and not for the best! I have worked in a hospital since I was 16 and now I am 60 and the hospitals are never held responsible, it is always the nurses!! Thanks for speaking truth!
No offence but this mistake is so easily observable if you took 2 seconds to see patient response to medication. The paralytic would've made the patient completely unresponsive and you would've known what was wrong then.
Lol, are you kidding? 99% of errors are made by nurses and usually the MD ends up taking the hit. It’s truly ironic that nurse practitioners are clamoring for independence from oversight from physicians….I would take a great deal of glee in watching them fall flat ln their arrogant asses is so many patients wouldn’t suffer in the meantime. Many, many nurses are simply greedy and entitled…want all the benefits but No accountability much like teachers
@I I Do you really think that it's the threat of jail that will prevent mistakes? You don't think that the possability of harming a patient motivates health care professionals? The only think criminal prosecuttion achieves is a decreased reporting of medical errors. That doesn't mean less errors are happening, just that people don't feelsafe enough to report them.
@I I as a med-surg nurse for the past 8 years, I can promise you this is going to make things worse because nurses won't be self reporting. The way bedside nursing is, without self reporting, most mistakes will never be found out and system processes would never be improved!
I’m all for forgiving mistakes, but I also work in emergency medicine and I can tell you there’s a huge difference between versed and vec. In the ERs I’ve worked in paralytics are not easily accessible; you can get them but there are measures to prevent anybody from getting into them by accident. This is probably why.
Sounds like she was called from another unit (maybe medsurg?) to give the med. Wasn't her patient and the med order hadn't transferred into the pyxis system yet (or whatever med cabinet they use). As someone who also works in the ER, I can (somewhat) see how a nurse from a floor unit or other unit who isn't familiar with sedatives or close monitoring could have this happen, I mean, so many errors, but I could sort of see it. She gets a call that a patient needs a med, maybe she's covering a lunch, runs down, the order hasn't come across yet, she can't find the med, pulls vec on accident, gives the med, and runs back to her patient load.
@@katrinag1880 She has been a nurse since 2015, she floated to radiology and also had a orientee with her at the time. Patient might have been anxious and moving around a lot so she probably felt hurried to give her something quick to calm her down. Her head was not in the right place as she bypassed all these warnings especially reconstituting a powder drug. She ignored so many things that led to this death. Was she overworked? Was she overwhelmed by floating and having an orientee? Was she sleep deprived? Is she having issues at home? All these play a factor in a profession that works with human life. I don't agree with her being sentenced to prison but it's happening. Charged with two felonies, 1st one is a 3-6 year sentence and second one is 1-2 year sentence. Her sentencing is set for May of 2022 and I would assume she will get 4 years in total. This case is just sad to all parties involved. This was a sentinel event and many hospitals settle these cases out of court. " Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death."
I'm a nurse. I've been in home care for a few years and was considering going back into hospital nursing. I saw this case and was immediately like, oh, hell, no, never again.
Basically the nurse was negligent and caused the death of her patient. Typically this results in getting fired, losing your nursing license and paying a fine. This nurse got prosecuted.
Amen! Im going back to private duty homecare for this and many other reasons!!! The hospital will NEVER support you if you make an error. Im at the end of my career (42 years now) and i will never work in an institution of any kind again!
Please do not be terrified. Have a healthy fear. Healthy fear will help you prevent making mistakes. Remember the things you learn in school. Med Admin, evidences based best outcome procedures and protocols. Question what does not seem correct protocol. Someone taught RV that it was okay to override. Slow down if you are not sure and think things through, ask questions, I still ask or go to a book after 30 years in nursing! If you are terrified (lets call it healthy fear) that tells me you just might be a really good nurse. It takes years to feel competent when you work in hospital.
Let’s just hope Vandy has an excellent communications and HR department for the recruitment and retention of nurses! Well articulated and objective commentary. Thank you. The implications of this precedent are indeed profound because not only has she lost her ability to practice nursing but she has lost a substantial ability to have normalcy and livelihood. The charges against her are a class E felony. As a felon, it will be incredibly difficult to obtain suitable employment and housing. The US has a deplorable recidivism rate so I am unsure of the potential psychological, social, and ethical implications this will have for the trajectory of her life. This integration and ever pervasive social ostracism of “cancel culture” will only further deter transparency of future nurses, health care providers, and physicians. Ultimately resulting in increased prevalence of sentinel events, health care worker job turnover, and patient death.
Nice points here we punish people twice one court room and in life by depriving housing,employement etc.This is why i advise people in medical field to have a backup plan or profession.You never know how things goes.
THERE MILLIONS OF ONLINE JOBS SHE COULD DO ....IN THE VID OF HER LOOKS LIKE SHE HAS HER OWN HOME SO SHE SAFE THERE FROM RENTING. BTW I WAS A NURCES AID FOR MRDD AND I ALSO HAD SEVERAL MED ERRORS AND THEY ONLY WRITE ME UP AND I KEPT MY JOB.
Why didn’t she know the difference in the medication if she’s given it so many time? Why didn’t she see the warming on top of the vial that she put the needle in? Why she should be held accountable is because she took a life that she can’t give back, loosing her license isn’t good enough. There should be others being held accountable as well, but she definitely needs to be. It is a mistake but it’s also a life. If it was my family member, sorry would not be good enough. Her losing a job would not be good enough. My aunts, sister, cousins, sister in laws, mother in law are all nurses, two doctors, this is something I hope they pay attention to. Oops is not the answer
She knew full well what she gave. When she came back to radiology and the code was ongoing she said she gave Vecuronium. In no practice anywhere can you not know thats not Versed. Drawing up the med she would have seen the words warning paralyzing agent. And she gave it anyway! When she was arrested and brought in for questioning, the fool waived her Miranda rights, and yapped nonstop about what she had done without benefit of counsel. I read in one of these posts she actually said after she gave the med, “i remember thinking I just killed that patient”. That speaks to the fact that she knew what she gave. All without an attorney present! She is a disgrace to nurses everywhere. To all those people proclaiming her innocence looking to pin this on a failed system at her former place of employment, shame on you. She knew what she was doing, she ignored her pt after she gave the drug left her there to die without even a cardio monitor on her even though she was an ICU pt! God bless the Murpheys, they are way more forgiving than I would be. This must be a nightmare for them. She deserves worse than what she got for sure. She’ll never work as a nurse again, ( thank God). IMHO she should go far away, like maybe Guam or something . She is a disgrace and should be in jail. She knowingly killed someone. This was not a simple mistake as people are trying to paint this mess. Ive been an RN for over 40 years, Ive never encountered any situation like this thank God. Why? Because I check check and recheck. I do not allow myself to be distracted, so I dont make mistakes. Pt safety first above all else!!!!
Death by an injection of Vecuronium must be one of the worst ways to day. Being completely paralized and sufocate while completely awake must be horrifying.
This saddens me on so many levels. My heart goes out to this nurse, because you’re right, it could have been any of us. She is being scapegoated to protect the reputation of the medical facility. She followed protocol in reporting the error; she was transparent in admitting the error. All of the “why’s” rou raise are valid, but will never see the light of day. If there was anything I learned in my 41 year nursing career (thankfully retired now), is the “trickle down effect” of blame.ultimately, it’s usually nursing who gets thrown under the bus to save face for the institution. Would I ever encourage anyone who’s considering a career in nursing? In this day and age, NO. Until nurses are recognized for their value and worth, and paid accordingly, jut NO. As much as I loved the majority of my career, the last 5 years or so were gut-wrenching, soul-sapping, emotionally draining and physically exhausting, abject misery. I would never want anyone to feel that way. Thankfully, the good times and wonderful memories and people will be what I hold dearest.
It sounds like the hospital admin leaked the info for the purpose of protecting their name and used her as the lowest hanging fruit as the scapegoat. Sounds like CYA to me
I'm a pharmacist of 5 years and was going through an abusive relationship and severe PTSD while working. Anything can happen anytime and this is incredibly scary for any HCP! I have a lot of compassion for this woman
Wow😮 I’m a retired Certified Pharmacy Technician with 15 yrs experience I worked briefly with a couple of new PT’s that did that! They couldn’t find the correct pills on the shelf,so they did what this nurse did!They pulled the wrong drug! They did it on purpose. Thank god they didn’t work there more than a few days! They couldn’t find the drug they needed so they picked the drug next to it. Thankfully we had a computer over ride system,where you needed to scan the script label then scan the medication bottle. If it matched up it took you to the next verification screen on the computer. You then filled the script and it went through 2 more checks by the pharmacist.I loved my job,took an early retirement when the pharmacy closed
As a retired nurse I completely agree with you. Makes me glad I’m not a practicing nurse. This nurse for sure did not intend to kill this patient. I don’t I understand how she could over ride the drug machine. I know of no way I could have done that
I am completely confused by anyone thinking that her actions somehow remover her culpability. It doesn't matter if the system failed following her error, that has nothing to do with her failure to ensure she administered the proper drug. Yes, she was honest. Yes, she reported her error. That doesn't change the significance of the error, or HOW it should be handled once law enforcement become involved. If anything, one could argue that once she observed the hospital wasn't going to report her negligence to the authorities, she should have reported her actions to the police herself. What she did is no different than a police officer accidentally using their firearm instead of their taser. Once you remove the actual tools used, it comes down to the same base thing. The trained professional knew the proper procedure, knew the importance of following the rules and regulations regarding their actions, and failed to follow those procedures. That is exactly what negligence IS. It is an accident that was caused by not following the proper rules and regulations... (apologies, I am Autistic and the previous sentence doesn't... FEEL right... so if it is confusing to anyone else, understand it is because I could not come up with better words to define what I feel). All the above brings us to the most important issue with what you were saying about not punishing medical practitioner's with making mistakes because then they won't report them. That... that is a VERY dangerous statement. The way I understood it is you were saying that there's a difference between a mistake and negligence... but that only works in one direction. One could always write a sentence and replace 'negligence' with 'mistake' and you would never have to worry about accidentally putting an innocent person in prison. If you write the same sentence and MEAN mistake, but use negligence, then someone innocent can go to prison. Reporting of the action itself though is not what defines negligence vs mistake. What she did was negligent. End of story. She was using a drug that she clearly KNEW how to use. She KNEW that she was supposed to read the labels. She KNEW she was supposed to monitor the patient. All these RESPONSIBILITIES were ignored which made her mistake, negligent. The exact same reason an accidental discharge is NEVER an accident and always NEGLIGENCE (unless the firearm itself broke in some way that allowed it to to fire without the operator). So as sad as it is... she deserved to go to jail. Her negligence led to a person dying and she is responsible for that. This is no different than expecting police to be held accountable for their actions, whether it was an accident or intentional.
@@pblegz3306 Exactly. I don't understand how anyone is trying to make this about the people above her. They're failure to do the right thing doesn't excuse her negligence. Her taking responsibility for her actions would be to plead guilty to making a mistake that could have been prevented if she followed the procedures designed to stop such a mistake.
Thank you. I am amazed at the insistence that this was a systems error when there were a number of very clearly defined safety behaviors she chose to ignore. Accountability seems to have gone out of the window.
I remember at my first job out of school. A nurse injected Milk of Magnesia into a patient. After the patient died, she was sued along with the hospital, the M.D. and anyone else even tangentially related to the case. The nurse then sued her nursing school for never specifically teaching her that you should not inject oral medications into a patient. The family got a huge payout and she had her license revoked and the nursing school and M.D. were absolved of any responsibility. The hospital, on the other hand, settled out of court.
AMEN! from a long time healthcare professional! Takes me back to my very early days as an RN - new grad- horrible staffing- being put in charge of whole floors - handed a med key and cart - and off we went!
I am a retired nurse also this is terrible she was made the scapegoat in this situation very frightening! Doesn't surprise me about the lack of support from the facility most don't care about staff or conditions and they wonder why they are so short staffed!! I miss my patients the doctors and fellow nurses but don't miss what medicine has become. I served my patients for 40 yrs. My last 3 were horrible in terms of stress and understaffed. Its a shame. God bless her heart my prayers out to her and her family. And to the patients family. Very scary.
I remember when I was in nursing school my teachers would tell us students stories about these nurses that were prosecuted for things like this and I used to think that they were kind of fear mongering and scare us into second guessing our decisions to become nurses ourselves. Now I realize how the system sets us up for failure. I can only speak for myself but I think that most of us go into the medical field with good intentions. We just want to care for our patients and see them get better and happy but with the way how things are it's like we are expected to make no errors and be perfect which is unrealistic because nothing will ever be. Even if we were to be replaced with robots/machines, they aren't perfect because they are as smart as whoever designed them which ultimately is us humans and we make errors because it's in our nature. It's crazy how one slip-up can turn your life upside down and end your whole career and pretty much your life. All the hard work you put in to become a nurse is down the drain.
Thanks for calling out the REAL PROBLEMS with how nurses are made into scapegoats for hospitals, which are the ones responsible for their safety standards, or lack thereof! Kudos to you for speaking out!
When there is a trillion things going around you, everyone calling you, things get out of hands really quick. I quit bedside. I quit been a nurse for that reason. I almost committed the same mistake, and that’s when I knew the system is failing us and the patients.
You said you didn't want to diminish concern for the patient but that is precisely what you did. The patient received all of 5 seconds of concern in this narrative.
Great points, Dr. C! As a seasoned RN, and nursing professor, I agree with everyone you said. I've given both those meds many times. The public does not realize that likely only 10% of all medical errors are ever reported. Most errors are minor, cause little to no harm, and frankly, filling out the paperwork takes a lot of time. The significant errors are often only dealt with when people are caught, are honest/take responsibility (like Rhonda), or hospitals are forced to deal with them (but look at how Vanderbilt hid the actual cause of death). The fear of getting in trouble, regardless if the organization has a "Just Culture" philosophy, is always real. The other real shocker is the HUGE under-reporting of "near misses"--I'm guessing more like 0.01%! Again, if "nothing" happened, who has time to report it? These are the realities of health care, and Rhonda's case (for all the reasons mentioned) will make it even less transparent.
As a nurse this video is much appreciated. The way this situation was handled was downright criminal and the verdict was definitely unjust, can this be appealed?
This blows my mind. You raise very cogent points. I'm still in my final year of RNs but I don't think this would be possible in Australia. All dangerous drugs and all IV meds are independently checked by two nurses (preparing and administering). ALL meds in paediatrics are double nurse checked as well. I guess this case is a reason why that's a good practice.
I have just started my TPPP and we discussed this case at an orientation meeting. This specific error may not happen but there was not a single senior nurse (or even those like me who had been ENs before doing RN) who hadn’t had a medication error. I gave a pt in aged care the complete wrong medication because there were 2 residents with same first name, I was agency and the carer I asked said this was the right resident, resident couldn’t tell me their name so I gave it. Didn’t find out about it till days later when I got a phone call from my agency saying what had happened, both the agency and the facility were quite good about it and nothing further came of it but that’s how easy it is. I could have given that pt something they were anaphylactic too, or could have given someone with a slow heart rate dig or a low BP an anti hypertensive. There are many ways that mistake could have killed the pt. That is why this case is so dangerous, because it will just breed fear in the next person to make a mistake, instead of reporting it they are more likely to cover it up and nothing will be learned from it. That’s why the safety and quality standards REQUIRE a blame free reporting environment for errors in health care. So we can improve the system as a whole and try to reduce errors and harms to patients
In an otherwise imperfect world, health care workers are expected to be perfect. Mistakes can happen at anytime and even the brightest and most experienced professional can and will err. People need to understand that their doctors/nurses/providers are human too. If you imagine this scenario as if the nurse's job is reduced to exclusively drawing a medication, preparing it and giving it to the patient, you are not considering that very likely she was also on the phone, charting, taking or giving report, getting called by multiple providers about other patients, procedures, orders, delays in labs, delays in medications, family members questions, transport, documentation, consents, rapid responses, pharmacy notifications... the list goes on and on and on. And this is true from the moment you clock in until the very last second of the unpaid extra hours you have to work to get everything done before going home. That is what we all mean when we say it is a "systemic" issue.
This is exactly one of the reasons I left hospital nursing years ago and have been working in the Home Health Care setting. You will be individually "Hung out to dry" by hospital administration and as mentioned, nothing will be done about a systemic problem.
Dr. Cellini - I have the utmost respect for you, thank for sharing the reality of this entire situation. You have put your professional neck on the line here. I am a long term quadriplegic (SCI for 40 years from a MVA at age 15) who has recently required multiple CT and MRIs due to a pressure sore. I still work and try to manage a general life. I'm grateful that I don't require sedation for any scans but for sure, this nurse certainly didn't have bad intentions. It's a rough call though as she made the wrong decision and I'm glad that I wasn't the recipient. Still, somehow the blame has to be shared with the larger system for sure, but by the time it hits the higher ups, it's too late and we patients would be gone. The simple problem was with the med delivery system - that poor nurse should never have had any 'V' medication option and it should have been questioned at the time of administration. I see both sides - my hope is to not blame but to just find a solution to rectify these challenges.
I understand this work is stressful but let's not speak on someone else's lack of following protocol. Not following the guidelines in place no matter how busy it is, is the best way to make sure something bad happens. I heard it was not a busy day and she was training someone to not follow protocol. I'm not trying to belittle the highly stressful environment but this isn't a delivery gone wrong so no matter how stressful it is you still have to do the right thing. I hope all medical personnel learned something from this. I learned from now on to ask more questions and to ask nurses and doctors how their day is going, make an attempt to make them smile, and talk to me about any meds they are giving me. You won't kill me because you are stressed.
Thank you for this video! This situation is terrifying and heartbreaking- I pray she doesn’t get jail time. I have some comments and welcome debate - 36 year nurse here with experience as a charge nurse as well as a nurse manager on a 40 bed inpatient BH unit. I’ve been obsessed with this case as are so many health professionals out there. I watched literally hours of this trial as well as listened to her interview with the board of nursing and her interview with the TBI. I think she has suffered enough and will be very sad for her if she serves jail time. All of that being said here is my take away: 1. Being honest is good, but this woman talked way way way too much. There’s such a thing as not hiding anything but she would NOT be quiet. She WAIVED her Miranda rights and did not have a lawyer with her and just talked and talked and talked, nailing herself to the cross. A lawyer in another video said he felt this case would have NEVER gone to trial if she had obtained a lawyer and did not speak to ANYONE until she secured one. She basically ruined any chance for the defense lawyer: she had the choice to precept that day: she welcomed it. Were you under staffed? “ no we were fine.” Were you stressed? “ no I was fine.” Do you feel unsupported? “ no I work with a great staff…” do you feel they need another float nurse on the unit? “No, one nurse can handle it….” And so it went, with no lawyer present and a signature waiving her Miranda rights she talked and talked and talked over an hour, telling them she caused it, etc etc. “I should have been more careful, I shouldn’t have made the overrides, I should have scanned the meds…”. several people including the lawyer in the video I watched said that we need to keep our mouths ZIPPED until we get a lawyer. Our mantra should be: “I wish to remain silent, I want a lawyer, I wish to remain silent, I want a lawyer…” period. Nothing else. After the interview with the woman who works with Medicaid fraud and who read her the Miranda rights prior to the interview the nurse Radonda asked, “ now what do you do again? What is your role? I guess I need to get a lawyer?” Last point: the interesting thing I noticed as both a charge nurse and a nurse manager- complacency leads you down the road to danger. Most incidents happened when there was more than enough staff present. We let our guard down, and in came the errors. You need that tiny nervous edge to maintain safety- just my opinion
By the time CMS got involved, some time had passed from the incident.....am I right? Did I read somewhere that she had been in counseling for a while as well? I'm just wondering if she was on any anti-anxiety meds or SSRIs, which may have affected what seems to be her own judgement....pictures don't always do justice, but it also seems like her countenance has gone through a huge transition, and not for the better ....
@@norxgirl1 I knew some time had definitely passed before CMS got involved, but I didn’t know she had been in counseling and didn’t think about the fact she could be on an SSRI. Thanks for bringing that up. I know as well when I’ve made errors I’ve immediately stated I was wrong etc etc. it’s so easy to do and when you interview in good faith you don’t think your words will be used against you 😓 I’ll be upset if she does jail time. She has been through enough already
She really missed the 5 W's of medication administration. I am an RN of 25 yrs and my husband had a car wreck that broke 22 bones and left him with a closed head injury. His pelvis was shattered which left him with an exterior fixator across his pelvis. He was non-ambulatory for about 4-5 months. He was also a Type II Diabetic. During his rehab stay I had asked several times that he not be given sliding scale insulin since he was on a 24 hour acting insulin. I was afraid it would lower his blood sugar too much. Well the doctor didn't listen and continued with sliding scale. One morning while I was there the nurse came in and administered the sliding scale. My husband's blood sugar went down to 13. He had zero metabolitic activity. EMT's got him back and when he got out of the hospital and back to rehab we had a come to Jesus meeting. I didn't sue them but I should have. Idiots.
I’m super glad she got criminally prosecuted her. How are you going to inject something into someone’s body without even reading the bottle and I feel really disturbing that so many nurses support and think it was fine.
Your expectation of a healthcare worker to work 40 hrs a week in a known staffing shortage, with supply shortages, long hours, and rare if any breaks and not make any mistakes is incredibly unrealistic. What other industry are you put in those circumstances and expected to take care of human life? Listen to what this guy is saying… it’s a systemic issue. It’s a healthcare system issue. Nurses are quitting for this reason. We’re being put into dangerous situations where mistakes happen. That’s a big reason why I quit intensive care nursing. The conditions aren’t conducive to keeping patients safe. Hospitals are a business. Businesses want money. The easiest was for hospitals to save money is cut staff to the bare minimum that is legal… and they can then staff you over what is legal and you can sign a paper that states that you were given an assignment that you consider unsafe conditions. However, I asked to sign one of these papers and not a single member of my management team knew where to find the form. Mind you, I work at one of the largest hospitals in the Midwest that is nationally ranked and a level 1 trauma center… This is why this issue should have be discussed and trialed by an actual jury of peers (healthcare workers) who understand the intricacies and state of healthcare as a whole throughout the last 5-10 years. Nothing will improve until we have universal healthcare and the business aspect of healthcare no longer exists.
Okay folks, let me try this another way, since many of you are still hell bent on taking up for this person. Your 16 year old child makes a few calls to friends, gets on Internet and hears there is a big party going on. She ask if she can go and after hearing it's a party of kids and young adults that she doesn't usually hang out with, you make the decision it's not a good idea and say " no " Your child sneaks out anyway and doesn't return until the next afternoon. Reason she gives is " mom I had a couple drinks and knew you wouldn't want me driving home" What a great kid. She made a good decision not to drive intoxicated. But you take her phone, and computer away anyway. She crys, tells you its unfair and slams her bedroom door in your face. You open it and tell her, you weren't finished. She is also grounded for 2 months except for going to school. Her reply, " but mom I said I was sorry." You want her to understand, there are consequences to not following your orders. She didn't know the kids. There were 21 and 25 year old young adults there, no parents and you had no idea where she was all night as you sat up and worried. Harsh punishment? Or good parenting? Sometimes saying " sorry " isn't enough. Same with the Nurse. Was it a mistake? As a Nurse, yes I've seen a few people make mistakes. Yes they are sorry and they didn't mean to cause harm to anyone. It's like running a red light accidentally. You either didn't see it or tried to beat it. You crash into a car and kill the family. You didn't mean to kill anyone but your reckless, careless mistake did kill a family. That was one red light. You probably will go to jail. The Nurse ran 15 to 18 red lights ( safety measures in place ) How many red lights were needed before she paid attention to one and stopped? She chose to over ride every safety measure. Not even look at the med label and warnings, then left a patient alone on 1st floor and went back to 6th floor. By her own admission she wasn't busy or rushed. Then why didn't you monitor the patient you just sedated? Careless, negligent and reckless. The patient, Charlene Murphy trusted the Nurse to give good care. Instead she died a horrific and terrifying death. Her body couldn't move. Yet she knew what was going on. Unable to call for help. This death was preventable. Not one Nurse I know has made these many careless mistakes. They usually catch the error by following safety measures. She didn't chart she gave the med. In fact she didn't admit her mistakes until a second Nurse confronted her with evidense. There are a lot of good Nurses who follow protocols, safety measures and rules. Then there are others. As a Nurse your priority is the care and safety of your patient. Because folks, without patients, we aren't needed. You can argue lots of people make mistakes. I'm telling you I've seen very few errors from competent, skilled Nurses. They give 100 %, they sacrificed and studied long hours going through school ( others barely got by) The good Nurses check, recheck, and check again. They are there for their patients for more than a job, they are there for their patients regardless of the patients finances, race or status. Jail time might make people and Nurses realize they have a patient's precious life in their hands and should be more responsible than to run red light after red light. Shame on you for not wanting the highest accountability from this Nurse. She took too many short cuts. Who knows if she did it before and just wasn't caught. She almost didn't get caught this time. Don't let another innocent patient be harmed or die in vain. Stand up, speak up for changes. But to stand up for this negligent Nurse won't solve anything but send a message to others like her, it's okay if you kill a patient, you won't do jail time. It's okay you aren't competent or skilled or even care for your patients safety. There should be laws in place to protect patients from Medical Staff such as Rodonda Vaught. And we all have worked with them, in every field of work. Just wondering if a drug test was done immediately after the event happened? As for the hospital. They too are guilty. They didn't report the med error because they said they didn't realize it was neglect. BS. You are covering your ass. They didn't report it to their accrediting agency either. Joint Commission. They didn't even report the non natural death to the medical examiner. As for the family forgiving the Nurse. They were paid off to keep quiet. Yet, some family that were notified had a different point of view. They took video of mom as she was having seizures while she died. Hmmm, the lawsuits may not be over yet. Think about what really happened here folks. It wasn't a simple error. But yes we do need changes. Put your effort in to making changes to protect patients. If not, med error Nurse may come knocking at your door or your grandchilds door the next time you go to the hospital. Don't let patients have died needlessly in vain.
She didn’t chart she gave the med because the nurse manager told her not to. She tried to do whatever to make it apparent she made a mistake…unfortunately it was an irreversible one.
@Gloria Bridges, YES, 100%! This nurse made so very many Repeated Negligent Mistakes, over and over again. And can argue, should have been even MORE CAREFUL while training one of her peers, yet didn't happen. This says a lot about the seriousness and negligent role she played in this poor woman's death. By not taking the time she should have taken, when people's lives are literally in her hands. This is what she trained for as a health care professional! She failed egregiously. Close to 250,000 people die Every Year - due to medical errors. This is an egregiously high number. It's appalling, and unacceptable! Maybe, just maybe, this is the wake up call people need, and will start taking their role as health-care giver/provider Very Seriously, as they should, and not make such negligent mistakes that causes harm, and leads to unnecessary premature deaths of patients, and loved ones. The jury got it right. And more than likely, she'll be out in a couple, or few years, with good behavior. But will send a clear message, when people's lives are literally in your hands, (that you train for) you better take your job, and your patients well being, Seriously.
I will never forget how hospital administrators were able to get the Covid-19 vaccine immediately after it was distributed to our hospital, while doctors and nurses had to wait. Insurance companies and hospital administrators are the main problem in the healthcare system.
Try being an EMT. In my state Telehealth docs got the vaccine while we were doing CPR on known COVID positive patients and weren't eligible until a month later. When it was finally available for first responders the city I worked in refused to give it to EMTs only Fire and PD.
PA type here. What a ridiculous ruling. -Vaught should lose her license, but negligent homicide? For context people who leave babies in hot cars get convicted of negligent homicide. -There were lots of systemic factors that led to this mistake. -Mistakes happen unfortunately. -Not reporting/covering up mistakes is unforgivable. It prevents a system of from improving itself. -We need Nurses. And we need those Nurses to tell us if a mistake was made. This ruling will make both of these things more difficult.
I have recently graduated from nursing school and this terrifies me. In school and on rotations I have learned that when administering medication the nurse suppose to do three checks against the doctor's order or the MAR. i.e when at the medicine cabinet, checking when drawing up the meds and at the patient's bedside. These are standard protocols to avoid medication errors. It doesn't matter how respected as a nurse you are any mistake can be for the worse as you can see in this case. Therefore, you always have to look out for yourself and be careful where you put your signature. Question physician's orders because even though it is the doctor that is prescribing the meds you are the one giving it thus you will be held accountable and responsible.
I worked in Transfusion medicine and we have so many checks and balances for the administration of blood products. I’m surprised that similar processes are not followed for medications.
Similar processes ARE followed for medications. Not to the extent for transfusions but protocols are in place and have been in place for decades. She screwed up on a number of levels. Even with all the screwups that led her to giving the wrong drug, if she'd only monitored the patient like she was supposed to this death would have been prevented. That is, she could have made many serious errors, but if she'd just done one thing right, (monitored the patient) no death would have occured.
I think healthcare workers in general are way too comfortable with errors happening and going to lunch. Everything is overridden by everyone. We need to be a little more terrified when we are on the clock. These are people's lives. Don't make excuses, we have to get better. Some things can be avoided. This was one of those times
Dr. Cellini, thanks for covering this topic. As an RN myself, I was curious to know your perspective and opinion, and I couldn't agree with you more. Well done.
"So instead she used the override function and found a similar drug that started with 'Ve.'" As Mark Twain said, the difference between the right word and wrong word is the difference between lightning and lightning bug.
Truly agree. You have to make sure when you don’t know, you ask and find out. I’m sorry she’s going through this but this is more than just a mistake it’sa life lost. I’m terrified at how many medical professionals that keep saying it’s just a mistake. It’s a life😔
I agree. I was wondering why she didn't use the generic name. This wouldn't have happened. When working as a paramedic, I would verify the medication twice. Once when pulling it out of the bag or drawer and once when pulling it up in a syringe. I wonder how many patients she was taking care of at the time? Always double or triple check your meds.
Could this have happened to anyone though? I would hope the people responsible for the patients health are not this careless. She disregarded multiple red flags that seemed like pretty big differences between the medicine she gave and the medicine she needed to give.
This is why I quit nursing. I was overwhelmed by overwork and was super prone to medication errors. My supervisors didn't care and the bottom line was profits for the company vs real genuine Healthcare.
@Natosha withanO all the Healthcare professions have been hijacked by a predatory capitalist model where profits are more important than patients and employees. This shift has caused untold pain and destruction to health-care in USA. It's called the medical industrial complex and many will continue to suffer at the hands of for profit corporate interests! Unless, there's a change, health-care professions are burn out and suffering places of employment imo!
These types of videos of yours really helps general public to get sensitised with matters related to healthcare. Its good that people like you can bring some sense into such delicate topics.
Vanderbilt was going to lose some federal funding when this was discovered and the DA is related to the head of Vanderbilt. This nurse was used as a scapegoat! Not to mention Vanderbilt has had SEVERAL issues over the years! How can we help fix this? I am not in healthcare but even I know this is horrible for healthcare! I hope she’s appealing and I hope there is a way the relationship between the DA and head of Vanderbilt is investigated!
Vandy wasn’t going to lose “some” federal funding- Vandy was going to lose ALL Medicare funding and would have to completely shut down. If you lose Medicare funding your doors are closed.
"We're human and we make mistakes"... Tiny mistake, tiny punishment; big deadly mistake, big punishment where you don't lose your life and get some jail time... Seems fair. You have great power in these syringes and with it comes great responsibility. Quit your job if you can't do it properly. In fact, if any action you perform puts others in danger, yeah, don't do that either. Malpractice insurance shouldn't be used to protect a murderer.
As a TRUCK DRIVER, I will sit this one out... Naw Nevermind...One fatal mistake out here and we are done. So many can be wrapped around a fatal error, but ultimately the accident is laid in the drivers hand because he or she had the final decision. Brokers are pushy asf and can really screw you up if they get mad with you. Pushy brokers, demanding customers and Jenks on the roads. All the questions you just asked at the end, I can relate to trucking. They rip your license up to shreds, so why prosecute? Because someone died.... Same goes for the nurse... Am I missing something?
The only thing you're missing is class. Medical professionals are basically held up as gods by society, so the idea that they could be held accountable for negligence is crazy to them. They think that normal laws of society don't apply, and because the medical boards are self regulating they can protect their own. Unlike trucking, which is seen as "working class" and actually has to answer to external accountability.
Reporting is the main issue here. In healthcare, whoever is providing care is often really the only one who fully knows what is happening or has been done with a patient, so if an error is made, it's very likely only one person on the care team knows. Unfortunately humans make errors. In Healthcare those can be life-threatening and time is vitally important to prevent death or disability which is why most discipline taken in medical is noncriminal. As soon as criminality gets involved,, unreported incidents go up and resultant patient deaths go up. She was a *good* nurse who reported the error, but there are a lot of bad nurses/medical professionals in the field and this ruling essentially serves as an incentive to not report an error, which vastly increases the chances of a totally reversible medical error resulting in a death or permanent disability because someone was afraid of jail time.
@@ilikewhales4971 Alternatively.... If she knew the risk of jail time, she might've been more careful dispensing the med. It's interesting though, how "we need to be able to commit criminal negligence without serious consequences because otherwise we'll do it anyway and not fess up" almost sounds like a sensible rationalisation. Probably not to the truckers who are in jail for negligent homicide, and the nurse's dead patients, though.
@@hmrobert7016 Nobody looks at somebody crushed to death in their vehicle and thinks, 'well they could have suffered a sudden unexpected cardiac event." You also can't just dump magical fairy dust on an truck accident after the fact and have everyone be OK. Medical is different. Someone accidentally mismeasures a heparin bolus? Great. Report it, order the antidote, no fatal hemorrhage. Patient falls with headstrike? It gets reported, they go to CT, fatal brain bleed avoided, management gets notified of increased falls, policies and staffing changes to stop more falls from happening. Cover any of those up and you absolutely WILL get slapped with negligent homicide charges. Your comment also implies intent and the reason it's called a mistake is because it is not intentional. It's the same with truckers, but the reality is trucking accidents are irreversible and medical errors are not. Reality also is that lots of people are stupid and selfish and if they're going to get slapped with criminal charges anyway, why not try to dodge them in the first place? In a place where most patients have potentially fatal comorbidities, some dishonest people will try. So bottom line is, encouraging proper reporting saves lives. And you can be as upset about how it gets done as you like, but humans make mistakes, which in this case happen to be in a large, fast moving, egregiously understaffed building full of very sick people and very powerful drugs. And as long as promptly reported errors aren't criminalized, you and everyone you know is safer when they visit the hospital.
The issue is that they're not actually doing anything to prevent this from happening in the future, they're making the issues that are already in place an even bigger problem. The exact issues that lead up to being a contributing factor in this case were not resolved, acknowledged or improved, and these issues will continue.
Thank you for speaking out against this case. As a future PA this is pretty scary. I certainly won't chose to work at Vanderbilt or even in Tennessee, but there are hospitals all over the country that have questionable practices and policies. Are there any databases where practicing providers can list some of the questionable practices at their hospital ie patient to provider ratio? This would help those of us entering the field to chose a facility that will support us as we are starting out.
This trial really resonates with me. As a critical care RN in a Neuroscience unit, we have patients who get pet scans all the time in presence of an hematoma because hematoma’s can be a result of masses. There are many times the MDs give patients medication to relax them for this imaging and other imaging for that matter. I agree with you, having a paralytic that can be overridden is scary. This does make me want to rethink being a nurse
I had a nurse forget to start a med for me recently. Nothing at all serious, it just delayed my leaving a bit and created a bit of a scheduling issue for the other patients. The thing was, I was asleep. She could easily have woken me and sent me on my way, on time, with no one the wiser. I’d have had a flare in symptoms, but no way to know why. She didn’t. She woke me, calmly explained why I was delayed and apologized. Then, she found her supervisor and explained why things were slow. That kind of integrity is admirable, and we shouldn’t do anything to discourage it. Avoiding mistakes happens with adequate staffing, higher wages, vacations and caps on overtime. These are all more expensive than scapegoating.
Thank you. Finally heard somebody do an unbiased evaluation of what happened. I just wish non-healthcare workers could really HEAR this and understand!
I don’t understand why everyone is standing up for her. I’m a nurse. We’ve all worked with those nurses who are terrible. They don’t give a crap about their patients. She obviously didn’t have any idea what she was doing. That is scary. What if that was your family member?
Example- I worked with an ER nurse who called the pharmacy to ask for another bag of TPA because hers was finished she thought it was a continuous infusion. These are the kind of nurses who don’t admit they don’t know what their doing, don’t look anything up, and have too much ego to ask for a second opinion. They are negligent.
@@MS-yu5cl I’ve called pharmacy thousands of times to ask about medications. Why would she reconstituted a medication and give it without looking it up or asking? She wasn’t giving the medication to an unstable patient, this wasn’t an emergency situation.
This comment is so wrong on so many levels. You're the reason why people say nurses way their own. That woman admitted to her mistake, her license was taken away and she reconciled with the family. The district decided to pick this case up and prosecutor her as a criminal. The fact that you can't empathize for her is disconcerting. I hate people like you.
Nurse Liz did a great job on the nursing perspective of this case. Physicians and providers generate income, but nurses are just a necessary expense. RNs and LPNs are more expendable and make easier scapegoats. I don't disagree that she made a horrible mistake, but to think that a nurse could become a felon for making an honest mistake is terrifying.
Yea. She talks about how in nursing med errors are usually taken care of without criminal charges and are used as opportunities to increase the safety and efficacy of the hospital systems we work in.
@@JoshTucker9151 i mean like people who do car accidents don’t go in with the intention of saving lives? If someone was in a car and the main brake failed and instead of pulling the parking brake the person panicked and slammed the pedal and tried to wildly steer out of the way, we would blame the person for killing but we would also examine the system that failed in order to create that brake failure? We would be angry at the car manufacturer. Do you know how many lives she HAS saved over the course of her career? It doesn’t excuse the life she took, absolutely not. But in a medical situation where so many lives are in your hands the unfortunate truth is mistakes happen. Most peoples mistakes are caught by safety methods in place but, in nursing, we call this the swiss cheese theory where at some point all the holes line up in the wrong way and a nursing error slips through. Losing her ability to practice and her livelihood is punishment enough, there was no ill will in killing the person and as a nurse it’s not fair to criminally charge for negligence when the social contract is broken. What about Vanderbilt’s responsibility? The radiologists who didn’t ask for nurse supervision of the pt? There are so many holes in the case and your car accident example. As a nursing student, having to take on this kind of liability terrifies me and makes me not want to treat patients because if I make a mistake no matter how well meaning what if I end up prosecuted like this? Without the support of the hospital and team who is supposed to have my back? I am learning pharmacology and pathology right now but having a doctor tell me a brand name and expecting me to be an expert on all drugs in all areas of the hospital when pharmacotherapy is constantly changing and new drugs are coming out all the time, and then having a malfunctioning warning system, and having no other nurses available to sign off even though that’s my hospital protocol because we are perpetually short staffed. It’s a systemic problem. That one person is being blamed for. Nurses should know better than to practice when overencumbered but if nurses actually didn’t show up when workplaces were unsafe to practice in no nurses would ever show up.
@@Ouchiness So you believe that nurses should be immune to the criminal laws that everybody else in society is held accountable to because they "go in with the intention of saving lives"? That's absurd. And the whole "think of the lives she saved" thing might go towards reduced sentencing, but you aren't allowed to be grossly negligent just because you have done good things in the past. The superiority complexes my medical and nursing colleagues seem to come out of school with these days makes me cringe and harms patient care. There are systemic issues here that would make the system safer, but at the end of the day Charlene is dead because her nurse didn't bother to check the formulary and chose a drug essentially at random because it sounded vaguely similar to the prescribed one. Even taking one second to google versed would've told her that she needed midazolam. She wasn't expected to commit every single drug to memory. And yes, there are systemic issues that need to be addressed. The hospital should be charged as well, but that doesn't mean the nurse was wrongfully charged. Nurses and doctors, comprising "the system", need to come together and change those systemic issues, challenging the hospitals if need be. Too often "The System" is just a cheap excuse to avoid individual accountability.
@@hmrobert7016 yea I believe nurses should be immune to criminal charges in the practice of medicine unless the malpractice is intentional. Also hospital systems should be criminally charged for the underpayment of nurses and the overburdening of nurses with patients.
If she was a general nurse helping out in several areas she should have been even more careful than usual. At the end of the day, this nurse is being held accountable for her reckless actions just like anyone outside a hospital would be. This doesn't sound like an emergency situation where her mental abilities were taxed, her job was to read the label and administer only what was prescribed. Others should've been held accountable as well.
I have been a nurse for 15 years. Regardless of policies, red flags, lack of monitor, no scanner, switching to new EMR, etc.; the issue is gross negligence and a human life was taken prematurely. I have 1 simple comment for everyone: Where was her common sense?
Nope.. it should serve as a wake up call. Many nurses are quitting and that's a good thing. It's better we purge the idiots than foster another potential tragedy. If she would have been not guilty, it could have served as a detriment to our profession. You know you don't wake up and decide to do this job. Roughly 33% if nursing students can complete and successfully pass a board examination. I'm a doctor of nursing and have completed a 4 year fellowship in intensive care medicine(intensivest). In all of my years of nursing I never would have believed such an idiotic error like this could have occured. It did unfortunately, this is what we call in medicine, a sentinel event. It is a world class fuck up... One that deserves this kind of attention, and prosecution. It's like the 9/11 of medicine! Lol . It's a sobering moment, intended to wake up the profession as a whole, or to drive off those who potentially could repeat it.. I'm dissapointed she was not charged for the higher offense, reckless homicide.. she deserved that.. she ignored our universal standards of care. Not something you can just simply forget, it's a robotic or rather mindless action that we all do without thinking. The fact that she left with an intensive care patient and neglected to continue telemetry through the transport is beyond me. This is not ever acceptable. If she would have continued that then maybe they could have discovered the signs of the distress early on... Her diagnosis alone required that supplimental oxygen and a bag valve mask be required for transport and conscious sedation. Further more, any nurse with half a brain that is transporting a patient to radiology for a procedure that requires conscious sedation medication would pull it from their floor stock and not wait till they are in a non-nursing area. If she was truly an experienced intensive care nurse, she would have also removed suggamadex along with the vecuronium to reverse it , in case of a unintended exaggerated effect.
@@dubuis69 I’m so shocked to see a medical professional agree with her being prosecuted. Literally EVERY other medical professional who I’ve watched cover this case feel she should not face any repercussions for her actions. There were literally safeguards in place to keep her from making such a fatal mistake. She gets no pass just because she reported it. It’s like “hey I accidentally killed somebody even though there were plenty of times during the process where I should have noticed my error but o well since I’m telling you don’t hold me accountable for literally being negligent because well I told you I killed her.”
I understand what was said and what some of y'all are saying however, someone died on her watch, due to her mistake. SOMEONE DIED. Consequences must be given.
Unless you actually work in a hospital setting and feel the rigor of what is expected of you (which contradicts the contract signed many times) I don’t think you will truly be able to comprehend how easy it is to make a mistake. Especially when the correct systemic protocol is not properly in place for whatever reason. She did make a mistake and no one is denying it. And it is unfortunate that someone had to pay such a big price. But the punishment being brought forward is not equitable. And she should not be the only one paying for it.
Thanks for this video. It could have been any nurses. I’m a nurse for 32 years in Chicago. We are overwhelmed daily due to staff shortage . We are ONLY humans. I felt bad for Miss Vaught😢
I am a nurse and been practicing in LTC since 1995..I am currently looking for assisted living or home health ...too much work. No time to do it and demands unrealistic..my heart goes out to the family of the deceased as well as the former nurse..
Thank you for making this video. You were spot on. No one will want to report mistakes. Her mistake was horrendous, but it was just that- a tragic mistake. We are all human. I am so glad I’m retired. I never worked with a Pyxis, but I understand there’s also a thing called ‘warning fatigue’- so many warnings pop up throughout one’s day that it becomes easy to dismiss them. #istandwithradonda #iamradonda
You said “No one will want to report mistakes.” I do not agree with you because it will be found sooner or later especially if it caused a fatal result.
Genuinely terrified by how many medical professionals see no issue with medical malpractice 😭 saying “this could be any medical professional” … maybe but it could also be any patient, such as you or a family member, life threatening mistakes are not just a small expected error!! She OVER RODE the system!!
the system allowed her to override it where is the accountability for the hospital she didn't want to kill that patient its horrible situation but for some reason people who don't truly understand what's happening in Healthcare want to criminalize Healthcare workers but these corporations are committing criminal acts daily and there's no uproar the medication shouldn't have been released without two nurses verification and possible supervisor also
Realy well done and well explained, I admire your confidence and conviction to your opinion. No one else spoke about this issue as honestly as you did. You earned my utmost respect!
My older sister was a meds nurse for over 20 years. She hated it. It made her a nervous wreck! She always triple checked, sometimes questioning the doctors who made MANY mistakes and actually stopped them from ordering the wrong thing.! She read her patients charts and made sure the doctors made notes! Her biggest peeve. She was so good at her job many doctors asked her to work for them.
After working as a bedside nurse for 3 years I have accepted a position away from the bedside. I saw absolutely no light at the end of the tunnel, as a matter of fact it is becoming dimmer and dimmer for nurses.
i've been a nurse for close to 5 years, and now I am in medical school. i can see both sides of this, however I can't ignore the facts. fact one: the nurse is to blame. there's no question on that, she overode the system, and pulled the wrong med. any number of excuses can be made for why, but ultimately there is a process called the 8 rights, 10 rights, 12 rights (they keep adding more) on medication administration. she didn't follow them. she went outside her scope of practice and killed someone. fact two: the hospital covered it up. this is the more scary part of this whole thing, because anyone can look up medical error stats, and I'll tell you I've seen numbers averaging anywhere from 100k, to 300k deaths per year attributed to medical errors. activists want to ban guns because 20-40k deaths per year are gun related (mostly suicides) but NO ONE is saying we should ban hospitals. the truth is, this story is scary because shit like this happens ALL THE TIME, we just never hear about it because the story is never publicized and no one is ever held accountable. healthcare is a joke, we as an industry tell the consumer, and don't get me wrong you are a consumer here; no facility exists to help you because it's the right thing over making a profit, if you don't believe me ask them why they automatically run sepsis bundles on one criteria when the standard is two, or why it takes 5-10 xrays to diagnose a fracture when they could probably do it in 1-2, why do 85 year olds need new hips and knees made of titanium when they have chronic CHF and/or renal failure and wouldn't get up to dance a jig even if it were 1956 again? why was this woman with a hemtoma going for a pet scan when she was due to be released anyway? it's billing. docs are often trapped in this broken system too, because they can't pay their loans if they don't make money, and hospitals won't pay out their contracts if they aren't generating enough revenue for the dept/facility. we tell you we got you, we'll take care of you, etc; but the truth is there are many dumb docs, and even dumber nurses being rolled off the assembly line to fill the demand of facilities. the real reason this story is getting so much attention; hopefully in my opinion is that some of these hospital executives will start getting charged with crimes too. mega corp healthcare facilities may also face harsher fines too. the only way to really change things, to really make any of those corporate robots care, is to hit them where it hurts; their wallets. or put them in jail with bubba.
"Medication errors" is a broad term. Errors this incompetent/ preventable don't happen that frequently. I agree with most of your points though. She was at fault. I disagree about the gun aspect. But we can agree to disagree there. Lastly, people have focused too excessively on the attempted cover-up. The coverup is separate from the incident. The incident itself is all her. The cover-up was all the admin. Both were negligent and potentially illegal. Good luck in your education and with match when that point comes.
Agreed. The discussion should be on the cover up. Her "mistake" was egregious and rather purposeful, even if somehow well-intended. Clearly she shouldn't be in nursing. The cover up is not surprising to me. As I posted above, nurses routinely asked myself and coresidents to adjust my orders (doses usually) if they accidentally administered too much (50mg vs 25 mg benadryl, 45 mg oxycodone vs. 15 mg, etc). They had no intention of reporting this -- in fact, they wanted the MDs to change the EMR so their dose amount (mistake) would reflect the changed order they asked for. The purpose of this was twofold -- 1. avoid reporting a mistake, even if minor 2. Shift responsibility/liability to the MD, in case the larger/wrong dose caused a problem, since now the MD is in the record as ordering it.
@@mar_man813 indeed, the system goes both ways. we all try to have each other's backs, but that's created an industry of dishonesty already. procedure rooms are usually pull and go document on the fly and that certainly is affecting errors too. the worrisome factor though is that the cover here is at every level. the nurses, the docs, the execs, the state nursing board, medicare investigators. yet we need to be arguing about will smith slapping chris rock to keep the oscars relevant. its sick.
@@cameronno6039 that's entirely the point though, we don't know because these errors are routinely covered up. do these type of errors happen often or not often? any of us can only attest to what we've personally seen, but bringing to light that there is indeed a well oiled system of sweeping these deaths under the rug in the name of profit is the point, and it does happen. probably a lot more often than any of us think. moreover, focusing on the cover up should be the focus, the nurse is done, shes facing consequences...where is the punishment for the admin? where is the regulatory initiate to prevent more cover ups? because this should make it clear to every pedestrian reader that if there was one cover up, there's likely more, and that's the problem. where's the justice? there isn't any.
What motivated you to go into medical school after nursing, and do you at all regret your choice of careers in any way? I'm at a crossroads, trying to figure it out based on the current climate of healthcare and economy besides personal motivations to enter it.
As a retired nurse, I thank you. Even before Covid, nurses were overworked. No nurse is perfect. I worked with a nurse who once hung a bag of Heprin, set the infusion rate, and mistakenly thought it was an antibiotic. The patient survived and so did the nurse. No one in the medical field is perfect. Mistakes happen.
Thank you for making a deep dive video on this topic! It was great to hear your opinion on the Cellini Rounds Podcast on Sunday, and then have this more in-depth video later in the week. Love the content!
I have a coworker that os allergic to 2 medications, And had a surgery coming up. She went to great measures to let Everyone know about her drug allergies. They were struggling to Wake her up after surgery (almost died) . They ended up giving her BOTH medications that she was allergic to! She is in the process of figuring out the responsible parties and filing suit.
This is sad and frightening. I have been a nurse for 17 years. I left bedside nursing and returned ten years later. So much has changed but the main thing is to slow down, check and verify what you are doing. I have been before the TxBNE twice….When these types of things happen you will definitely be standing alone and have to speak on your own behalf about your actions.
HUGE thanks to the team over at Dr. Levin Jubbal's channel for making this video possible and providing me with ALL of the details and research to make this video. Go check out his video as well! ua-cam.com/video/XW5oMCVb5S0/v-deo.html
She killed someone... You think you are above the Law just because you are Doctors and Nurses! When you kill someone due to your Next, that's Man Slaughter, but what she did was so out of line, one could easily think Murder! And you think the Courts are going to let someone Guilty of Manslaughter and maybe even Murder just gets to Walk, just because you've been told your whole life you are the Greatest and Beyond Reproach, as 100s of 1000s of Americans die every year due to medical malpractice! And if more of you want to Jail and Prison, than 100s of 1000s would become 10s of 1000s! Personally it sounds like something so out of line to do I'd vote guilty for Murder!!!
Sounds like all these masses of Medical Doctors like you on UA-cam are engaged in a Conspiracy to Spread Propaganda to Condone a Murder! Which was her Crime she was Found Guilty of, which was Murder! Suspicious that the Medical Community on UA-cam is so inline with one line of Rhetorics in their Favor for a Murderer! Very Suspicious Indeed! Oh wait weren't you guys just refusing people treatments, putting them in medically induced comas, pills to crush the kidneys, and High Pressure Ventilators destroying the Lungs, and you don't think you didn't make Millions of Enemies! We are cracking down on you Doc! Get Use to It... Traitor!
Hhmmm... How many Doctors in Hospitals Refused people's personal doctors orders for treatment backed by a Court Order to Impose those wills, and after all that you still refused, and put people into Medically Induced Comas and Killed Them! And some how you Doctors are so high and mighty but mostly Brainwashed you don't think the Courts aren't going to Crack Down On You! Like Huck You Traitor!
You said wait around in the pt room for awhile after med administration and take vitals? I said lol @ u but looks like my comment got deleted. At any rate what med Surg floor are you at that's fully staffed with nurses and techs with a normal 4 to 1 rn to pt ratio where you can hang out in the pt's room for a half an hour after med administration and take vitals? And that's morning meds, afternoon meds, and anything the hospitalist or a myriad of consulting doctors add in-between. I mean get outta here dude
@@randyross5630 you randy are clearly a flake with no medical background
I'v been a nurse for 17 years, and the best thing that ever happened to me was exiting this profession during COVID19, I can say this with absolute certainty, because I am no longer on blood pressure medications, I sleep good at night, my stress level is low, etc...
So if every nurse decides to take your lead and quit, who is going to take care of you when you are sick. Listen the job is not for everyone. I'm glad you found peace now but maybe you were not meant to be a nurse.
I understand you and I agree with you
I totally agree with you. I was a travel/strike/perdiem ICU nurse of about a decade. Trauma certified sub specialized in NEURO. It’s unfortunate where legislation and administration is taking healthcare. I would always tell my colleagues that they had to do what was best for themselves and not put others before them and travel and not stay staff with facilities that would throw them under the bus at the soonest chance they had. I retired from nursing too in 2020 when COVID hit. I was telling my family to stock up on masks before the nationwide shut down because it was so obvious, watching COVID spread in Asia and Europe, that it would make its way here. Anyway I say this to say the entire healthcare system is not the responsibility of nurses. Administrators and politicians should probably make changes in legislation and policies if they’re concern is for the people of this great country. It’s no one nurses responsibility to be concerned with every sick person in the country. So congratulations on your retirement and your improving health!
I hear ya.. about the stress..
louis Kwaku it is very stressful . Especially, when people are quitting and the others need to pick up the slack.. You get so called “ Mandated.” Which means you must work or get disciplined.. it’s sad but true.. accidents happen…. But, not at work..
It’s nice to hear from the point of a true medical professional instead of the true crimers. Coming from healthcare administration, I am confused as to why the nurse manager didn’t get charged somehow for not reporting
It is odd…
@@DrCellini administration getting peoples attention off of them...saving their money/self/brand by having a scapegoat. Happens all the time. I have been pulled into the office with a CEO and Lawyer before because they thought I reported externally. The system of capitalistic gain in human healthcare is disgusting. I'm sure many other countries look at these issues and go... "duh"
It should have never been a criminal matter….
"It’s nice to hear from the point of a true medical professional instead of the true crimers"
lol. It's nice to hear from a true medical professional... who manages to explain the situation in such a way that conveniently enough goes out of its way to not state the actual reasons for this prosecution. True crimer types are all silly goose types, what with watching cases and reading the transcripts and all that silly 'wanting to know the facts' stuff. Unlike the good doctor here, who has an opinion and bizarre ability to give the appearance he understands the facts of the case while managing to avoid, at all times, mentioning the facts that explain why this woman was prosecuted.
The nurse was not prosecuted for a mistake that any random healthcare worker might make. Among the reasons for the prosecution, and one of the most important, is that she was orally instructed by staff that they cannot administer the medication or monitor patients who are sedated; the nurse has to do that. This nurse acknowledged that, injected the patient and then left her for dead in a place she knew, and acknowledged she knew, she would not be monitored by anyone. She literally swabbed, jabbed, withdrew and just left.
Further, she did not document that she administered the drug. Since she did not annotate what was done, those trying to save the patient's life had no chance at all in reversing the effects. Sometime after the code was called, Vaught returned and then informed the people failing to revive the patient that she had administered Vecuronium to the patient. The response from the code team was, "I'm so sorry.' So, she didn't give a medication by mistake, thinking one thing was some other thing.
She knew what she had administered. She knew no one would monitor her patient for her; that she had to do that. She administered the medication, spared not even a second to observe the patient after doing so, left the patient alone and didn't even bother to tell anyone what she'd done or make an entry in the chart so the next person would know what had happened. Oh, and the whole time she was doing this, she was busy flapping her gums with some guy named Darren and that she thought, at the time she was doing all of that, it struck her as a really odd. But she decided to do it anyway and then just leave. The patent. Alone.
She was prosecuted for reckless homicide, not negligent homicide. Reckless homicide is a conscious disregard of a substantial and unjustifiable risk that causes death. The good doctor here notes what she was convicted of, but omits the charges filed... while disingenuously claiming that he was going to go through exactly what happened.
Good thing no crime folks around these parts to disrupt a good bit of delusional fluff with the hammer of what actually is up in this case. Protip: get medical advice/information from a doctor, not crime information. They're typically utterly incompetent in the latter, what with having approximately 0 seconds of education in the subject and all.
@@integralmath Wow! That explains it all better! I sensed that there was something wrong with this. Your comment should not be under other comments where it is hard to find. Also, still do not need to be rude about it, but sharing of *CORRECT* information under this video should be done!!!
As a retired Rn of 44 years this is terrifying. Yes mistakes happen and I’ve carried my own malpractice insurance for decades knowing that my employers would NEVER have my back, no matter how loyal you are/were with them. Telling the truth about errors is paramount. The good people understand.🙏
You realize that malpractice would no have protected you from criminal issues. Vanderbilt did protect her financially…they settled with the family on her behalf as well.
@@sallycinnamon5370 what OP is saying about her own protection is different from what happened in the true story. Yes, there is criminal negligence but there is also just plain unfortunate mistake that isn’t criminal. That insurance would be useful in the non-criminal situations. As for the hospital settling the case, they weren’t doing it on behalf of that nurse. They were covering up the whole situation because they wanted to cover their own asses. So in that regard they were motivated to cover the nurse’s ass because it helped them too. If covering up for the nurse wouldn’t help the hospital, I bet you they would throw her under the bus.
@@SL-lz9jr are you reading my mind ??? please stop :-) . There was a case, where several babies were overdosed(did not die) due to a dosage mistake: the drug is available in two different concentrations..The vials (its an injection) were identical. The babies ended up getting the high concentration and not the diluted form. they nearly bled out. Who is was at fault ?
I have seen pharmacy put the wrong drug in the Pyxis drawer & nurses not look at the vial label when making up an emergency drip. Always check 3 times.
@@SL-lz9jr Oh, I am more distressed about the hospitals than I can truly express. And VB was definitely covering their own ass and the nurse was just included.
I’m just saying that malpractice insurance, I think, is generally to cover civil damages. Malpractice insurance would not likely make a difference in this case as she wasn’t pursued civilly. Although I don’t know if it is possible that they would cover the cost of a criminal defence? I don’t know. i don’t carry independent malpractice insurance. In the event of legal issues I would be covered by my union likely.
I'm a retired nurse of 25 years experience in Canada. This nurse made a bad medication error, but it seems to me that there was a problem with the system. Why was this high level sedative medication so easily accessible, why wasn't there a 2 nurse sign off, or an administration checklist or protocol? This sets up a "trap" for any nurse who is having a bad day. If nurses can be prosecuted and go to jail for errors, nobody will want to do their job anymore. Stay in a job where an error does not send you to jail.
Why this, why that? Can’t you simply accept that an inept colleague made a castrophic error despite numerous warnings that would have given my cat pause? DO BETTER!
It's not a sedative and that's where she messed up in the first place
@@thehonesttruth8808 And unless ALL the things leading up to the error are identified and looked at, nothing would ever change. In Canada -- at least in the province I practiced for 30+ years - there are "incident" reports. An incident report is not used to assign blame, but to identify all issues and make the necessary changes to policy. This type of evaluation was taken from the airline industry. No one is immune from errors. While what might seem obvious to you watching the video, might not be so obvious in the work environment. I can tell you one thing: no one goes to work planning on making an error. IMO, the hospital administration are the ones who are ultimately responsible because it seem that they didn't have safeguards in place to start with. The employer also has the responsibility to report the nurse to her registering body for a separate investigation if appropriate, but they also have the responsibility for developing policy and making changes to the system that caused the nurse to make the error. Using this method the employer can also identify what in the nurse's world is going wrong, if there are previous errors, etc. Perhaps there might be a need for remedial training. Shouting at someone to "do better" is not an answer. Essentially, that is what this hospital administration did by firing her. Tossed the nurse under the bus and as far as this story is concerned we have no idea if changes were made to procedures and if not, there is potential for a repeat. And worse, it discourages medical/nursing coming forward when errors are made.
@@thehonesttruth8808 Well, I guess YOU are perfect!
So true, these meds require 2 nurse verification.
I’m a nurse of 30 years and NO hospital can pay me enough to go back to bedside nursing! I have been on the other side for the past 15 years and it’s very disheartening especially if you stand up for your staff! What this case did is to say nurse are not valued and are easily replaced because schools are popping them out every 6 to 18 months. This is a very very bad standard for the future of bedside nursing. I would not encourage any of my daughters or granddaughters into hospital base nursing!! My heart broke for this young lady who was used as a scapegoat 😤
Good. Please stay out of medicine if you think what this nurse did was acceptable. She must either be one dumb *** woman, or she did it on purpose. Those red flags that the system are there FOR A REASON. She ignored, not just one, or two of them, but ALL of them... on a ROUTINE medication that she is USED to giving to patients. She ignored the warning label, failed to monitor the patient, and didn't even double check the medication she was administering to the patient. And as a RESULT, the PATIENT **DIED**. THen to top it all off, the hospital tried to cover it up and bribe the family with money. The thing is, this case is just one of MANY that have happened, but most of them are probably covered up.
How shameful and disgraceful of you to defend this person. You all in medical care have no overseers. No one who holds you accountable and it's disgusting. Why even was she being taken for a PET scan in the first place. After hearing the details of this case, I am so glad she was convicted. An ape would not have made that mistake, and it's my belief that it's even possible she did it intentionally. Again, please STAY OUT OF MEDICINE. If you have that much of a callous disregard for human life then you don't have a right to treat patients.
I agree with you Marlene. I have been a nurse for 20 years and a nursing professor for 5 years. It is scary how badly nurses at the bedside are treated by administration. Nurses are the scapegoats for everyone's mistakes including their own. Nurses work 12 hour shifts and go above and beyond to help out, but they get thrown under the bus even with the slightest mistakes by administration who do not appreciate them. Nursing schools nowadays are not spitting out qualified nurses, because the bar has been lowered. The new nurses no longer want to critically think, they just want NCLEX questions and answers and that us promotes by school administrators. COVID-19 showed us how those in politics and the world elites think about health care workers, we are not as appreciates as the basketball players and entertainers until they find themselves in a sick bed reflecting on what's important in life.
she didnt know the name of the medication and she guessed the name! wtf
🥰
@@spitzy8778 she didn't know the generic name of the medication. big difference
She didn't work in nuclear medicine or radiology. She was called down to the unit to help a patient who was from her original unit, though not her own patient (most units don't give Versed outside of OR or radiology). Next, the hospital was changing to a new system (Epic) and nurse's had been having to override medications a lot in that time. Even if not, there is often a delay in when a med is ordered and when it shows in the pyxis which is why it didn't show up in the patient's name. However, she didn't seem to know the generic name which is how the meds are found in the med dispensing system. Versed is a brand name and she searched by it. She obviously didn't closely look at the med however and so definitely negligent here. Next when she got down to radiology (where she didn't work), there was no scanner to scan the med and the patient. She did attempt to find one but time was running out and supposedly radiology was threatening to send the patient back up stairs without the test. It was the day after Christmas and the patient was anxious to get home to her family. So, big mistake, she gave the med without scanning the patient which would have alerted that the med wasn't on their med list. Lastly, she had a student or preceptee with her which added distraction. I'm not excusing what happened, but the hospital did not provide the tools for her to do her job as well as possible. Per her there was no warning that came up and her preceptee agreed to that. They were also being asked to go to the ER to help there and radiology said there was no need to stay and monitor and so she left. I'm not saying it's OK that this happened, but charging her and not addressing the systemic issues that helped create it, make it easy for this to just happen again.
Sounds she just happened to be at a wrong place and wrong time. If that was me, if I wasn't able to find the right med as prescribed then the patient can either go ahead with a scan without it or she can choose to reschedule. Better safe than sorry.
Very much so the Swiss cheese effect. You’re dead on. We use Versed all the time in ICU but we closely monitor the patient. I’m really surprised they didn’t monitor this patient in such a closed setting.
Right. Why was this med even available to her?
I agree with the fact that majority of nurses just do not know the generic names of drugs which is standard for any electronic medication cabinets because those are the real names of the drugs. I, as a nurse, prefer to remember drugs by generic or chemical name. It annoys my coworkers and pharmacists but that’s how I operate.
@@chrisgurl3043 she worked on a neuro ICU. I’m not shocked that paralytics it would be present on ICU’s.
I’m shocked out how much outsourcing of checking to the computer system.
I work in a system that has an electronic ordering system but not one that checks our meds for us. What she did was walk into a room and grab a random V medication then gave it.
I think the fact that they are trying to implement the independent double of the medication via computers is a good thing.
Turns out the DA has ties to Vanderbilt along with the Board of Nursing. When Vandy found out they were going to be investigated by CMS, they needed a scapegoat. It’s the biggest conflict of interest but those that would otherwise have overseen that, are involved. Later we found out that her defense should have caught something like this but turns out he also contributed to the DA’s campaign. It’s a whole mess.
i think the DA plays golf with billionaires and the billionaires want to go back to doctors burying their mistakes. A lot more cost-efficient for the billionaires than setting up and upgrading safety protocols at their hospitals. If no health care employees admit any wrongdoing, the families do not need to be paid millions. just a thought.
Thank you! I knew that was probably the case. They were liable to lose their residency privileges!
I hope she is able to appeal to the highest courts and wins. She’s already lost everything , but then to realize it was handled SO egregiously, with conflicts of interest at every corner…..it turns my stomach even more. Prayers for nurse RaDonda, that her case is either overturned on appeal, or at the least, given a new trial, with new evidence forced to light. I’m just sickened and saddened that a system I believed in and gave more than half my life to, has become so degraded and vile, both in the way they operate, and the way they treat others, especially one of their “own”.
Wow!!! It’s disgusting how many conflicts of interest there are in various cases and how people get charged or on the other hand, found not guilty.
Surely a conflict of interest with the DA like that, would be big enough to warrant a retrial?
Was she negligent? Absolutely. Should this be a criminal case? No. Vanderbilt needs to be reprimanded for this.
Can a driver that accidentally kills/ maims another driver/ pedestrian be held criminally liable? Yes. This is no different. It was a grossly negligent series of events. No intention (intention = murder), but this was extremely abnormal incompetence. Trust, I am among the first to tell you how stupid the naming system is for drugs.
You obviously aren't a nurse. Obviously don't have a clue if you are. Quit like the rest ... You can't stand the heat, get out of the kitchen.
@@dubuis69 Your response was to whom, exactly?
@@cameronno6039 Using your example, the hospital spilled ice on the road and told their driver he needs to deliver on time. What changed my mind was that Vanderbilt instructed nurses to use overrides when getting certain meds. So on a daily basis, there was a culture of nurses overriding the warning signs BY THEMSELVES on the floor. There is no 2 nurse system for high risk meds (really weird). Why was there Vecuronium next to the PET scan in the first place? Most importantly, the family directly forgave RV.
@@Backyard_Brouhaha the family forgiving someone is the least important manner. If the DA wished to prosecute will Smith, they could. Family wishes are irrelevant to prosecutorial discretion.
My logic is based on actual precedent, not tomfoolery.
Why vecuronium is available at the PET scanner is likely why is available everywhere in the hospital... in case a patient crashes.
If you've noticed my actual logic, i put very little weight on the process she used to obtain the vecuronium. I put the majority on the fact she had to reconstitute it (required her to read the bottle) and that she immediately left afterwards (also little weight but still important). The reconstitutuon is a huge red flag for negligence.
I am a Registered Nurse myself, this could happen to anyone of us. I watch the story in detail, my heart goes out to her. God is in the detail, it's great to see so many people supporting her
It's heartbreaking to hear. As a nurse, I think the only way to avoid mistakes is to have a 1: 1 or 1: 2 ratio in any department.
Considering all the dancing around and obnoxious preening I've had to endure from nurses while the government destroyed my entire life over Covid because you people supposedly couldn't keep up with it, I have no sympathy for you at all. Here's the good news, though, I've rebuilt. Things are back to normal for me. But you'll always have this sword of damocles hanging over you. That makes me smile.
@@thisisaname5589 there’s a lot of anger behind this post….I’m sorry you feel that way about nurses. I’m a nurse and covid pretty much messed up my life for 2 years too. Maybe not to the extent that u have, but we have all suffered. Glad that things are going better for u 👍
@@angiemansfield9381 It's not your fault necessarily, but surely you understand why I'd be absolutely furious at the way nurses' whining about their jobs was used to justify destroying our lives. I risk getting electrocuted every day. If I lean a few inches in the wrong direction and touch a busbar, that's it, I'm dead. But society had to be ground to a halt for years, because your jobs are hard.
@@thisisaname5589 try not to paint everyone with the same brush. I do understand what u are saying and i do know that for 2 years life has been pretty different for ALL of us. Our jobs have ALWAYS been hard. It just got harder. And the work load increased far more than our bodies could handle. But though we may say the job has been hard, that doesn’t mean we are whining. It’s just a fact. And a lot of times when i would tell someone it would be in a distant way, that far off look people get in their eyes when they think about it. Because there is no way to really convey what we go thru. Most of us are not in it for the glory. We do what we do, go home exhausted, and get up and do it the next day too. We have families and lives too. But it’s our chosen profession and we just do it. But we did not ask for society to be put on hold. Nurses are the worker bees….we do the bidding of the Boss. We didn’t have a choice when they told us people had to shut down their businesses and lose their incomes and homes etc….I’m guessing maybe ur a lineman or something? I have tremendous respect for these men and women who do that. And i personally have friends in that profession. But i don’t blame them when the power goes off. When our town got demolished by a tornado in dec 2021, some folks had no power for weeks….frustrating yes, but the evidence showed that these men an women were out there working day and night trying to put the poles and lines back up. We had to learn to live without some things during that first few weeks. And 4 months later our town is still visibly and emotionally different. So we all just do what we gotta do. This crazy shut down in the last 2 years came from the nutty professor hired by the clown in the White House. With all due respect we have all just been surviving sir.
Sorry i should have put that into paragraphs to make it easier to read!!! 🤦♀️
As a medical student, I am concerned that this could happen to any of us since we are prone to make mistakes with long-hour shifts, especially during residency. Imagine long hours of study and years of training to be placed in court as a criminal is something I can not even comprehend.
And your license is snatched for ever as if you forgot everything you learnt
I don't think we have 36 hour shifts anymore, which is a great improvement. But when you are working 12-14 hour night admission shifts for 6-14 days straight you will be very tired. My advice, (been out of my training for 7 years now) even when you are 4 admission behind and constantly distracted by pages and needing to stop your work to see sick patients on the floors, always take a moment to reflect if you are making the right decisions. Your attendings may be unhappy with you being slow one night and long board times in the ED, but it is better than making a mistake that harms someone or jeopardizes your career.
@@whazzas5023 did 30h recently
(24 h +6 OPD)
I doubt your credibility.
Personally, I understand the fear that you could be charged for a mistake, but you took an oath and owe your patients perfect decision making. Lots of people have been citing that this was a "mistake" and "accident" , that there was no intent to harm, and therefore the nurse should not have been charged. But we charge people all the time for causing harm to others without intent. Its the difference between manslaughter and murder.
My 0.02 is that the extended shifts in nursing, are a moral dilemma in and of themselves. I understand there aren't enough nurses to fill all the slots. Maybe the hospitals should raise their rates for nurses to increases the pool of nursing talent and incentivise it as a career going forward. But in the meantime, staff must be held accountable for their actions on those shifts too. If someone drives home tired from a double shift at a coal mine and hits someone on the way home, they would get charged. Tired is a reason, but it isn't an excuse.
I do extend my sympathies to this nurse. It does not bring me pleasure that she is being charged and convicted
Just tried pulling Vecuronium from our Pyxis and yup, there were warnings and big orange labels around the vial and cubbie, but no two-nurse verifications, didn’t need to override it (in the ED albeit not in the orders) just shows how the system really has the potential to allow these errors to happen on possibly your worst day ever
😰😰😰
But does one need to be prompted by a computer system to verify with a colleague that the action is correct? Ever work a shift during system downtime?
There are more warnings now with this case. But she still had alerts that went off. Both hospitals I’ve worked at have a two-nurse dual sign off on this med so not sure why this hospital didn’t. I have so many questions…
Why people try to justify this because a computer didn't do 100 percent of the thinking for her blows my mind. This wasn't an emergency situation. She herself admitted she wasn't overwhelmed, etc at the time of administration. Those big orange labels and warnings you mentioned should be enough. Had she paid attention to just ONE of those things this would not have happened. SHE WAS CRIMINALLY NEGLIGENT. You have to READ what you're giving and know what it is. That's med administration 101. The only thing that bothers me is that the hospital administration involved in the attempted cover up weren't charged as well
This scenario happened at one of the ERs I worked at. The nurse pulled out and gave Norcuron, instead of cardizem, fortunately; the patient was quickly intubated, thanks to the monitor and us quickly noticing AMS changes. Management did some changes to prevent this from happening again.
As a student in healthcare, this story is terrifying. Thank you for speaking out and raising all these relevant questions
I wholeheartedly agree as I am literally trying to enter the healthcare field this have me questioning my decision now.
@@Carima72 i understand your impulse but we shouldn't back down because of one drawback. The people are loud on this case and there's no telling what it may change in the future. People aren't sleeping on this so we can push through
@@someones_daughter_ ok thank you for your words of encouragement
Do not worry. I have been an RN for seven years. Just make sure you scan the meds, pay close attention to detail when passing meds, as that is our job. It honestly is VERY hard to do so many overrides and make the error she did, even though no one wants to say that.
@@ericafitzgerald Okay sure maybe not the exact same mistake. But what if it's something else? Who knows what will be taken as prosecutable next? This opened up a whole can of worms that makes the whole field far riskier to get into.
Hey there are some things you got wrong/may not know.
1)she wasn’t specifically a radiology/nm nurse. She was a ICU nurse who came down to admin the medication as a favor to the patients assigned nurse that day.
2) There also was no scanner in the NM department and that part of radiology. This means she could scan the patient and the drug.
3) At the time of the incident the policy at Vanderbilt was if only versed was being given no monitoring was necessary.
4) She pulled that med from the upstairs med drawer from the ICU.
5) The doctor who determined COD stated it was a brain bleed. Indicating a cover up attempt (on behalf of himself and Vandy likely) and apparently he had done it before
5)The reason why she was able to override the med was because Vanderbilt at the time was switching EHR systems and was having issues with meds not being able to be pulled despite it being ordered and in the EHR chart so nurses were having to override meds until it could get fixed (and this is what they were specifically told to do; they were told until it gets fixed they needed to override if necessary).
6) That DA has ties to Vanderbilt by the way. He is up for re-election too and Vanderbilt has a lot of sway. Therefore by charging and convicting it clears Vanderbilt name and then they will still support that DA. The DA also has ties to the nursing board.
She blew through many safety checks and is negligent with a capital “N”
She must've been a terrible icu nurse if she didn't know the difference between vecuronium and versed
@@Randy-BBMM I agree completely and now that policy has changed but at the time of the incident she was within Vanderbilt policy.
Like so many tragedies, it's the accumulation of events that coalesce to create the dire event. Wrong medication, sloppy procedures in effect, working out of usual role doing favor in unfamiliar setting. Sh*t rolls downhill. Management is never willing to take the blame when they can find line staff to take the blame.
Well said. In a similar case that happened a long time ago in Colorado, the DA found out about the case because his wife, who was a nurse in the hospital where the even occurred told him about it. It would not surprise me if something similar occurred in this case. Wha is troubling to me is that as an ICU nurse she should be familiar with Vecuronium since it is given as a premed before intubation or to intubated patients who need to lie still and are unable to such as person with a brain stem contusion or a patient with a neck fracture. Note: in addition to being given a paralytic to prevent movement they are also heavily sedated, so they are comfortable. So much about this case doesn't make a lot of sense yet I feel that jail time is not warranted because there was no criminal intent. At the worst she should be given a suspended sentence and I agree she is also being scapegoated by the hospital. In theory one could also go after the physician who falsified the cause of death on the death certificate unless he was unaware of the drug administration. I am a retired RN and loved my career but if I were young today, I would never pursue medicine or nursing as a career choice because of all the risks involved and the unrealistic expectations of both the government and society. It is not just me: a lot of doctors and nurses are leaving the profession because of all the difficulties that get in the way of doing their jobs. While this is an extreme example, there have been cases where medical staff have been sued when referring to a patient using the wrong pronouns. In one state criminal prosecution was considered for this offense in a bill before the legislature. These types of expectations only increase the risk of medication and procedure errors.
As an anesthesiologist, I can tell you this was not a simple med error, (not going to go into the fact that elderly patients, and especially Neuro critical care patients who have SDH should NOT EVER GET BENZOS) This nurse put forth an enormous effort to kill this patient. Forcing her to reconstitute a drug would give anyone pause, overriding 5 paralyzing warnings in the pyxis, not reading med label. In fact while reconstituting she would have had to read the vial where it says vecuronium and paralyzing agent to see how much saline is needed to reconstitute. Idk what went on in her head during this but if criminically negligent homicide exists this is it. She took 100 steps OUT OF HER WAY to kill this patient. If it was a liquid maybe people could give the benefit of the doubt of this being a med error but no way in hell can you say this was a simple med error when she had to reconstitute.
also if you are someone saying "this could have happened to any of us" lemme steer clear 1000 miles of your institution, this is so disturbing
You seem to think that "this could have happened to any of us" means going through the EXACT same steps with the exact same med errors. No, he means any institution could have covered up any medical error and then later decides to make somebody a scapegoat after covering it up for over a year.
The second they went out of protocol and decided not to report a sentinel event like this, this stopped being about Radonda and started being about the a heavy amount of corruption with the people involved.
She needs to be removed from ever working in the medical field!! Oh she was!
I was a med surg bedside nurse for about 3 years. I already had intentions of quiting due to how we were being treated but Radonda's case proved to me that I made the right decision in leaving nursing. It was truly the best decision I ever made. Which is sad because it just shows where Healthcare is headed..
what do you do now?
@@imeverywhere9633 I'm an organ donation coordinator
@@LeahD40 do you have to be a RN to do that? I was looking into that. I have more questions about the job if you can answer them.
See?? Told ya so.
I am starting my career soon in med surg unit. Can't wait to see how it goes. I am sad to see a fellow nurses quitting. This cycle must be stop.
This is terrifying! As a nurse, I have made mistakes and self reported. When I worked in the hospital, if needed I could be assigned extra patients, above the set nurse to patient ratio, and I could not refuse. In addition, I couldn’t walk out or I could be charged with abandonment. Why isn’t the administration being held accountable? We are human. We all make mistakes and now we need to worry about going to prison too.
This doesn't sound like just a common mistake since she actually entered in the medication name rather than stopping when she couldn't find versed. She also could have googled the medication when she read the bottle. And was stopped to monitor the patient regardless. That's pretty serious incompetence. At minimum she should have lost her license.
She lost her license after the incident. I’m not trying to defend her actions and it’s a tragedy that this happened. What most people don’t understand is that nurses are so overwhelmed, it is a recipe for disaster. All medications have a minimum of two names. I personally am not familiar with the medication she gave. That being said, how are we supposed to know every name? When I worked in the hospital, I rarely had time to go to the bathroom much less google something. Please understand I am not trying to minimize her mistakes. I am simply saying she self reported and subsequently lost her license yet the administration didn’t do what they were supposed to do and they are not being held accountable. As nurses, we self report in order to improve processes to prevent similar mistakes. Now nurses are going to be afraid of going to prison if they say “I made a mistake”. I almost gave a patient a super high dose of insulin because they were on an insulin I wasn’t familiar with. It turned out that for what would normally be one unit of insulin, it was 5 units of insulin. The patient was the person who told me it wasn’t right. I called the pharmacy and the pharmacist came up to the unit. We then put a process in place that the pharmacist would draw up this insulin so this particular bottle would not be on the unit because I guarantee someone else would have made the same mistake and the patient might not have said it wasn’t right. I would never want to harm someone even by accident. Administration is supposed to work with nursing staff to improve patient safety however; that is not how it always works.
Not all nurses are heroes
You are absolutely right!
EXACTLY. I’m a nurse too. I’ve made mistakes also. Nothing this big. But, it happens. You get overrun. There are shifts when I go to the bathroom one time in 13 hours. It’s too much !
Couldn’t agree more. Why wouldn’t Vanderbilt/ whoever didn’t report the error get prosecuted?
🤷🏽♂️
It's the DA who is charging her faculty for Vanderbilts law school? How close are the law school and the hospital administration?
Money
They should be on trial as well. But that doesn't mean the nurse should get off, either.
As a nurse of 7 years, Dr C, I want to thank you for the beautiful speech!!!! Totally agree. I’m still a baby in comparison to the OGs in this field but it’s scary for anyone working in healthcare 👍👍👍👍👍
I appreciate your analysis of the situation. There is so much more to the situation than what you discussed here. I 100% agree with your opinion though. During this time at Vanderbilt they were in a transition phase from their previous EMR to Epic. There was an issue with medications crossing over from the EMR to the Pyxis/omnicell. When the physician entered Versed into the EMR it did not cross over and show up in the Omnicell. This was a reoccurring issue with all patients at Vanderbilt during this time. There were major systemic failures at the hospital. This one patient had over 20 to 30 overrides under her name for medications during her stay at the hospital and she had only been there a few days. Also the prosecution liked to point out that she did not scan the patient & the medication before administration which was hospital policy. However they failed to mention that the radiology department did not have a computer with a scanner installed. There was no access to one. Why would Vanderbilt install a medication Omni cell in the radiology department but never install a scanner for medication administration? I have carried medication into a patient’s room before and the only thing that stopped me from administering it was the fact that when I scanned the patient and then the medication I was alerted that that medication was not on that patients EMAR. She was unable to do this. Being a Nashville nurse I have followed this case closely and I have friends who worked at Vanderbilt during the time that this happened. They have told me that the transition to the new EMR epic was a complete nightmare. They say that nothing was working correctly at that time. I also know a nurse who knew Radonda and he says that she was a wonderful nurse and when she realized her medication error she immediately spoke up and told everyone and did not hide anything. This entire situation is horrible and there is still so much more involved in this situation. The district attorney, Glenn Funk, who chose to prosecute her is also a Vanderbilt law professor. Something does not sound right about that since this incident happened at Vanderbilt University. Radonda’s sentencing hearing is May 13th in Nashville and I have heard that there are nurses from all over the country flying in to be there. I’m interested to see if there will be a few hundred there or a few thousand. There is also a change.org petition that has almost 200,000 signatures on it asking for clemency for her.
www.change.org/p/grant-radonda-vaught-clemency
Wow. This is pure insanity 😳.
I'm an MD who LOVES nurses, btw.
Pray 🙏 she's vindicated...
Clemency for murder? Sorry what? If this happened to your mother or father would you be this cold-hearted? Somebody DIED from her actions!
@@MissGold888 this wasn't murder. Murder requires intent. For all the different views I'm seeing on this case, including those who argue that Radonda deserved to be convicted of a more serious offence than she was, no-one is stating that she deliberately set out to kill her patient. That is the actual definition of the difference between murder and manslaughter - did the perpetrator actually plan to take the person's life and then take actions in the full knowledge and intent that these actions would probably end their victim's life? If not, its not murder. And I don't see any evidence that Radonda wanted or intended for her patient to die, however negligent she may have been.
@@MissGold888 this wasn't murder. Murder requires intent. For all the different views I'm seeing on this case, including those who argue that Radonda deserved to be convicted of a more serious offence than she was, no-one is stating that she deliberately set out to kill her patient. That is the actual definition of the difference between murder and manslaughter - did the perpetrator actually plan to take the person's life and then take actions in the full knowledge and intent that these actions would probably end their victim's life? If not, its not murder. And I don't see any evidence that Radonda wanted or intended for her patient to die, however negligent she may have been.
@@PonderingStudent We don’t say man-slaughterer though honey, we call her for what she is… MURDERER.
All nurses need to refuse to "over ride" the med dispenser. The hospital needs to have enough pharmacists on hand to make sure those orders are processed timely and correctly. Further those medications should only be referred to by their generic names. Looking up by a brand name should be a separate lookup. When these agents are administered it should be understood that the administering nurse is now required to monitor for some set period of time.. They are not to by punished for not doing other things, like they usually are. Lastly, all nurses should immediately start invoking the 5th amendment when questioned about past actions. Their replies should simply by, "All actions for a patient are charted, please check it for answers to your questions. I'm invoking my fifth amendment right's with regards to additional questions."
Thank you I couldn’t understand why she would override the system. Is this is what hospitals intended you to do when the medication isn’t available and process and orderly fashion?
@@mydillweed It is. Especially in ER and ICU settings where timing is critical. They don't want to have to wait for it to be routed through the pharmacist. But they also critically understaff their pharmacists so even regular routine orders can take HOURS to process. So when you have a patient in pain who just heard the Dr. tell the nurse he's ordering something they kindve expect it sooner rather than hours later.
I was FORCED to over ride in the many ER and ICU I worked in 30 years. I was nursing before PYXIS. Every ICU I worked in had their own satellite pharmacy,LAB,, back before BUUDGET issues. I am still a RN BSN CCRN, recently retired .I miss my patients!! Not the system .
@@kznsky14 Yes! Challenge "the system" and force changes. Nurses and doctors need to come together and advocate for their patients and themselves. Hospitals aren't going to listen to patients, but nurses and other staff have some leverage.
@@hmrobert7016 Hospitals don't listen to nurses or doctors either. They've been saying this for years. Nurses and Doctors need to start making the hospitals pay for this crap by refusing to do things they know are unsafe or against policy. Patients need to start enforcing this stuff by REFUSING to be treated substandardly and taking that concern to the Admins and ultimately refusing to pay if not treated properly.
If I hired a contractor to fix my plumbing and it still leaked when he left because he used substandard parts, did the bare minimum of cleanup, and didn't double check his work cause he was rushing to the next job no one would think twice about not paying him.
Why should healthcare be any different?
I am glad I am retiring soon, nursing has changed and not for the best! I have worked in a hospital since I was 16 and now I am 60 and the hospitals are never held responsible, it is always the nurses!! Thanks for speaking truth!
No offence but this mistake is so easily observable if you took 2 seconds to see patient response to medication. The paralytic would've made the patient completely unresponsive and you would've known what was wrong then.
Lol, are you kidding? 99% of errors are made by nurses and usually the MD ends up taking the hit. It’s truly ironic that nurse practitioners are clamoring for independence from oversight from physicians….I would take a great deal of glee in watching them fall flat ln their arrogant asses is so many patients wouldn’t suffer in the meantime. Many, many nurses are simply greedy and entitled…want all the benefits but No accountability much like teachers
@@retinapeg1846 no offence but this would have been avoided if the hospital hired more staff. That way the staff they have don't get spread too thin.
You mean the nurse who killed somebody is being held responsible? Oh my goodness how dare they?!
@@MissGold888 you are not doing whatever it is you think you are doing.
Mistakes have been made in the healthcare system throughout history. Blaming and sending a nurse to prison, taking her license, etc., is insane!
I actually feel taking her license is appropriate but not sending her to jail. It's kinda a massive mistake too make.
@I I Do you really think that it's the threat of jail that will prevent mistakes? You don't think that the possability of harming a patient motivates health care professionals?
The only think criminal prosecuttion achieves is a decreased reporting of medical errors. That doesn't mean less errors are happening, just that people don't feelsafe enough to report them.
@I I as a med-surg nurse for the past 8 years, I can promise you this is going to make things worse because nurses won't be self reporting. The way bedside nursing is, without self reporting, most mistakes will never be found out and system processes would never be improved!
I agree. They don't easily send police officers to jail for fatal mistakes.
Well...from every job I ever worked...💩 always rolls downhill. Unfortunately nurses are at the bottom of said hill...
I’m all for forgiving mistakes, but I also work in emergency medicine and I can tell you there’s a huge difference between versed and vec. In the ERs I’ve worked in paralytics are not easily accessible; you can get them but there are measures to prevent anybody from getting into them by accident. This is probably why.
Yea there are so many warnings on the pixus for this. I just wonder what her patient load was and how long she's been a nurse.
What strikes me is the lack of monitoring when midazolam can also depress and potentially trigger a respiratory arrest.
@@noctusowl that is a very fair point.
Sounds like she was called from another unit (maybe medsurg?) to give the med. Wasn't her patient and the med order hadn't transferred into the pyxis system yet (or whatever med cabinet they use).
As someone who also works in the ER, I can (somewhat) see how a nurse from a floor unit or other unit who isn't familiar with sedatives or close monitoring could have this happen, I mean, so many errors, but I could sort of see it. She gets a call that a patient needs a med, maybe she's covering a lunch, runs down, the order hasn't come across yet, she can't find the med, pulls vec on accident, gives the med, and runs back to her patient load.
@@katrinag1880 She has been a nurse since 2015, she floated to radiology and also had a orientee with her at the time. Patient might have been anxious and moving around a lot so she probably felt hurried to give her something quick to calm her down. Her head was not in the right place as she bypassed all these warnings especially reconstituting a powder drug. She ignored so many things that led to this death. Was she overworked? Was she overwhelmed by floating and having an orientee? Was she sleep deprived? Is she having issues at home? All these play a factor in a profession that works with human life. I don't agree with her being sentenced to prison but it's happening. Charged with two felonies, 1st one is a 3-6 year sentence and second one is 1-2 year sentence. Her sentencing is set for May of 2022 and I would assume she will get 4 years in total. This case is just sad to all parties involved. This was a sentinel event and many hospitals settle these cases out of court. " Recent studies of medical errors have estimated errors may account for as many as 251,000 deaths annually in the United States (U.S)., making medical errors the third leading cause of death."
I'm a nurse. I've been in home care for a few years and was considering going back into hospital nursing. I saw this case and was immediately like, oh, hell, no, never again.
What do you mean I’m not sure I get this case
Basically the nurse was negligent and caused the death of her patient. Typically this results in getting fired, losing your nursing license and paying a fine. This nurse got prosecuted.
@@melissahood2960 But why she neglected patient? Did she forgot bout them?
It sounds like she either was terrible at her job or very distracted.
Amen! Im going back to private duty homecare for this and many other reasons!!! The hospital will NEVER support you if you make an error. Im at the end of my career (42 years now) and i will never work in an institution of any kind again!
As a senior nursing student, this legitimately terrifies me.
Nursing takes almost no school or education don’t say senior nursing student like that means something.
@@trumpisgod2535 Nursing school takes an average 4-8 years, how is that no education?
Please do not be terrified. Have a healthy fear. Healthy fear will help you prevent making mistakes. Remember the things you learn in school. Med Admin, evidences based best outcome procedures and protocols. Question what does not seem correct protocol. Someone taught RV that it was okay to override. Slow down if you are not sure and think things through, ask questions, I still ask or go to a book after 30 years in nursing! If you are terrified (lets call it healthy fear) that tells me you just might be a really good nurse. It takes years to feel competent when you work in hospital.
@@Savsabio 8 years who you lying to and those undergrad classes are elementary at best.
@@abrasky007 you a sad person who loves uncle Joe and likely on a camping trip with him it’s okay to cry you can do it 😀
Let’s just hope Vandy has an excellent communications and HR department for the recruitment and retention of nurses! Well articulated and objective commentary. Thank you. The implications of this precedent are indeed profound because not only has she lost her ability to practice nursing but she has lost a substantial ability to have normalcy and livelihood. The charges against her are a class E felony. As a felon, it will be incredibly difficult to obtain suitable employment and housing. The US has a deplorable recidivism rate so I am unsure of the potential psychological, social, and ethical implications this will have for the trajectory of her life. This integration and ever pervasive social ostracism of “cancel culture” will only further deter transparency of future nurses, health care providers, and physicians. Ultimately resulting in increased prevalence of sentinel events, health care worker job turnover, and patient death.
Nice points here we punish people twice one court room and in life by depriving housing,employement etc.This is why i advise people in medical field to have a backup plan or profession.You never know how things goes.
She will have to write a book and sign up for speakers gigs
@@Lovebk98l
THERE MILLIONS OF ONLINE JOBS SHE COULD DO ....IN THE VID OF HER LOOKS LIKE SHE HAS HER OWN HOME SO SHE SAFE THERE FROM RENTING. BTW I WAS A NURCES AID FOR MRDD AND I ALSO HAD SEVERAL MED ERRORS AND THEY ONLY WRITE ME UP AND I KEPT MY JOB.
Why didn’t she know the difference in the medication if she’s given it so many time? Why didn’t she see the warming on top of the vial that she put the needle in? Why she should be held accountable is because she took a life that she can’t give back, loosing her license isn’t good enough. There should be others being held accountable as well, but she definitely needs to be.
It is a mistake but it’s also a life. If it was my family member, sorry would not be good enough. Her losing a job would not be good enough. My aunts, sister, cousins, sister in laws, mother in law are all nurses, two doctors, this is something I hope they pay attention to.
Oops is not the answer
Well said
She knew full well what she gave. When she came back to radiology and the code was ongoing she said she gave Vecuronium. In no practice anywhere can you not know thats not Versed. Drawing up the med she would have seen the words warning paralyzing agent. And she gave it anyway! When she was arrested and brought in for questioning, the fool waived her Miranda rights, and yapped nonstop about what she had done without benefit of counsel. I read in one of these posts she actually said after she gave the med, “i remember thinking I just killed that patient”. That speaks to the fact that she knew what she gave. All without an attorney present! She is a disgrace to nurses everywhere. To all those people proclaiming her innocence looking to pin this on a failed system at her former place of employment, shame on you. She knew what she was doing, she ignored her pt after she gave the drug left her there to die without even a cardio monitor on her even though she was an ICU pt! God bless the Murpheys, they are way more forgiving than I would be. This must be a nightmare for them. She deserves worse than what she got for sure. She’ll never work as a nurse again, ( thank God). IMHO she should go far away, like maybe Guam or something . She is a disgrace and should be in jail. She knowingly killed someone. This was not a simple mistake as people are trying to paint this mess. Ive been an RN for over 40 years, Ive never encountered any situation like this thank God. Why? Because I check check and recheck. I do not allow myself to be distracted, so I dont make mistakes. Pt safety first above all else!!!!
I can't say Thank you enough! People are out their effing minds making excuses for this nurse's major error.
I'm a retired nurse and I agree.
The warnings she overrode couldn't be missed unless you were just way too careless.
I truly agree. I’m sorry but mistake is dropping a bandage on the floor and having to get another. Fatal medication with warnings all over is not
Death by an injection of Vecuronium must be one of the worst ways to day. Being completely paralized and sufocate while completely awake must be horrifying.
This saddens me on so many levels. My heart goes out to this nurse, because you’re right, it could have been any of us. She is being scapegoated to protect the reputation of the medical facility. She followed protocol in reporting the error; she was transparent in admitting the error. All of the “why’s” rou raise are valid, but will never see the light of day. If there was anything I learned in my 41 year nursing career (thankfully retired now), is the “trickle down effect” of blame.ultimately, it’s usually nursing who gets thrown under the bus to save face for the institution. Would I ever encourage anyone who’s considering a career in nursing? In this day and age, NO. Until nurses are recognized for their value and worth, and paid accordingly, jut NO. As much as I loved the majority of my career, the last 5 years or so were gut-wrenching, soul-sapping, emotionally draining and physically exhausting, abject misery. I would never want anyone to feel that way. Thankfully, the good times and wonderful memories and people will be what I hold dearest.
Ditto
41 years as a nurse? You deserve a purple heart medal💜
It sounds like the hospital admin leaked the info for the purpose of protecting their name and used her as the lowest hanging fruit as the scapegoat. Sounds like CYA to me
Sure sounds fishy…
That would be my guess.
The DA involved is an adjunct law professor at Vanderbilt University so there’s that, too…
Or the family
I'm a pharmacist of 5 years and was going through an abusive relationship and severe PTSD while working. Anything can happen anytime and this is incredibly scary for any HCP! I have a lot of compassion for this woman
If you are that compromised you should go home and nurse yourself well.
Wow😮
I’m a retired Certified Pharmacy Technician with 15 yrs experience
I worked briefly with a couple of new PT’s that did that! They couldn’t find the correct pills on the shelf,so they did what this nurse did!They pulled the wrong drug!
They did it on purpose. Thank god they didn’t work there more than a few days! They couldn’t find the drug they needed so they picked the drug next to it. Thankfully we had a computer over ride system,where you needed to scan the script label then scan the medication bottle. If it matched up it took you to the next verification screen on the computer. You then filled the script and it went through 2 more checks by the pharmacist.I loved my job,took an early retirement when the pharmacy closed
As a retired nurse I completely agree with you. Makes me glad I’m not a practicing nurse. This nurse for sure did not intend to kill this patient. I don’t I understand how she could over ride the drug machine. I know of no way I could have done that
I am completely confused by anyone thinking that her actions somehow remover her culpability. It doesn't matter if the system failed following her error, that has nothing to do with her failure to ensure she administered the proper drug. Yes, she was honest. Yes, she reported her error. That doesn't change the significance of the error, or HOW it should be handled once law enforcement become involved. If anything, one could argue that once she observed the hospital wasn't going to report her negligence to the authorities, she should have reported her actions to the police herself.
What she did is no different than a police officer accidentally using their firearm instead of their taser. Once you remove the actual tools used, it comes down to the same base thing. The trained professional knew the proper procedure, knew the importance of following the rules and regulations regarding their actions, and failed to follow those procedures. That is exactly what negligence IS. It is an accident that was caused by not following the proper rules and regulations... (apologies, I am Autistic and the previous sentence doesn't... FEEL right... so if it is confusing to anyone else, understand it is because I could not come up with better words to define what I feel).
All the above brings us to the most important issue with what you were saying about not punishing medical practitioner's with making mistakes because then they won't report them. That... that is a VERY dangerous statement. The way I understood it is you were saying that there's a difference between a mistake and negligence... but that only works in one direction. One could always write a sentence and replace 'negligence' with 'mistake' and you would never have to worry about accidentally putting an innocent person in prison. If you write the same sentence and MEAN mistake, but use negligence, then someone innocent can go to prison. Reporting of the action itself though is not what defines negligence vs mistake.
What she did was negligent. End of story. She was using a drug that she clearly KNEW how to use. She KNEW that she was supposed to read the labels. She KNEW she was supposed to monitor the patient. All these RESPONSIBILITIES were ignored which made her mistake, negligent. The exact same reason an accidental discharge is NEVER an accident and always NEGLIGENCE (unless the firearm itself broke in some way that allowed it to to fire without the operator).
So as sad as it is... she deserved to go to jail. Her negligence led to a person dying and she is responsible for that. This is no different than expecting police to be held accountable for their actions, whether it was an accident or intentional.
Finally somebody with some goddamn sense! She was negligent and it’s not excusable.
@@pblegz3306 Exactly. I don't understand how anyone is trying to make this about the people above her. They're failure to do the right thing doesn't excuse her negligence. Her taking responsibility for her actions would be to plead guilty to making a mistake that could have been prevented if she followed the procedures designed to stop such a mistake.
Thank you. I am amazed at the insistence that this was a systems error when there were a number of very clearly defined safety behaviors she chose to ignore. Accountability seems to have gone out of the window.
@@morganroete1562 It makes no sense. The same people cry for full accountability for others but somehow a nurse can't be expected to read the labels?
I remember at my first job out of school. A nurse injected Milk of Magnesia into a patient. After the patient died, she was sued along with the hospital, the M.D. and anyone else even tangentially related to the case. The nurse then sued her nursing school for never specifically teaching her that you should not inject oral medications into a patient. The family got a huge payout and she had her license revoked and the nursing school and M.D. were absolved of any responsibility. The hospital, on the other hand, settled out of court.
Did the doctor order the MoM to be injected?? Why would she think that they wanted the MoM to be injected instead of PO?
Conscious, well aware, and completely unable to breath… incredibly tragic
AMEN! from a long time healthcare professional! Takes me back to my very early days as an RN - new grad- horrible staffing- being put in charge of whole floors - handed a med key and cart - and off we went!
I am a retired nurse also this is terrible she was made the scapegoat in this situation very frightening! Doesn't surprise me about the lack of support from the facility most don't care about staff or conditions and they wonder why they are so short staffed!! I miss my patients the doctors and fellow nurses but don't miss what medicine has become. I served my patients for 40 yrs. My last 3 were horrible in terms of stress and understaffed. Its a shame. God bless her heart my prayers out to her and her family. And to the patients family. Very scary.
I remember when I was in nursing school my teachers would tell us students stories about these nurses that were prosecuted for things like this and I used to think that they were kind of fear mongering and scare us into second guessing our decisions to become nurses ourselves. Now I realize how the system sets us up for failure. I can only speak for myself but I think that most of us go into the medical field with good intentions. We just want to care for our patients and see them get better and happy but with the way how things are it's like we are expected to make no errors and be perfect which is unrealistic because nothing will ever be. Even if we were to be replaced with robots/machines, they aren't perfect because they are as smart as whoever designed them which ultimately is us humans and we make errors because it's in our nature. It's crazy how one slip-up can turn your life upside down and end your whole career and pretty much your life. All the hard work you put in to become a nurse is down the drain.
Thanks for calling out the REAL PROBLEMS with how nurses are made into scapegoats for hospitals, which are the ones responsible for their safety standards, or lack thereof! Kudos to you for speaking out!
When there is a trillion things going around you, everyone calling you, things get out of hands really quick. I quit bedside. I quit been a nurse for that reason. I almost committed the same mistake, and that’s when I knew the system is failing us and the patients.
You said you didn't want to diminish concern for the patient but that is precisely what you did. The patient received all of 5 seconds of concern in this narrative.
Great points, Dr. C! As a seasoned RN, and nursing professor, I agree with everyone you said. I've given both those meds many times. The public does not realize that likely only 10% of all medical errors are ever reported. Most errors are minor, cause little to no harm, and frankly, filling out the paperwork takes a lot of time. The significant errors are often only dealt with when people are caught, are honest/take responsibility (like Rhonda), or hospitals are forced to deal with them (but look at how Vanderbilt hid the actual cause of death). The fear of getting in trouble, regardless if the organization has a "Just Culture" philosophy, is always real. The other real shocker is the HUGE under-reporting of "near misses"--I'm guessing more like 0.01%! Again, if "nothing" happened, who has time to report it? These are the realities of health care, and Rhonda's case (for all the reasons mentioned) will make it even less transparent.
As a nurse this video is much appreciated.
The way this situation was handled was downright criminal and the verdict was definitely unjust, can this be appealed?
This blows my mind. You raise very cogent points. I'm still in my final year of RNs but I don't think this would be possible in Australia. All dangerous drugs and all IV meds are independently checked by two nurses (preparing and administering). ALL meds in paediatrics are double nurse checked as well. I guess this case is a reason why that's a good practice.
Totally possible in Oz. I've had nurses give metaraminol to a patient prescibed metoprolol. It was double checked.
It’s always possible to happen even being checked by two people
@@natsqi6192 What is “metaraminol”? I’ve never heard of it before, & it isn’t in my drug books/programs! ???
I have just started my TPPP and we discussed this case at an orientation meeting. This specific error may not happen but there was not a single senior nurse (or even those like me who had been ENs before doing RN) who hadn’t had a medication error. I gave a pt in aged care the complete wrong medication because there were 2 residents with same first name, I was agency and the carer I asked said this was the right resident, resident couldn’t tell me their name so I gave it. Didn’t find out about it till days later when I got a phone call from my agency saying what had happened, both the agency and the facility were quite good about it and nothing further came of it but that’s how easy it is. I could have given that pt something they were anaphylactic too, or could have given someone with a slow heart rate dig or a low BP an anti hypertensive. There are many ways that mistake could have killed the pt.
That is why this case is so dangerous, because it will just breed fear in the next person to make a mistake, instead of reporting it they are more likely to cover it up and nothing will be learned from it. That’s why the safety and quality standards REQUIRE a blame free reporting environment for errors in health care. So we can improve the system as a whole and try to reduce errors and harms to patients
In an otherwise imperfect world, health care workers are expected to be perfect. Mistakes can happen at anytime and even the brightest and most experienced professional can and will err. People need to understand that their doctors/nurses/providers are human too. If you imagine this scenario as if the nurse's job is reduced to exclusively drawing a medication, preparing it and giving it to the patient, you are not considering that very likely she was also on the phone, charting, taking or giving report, getting called by multiple providers about other patients, procedures, orders, delays in labs, delays in medications, family members questions, transport, documentation, consents, rapid responses, pharmacy notifications... the list goes on and on and on. And this is true from the moment you clock in until the very last second of the unpaid extra hours you have to work to get everything done before going home. That is what we all mean when we say it is a "systemic" issue.
And holidays are usually more stressful both personally and professionally....
This is exactly one of the reasons I left hospital nursing years ago and have been working in the Home Health Care setting. You will be individually "Hung out to dry" by hospital administration and as mentioned, nothing will be done about a systemic problem.
Dr. Cellini - I have the utmost respect for you, thank for sharing the reality of this entire situation. You have put your professional neck on the line here. I am a long term quadriplegic (SCI for 40 years from a MVA at age 15) who has recently required multiple CT and MRIs due to a pressure sore. I still work and try to manage a general life. I'm grateful that I don't require sedation for any scans but for sure, this nurse certainly didn't have bad intentions. It's a rough call though as she made the wrong decision and I'm glad that I wasn't the recipient. Still, somehow the blame has to be shared with the larger system for sure, but by the time it hits the higher ups, it's too late and we patients would be gone. The simple problem was with the med delivery system - that poor nurse should never have had any 'V' medication option and it should have been questioned at the time of administration. I see both sides - my hope is to not blame but to just find a solution to rectify these challenges.
I refuse to work in a hospital at this point. I’ll take my nursing license literally anywhere else.
if i were a nurse i would go into anesthetics at this point, wouldn't even consider bedside
@@alia6918 I like research!! You make more money in research too!!
@@squidphish. thats a great suggestion, thank you!!
I understand this work is stressful but let's not speak on someone else's lack of following protocol. Not following the guidelines in place no matter how busy it is, is the best way to make sure something bad happens.
I heard it was not a busy day and she was training someone to not follow protocol.
I'm not trying to belittle the highly stressful environment but this isn't a delivery gone wrong so no matter how stressful it is you still have to do the right thing.
I hope all medical personnel learned something from this.
I learned from now on to ask more questions and to ask nurses and doctors how their day is going, make an attempt to make them smile, and talk to me about any meds they are giving me. You won't kill me because you are stressed.
Thank you for this video! This situation is terrifying and heartbreaking- I pray she doesn’t get jail time. I have some comments and welcome debate - 36 year nurse here with experience as a charge nurse as well as a nurse manager on a 40 bed inpatient BH unit. I’ve been obsessed with this case as are so many health professionals out there. I watched literally hours of this trial as well as listened to her interview with the board of nursing and her interview with the TBI. I think she has suffered enough and will be very sad for her if she serves jail time. All of that being said here is my take away: 1. Being honest is good, but this woman talked way way way too much. There’s such a thing as not hiding anything but she would NOT be quiet. She WAIVED her Miranda rights and did not have a lawyer with her and just talked and talked and talked, nailing herself to the cross. A lawyer in another video said he felt this case would have NEVER gone to trial if she had obtained a lawyer and did not speak to ANYONE until she secured one. She basically ruined any chance for the defense lawyer: she had the choice to precept that day: she welcomed it. Were you under staffed? “ no we were fine.” Were you stressed? “ no I was fine.” Do you feel unsupported? “ no I work with a great staff…” do you feel they need another float nurse on the unit? “No, one nurse can handle it….” And so it went, with no lawyer present and a signature waiving her Miranda rights she talked and talked and talked over an hour, telling them she caused it, etc etc. “I should have been more careful, I shouldn’t have made the overrides, I should have scanned the meds…”. several people including the lawyer in the video I watched said that we need to keep our mouths ZIPPED until we get a lawyer. Our mantra should be: “I wish to remain silent, I want a lawyer, I wish to remain silent, I want a lawyer…” period. Nothing else. After the interview with the woman who works with Medicaid fraud and who read her the Miranda rights prior to the interview the nurse
Radonda asked, “ now what do you do again? What is your role? I guess I need to get a lawyer?”
Last point: the interesting thing I noticed as both a charge nurse and a nurse manager- complacency leads you down the road to danger. Most incidents happened when there was more than enough staff present. We let our guard down, and in came the errors. You need that tiny nervous edge to maintain safety- just my opinion
By the time CMS got involved, some time had passed from the incident.....am I right? Did I read somewhere that she had been in counseling for a while as well? I'm just wondering if she was on any anti-anxiety meds or SSRIs, which may have affected what seems to be her own judgement....pictures don't always do justice, but it also seems like her countenance has gone through a huge transition, and not for the better ....
@@norxgirl1 I knew some time had definitely passed before CMS got involved, but I didn’t know she had been in counseling and didn’t think about the fact she could be on an SSRI. Thanks for bringing that up. I know as well when I’ve made errors I’ve immediately stated I was wrong etc etc. it’s so easy to do and when you interview in good faith you don’t think your words will be used against you 😓 I’ll be upset if she does jail time. She has been through enough already
She really missed the 5 W's of medication administration. I am an RN of 25 yrs and my husband had a car wreck that broke 22 bones and left him with a closed head injury. His pelvis was shattered which left him with an exterior fixator across his pelvis. He was non-ambulatory for about 4-5 months. He was also a Type II Diabetic. During his rehab stay I had asked several times that he not be given sliding scale insulin since he was on a 24 hour acting insulin. I was afraid it would lower his blood sugar too much. Well the doctor didn't listen and continued with sliding scale. One morning while I was there the nurse came in and administered the sliding scale. My husband's blood sugar went down to 13. He had zero metabolitic activity. EMT's got him back and when he got out of the hospital and back to rehab we had a come to Jesus meeting. I didn't sue them but I should have. Idiots.
I’m super glad she got criminally prosecuted her. How are you going to inject something into someone’s body without even reading the bottle and I feel really disturbing that so many nurses support and think it was fine.
Your expectation of a healthcare worker to work 40 hrs a week in a known staffing shortage, with supply shortages, long hours, and rare if any breaks and not make any mistakes is incredibly unrealistic. What other industry are you put in those circumstances and expected to take care of human life? Listen to what this guy is saying… it’s a systemic issue. It’s a healthcare system issue. Nurses are quitting for this reason. We’re being put into dangerous situations where mistakes happen. That’s a big reason why I quit intensive care nursing. The conditions aren’t conducive to keeping patients safe. Hospitals are a business. Businesses want money. The easiest was for hospitals to save money is cut staff to the bare minimum that is legal… and they can then staff you over what is legal and you can sign a paper that states that you were given an assignment that you consider unsafe conditions. However, I asked to sign one of these papers and not a single member of my management team knew where to find the form. Mind you, I work at one of the largest hospitals in the Midwest that is nationally ranked and a level 1 trauma center…
This is why this issue should have be discussed and trialed by an actual jury of peers (healthcare workers) who understand the intricacies and state of healthcare as a whole throughout the last 5-10 years. Nothing will improve until we have universal healthcare and the business aspect of healthcare no longer exists.
Okay folks, let me try this another way, since many of you are still hell bent on taking up for this person.
Your 16 year old child makes a few calls to friends, gets on Internet and hears there is a big party going on. She ask if she can go and after hearing it's a party of kids and young adults that she doesn't usually hang out with, you make the decision it's not a good idea and say " no "
Your child sneaks out anyway and doesn't return until the next afternoon. Reason she gives is " mom I had a couple drinks and knew you wouldn't want me driving home"
What a great kid. She made a good decision not to drive intoxicated. But you take her phone, and computer away anyway. She crys, tells you its unfair and slams her bedroom door in your face.
You open it and tell her, you weren't finished. She is also grounded for 2 months except for going to school.
Her reply, " but mom I said I was sorry."
You want her to understand, there are consequences to not following your
orders. She didn't know the kids. There were 21 and 25 year old young adults there, no parents and you had no idea where she was all night as you sat up and worried.
Harsh punishment? Or good parenting?
Sometimes saying " sorry " isn't enough.
Same with the Nurse.
Was it a mistake? As a Nurse, yes I've seen a few people make mistakes. Yes they are sorry and they didn't mean to cause harm to anyone.
It's like running a red light accidentally. You either didn't see it or tried to beat it. You crash into a car and kill the family. You didn't mean to kill anyone but your reckless, careless mistake did kill a family. That was one red light. You probably will go to jail.
The Nurse ran 15 to 18 red lights ( safety measures in place ) How many red lights were needed before she paid attention to one and stopped? She chose to over ride every safety measure. Not even look at the med label and warnings, then left a patient alone on 1st floor and went back to 6th floor. By her own admission she wasn't busy or rushed. Then why didn't you monitor the patient you just sedated? Careless, negligent and reckless.
The patient, Charlene Murphy trusted the Nurse to give good care. Instead she died a horrific and terrifying death. Her body couldn't move. Yet she knew what was going on. Unable to call for help. This death was preventable.
Not one Nurse I know has made these many careless mistakes. They usually catch the error by following safety measures.
She didn't chart she gave the med. In fact she didn't admit her mistakes until a second Nurse confronted her with evidense.
There are a lot of good Nurses who follow protocols, safety measures and rules. Then there are others.
As a Nurse your priority is the care and safety of your patient. Because folks, without patients, we aren't needed.
You can argue lots of people make mistakes. I'm telling you I've seen very few errors from competent, skilled Nurses. They give 100 %, they sacrificed and studied long hours going through school ( others barely got by) The good Nurses check, recheck, and check again. They are there for their patients for more than a job, they are there for their patients regardless of the patients finances, race or status.
Jail time might make people and Nurses realize they have a patient's precious life in their hands and should be more responsible than to run red light after red light.
Shame on you for not wanting the highest accountability from this Nurse. She took too many short cuts. Who knows if she did it before and just wasn't caught. She almost didn't get caught this time.
Don't let another innocent patient be harmed or die in vain. Stand up, speak up for changes. But to stand up for this negligent Nurse won't solve anything but send a message to others like her, it's okay if you kill a patient, you won't do jail time. It's okay you aren't competent or skilled or even care for your patients safety.
There should be laws in place to protect patients from Medical Staff such as Rodonda Vaught.
And we all have worked with them, in every field of work.
Just wondering if a drug test was done immediately after the event happened?
As for the hospital. They too are guilty. They didn't report the med error because they said they didn't realize it was neglect. BS. You are covering your ass. They didn't report it to their accrediting agency either. Joint Commission. They didn't even report the non natural death to the medical examiner.
As for the family forgiving the Nurse. They were paid off to keep quiet. Yet, some family that were notified had a different point of view. They took video of mom as she was having seizures while she died. Hmmm, the lawsuits may not be over yet.
Think about what really happened here folks. It wasn't a simple error. But yes we do need changes. Put your effort in to making changes to protect patients. If not, med error Nurse may come knocking at your door or your grandchilds door the next time you go to the hospital. Don't let patients have died needlessly in vain.
She didn’t chart she gave the med because the nurse manager told her not to. She tried to do whatever to make it apparent she made a mistake…unfortunately it was an irreversible one.
@Gloria Bridges, YES, 100%!
This nurse made so very many Repeated Negligent Mistakes, over and over again. And can argue, should have been even MORE CAREFUL while training one of her peers, yet didn't happen. This says a lot about the seriousness and negligent role she played in this poor woman's death. By not taking the time she should have taken, when people's lives are literally in her hands. This is what she trained for as a health care professional! She failed egregiously. Close to 250,000 people die Every Year - due to medical errors. This is an egregiously high number. It's appalling, and unacceptable! Maybe, just maybe, this is the wake up call people need, and will start taking their role as health-care giver/provider Very Seriously, as they should, and not make such negligent mistakes that causes harm, and leads to unnecessary premature deaths of patients, and loved ones. The jury got it right. And more than likely, she'll be out in a couple, or few years, with good behavior. But will send a clear message, when people's lives are literally in your hands, (that you train for) you better take your job, and your patients well being, Seriously.
I will never forget how hospital administrators were able to get the Covid-19 vaccine immediately after it was distributed to our hospital, while doctors and nurses had to wait.
Insurance companies and hospital administrators are the main problem in the healthcare system.
Try being an EMT. In my state Telehealth docs got the vaccine while we were doing CPR on known COVID positive patients and weren't eligible until a month later. When it was finally available for first responders the city I worked in refused to give it to EMTs only Fire and PD.
PA type here. What a ridiculous ruling.
-Vaught should lose her license, but negligent homicide? For context people who leave babies in hot cars get convicted of negligent homicide.
-There were lots of systemic factors that led to this mistake.
-Mistakes happen unfortunately.
-Not reporting/covering up mistakes is unforgivable. It prevents a system of from improving itself.
-We need Nurses. And we need those Nurses to tell us if a mistake was made. This ruling will make both of these things more difficult.
Leaving a baby in a hot car is very similar to leaving a paralysed elderly woman with a brain injury to suffocate in a scanner tbh
@@Amkay89 the difference of you know you are leaving a baby in a hot car. The nurse didn't know she had given the wrong drug.
Quite a few babies left in hot cars are done so accidentally.
@@LulaMae21 that's what people say after the fact
I have recently graduated from nursing school and this terrifies me. In school and on rotations I have learned that when administering medication the nurse suppose to do three checks against the doctor's order or the MAR. i.e when at the medicine cabinet, checking when drawing up the meds and at the patient's bedside. These are standard protocols to avoid medication errors. It doesn't matter how respected as a nurse you are any mistake can be for the worse as you can see in this case. Therefore, you always have to look out for yourself and be careful where you put your signature. Question physician's orders because even though it is the doctor that is prescribing the meds you are the one giving it thus you will be held accountable and responsible.
I worked in Transfusion medicine and we have so many checks and balances for the administration of blood products. I’m surprised that similar processes are not followed for medications.
Similar processes ARE followed for medications. Not to the extent for transfusions but protocols are in place and have been in place for decades. She screwed up on a number of levels. Even with all the screwups that led her to giving the wrong drug, if she'd only monitored the patient like she was supposed to this death would have been prevented. That is, she could have made many serious errors, but if she'd just done one thing right, (monitored the patient) no death would have occured.
I think healthcare workers in general are way too comfortable with errors happening and going to lunch. Everything is overridden by everyone. We need to be a little more terrified when we are on the clock. These are people's lives. Don't make excuses, we have to get better. Some things can be avoided. This was one of those times
True.. Very True
Dr. Cellini, thanks for covering this topic. As an RN myself, I was curious to know your perspective and opinion, and I couldn't agree with you more. Well done.
"So instead she used the override function and found a similar drug that started with 'Ve.'" As Mark Twain said, the difference between the right word and wrong word is the difference between lightning and lightning bug.
Truly agree. You have to make sure when you don’t know, you ask and find out. I’m sorry she’s going through this but this is more than just a mistake it’sa life lost. I’m terrified at how many medical professionals that keep saying it’s just a mistake. It’s a life😔
I agree. I was wondering why she didn't use the generic name. This wouldn't have happened. When working as a paramedic, I would verify the medication twice. Once when pulling it out of the bag or drawer and once when pulling it up in a syringe. I wonder how many patients she was taking care of at the time? Always double or triple check your meds.
Could this have happened to anyone though? I would hope the people responsible for the patients health are not this careless. She disregarded multiple red flags that seemed like pretty big differences between the medicine she gave and the medicine she needed to give.
I totally agree.
Agreed!!!
This is why I quit nursing. I was overwhelmed by overwork and was super prone to medication errors. My supervisors didn't care and the bottom line was profits for the company vs real genuine Healthcare.
@Natosha withanO all the Healthcare professions have been hijacked by a predatory capitalist model where profits are more important than patients and employees. This shift has caused untold pain and destruction to health-care in USA. It's called the medical industrial complex and many will continue to suffer at the hands of for profit corporate interests! Unless, there's a change, health-care professions are burn out and suffering places of employment imo!
@Natosha withanO I felt like a prisoner until I realized I was choosing it then I decided to choose to leave...never regretted it
These types of videos of yours really helps general public to get sensitised with matters related to healthcare. Its good that people like you can bring some sense into such delicate topics.
Vanderbilt was going to lose some federal funding when this was discovered and the DA is related to the head of Vanderbilt. This nurse was used as a scapegoat! Not to mention Vanderbilt has had SEVERAL issues over the years! How can we help fix this? I am not in healthcare but even I know this is horrible for healthcare! I hope she’s appealing and I hope there is a way the relationship between the DA and head of Vanderbilt is investigated!
Vandy wasn’t going to lose “some” federal funding- Vandy was going to lose ALL Medicare funding and would have to completely shut down. If you lose Medicare funding your doors are closed.
Supreme Court, maybe? Vanderbilt is Nashville's largest private employer ....going to be hard to find objectivity in that town....
Thank you for mentioning the whole story. I hate when people don't tell the full story CNN, Fox news. You are so true she was a scapegoat
Yes, a murderous scapegoat it seems. I wouldn’t want that kind of a nurse attending to me or my loved ones.
@@joneszw1 What would have been different if it was reported properly? How does that change her responsibility in the death of the patient?
"We're human and we make mistakes"... Tiny mistake, tiny punishment; big deadly mistake, big punishment where you don't lose your life and get some jail time... Seems fair. You have great power in these syringes and with it comes great responsibility. Quit your job if you can't do it properly. In fact, if any action you perform puts others in danger, yeah, don't do that either. Malpractice insurance shouldn't be used to protect a murderer.
As a TRUCK DRIVER, I will sit this one out... Naw Nevermind...One fatal mistake out here and we are done. So many can be wrapped around a fatal error, but ultimately the accident is laid in the drivers hand because he or she had the final decision.
Brokers are pushy asf and can really screw you up if they get mad with you. Pushy brokers, demanding customers and Jenks on the roads.
All the questions you just asked at the end, I can relate to trucking. They rip your license up to shreds, so why prosecute? Because someone died.... Same goes for the nurse... Am I missing something?
The only thing you're missing is class. Medical professionals are basically held up as gods by society, so the idea that they could be held accountable for negligence is crazy to them. They think that normal laws of society don't apply, and because the medical boards are self regulating they can protect their own. Unlike trucking, which is seen as "working class" and actually has to answer to external accountability.
Reporting is the main issue here. In healthcare, whoever is providing care is often really the only one who fully knows what is happening or has been done with a patient, so if an error is made, it's very likely only one person on the care team knows. Unfortunately humans make errors. In Healthcare those can be life-threatening and time is vitally important to prevent death or disability which is why most discipline taken in medical is noncriminal. As soon as criminality gets involved,, unreported incidents go up and resultant patient deaths go up. She was a *good* nurse who reported the error, but there are a lot of bad nurses/medical professionals in the field and this ruling essentially serves as an incentive to not report an error, which vastly increases the chances of a totally reversible medical error resulting in a death or permanent disability because someone was afraid of jail time.
@@hmrobert7016 That was a great explanation... Blue collar vs. White collar crimes. 👌🏾👌🏾👌🏾
@@ilikewhales4971 Alternatively.... If she knew the risk of jail time, she might've been more careful dispensing the med.
It's interesting though, how "we need to be able to commit criminal negligence without serious consequences because otherwise we'll do it anyway and not fess up" almost sounds like a sensible rationalisation.
Probably not to the truckers who are in jail for negligent homicide, and the nurse's dead patients, though.
@@hmrobert7016 Nobody looks at somebody crushed to death in their vehicle and thinks, 'well they could have suffered a sudden unexpected cardiac event." You also can't just dump magical fairy dust on an truck accident after the fact and have everyone be OK. Medical is different. Someone accidentally mismeasures a heparin bolus? Great. Report it, order the antidote, no fatal hemorrhage. Patient falls with headstrike? It gets reported, they go to CT, fatal brain bleed avoided, management gets notified of increased falls, policies and staffing changes to stop more falls from happening. Cover any of those up and you absolutely WILL get slapped with negligent homicide charges. Your comment also implies intent and the reason it's called a mistake is because it is not intentional. It's the same with truckers, but the reality is trucking accidents are irreversible and medical errors are not. Reality also is that lots of people are stupid and selfish and if they're going to get slapped with criminal charges anyway, why not try to dodge them in the first place? In a place where most patients have potentially fatal comorbidities, some dishonest people will try. So bottom line is, encouraging proper reporting saves lives. And you can be as upset about how it gets done as you like, but humans make mistakes, which in this case happen to be in a large, fast moving, egregiously understaffed building full of very sick people and very powerful drugs. And as long as promptly reported errors aren't criminalized, you and everyone you know is safer when they visit the hospital.
The issue is that they're not actually doing anything to prevent this from happening in the future, they're making the issues that are already in place an even bigger problem. The exact issues that lead up to being a contributing factor in this case were not resolved, acknowledged or improved, and these issues will continue.
Thank you for speaking out against this case. As a future PA this is pretty scary. I certainly won't chose to work at Vanderbilt or even in Tennessee, but there are hospitals all over the country that have questionable practices and policies. Are there any databases where practicing providers can list some of the questionable practices at their hospital ie patient to provider ratio? This would help those of us entering the field to chose a facility that will support us as we are starting out.
This trial really resonates with me. As a critical care RN in a Neuroscience unit, we have patients who get pet scans all the time in presence of an hematoma because hematoma’s can be a result of masses. There are many times the MDs give patients medication to relax them for this imaging and other imaging for that matter. I agree with you, having a paralytic that can be overridden is scary. This does make me want to rethink being a nurse
What a Gracious and Non - judgemental comments. We need coworkers like you , Dr Cellini.
I had a nurse forget to start a med for me recently. Nothing at all serious, it just delayed my leaving a bit and created a bit of a scheduling issue for the other patients. The thing was, I was asleep. She could easily have woken me and sent me on my way, on time, with no one the wiser. I’d have had a flare in symptoms, but no way to know why. She didn’t. She woke me, calmly explained why I was delayed and apologized. Then, she found her supervisor and explained why things were slow. That kind of integrity is admirable, and we shouldn’t do anything to discourage it. Avoiding mistakes happens with adequate staffing, higher wages, vacations and caps on overtime. These are all more expensive than scapegoating.
Thank you. Finally heard somebody do an unbiased evaluation of what happened. I just wish non-healthcare workers could really HEAR this and understand!
I don’t understand why everyone is standing up for her. I’m a nurse. We’ve all worked with those nurses who are terrible. They don’t give a crap about their patients. She obviously didn’t have any idea what she was doing. That is scary. What if that was your family member?
Example- I worked with an ER nurse who called the pharmacy to ask for another bag of TPA because hers was finished she thought it was a continuous infusion. These are the kind of nurses who don’t admit they don’t know what their doing, don’t look anything up, and have too much ego to ask for a second opinion. They are negligent.
What if she wasn’t one of those “terrible” nurses you are describing?
@@MS-yu5cl I’ve called pharmacy thousands of times to ask about medications. Why would she reconstituted a medication and give it without looking it up or asking? She wasn’t giving the medication to an unstable patient, this wasn’t an emergency situation.
This comment is so wrong on so many levels. You're the reason why people say nurses way their own. That woman admitted to her mistake, her license was taken away and she reconciled with the family. The district decided to pick this case up and prosecutor her as a criminal. The fact that you can't empathize for her is disconcerting. I hate people like you.
What terrifies patients is that this could be any of us.
Nurses as well..
Nurse Liz did a great job on the nursing perspective of this case. Physicians and providers generate income, but nurses are just a necessary expense. RNs and LPNs are more expendable and make easier scapegoats. I don't disagree that she made a horrible mistake, but to think that a nurse could become a felon for making an honest mistake is terrifying.
Yea. She talks about how in nursing med errors are usually taken care of without criminal charges and are used as opportunities to increase the safety and efficacy of the hospital systems we work in.
Are you going to excuse vehicular manslaughter charges. Car accidents are mistakes
@@JoshTucker9151 i mean like people who do car accidents don’t go in with the intention of saving lives? If someone was in a car and the main brake failed and instead of pulling the parking brake the person panicked and slammed the pedal and tried to wildly steer out of the way, we would blame the person for killing but we would also examine the system that failed in order to create that brake failure? We would be angry at the car manufacturer. Do you know how many lives she HAS saved over the course of her career? It doesn’t excuse the life she took, absolutely not. But in a medical situation where so many lives are in your hands the unfortunate truth is mistakes happen. Most peoples mistakes are caught by safety methods in place but, in nursing, we call this the swiss cheese theory where at some point all the holes line up in the wrong way and a nursing error slips through. Losing her ability to practice and her livelihood is punishment enough, there was no ill will in killing the person and as a nurse it’s not fair to criminally charge for negligence when the social contract is broken. What about Vanderbilt’s responsibility? The radiologists who didn’t ask for nurse supervision of the pt? There are so many holes in the case and your car accident example. As a nursing student, having to take on this kind of liability terrifies me and makes me not want to treat patients because if I make a mistake no matter how well meaning what if I end up prosecuted like this? Without the support of the hospital and team who is supposed to have my back? I am learning pharmacology and pathology right now but having a doctor tell me a brand name and expecting me to be an expert on all drugs in all areas of the hospital when pharmacotherapy is constantly changing and new drugs are coming out all the time, and then having a malfunctioning warning system, and having no other nurses available to sign off even though that’s my hospital protocol because we are perpetually short staffed. It’s a systemic problem. That one person is being blamed for. Nurses should know better than to practice when overencumbered but if nurses actually didn’t show up when workplaces were unsafe to practice in no nurses would ever show up.
@@Ouchiness So you believe that nurses should be immune to the criminal laws that everybody else in society is held accountable to because they "go in with the intention of saving lives"? That's absurd. And the whole "think of the lives she saved" thing might go towards reduced sentencing, but you aren't allowed to be grossly negligent just because you have done good things in the past. The superiority complexes my medical and nursing colleagues seem to come out of school with these days makes me cringe and harms patient care.
There are systemic issues here that would make the system safer, but at the end of the day Charlene is dead because her nurse didn't bother to check the formulary and chose a drug essentially at random because it sounded vaguely similar to the prescribed one. Even taking one second to google versed would've told her that she needed midazolam. She wasn't expected to commit every single drug to memory.
And yes, there are systemic issues that need to be addressed. The hospital should be charged as well, but that doesn't mean the nurse was wrongfully charged. Nurses and doctors, comprising "the system", need to come together and change those systemic issues, challenging the hospitals if need be. Too often "The System" is just a cheap excuse to avoid individual accountability.
@@hmrobert7016 yea I believe nurses should be immune to criminal charges in the practice of medicine unless the malpractice is intentional. Also hospital systems should be criminally charged for the underpayment of nurses and the overburdening of nurses with patients.
If she was a general nurse helping out in several areas she should have been even more careful than usual. At the end of the day, this nurse is being held accountable for her reckless actions just like anyone outside a hospital would be. This doesn't sound like an emergency situation where her mental abilities were taxed, her job was to read the label and administer only what was prescribed. Others should've been held accountable as well.
I have been a nurse for 15 years. Regardless of policies, red flags, lack of monitor, no scanner, switching to new EMR, etc.; the issue is gross negligence and a human life was taken prematurely. I have 1 simple comment for everyone: Where was her common sense?
Agree with everything you said. This should be terrifying to medical providers.
It is quite alarming to say the least…
@@DrCellini Yea true, the way they managed this case in court is quite questionable.
Nope.. it should serve as a wake up call. Many nurses are quitting and that's a good thing. It's better we purge the idiots than foster another potential tragedy. If she would have been not guilty, it could have served as a detriment to our profession. You know you don't wake up and decide to do this job. Roughly 33% if nursing students can complete and successfully pass a board examination. I'm a doctor of nursing and have completed a 4 year fellowship in intensive care medicine(intensivest). In all of my years of nursing I never would have believed such an idiotic error like this could have occured. It did unfortunately, this is what we call in medicine, a sentinel event. It is a world class fuck up... One that deserves this kind of attention, and prosecution. It's like the 9/11 of medicine! Lol . It's a sobering moment, intended to wake up the profession as a whole, or to drive off those who potentially could repeat it.. I'm dissapointed she was not charged for the higher offense, reckless homicide.. she deserved that.. she ignored our universal standards of care. Not something you can just simply forget, it's a robotic or rather mindless action that we all do without thinking. The fact that she left with an intensive care patient and neglected to continue telemetry through the transport is beyond me. This is not ever acceptable. If she would have continued that then maybe they could have discovered the signs of the distress early on... Her diagnosis alone required that supplimental oxygen and a bag valve mask be required for transport and conscious sedation. Further more, any nurse with half a brain that is transporting a patient to radiology for a procedure that requires conscious sedation medication would pull it from their floor stock and not wait till they are in a non-nursing area. If she was truly an experienced intensive care nurse, she would have also removed suggamadex along with the vecuronium to reverse it , in case of a unintended exaggerated effect.
@@dubuis69 I’m so shocked to see a medical professional agree with her being prosecuted. Literally EVERY other medical professional who I’ve watched cover this case feel she should not face any repercussions for her actions. There were literally safeguards in place to keep her from making such a fatal mistake. She gets no pass just because she reported it. It’s like “hey I accidentally killed somebody even though there were plenty of times during the process where I should have noticed my error but o well since I’m telling you don’t hold me accountable for literally being negligent because well I told you I killed her.”
Thank you!!! Finally a medical professional who isn't cowed by the white coat wall of silence.
I understand what was said and what some of y'all are saying however, someone died on her watch, due to her mistake. SOMEONE DIED. Consequences must be given.
AMEN! EXACTLY
Yes, everyone is treating her like she is the victim. The cap literally said "WARNING: PARALYZING AGENT"
Exactly!!!!!!
Unless you actually work in a hospital setting and feel the rigor of what is expected of you (which contradicts the contract signed many times) I don’t think you will truly be able to comprehend how easy it is to make a mistake. Especially when the correct systemic protocol is not properly in place for whatever reason. She did make a mistake and no one is denying it. And it is unfortunate that someone had to pay such a big price. But the punishment being brought forward is not equitable. And she should not be the only one paying for it.
Thank you for bringing all of this to light. I totally agree that many others should have held responsible. Terrible tragedy!
Thanks for this video. It could have been any nurses. I’m a nurse for 32 years in Chicago. We are overwhelmed daily due to staff shortage . We are ONLY humans. I felt bad for Miss Vaught😢
I am a nurse and been practicing in LTC since 1995..I am currently looking for assisted living or home health ...too much work. No time to do it and demands unrealistic..my heart goes out to the family of the deceased as well as the former nurse..
Thank you for making this video. You were spot on. No one will want to report mistakes. Her mistake was horrendous, but it was just that- a tragic mistake. We are all human. I am so glad I’m retired. I never worked with a Pyxis, but I understand there’s also a thing called ‘warning fatigue’- so many warnings pop up throughout one’s day that it becomes easy to dismiss them.
#istandwithradonda #iamradonda
You said “No one will want to report mistakes.”
I do not agree with you because it will be found sooner or later especially if it caused a fatal result.
Genuinely terrified by how many medical professionals see no issue with medical malpractice 😭 saying “this could be any medical professional” … maybe but it could also be any patient, such as you or a family member, life threatening mistakes are not just a small expected error!! She OVER RODE the system!!
the system allowed her to override it where is the accountability for the hospital she didn't want to kill that patient its horrible situation but for some reason people who don't truly understand what's happening in Healthcare want to criminalize Healthcare workers but these corporations are committing criminal acts daily and there's no uproar the medication shouldn't have been released without two nurses verification and possible supervisor also
@@dprizeprice2062 if the system is so bad and you deem yourself incompetent to its demands then leave rather than taking someone's life away.
Realy well done and well explained, I admire your confidence and conviction to your opinion. No one else spoke about this issue as honestly as you did. You earned my utmost respect!
Working (NJ) RN and Pre-med student (getting ready to apply to Med school), really appreciated your commentary on this case.
My older sister was a meds nurse for over 20 years. She hated it. It made her a nervous wreck! She always triple checked, sometimes questioning the doctors who made MANY mistakes and actually stopped them from ordering the wrong thing.! She read her patients charts and made sure the doctors made notes! Her biggest peeve. She was so good at her job many doctors asked her to work for them.
She was grossly negligent and it lead to the untimely death of a vulnerable adult in her care.
After working as a bedside nurse for 3 years I have accepted a position away from the bedside. I saw absolutely no light at the end of the tunnel, as a matter of fact it is becoming dimmer and dimmer for nurses.
i've been a nurse for close to 5 years, and now I am in medical school. i can see both sides of this, however I can't ignore the facts.
fact one: the nurse is to blame. there's no question on that, she overode the system, and pulled the wrong med. any number of excuses can be made for why, but ultimately there is a process called the 8 rights, 10 rights, 12 rights (they keep adding more) on medication administration. she didn't follow them. she went outside her scope of practice and killed someone.
fact two: the hospital covered it up. this is the more scary part of this whole thing, because anyone can look up medical error stats, and I'll tell you I've seen numbers averaging anywhere from 100k, to 300k deaths per year attributed to medical errors. activists want to ban guns because 20-40k deaths per year are gun related (mostly suicides) but NO ONE is saying we should ban hospitals. the truth is, this story is scary because shit like this happens ALL THE TIME, we just never hear about it because the story is never publicized and no one is ever held accountable.
healthcare is a joke, we as an industry tell the consumer, and don't get me wrong you are a consumer here; no facility exists to help you because it's the right thing over making a profit, if you don't believe me ask them why they automatically run sepsis bundles on one criteria when the standard is two, or why it takes 5-10 xrays to diagnose a fracture when they could probably do it in 1-2, why do 85 year olds need new hips and knees made of titanium when they have chronic CHF and/or renal failure and wouldn't get up to dance a jig even if it were 1956 again? why was this woman with a hemtoma going for a pet scan when she was due to be released anyway? it's billing. docs are often trapped in this broken system too, because they can't pay their loans if they don't make money, and hospitals won't pay out their contracts if they aren't generating enough revenue for the dept/facility. we tell you we got you, we'll take care of you, etc; but the truth is there are many dumb docs, and even dumber nurses being rolled off the assembly line to fill the demand of facilities.
the real reason this story is getting so much attention; hopefully in my opinion is that some of these hospital executives will start getting charged with crimes too. mega corp healthcare facilities may also face harsher fines too. the only way to really change things, to really make any of those corporate robots care, is to hit them where it hurts; their wallets. or put them in jail with bubba.
"Medication errors" is a broad term. Errors this incompetent/ preventable don't happen that frequently. I agree with most of your points though. She was at fault. I disagree about the gun aspect. But we can agree to disagree there.
Lastly, people have focused too excessively on the attempted cover-up. The coverup is separate from the incident. The incident itself is all her. The cover-up was all the admin. Both were negligent and potentially illegal.
Good luck in your education and with match when that point comes.
Agreed. The discussion should be on the cover up. Her "mistake" was egregious and rather purposeful, even if somehow well-intended. Clearly she shouldn't be in nursing.
The cover up is not surprising to me. As I posted above, nurses routinely asked myself and coresidents to adjust my orders (doses usually) if they accidentally administered too much (50mg vs 25 mg benadryl, 45 mg oxycodone vs. 15 mg, etc). They had no intention of reporting this -- in fact, they wanted the MDs to change the EMR so their dose amount (mistake) would reflect the changed order they asked for. The purpose of this was twofold -- 1. avoid reporting a mistake, even if minor 2. Shift responsibility/liability to the MD, in case the larger/wrong dose caused a problem, since now the MD is in the record as ordering it.
@@mar_man813 indeed, the system goes both ways. we all try to have each other's backs, but that's created an industry of dishonesty already. procedure rooms are usually pull and go document on the fly and that certainly is affecting errors too. the worrisome factor though is that the cover here is at every level. the nurses, the docs, the execs, the state nursing board, medicare investigators. yet we need to be arguing about will smith slapping chris rock to keep the oscars relevant. its sick.
@@cameronno6039 that's entirely the point though, we don't know because these errors are routinely covered up. do these type of errors happen often or not often? any of us can only attest to what we've personally seen, but bringing to light that there is indeed a well oiled system of sweeping these deaths under the rug in the name of profit is the point, and it does happen. probably a lot more often than any of us think.
moreover, focusing on the cover up should be the focus, the nurse is done, shes facing consequences...where is the punishment for the admin? where is the regulatory initiate to prevent more cover ups? because this should make it clear to every pedestrian reader that if there was one cover up, there's likely more, and that's the problem. where's the justice? there isn't any.
What motivated you to go into medical school after nursing, and do you at all regret your choice of careers in any way? I'm at a crossroads, trying to figure it out based on the current climate of healthcare and economy besides personal motivations to enter it.
As a retired nurse, I thank you. Even before Covid, nurses were overworked. No nurse is perfect. I worked with a nurse who once hung a bag of Heprin, set the infusion rate, and mistakenly thought it was an antibiotic. The patient survived and so did the nurse. No one in the medical field is perfect. Mistakes happen.
Are we supposed to give nurses who kill a patient a FREE PASS? "Oh, oops. Sorry. Next patient, please." There HAS to be some accountability.
SHE LOST HER LISCENSE.
Of all the videos I have watched on this case, yours is the most informative and detailed. Thank you!
Thank you for making a deep dive video on this topic! It was great to hear your opinion on the Cellini Rounds Podcast on Sunday, and then have this more in-depth video later in the week. Love the content!
Thanks so much!
As a nurse. I love hearing about such incidents.Helps me improving my practice all the time.
Yea like taking a couple seconds to double check what drug you are about to administer
@@Unknown_Oohyup.
I have a coworker that os allergic to 2 medications, And had a surgery coming up. She went to great measures to let Everyone know about her drug allergies. They were struggling to Wake her up after surgery (almost died) . They ended up giving her BOTH medications that she was allergic to! She is in the process of figuring out the responsible parties and filing suit.
This is sad and frightening. I have been a nurse for 17 years. I left bedside nursing and returned ten years later. So much has changed but the main thing is to slow down, check and verify what you are doing. I have been before the TxBNE twice….When these types of things happen you will definitely be standing alone and have to speak on your own behalf about your actions.