Nurses everywhere have been following the trial and verdict of RaDonda Vaught, RN, the Vanderbilt University Medical Center nurse convicted on March 25 of gross neglect and criminally negligent homicide for a fatal drug error.
The reaction, especially on social media, has run the gamut between disbelief that a nurse could have made such a grave mistake, to outrage that Tennessee pursued criminal charges in addition to the usual administrative process where the state nurse licensing board stripped Vaught of her nursing license.
But the implications of this case go beyond the chilling effect that criminalizing medical mistakes may have on nurses and other healthcare professionals when it comes to self-reporting medical errors. The case shows how individuals are scapegoated at the expense of fixing systemic issues caused by the healthcare industry cutting corners on staffing, training, equipment, and the health and safety of workers and patients.
How many nurses saw this case and thought about their past errors or near misses? How many nurses reflected on a time when the system forced them to override faulty equipment, overlook a safety issue, take on an unsafe patient load, float to an unfamiliar area without much training, or not strictly follow a procedure because that is what hospital administrators routinely expect of them?
Nurses are under tremendous pressure every day to cut corners and “do more with less.” Although many hospitals say they promote a culture of safety, the reality is very different. Hospital policy may say that if a member of the healthcare team raises a safety concern, everything stops until the problem is addressed. In practice, nurses are too often rewarded for creative workarounds and diminished for being the squeaky wheel who notices too many problems or submits too many Protests of Assignments or Occupational Safety and Health Administration complaints.
In the RaDonda Vaught case, her hospital reported that the patient died of natural causes instead of notifying federal regulators of the medication error as required by law. Although state investigators admitted that Vanderbilt had a "heavy burden of responsibility" for the deadly error, prosecutors pursued penalties and criminal charges only against the nurse, not the hospital. Vanderbilt only took corrective action and made safety improvements after a full investigation by the Centers for Medicare & Medicaid Services.
What does justice look like for the patient, the patient’s family, and the nurse when hospitals are not held accountable? Many failures likely led to the patient’s death in this case, but only the nurse—the patient’s last line of defense—was punished for her error. What does justice look like when healthcare systems are not proactively working to prevent future harm?
Healthcare systems, with the help of policymakers, relaxed many health and safety protocols and protections during the COVID-19 pandemic. The Vaught case reminds us that systemic issues of understaffing and cutting corners on safety also predate the pandemic. As we enter the next phase of the pandemic fight, we do not want “a return to normal;” we need to transform our healthcare system into one that prioritizes patient safety.
This case should be a wake-up call. Nurses have been speaking out on behalf of creating the safe, quality healthcare system we all deserve. We know patient safety issues are systemic and not just the result of one-off individual errors. We know that healthcare systems—and regulators and policymakers—have the power to address these issues and improve safety and quality patient care. It is time they listen to the nurses and act. It is time they put patients over profits!