Providers: Things Have Changed
Nursing Care After RaDonda Vaught
I recently wrote an article in which I blamed RaDonda Vaught for her negligence. I supported (and still support) the outcome of her case. In my opinion, it was right to revoke her nursing license, and the charge of criminal negligence seems appropriate to me.
I’ve spent the last few days poring over the comments. To my surprise, I was met with a lot of pushback. Like — a LOT of it. I had plenty of people message me privately to show their support, but the most and the loudest comments were against my view. Some just called me names, some said I was arrogant and a perfectionist, some wished medication errors on me, and some simply explained their opposite views.
The point of this, providers, is that times have changed.
Nurses are outraged. (Well, we’ve been outraged for decades, but after COVID and now this trial, it’s noticeably worse.) We feel like scapegoats. Systemic errors and flaws in organizations, physician and provider errors, understaffing, overworking conditions, etc. It all rolls down to the nurse. All problems end with nursing.
When there’s a budget shortage, ancillary staff gets cut. But the work doesn’t get reduced. The work gets shifted to the nurse. No more phlebotomy? No problem, nurses can draw blood. The budget doesn’t allow for transporters anymore? It’s cool, the nurses can take patients to other departments. The tube system broke? Nurses can walk the specimens to the lab and pick up meds from the pharmacy. We’re out of flushes? Nurses can make their own from bags of saline. Not enough nurses scheduled for today? The nurses will have to step up and take on more.
You get the point. At every system breakdown, the nurse is the bandage. Instead of solving the problems, we’re expected to just deal with it.
And we have been dealing with it. Really well, I might add.
We have been covering for providers and the organizations for a long time. We chart delays and errors in politically correct ways. We never say “care delay: physician forgot to enter orders” or “medication dose ordered by physician exceeds safety guidelines.” Instead, we say to ourselves, “oversights happen. We’re all human. Doctors are busy and forget stuff, too. We are part of a team.”
Or so we thought. Now that a nurse has been charged with a crime and faces prison time, things have changed. We don’t feel like we’re part of a team anymore. We feel like workhorses who was initially “heroes” when COVID started. But the second things go wrong, we’re the only ones left holding the blame.
For the RaDonda Vaught case, she incorrectly and negligently gave a drug and caused someone’s death. Most nurses would never make that mistake. But that’s not the point.
The point is that all nurses make some mistakes. Most would never make a mistake like she did, but they make mistakes nonetheless. Most mistakes cause no patient harm, but some do.
And if the consequence of making mistakes is prison, a lot of nurses are (understandably) very concerned. There’s fear in the air.
If we’re the ones to blame, you can expect that there will be changes. Providers need to adjust their practice and their expectations of us.
So, providers: a lot of nurses will refuse to take verbal orders, no longer trusting you’ll enter them later and support us if things go wrong. A lot of nurses will no longer override the medication dispensing system and instead wait until the pharmacy verifies the medication and corrects the issue. A lot of nurses will no longer administer medications if the computer or the scanner is malfunctioning.
This will delay patient care. This will affect the providers’ flow. But, the nurses will document this delay as necessary to protect patients. And they will do this to protect themselves from blame.
Reflection
Writing my previous article and reading the outrage from my peers made me reflect. I am in a master’s program for nursing administration. My goal is to be a leader.
It worried me that I seemed to be on the wrong side of things based on the negativity my last post received. Maybe I wouldn’t make a good nursing leader if it seems that so many are against me.
But what I realized is that I agreed with what most of these nurses were saying. I firmly believe that Ms. Vaught was wrong; but so do these nurses. They disagreed about the criminal charges. They questioned where the blame for the facility was. But overall, they agree that the nurse was negligent.
And what I realized is that a lot of the negativity directed towards me was based in fear. Fear of what precedent this case sets. There was a lot of “what if I’m next?”
To those nurses whom I upset, I understand your frustration and your fear. It’s valid. This case has changed nursing. Our lives have changed because of it.
If I am ever in a position of authority, I can promise that your best interests are in my mind. That is my motivation: to improve nursing for nurses. To advance our field.
That’s why this case upset me. To me, she put us all at risk. Her negligence is something we now have to pay the consequence for. All of the fear is, in my opinion, is because of her case. It’s not fair to place all of this blame on her, though. She didn’t have any ill-intent. I have empathy for her as a human, but this case will have ramifications for all of us.
I now expect patients to ask us to show them the vials of medications before we administer them. I now expect patients to doubt us. I now expect patients to fear they are going to be accidentally killed by our mistakes.
And maybe they should be more aware of what we’re doing to them. Maybe this will help reduce errors. But it’s not a good feeling to be doubted or viewed as incompetent.
The Future
So, where do we go from here? Nursing administrators need to work to solve the underlying problems. More staff, more training, more education, more accountability for poor performers. Implementing Just Culture. We know how to fix these issues. We just need to do it.
