Becker's Hospital Review

54 CMO / CARE DELIVERY Nurses make exit plans after RaDonda Vaught's conviction Mackenzie Bean, Erica Carbajal and Cailey Gleeson M ore than 100,000 nurses le the workforce in 2021, according to an analysis published April 13 in Health Affairs. Now a nurse's criminal con- viction for a medical error has the profession worried about how that number might swell. RaDonda Vaught's March 25 conviction for a fatal medical mistake has spurred an outcry from nurses across the country, who say the ruling sets a dangerous precedent for the pro- fession and will discourage nurses from speak- ing up about errors. Ms. Vaught was convicted of criminally neg- ligent homicide and abuse of an impaired adult for a fatal medication error she made in December 2017 aer overriding an elec- tronic medical cabinet as a nurse at Vander- bilt University Medical Center in Nashville, Tenn. Ms. Vaught, 38, faces up to eight years in prison for the error. Her sentencing is scheduled for May 13. e case is a rare example of a healthcare worker facing criminal charges for a medical error. An estimated 22,000 people die annu- ally in U.S. hospitals because of preventable errors, a 2020 study found. Many nurses have expressed concerns about the likelihood of similar mistakes under increasingly difficult working conditions. "e RaDonda case could have been any one of us who was busy, tired, overwhelmed and trying to do the right thing," Christen Bryce, RN, a New York-based mental health and sub- stance abuse nurse, told Becker's. is viewpoint is hardly universal. Other nurs- es believe Ms. Vaught was rightfully held ac- countable for her error. "I understand that the majority of nurses don't want to see RaDonda prosecuted. Neither did I. But we take an oath to not cause harm," La- trina Walden, MSN, a nurse practitioner based in Georgia, told Becker's. For some nurses and nursing students, the risk of criminal prosecution is enough to make them reconsider a career in nursing. Erica, a Las Vegas-based hospice nurse and social me- dia influencer who asked not to share her last name and goes by the pseudonym "Nurse Eri- ca," said she's heard from thousands of nurses who have expressed concerns about staying in the profession since Ms. Vaught's conviction. "I've heard thousands of them say, 'Yep, that's it. I just quit,' or 'I just turned in my two weeks notice,' or 'I am now in the process of figuring out my exit plan to leave within the next three to six months,'" she said. Some have aban- doned bedside positions; others have le the field entirely. Ms. Bryce is one such nurse who has le the bedside. She resigned from her hospital role in August because of severe burnout and con- cerns over the organization's safety practices. "It's safe to say that had I still been there when the conviction was announced, it may have pushed me out the door," she said. Some safety and medical organizations, in- cluding the American Nurses Association, the Institute for Safe Medicine Practices and the Institute for Healthcare Improvement, have warned the verdict could have broader reper- cussions on healthcare recruitment efforts. "Why would you want to go into nursing now, if you know you could not just lose your job or license, but be charged criminally or go to jail," Erica said. "I've heard from countless nursing students who are trying to decide if they want to drop out or stay and continue but not use their degree as a nurse. I've heard from count- less parents of nursing students who are so concerned for kids going into this profession. It's very widespread." Society watched as healthcare workers lost their lives to COVID-19, and endured the whiplash of being hailed as "healthcare heroes" to facing harassment and threats in their ef- forts to fight the virus and treat patients. On top of these challenges, Erica called the con- viction "the straw that broke the camel's back." e verdict's potential to deter people from entering nursing creates further challenges for the healthcare industry at a time when it is working especially hard to strengthen its workforce. "e nursing profession is already extremely short-staffed, strained and facing immense pressure — an unfortunate multiyear trend that was further exacerbated by the effects of the pandemic," the American Nurses Associ- ation and Tennessee Nurses Association said March 25. "is ruling will have a long-lasting negative impact on the profession." A call for change Nurses have overwhelmingly called for sys- temwide workforce and safety reforms in the wake of the verdict. Many argue that health systems, not just individual clinicians, are to blame for medical errors by permitting unsafe working conditions. "Rather than criminally prosecuting a nurse, we should be cross-examining the healthcare system that understaffs its floors and over- works its nurses, making room for tragedies like this to happen," said Rebecca Love, MSN, RN, chief clinical officer of IntelyCare, a nurs- ing agency. California remains the only state with a nurse- to-patient ratio law, which requires hospitals to abide by minimum staffing ratios. e law permits medical-surgical nurses to care for up to five patients; intensive care unit nurses no more than two patients; operating room nurs- es one patient; and emergency room nurses up to four patients. "If you look at California, they have experi- enced nurses at the bedside, which is some- thing that doesn't really exist anywhere else in the country anymore," Erica said, adding the staffing law entices seasoned nurses to stay at the bedside "because they know they can prac- tice safely." "ey know they can't be given more than a reasonable amount of patients to safely care for. ey are paid appropriately, they are given appropriate overtime and lunch breaks, and all the things you should naturally have as an employee in any sort of an environment. Why can't we have that in the rest of the country?" she said. Over three dozen health systems, patient safe- ty organizations and nonprofit groups pro- posed a national patient safety board focused on reducing preventable harm in September 2021. e board would study adverse health- care events and develop solutions to be broad- ly implemented to reduce medical errors. Nurses across the nation also urged e Joint Commission in a March petition — which has since amassed 549,944 signatures — to require "safe staffing ratios" as a condition of accredi- tation for healthcare facilities. en there are proposed technology and pro- tocol changes. Safety advocates have called for hospitals to require nurses to type in at least five letters of a drug's name when using elec- tronic medication cabinets, given how vul- nerabilities of electronic medication cabinets

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