About Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)

Editor-in-chief, (emerita), AJN

Case of Nurse Charged with Homicide for Medication Error Raises Concerns

Every nurse’s nightmare.

On February 1, Radonda Leanne Vaught, a former nurse at Vanderbilt University Medical Center in Nashville, was indicted and arrested for impaired adult abuse and reckless homicide. She is accused of inadvertently administering the wrong medication and causing a patient’s death in an incident in late 2017.

This is every nurse’s nightmare.

According to the CMS report from its investigation, Vaught administered IV vecuronium (a neuromuscular blocking agent that causes paralysis and is often used during surgery) instead of IV Versed (a sedating agent) to an anxious patient undergoing a diagnostic scan. The patient stopped breathing, suffered brain damage, and subsequently died. Vaught was charged with recklessness because she overrode the automated medication dispensing system and didn’t follow standard procedures in properly checking the drug name or in monitoring the patient after administering the medication.

What the CMS report says.

The CMS report, which includes interviews with Vaught as well as witnesses and safety officers at the hospital, notes the following information about Vaught’s actions while she was in the medication system searching for the medication:

“[Vaught]. . . was talking to [an] Orientee while he/she was searching the ADC for the Versed and had typed in the first 2 letters of Versed which are […]

2019-03-01T14:14:51-05:00February 12th, 2019|Nursing, nursing career|10 Comments
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Hodgkin Lymphoma: Knowing the Long-Term Treatment Effects

Most nurses will likely encounter a Hodgkin lymphoma (HL) survivor at some point, but will they know what to assess for?

‘Hodgkin’s is the good one to get.’

When I was going to graduate school, I worked part-time for a hematologist who mostly treated people with leukemias and lymphomas. Many of them had Hodgkin lymphoma (though we called it Hodgkin’s disease then). I administered chemotherapy, did a lot of patient teaching and a lot of listening and answering questions for this largely young group of patients. Most were close to my own age; it was easy to relate to their shock at finding out they had a life-threatening disease and that the treatment would not be easy.

I especially recall two young women—one had gone to her physician for a pre-marriage physical; the other went for a check-up because she felt she wasn’t “bouncing back” from the birth of her daughter three months previously. They were distraught at the diagnosis, and as they went through chemotherapy, they were often depressed over the side effects from the drugs: hair loss, GI upset, and fatigue.

But both of them did well. I remember the physician telling them his standard line, “If you had to get cancer, Hodgkin’s is the good one to get,” since it was […]

2019-02-01T13:09:38-05:00February 1st, 2019|Nursing|0 Comments
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True Grit: A Core Nursing Attribute?

‘Seeing things through.’

In the popular movie named after the attribute, a young girl searches for a man with “true grit”—someone with courage, fortitude, and determination to see things through. She needed someone to find her father’s murderer and believed only someone with true grit would be able to persevere against the odds.

The concept of grit is a good one to describe attributes that a good nurse should possess. How often do we get through challenging days—with short staff and patient crises, for example—just by sheer grit, by having the willpower to soldier on and do what needs to be done?

Helping nursing students develop grit.

In this month’s issue of AJN, Linda Koharchik reflects on the need for grit in nursing and believes nursing faculty can help students develop it. In her article “Helping Students to be Gritty,” she cites several sources that describe ways for clinical instructors to help students. One way is to assign challenging patients or situations, so students can benefit from the instructor’s guidance in handling particularly difficult circumstances.

I agree. As a nursing student, I gained most of my clinical experience in a large municipal hospital that was often underequipped, with basic supplies sometimes hard to come by. We learned to problem-solve […]

2019-01-16T15:57:20-05:00January 16th, 2019|Nursing, nursing students, students|2 Comments
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Safety Starts with Self When It Comes to Giving Chemo

The way it was.

cyclophosphamide IV

When I was in graduate school in the mid-1970s, I had a part-time job working for a physician group that treated patients with blood cancers, mostly leukemia and lymphomas. I started the IVs and administered chemotherapy, which typically included drugs such as vincristine, nitrogen mustard, doxorubicin, and cyclophosphamide.

I drew up the medications in a utility room—there was no special fume hood to clean the air. Initially, I did not use either a protective gown or gloves; after a bout of contact dermatitis on my hands, I used gloves, but I never used a gown. At that time, there were no guidelines for those of us who administered the drugs. Given what is known today about the reproductive toxicity of many of these drugs, I was fortunate that my exposure was short-term and before I became pregnant.

Do nurses follow today’s guidelines?

Today, there are clear recommendations for using personal protective equipment (PPE) like gloves and gowns when administering these hazardous agents. Yet, surprisingly, many nurses—even pregnant nurses—don’t follow them, according to a study published in AJN’s January issue.

In “Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns,” the researchers used data from the Nurses Health Study 3 to assess […]

2019-01-04T10:13:33-05:00January 4th, 2019|Nursing|1 Comment
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Who Is Doing Advance Care Planning in Nursing Homes?

When I was an ED nurse in a city hospital years ago, we often received patient transfers from area nursing homes. Usually these patients were very elderly, appeared cachectic, and were largely unresponsive (as I recall, many were post-stroke or had dementia). Diagnoses were usually very similar: dehydration, hypotension, UTI, pneumonia; many had contractures. The usual care was rehydration with IV fluids, an NG tube, antibiotics, and often a Foley catheter. Sometimes they were septic and then they were intubated, placed on ventilators, and sent to the ICU, where just about everyone died after a short stay.

What’s the point of this care?

I often wondered, as did many of my colleagues, what was the point of this. It seemed futile, and injurious to the patient. Sometimes, if we could reach family members before nasogastric or endotracheal tubes were placed, we were able to secure an order to dispense with all but comfort measures. Otherwise, all measures were initiated and then things became complicated—legal issues arose about discontinuing futile care and families often couldn’t bring themselves to discontinue life support measures.

Today, a greater focus on advance care planning.

Advance care planning (ACP) was hit or miss in those days—mostly miss—and our patients suffered because of this. It’s only recently that emphasis has been […]

2018-12-10T11:07:41-05:00December 10th, 2018|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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