The Rise of Malpractice Claims Against NPs

The Rise of Malpractice Claims Against NPs

According to “The 2022 Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition,” claims again nurse practitioners (NPs) are rising.

To find out what this means and what NPs can do about it, Daily Nurse interviewed Georgia Reiner, MS, CPHRM, Risk Analyst, Nurses Service Organization (NSO).

What follows is our interview, edited for length and clarity.

According to the Claim Report, you found that aging services against NPs are up. What did they increase from and to? Why do you think this is happening? Why are more NPs being sued? 

NSO’s & CNA’s report entitled, The 2022 Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition , revealed that aging services claims increased from 17.2 percent of the total distribution in the 2017 dataset to 20.3 percent of the total distribution in the 2022 dataset. Specifically, allegations against nurse practitioners (NPs) that occurred most often in the aging services setting included improper or untimely management of a pressure injury and improper prescribing/management of anticoagulants and controlled medications. Three main factors may drive the increase in these claims:

  • The number of older Americans is increasing.
  • There is a shortage of primary care physicians.
  • The number of NPs in the workforce is increasing.

One of the realities of life is that our medical needs increase as we age. And the number of older Americans is steadily growing. According to the Administration on Aging, in 2020, the population of 65 and older numbered 55.7 million. It is projected to grow to more than 80 million by 2040. Many older Americans receive care from aging services facilities across the United States. There are currently about 14 million people receiving some form of long-term care services. That number is expected to double by 2050, according to the U.S. Centers for Medicare and Medicaid Services.

However, aging service facilities need more staffing to meet regulatory and quality of care standards. In addition, risk factors for older adults include increased physical health problems/conditions, side effects from medications, loss of mobility, and social isolation, which may lead to depression. These factors can contribute to an NP’s liability risks as NPs are responsible for diagnosis, medication management, and timely treatment and care.

Injuries the patient or resident sustained can result in allegations against the NP for negligent care.

This increase in claims may also be attributed partly to the overall rise of NPs in the workforce coupled with the expansion of NPs working in underserved specialties, such as aging services, and the steady decline of primary care physicians. In December 2019, the American Association of Nurse Practitioners (AANP) reported that 290,000 NPs were licensed to practice in the United States. In November 2022, the AANP reported that the number of NPs in the workforce had increased to 355,000.

Lastly, experts have warned that a shortage of primary care physicians could lead to challenges in accessing care. According to The Association of American Medical Colleges, by 2030, we will face a physician shortage of 40,000 and 100,000 doctors. As a result, an increasingly common solution is staffing more NPs at offices, clinics, hospitals, and aging services facilities, encouraging patients to receive care from NPs instead of physicians.

Why have malpractice claims – in terms of the amount of money awarded – been increasing? 

According to NSO’s & CNA’s new NP report, the average total incurred of professional liability claims in the 2022 dataset ($332,137) increased more than 10.5 percent compared to the 2017 dataset ($300,506). In addition, the findings suggest a continued shift towards larger claim settlements. For example, claims that resolved for over $500,000 represented 21.5 percent of all claims in the 2022 dataset, compared to 13 percent in the 2012 dataset.

The increasing severity of claim costs can be attributed, at least in part, to social inflation, which is the growth of liability/litigation risks and costs. This rate of growth is more rapid than what could be explained by just inflation by itself. Several potential drivers of this growth rate include:

  • More sophisticated plaintiff attorney litigation strategies.
  • Tort reform rollbacks.
  • Litigation funding.
  • Other large jury verdicts across the country.

Another possible driver of social inflation is the liability associated with the increasing complexity of patient needs. For example, meeting the needs of high-acuity patients can involve many surgical, restorative, and diagnostic procedures, which can incur significant expenses. And with rising healthcare costs in general, it then follows that it requires more significant verdicts to make plaintiffs whole for their losses.

What were the nursing specialties that you found to have the highest exposures? Why do you think they are sued the most?  

NSO and CNA’s Nurse Practitioner Claim Report revealed that in the 2022 dataset, 66 percent of all claims involved NPs specializing in family and adult-gerontology primary care. Family and adult-gerontology primary care have consistently represented the majority of NP claims across 2012, 2017, and 2022 claim report datasets. Most of these claims occurred in the office of an NP or physician, with many involving allegations related to diagnosis and medication prescribing. These specialties likely account for most claims because, according to the AANP, 79.2 percent of licensed NPs in the U.S. are certified in family and adult-gerontology primary care.

What can NPs do to protect themselves from malpractice claims? Please explain.  

Below are some proactive concepts and behaviors that NPs can include in their customary nursing practice:

  • Practice within the requirements of your state nurse practice act, in compliance with organizational policies and procedures, and within the standard of care.
  • Maintain basic clinical and specialty competencies by proactively obtaining the professional information, education, and training needed to remain current regarding nursing techniques, clinical practice, medications, biologics, and equipment.
  • Document your patient care assessments, observations, communications, and actions in an objective, timely, accurate, complete, and appropriate manner.
  • To help improve the diagnostic process, consider the potential unintended consequences of pursuing a specific diagnosis:
    • Are factors present that do not align with the diagnosis?
    • Are there symptoms that are inconsistent with the current diagnosis?
    • Why are these symptoms not indicative of another diagnosis?
    • Are there elements that can’t be explained?
    • Is there a condition with similar symptoms to consider?
  • If a patient is uninsured or unable to afford necessary diagnostic and consultative procedures, refer them to appropriate organizations or social agencies for financial assistance, payment counseling, and/or free or low-cost alternatives, and document these actions.
  • Remind patients to seek emergency treatment if a condition worsens, and document this action.
  • If necessary, utilize the chain of command, risk management, or legal department regarding patient care or practice issues.
  • Maintain files that can be helpful for your character, such as letters of recommendation, performance evaluations, and continuing education certificates.
Nurse Practitioner Liability Report Reveals Malpractice Claim Costs Are on the Rise

Nurse Practitioner Liability Report Reveals Malpractice Claim Costs Are on the Rise

The average total incurred amount of a nurse practitioner malpractice claim has increased to $332,137 – a jump of more than 10.5% since 2017, according to a newly released claim report published by the Nurses Service Organization (NSO) , a division of Aon Affinity.

The Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition highlights the top professional exposures facing nurse practitioners, including professional liability claims and license protection matters, as well as case studies, analyses, and insights.

“Because NPs can diagnose, treat and prescribe to patients, they are more vulnerable to the threat of a malpractice suit,” says Michael Loughran, president of Aon Affinity Healthcare. “Our goal is to equip them with data and tools that can help them recognize their exposures, reduce their risks and ultimately help them improve patient outcomes.”

Nurse Practitioner Malpractice Report Key Findings

  • The cost to defend license matters is increasing. The average cost of defending complaints against NPs to the State Board of Nursing is $7,155, a 19.5% increase compared to the 2017 report and a 61.1% increase compared to the 2012 report. 
  • Nursing specialties with high exposure. Family and adult-gerontology primary care constitute 66% of all claims – with most occurring in the office of an NP or physician and many involving diagnoses and medication prescribing failures. The neonatal specialty again represents the highest average total incurred of closed claims.
  • Key allegations. A majority of nurse practitioner professional liability claims involve diagnosis allegations. Death and cancer are the two most common injuries, representing more than half of the claims.
  • Top nurse practitioner licensure complaints. The allegations that most frequently lead to licensing board complaints include allegations related to professional conduct and prescribing medication.  

“Understanding the conditions that lead to a claim can help nurses develop techniques to mitigate risk and minimize the potential for litigation,” says Michael Scott, Assistant Vice President, Healthcare Underwriting, CNA. “This report provides nurses with tools and best practices to help create a safer environment for their patients and themselves.”

Resources for Nurse Practitioners 

The report also includes links to Nurse Practitioner Spotlights and resources highlighting risk control best practices for NPs on several key topics: license defense, depositions, patient adherence, telemedicine, diagnosis, documentation, and prescribing.

The Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition is the fifth claim report published by CNA and NSO addressing nurse practitioner liability since 2005 and represents NSO and CNA’s ongoing commitment to educating the nursing community.

The general analysis includes 232 anonymized closed claims involving an NP, NP receiving coverage through a CNA-insured healthcare business, or an NP student that resulted in paid indemnity greater than or equal to $10,000.

Download the complete report here.

Judge: Former RN Can Serve 3 Year Probation Term to Expunge Conviction for Fatal Error

Judge: Former RN Can Serve 3 Year Probation Term to Expunge Conviction for Fatal Error

RaDonda Vaught, the former Tennessee RN convicted of two felonies for a fatal drug error, whose trial became a rallying cry  for nurses fearful of the criminalization of medical mistakes, will not be required to spend any time in prison.

Davidson County criminal court Judge Jennifer Smith on Friday granted Vaught a judicial diversion, which means her conviction will be expunged if she completes a three-year probation.

Smith said that the family of the patient who died as a result of Vaught’s medication mix-up suffered a “terrible loss” and “nothing that happens here today can ease that loss.”  Originally published in Kaiser Health News.

“Miss Vaught is well aware of the seriousness of the offense,” Smith said. “She credibly expressed remorse in this courtroom.”

The judge noted that Vaught had no criminal record, has been removed from the health care setting, and will never practice nursing again. The judge also said, “This was a terrible, terrible mistake and there have been consequences to the defendant.”

As the sentence was read, cheers erupted from a crowd of hundreds of purple-clad protesters who gathered outside the courthouse in opposition to Vaught’s prosecution.

Vaught, 38, a former nurse at Vanderbilt University Medical Center in Nashville, faced up to eight years in prison. In March she was convicted of criminally negligent homicide and gross neglect of an impaired adult for the 2017 death of 75-year-old patient Charlene Murphey. Murphey was prescribed Versed, a sedative, but Vaught inadvertently gave her a fatal dose of vecuronium, a powerful paralyzer.

Charlene Murphey’s son, Michael Murphey, testified at Friday’s sentencing hearing that his family remains devastated by the sudden death of their matriarch. She was “a very forgiving person” who would not want Vaught to serve any prison time, he said, but his widower father wanted Vaught to receive “the maximum sentence.”

“My dad suffers every day from this,” Michael Murphey said. “He goes out to the graveyard three to four times a week and just sits out there and cries.”

Vaught’s case stands out because medical errors ― even deadly ones ― are generally within the purview of state medical boards, and lawsuits are almost never prosecuted in criminal court.

The Davidson County district attorney’s office, which did not advocate for any particular sentence or oppose probation, has described Vaught’s case as an indictment of one careless nurse, not the entire nursing profession. Prosecutors argued in trial that Vaught overlooked multiple warning signs when she grabbed the wrong drug, including failing to notice Versed is a liquid and vecuronium is a powder.

“I will never be the same person.”

Former Nashville nurse RaDonda Vaught on trial for fatal medication error.Vaught admitted her error after the mix-up was discovered, and her defense largely focused on arguments that an honest mistake should not constitute a crime.

During the hearing on Friday, Vaught said she was forever changed by Murphey’s death and was “open and honest” about her error in an effort to prevent future mistakes by other nurses. Vaught also said there was no public interest in sentencing her to prison because she could not possibly re-offend after her nursing license was revoked.

“I have lost far more than just my nursing license and my career. I will never be the same person,” Vaught said, her voice quivering as she began to cry. “When Ms. Murphey died, a part of me died with her.”

At one point during her statement, Vaught turned to face Murphey’s family, apologizing for both the fatal error and how the public campaign against her prosecution may have forced the family to relive their loss.

“You don’t deserve this,” Vaught said. “I hope it does not come across as people forgetting your loved one. … I think we are just in the middle of systems that don’t understand one another.”

Prosecutors also argued at trial that Vaught circumvented safeguards by switching the hospital’s computerized medication cabinet into “override” mode, which made it possible to withdraw medications not prescribed to Murphey, including vecuronium. Other nurses and nursing experts have told KHN that overrides are routinely used in many hospitals to access medication quickly.

Theresa Collins, a travel nurse from Georgia who closely followed the trial, said she will no longer use the feature, even if it delays patients’ care, after prosecutors argued it proved Vaught’s recklessness.

“I’m not going to override anything beyond basic saline. I just don’t feel comfortable doing it anymore,” Collins said. “When you criminalize what health care workers do, it changes the whole ballgame.”

“She shouldn’t have been charged in the first place.”

Vaught’s prosecution drew condemnation from nursing and medical organizations that said the case’s dangerous precedent would worsen the nursing shortage and make nurses less forthcoming about mistakes.

The case also spurred a considerable backlash on social media as nurses streamed the trial through Facebook and rallied behind Vaught on TikTok. That outrage inspired last Friday’s protest in Nashville, which drew supporters from as far as Massachusetts, Wisconsin, and Nevada. RaDonda Vaught gave a patient a fatal dose from this vecuronium vial in 2017.

“The things being protested in Washington—practices in place because of poor staffing in hospitals—that’s exactly what happened to RaDonda.
And it puts every nurse at risk every day.”

Among those protesters was David Peterson, a nurse who marched on Thursday, May 12 in Washington, D.C., to demand health care reforms and safer nurse-patient staffing ratios, then drove through the night to Nashville and slept in his car so he could protest Vaught’s sentencing. The events were inherently intertwined, he said.

“The things being protested in Washington, practices in place because of poor staffing in hospitals, that’s exactly what happened to RaDonda. And it puts every nurse at risk every day,” Peterson said. “It’s cause and effect.”

Tina Vinsant, a Knoxville nurse and podcaster who organized the Nashville protest, said the group had spoken with Tennessee lawmakers about legislation to protect nurses from criminal prosecution for medical errors and would pursue similar bills “in every state.”

Vinsant said they would pursue this campaign even though Vaught was not sent to prison.

“She shouldn’t have been charged in the first place,” Vinsant said. “I want her not to serve jail time, of course, but the sentence doesn’t really affect where we go from here.”

Janis Peterson, a recently retired ICU nurse from Massachusetts, said she attended the protest after recognizing in Vaught’s case the all-too-familiar challenges from her own nursing career. Peterson’s fear was a common refrain among nurses: “It could have been me.”

“And if it was me, and I looked out that window and saw 1,000 people who supported me, I’d feel better,” she said. “Because for every one of those 1,000, there are probably 10 more who support her but couldn’t come.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Nursing Groups Respond to Vaught Conviction for Fatal Drug Error

Nursing Groups Respond to Vaught Conviction for Fatal Drug Error

RaDonda Vaught, a former nurse criminally prosecuted for a fatal drug error in 2017, was convicted of gross neglect of an impaired adult and negligent homicide Friday after a three-day trial that gripped nurses across the country.

Vaught faces three to six years in prison for neglect and one to two years for negligent homicide as a defendant with no prior convictions, according to sentencing guidelines provided by the Nashville district attorney’s office. Vaught is scheduled to be sentenced May 13, and her sentences are likely to run concurrently, said DA spokesperson Steve Hayslip.

Vaught was acquitted of reckless homicide. Criminally negligent homicide was a lesser charge included under reckless homicide.

Vaught’s trial has been closely watched by nurses  and medical professionals across the country, many of whom worry it could set a precedent of criminalizing medical mistakes. Medical errors are generally handled by professional licensing boards or civil courts, and criminal prosecutions like Vaught’s case are exceedingly rare.

Janie Harvey Garner, the founder of Show Me Your Stethoscope, a Facebook nursing group with more than 600,000 members, worried the conviction would have a chilling effect on nurses disclosing their own errors or near-errors, which would have a detrimental effect on the quality of patient care.

“Health care just changed forever,” she said after the verdict. “You can no longer trust people to tell the truth because they will be incriminating themselves.”

Originally published in Kaiser Health News.

In the wake of the verdict, the American Nurses Association issued a statement expressing similar concerns about Vaught’s conviction, saying it sets a “dangerous precedent” of “criminalizing the honest reporting of mistakes.” Some medical errors are “inevitable,” the statement said, and there are more “effective and just mechanisms” to address them than criminal prosecution.

“The nursing profession is already extremely short-staffed, strained and facing immense pressure — an unfortunate multi-year trend that was further exacerbated by the effects of the pandemic,” the statement said. “This ruling will have a long-lasting negative impact on the profession.” The Tennessee Nurses Association cosigned the ANA statement and shared it on their Facebook page.

Vaught, 38, of Bethpage, Tennessee, was arrested in 2019 and charged with reckless homicide and gross neglect of an impaired adult in connection with the killing of Charlene Murphey, who died at Vanderbilt University Medical Center in late December 2017. The neglect charge stemmed from allegations that Vaught did not properly monitor Murphey after she was injected with the wrong drug.

Murphey, 75, of Gallatin, Tennessee, was admitted to Vanderbilt for a brain injury. At the time of the error, her condition was improving, and she was being prepared for discharge from the hospital, according to courtroom testimony and a federal investigation report. Murphey was prescribed a sedative, Versed, to calm her before being scanned in a large, MRI-like machine.

Vaught was tasked to retrieve Versed from a computerized medication cabinet but instead grabbed a powerful paralyzer, vecuronium. According to an investigation report filed in her court case, the nurse overlooked several warning signs as she withdrew the wrong drug — including that Versed is a liquid but vecuronium is a powder — and then injected Murphey and left her to be scanned. By the time the error was discovered, Murphey was brain-dead.

During the trial, prosecutors painted Vaught as an irresponsible and uncaring nurse who ignored her training and abandoned her patient. Assistant District Attorney Chad Jackson likened Vaught to a drunken driver who killed a bystander, but said the nurse was “worse” because it was as if she was “driving with [her] eyes closed.”

“The immutable fact of this case is that Charlene Murphey is dead because RaDonda Vaught could not bother to pay attention to what she was doing,” Jackson said.

Vaught’s attorney, Peter Strianse, argued that his client made an honest mistake that did not constitute a crime and became a “scapegoat” for systemic problems related to medication cabinets at Vanderbilt University Medical Center in 2017.

But Vanderbilt officials countered on the stand. Terry Bosen, Vanderbilt’s pharmacy medication safety officer, testified that the hospital had some technical problems with medication cabinets in 2017 but that they were resolved weeks before Vaught pulled the wrong drug for Murphey.

In his closing statement, Strianse targeted the reckless homicide charge, arguing that his client could not have “recklessly” disregarded warning signs if she earnestly believed she had the right drug and saying that there was “considerable debate” over whether vecuronium actually killed Murphey.

During the trial, Dr. Eli Zimmerman, a Vanderbilt neurologist, testified it was “in the realm of possibility” Murphey’s death was caused entirely by her brain injury. Additionally, Davidson County Chief Medical Examiner Feng Li testified that although he determined Murphey died from vecuronium, he couldn’t verify how much of the drug she actually received. Li said a small dose may not have been lethal.

“I don’t mean to be facetious,” Strianse said of the medical examiner’s testimony, “but it sort of sounded like some amateur ‘CSI’ episode — only without the science.”

Vaught did not testify. On the second day of the trial, prosecutors played an audio recording of Vaught’s interview with law enforcement officials in which she admitted to the drug error and said she “probably just killed a patient.”

During a separate proceeding before the Tennessee Board of Nursing last year, Vaught testified that she allowed herself to become “complacent” and “distracted” while using the medication cabinet and did not double-check which drug she had withdrawn despite multiple opportunities.

“I know the reason this patient is no longer here is because of me,” Vaught told the nursing board, starting to cry. “There won’t ever be a day that goes by that I don’t think about what I did.”

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The Massachusetts Nurses Association also issued a statement, and noted, “Nurses in Massachusetts may well remember the 1994 case at the Dana Farber Cancer Center when 13 nurses were sanctioned by the state for their role in administering a lethal dose of medication to Betsy Lehman, a Boston Globe Reporter.  Those nurses were later exonerated as it was shown that it was the system that was at fault.  In fact, that case led to major changes in how medical errors in Massachusetts and across the nation were addressed – as efforts were made to look at the systems involved as opposed to focusing on the individual practitioner. The MNA shared the below Court TV interview with Vaught prior to the verdict:

This article is republished courtesy of KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Learn How to Recognize Health Misinformation (and Protect Your Nursing Career)

Learn How to Recognize Health Misinformation (and Protect Your Nursing Career)

Social media makes it easier for relatively small, but vocal, groups of people to shape the conversation around public health issues, such as COVID-19 vaccines and treatments. This can be beneficial if the health information being spread is true, but unfortunately, social media also helps to facilitate the spread of misinformation. Nurses will likely encounter health misinformation at work and in their personal lives- whether it’s on their social media feed, in conversations with friends and coworkers, or in interactions with patients. Nurses should understand the professional risks associated with sharing misinformation, what they can do to spot misinformation, and how they can help stop its spread.

The professional risks of spreading misinformation

Nurses, like everyone else, can be vulnerable to the influence of misinformation online. However, unlike most other people, nurses have a professional, ethical responsibility to provide information to the public that meets professional standards. Holding a nursing license means accepting the responsibility to uphold the ethical and regulatory standards of the profession. Regardless of intention, when a nurse identifies with their profession or uses their credentials to talk about health information, it can be considered nursing practice. Nurses who use their credentials in public forums or on social media to disseminate COVID-19 misinformation violate their responsibility to the profession and the public. The National Council of State Boards of Nursing (NCSBN) has stated that “nurses are professionally accountable for the information they provide to the public.”

In December, the NCSBN made it clear that nurses who spread COVID misinformation online could be disciplined by their State Board of Nursing (SBON). SBON discipline can include fines, public reprimands, continuing education, probation, practice restrictions, or even suspension, surrender, or revocation of a nurse’s license. SBONs often maintain lists of disciplinary actions on state databases, newsletters, or websites as they are considered public information. SBONs also report disciplinary action to NURSYS® and the National Practitioner Data Bank (NPDB). An SBON may report disciplinary action to other agencies, regulatory authorities, or other SBONs, which may decide to initiate their own investigation and take disciplinary action against the nurse. In more severe cases, SBON discipline can result in the nurse being excluded from working for any providers or healthcare facilities who participate in state Medicaid programs, or federal healthcare programs such as Medicare. These sanctions can effectively end a nurse’s career.

Spotting misinformation

With respect to COVID-19, the NCSBN defines misinformation as “distorted facts, inaccurate or misleading information not grounded in the peer-reviewed scientific literature and counter to information being disseminated by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).” But with so much content available online, it can be difficult to differentiate factual information and news from rumors, opinions, falsehoods, and conspiracy. Here are some tips that can help nurses spot misinformation online:

  • Analyze both the content and the source
    • Does the author use sensationalistic language or lack specific evidence? Opinion and “news commentary” represent a point of view, while fact-based writing or analysis represent verifiable facts that are framed in appropriate context. Examine supporting evidence to see if the cited sources are reputable and if they support the claims being made. For example, statistics can be cherry-picked out of context to support a particular argument.
    • Check if an image, graph, or figure is being represented correctly. Search for an image to see if it has appeared online before and in what context. Graphs or diagrams can be fabricated, and pictures and videos can be edited or shown out of context to mislead viewers.
    • Is the source of this information fake news or satire? One easy way to check a source is to visit the “About” or “Contact Us” section of the website. Illegitimate sources often won’t have any information about their mission, staff, physical location, or a way to contact the organization.
  • Examine the author
    • What other content have they produced in the past? Are they credible enough to speak on this topic? Reviewing an author’s past work can reveal an agenda, point of view, or bias if they have repeatedly published content on the same topic.
    • Try to identify the intent behind the post or information. Information can intentionally be distorted to advance a specific agenda, endorse a belief system, or incite strong emotions to get users to click on or share an article.
  • Engage in self-reflection
    • Evaluate how the information fits into your pre-existing beliefs. People may rely on their personal beliefs to interpret evidence, and confirmation bias leads people to seek out information that supports their preexisting beliefs.
    • Evaluate the completeness of your knowledge. Consider whether there may be some relevant information or a different perspective that you may have discounted or dismissed.

 

Addressing misinformation and misperceptions

Nurses and other health professionals play an important role in countering health misinformation by proactively engaging with their patients. Helping to ensure their patients have access to accurate information that they can understand supports nurses’ duty to protect patients’ right to autonomy and informed consent. While these conversations can take time, a personalized, individual approach can be effective, according to the Office of the U.S. Surgeon General, which developed a Toolkit for Addressing Health Misinformation. Nurses should be careful to avoid using shame or embarrassment tactics because they can shut down dialogue. Instead of trying to fact-check misinformation or misperceptions, ask questions to understand the patient’s concerns. Additionally, many people have experienced discrimination in past interactions with healthcare providers, so it is critical for nurses to approach these conversations carefully to avoid coming across as judgmental or minimizing the patient’s concerns. Nurses should be empathetic to their patients’ intersectional identities and their cultural, social, and emotional needs. If an individual is open to recommendations, a nurse can offer reliable sources or help to connect them with other health professionals who can help answer their questions.

Final thoughts

When posting online about nursing practice or healthcare in general, nurses should consider the source and scientific validity of any piece of health information before sharing it publicly. Failure to do so can put their license and career in jeopardy.

 

References

Association of State and Territorial Health Officials (ASTHO). (2021). Reducing Vaccine Hesitancy for People Living with Disabilities. https://www.astho.org/globalassets/brief/reducing-vaccine-hesitancy-for-people-living-with-disabilities.pdf.

CNA and NSO. Nurse Spotlight: Defending Your License. https://www.nso.com/nurseclaimreport_defendlicense.

Grace, P.J. (2021). Nurses Spreading Misinformation. Am J Nurs, 121(12), 49-53.

Himmelfarb Health Sciences Library. (2022). Correcting misinformation with patients: Misinformation and cultural competency. George Washington University. Retrieved January 21, 2022, from https://guides.himmelfarb.gwu.edu/correcting-misinformation.

Kiely, E. & Robertson, L. (2016). How to spot fake news. FactCheck.org. https://www.factcheck.org/2016/11/how-to-spot-fake-news/.

Mantzarlis, A. (2021). Spot misinformation online with these tips. Google News Lab. https://blog.google/products/news/fact-checking-tips/.

National Council of State Boards of Nursing (NCSBN). (2021). Policy Statement: Dissemination of Non-scientific and Misleading COVID-19 Information by Nurses. https://www.ncsbn.org/PolicyBriefDisseminationofCOVID19Info.pdf.

Office of the U.S. Surgeon General. (2021). A Community Toolkit for Addressing Health Misinformation. https://www.hhs.gov/sites/default/files/health-misinformation-toolkit-english.pdf.

Syracuse University School of Information Studies. (2021). 5 ways to spot misinformation and disinformation online. https://ischool.syr.edu/5-ways-to-spot-misinformation-and-disinformation-online/.

Villarruel, A.M. & James, R. (2022). Preventing the spread of misinformation. Am Nur J, 17(2), 22-26. https://www.myamericannurse.com/preventing-the-spread-of-misinformation/.

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This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. Reproduction without permission of NSO is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.

This article is provided for general informational purposes only and is not intended to establish any standard of care, nor provide individualized business, insurance or legal advice.  The content is made available on an “as is” basis, without warranty of any kind. NSO will not be responsible for any loss, damage, cost or expense you or anyone else incurs in reliance on or use of any information contained herein.  

 

 

 

As DaRonda Vaught Trial Continues, Nurses Worry: Could I Be Next?

As DaRonda Vaught Trial Continues, Nurses Worry: Could I Be Next?

Four years ago, inside the most prestigious hospital in Tennessee, nurse RaDonda Vaught withdrew a vial from an electronic medication cabinet, administered the drug to a patient, and somehow overlooked signs of a terrible and deadly mistake.

The patient was supposed to get Versed, a sedative intended to calm her before being scanned in a large, MRI-like machine. But Vaught accidentally grabbed vecuronium, a powerful paralyzer, which stopped the patient’s breathing and left her brain-dead before the error was discovered.

Vaught, 38, admitted her mistake at a Tennessee Board of Nursing hearing  last year, saying she became “complacent” in her job and “distracted” by a trainee while operating the computerized medication cabinet. She did not shirk responsibility for the error, but she said the blame was not hers alone.

“I know the reason this patient is no longer here is because of me,” Vaught said, starting to cry. “There won’t ever be a day that goes by that I don’t think about what I did.”

If Vaught’s story followed the path of most medical errors, it would have been over hours later, when the Board of Nursing revoked her RN license and almost certainly ended her nursing career. But Vaught’s case is different: This week she goes on trial in Nashville on criminal charges of reckless homicide and felony abuse of an impaired adult for the killing of Charlene Murphey, a 75-year-old patient who died at Vanderbilt University Medical Center on Dec. 27, 2017.

Prosecutors do not allege in their court filings that Vaught intended to hurt Murphey or was impaired by any substance when she made the mistake, so her prosecution is a rare example of a health care worker facing years in prison for a medical error. Fatal errors are generally handled by licensing boards and civil courts. And experts say prosecutions like Vaught’s loom large for a profession terrified of the criminalization of such mistakes — especially because her case hinges on an automated system for dispensing drugs that many nurses use every day.

The Nashville district attorney’s office declined to discuss Vaught’s trial. Vaught’s lawyer, Peter Strianse, did not respond to requests for comment. Vanderbilt University Medical Center has repeatedly declined to comment on Vaught’s trial or its procedures.Originally published in Kaiser Health News.

Vaught’s trial will be followed by nurses nationwide, many of whom worry a conviction may set a precedent even as the coronavirus pandemic leaves countless nurses exhausted, demoralized, and likely more prone to error.

Janie Harvey Garner, a St. Louis registered nurse and founder of Show Me Your Stethoscope, a nursing group with more than 600,000 members on Facebook, said the group has closely watched Vaught’s case for years out of concern for her fate — and their own.

Garner said most nurses know all too well the pressures that contribute to such an error: long hours, crowded hospitals, imperfect protocols, and the inevitable creep of complacency in a job with daily life-or-death stakes.

Garner said she once switched powerful medications just as Vaught did and caught her mistake only in a last-minute triple-check.

“In response to a story like this one, there are two kinds of nurses,” Garner said. “You have the nurses who assume they would never make a mistake like that, and usually it’s because they don’t realize they could. And the second kind are the ones who know this could happen, any day, no matter how careful they are. This could be me. I could be RaDonda.”

As the trial begins, the Nashville DA’s prosecutors will argue that Vaught’s error was anything but a common mistake any nurse could make. Prosecutors will say she ignored a cascade of warnings that led to the deadly error.

The case hinges on the nurse’s use of an electronic medication cabinet, a computerized device that dispenses a range of drugs. According to documents filed in the case, Vaught initially tried to withdraw Versed from a cabinet by typing “VE” into its search function without realizing she should have been looking for its generic name, midazolam. When the cabinet did not produce Versed, Vaught triggered an “override” that unlocked a much larger swath of medications, then searched for “VE” again. This time, the cabinet offered vecuronium.

Vaught then overlooked or bypassed at least five warnings or pop-ups saying she was withdrawing a paralyzing medication, documents state. She also did not recognize that Versed is a liquid but vecuronium is a powder that must be mixed into liquid, documents state.

Finally, just before injecting the vecuronium, Vaught stuck a syringe into the vial, which would have required her to “look directly” at a bottle cap that read “Warning: Paralyzing Agent,” the DA’s documents state.

The DA’s office points to this override as central to Vaught’s reckless homicide charge. Vaught acknowledges she performed an override on the cabinet. But she and others say overrides are a normal operating procedure used daily at hospitals.

While testifying before the nursing board last year, foreshadowing her defense in the upcoming trial, Vaught said at the time of Murphey’s death that Vanderbilt was instructing nurses to use overrides to overcome cabinet delays and constant technical problems caused by an ongoing overhaul of the hospital’s electronic health records system.

Murphey’s care alone required at least 20 cabinet overrides in just three days, Vaught said.

“Overriding was something we did as part of our practice every day,” Vaught said. “You couldn’t get a bag of fluids for a patient without using an override function.”

Overrides are common outside of Vanderbilt too, according to experts following Vaught’s case.

Michael Cohen, president emeritus of the Institute for Safe Medication Practices, and Lorie Brown, past president of the American Association of Nurse Attorneys, each said it is common for nurses to use an override to obtain medication in a hospital.

Cohen and Brown stressed that even with an override it should not have been so easy to access vecuronium.

“This is a medication that you should never, ever, be able to override to,” Brown said. “It’s probably the most dangerous medication out there.”

Cohen said that in response to Vaught’s case, manufacturers of medication cabinets modified the devices’ software to require up to five letters to be typed when searching for drugs during an override, but not all hospitals have implemented this safeguard. Two years after Vaught’s error, Cohen’s organization documented a “strikingly similar” incident in which another nurse swapped Versed with another drug, verapamil, while using an override and searching with just the first few letters. That incident did not result in a patient’s death or criminal prosecution, Cohen said.

Maureen Shawn Kennedy, the editor-in-chief emerita of the American Journal of Nursing, wrote in 2019 that Vaught’s case was “every nurse’s nightmare.”

In the pandemic, she said, this is truer than ever.

“We know that the more patients a nurse has, the more room there is for errors,” Kennedy said. “We know that when nurses work longer shifts, there is more room for errors. So I think nurses get very concerned because they know this could be them.”

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