Emma Moore felt cornered. At a community health clinic in Portland, Ore., the 29-year-old nurse practitioner said she felt overwhelmed and undertrained. Coronavirus patients flooded the clinic for two years, and Moore struggled to keep up.
Then the stakes became clear. On March 25, about 2,400 miles away in a Tennessee courtroom, former nurse RaDonda Vaught was convicted of two felonies and now faces eight years in prison for a fatal medication mistake.
Like many nurses, Moore wondered if that could be her. She'd made medication errors before, although none so grievous. But what about the next one? In the pressure cooker of pandemic-era health care, another mistake felt inevitable.
Four days after Vaught's verdict, Moore quit. She said the verdict contributed to her decision.
"It's not worth the possibility or the likelihood that this will happen," Moore said, "if I'm in a situation where I'm set up to fail." In the wake of Vaught's trial ― an extremely rare case of a health care worker being criminally prosecuted for a medical error ― nurses and nursing organizations have condemned the verdict through tens of thousands of social media posts, shares, comments and videos. They warn that the fallout will ripple through their profession, demoralizing and depleting the ranks of nurses already stretched thin by the pandemic. Ultimately, they say, it will worsen health care for all.
Statements from the American Nurses Association, the American Association of Critical-Care Nurses, and the National Medical Association each said Vaught's conviction set a "dangerous precedent." Linda Aiken, a nursing and sociology professor at the University of Pennsylvania, said that although Vaught's case is an "outlier," it will make nurses less forthcoming about mistakes.
"One thing that everybody agrees on is it's going to have a dampening effect on the reporting of errors or near misses, which then has a detrimental effect on safety," Aiken said. "The only way you can really learn about errors in these complicated systems is to have people say, 'Oh, I almost gave the wrong drug because ...'"
"Well, nobody is going to say that now."
Fear and outrage about Vaught's case have swirled among nurses on Facebook, Twitter and Reddit. On TikTok, a video platform increasingly popular among medical professionals, videos with the "#RaDondaVaught" hashtag totaled more than 47 million views. Vaught's supporters catapulted a plea for her clemency to the top of Change.org, a petition website. And thousands also joined a Facebook group planning to gather in protest outside Vaught's sentencing hearing in May.
Ashley Bartholomew, 36, a Tampa, Fla., nurse who followed the trial through YouTube and Twitter, echoed the fear of many others. Nurses have long felt forced into "impossible situations" by mounting responsibilities and staffing shortages, she said, particularly in hospitals that operate with lean staffing models.
"The big response we are seeing is because all of us are acutely aware of how bad the pandemic has exacerbated the existing problems," Bartholomew said. "Setting a precedent for criminally charging [for] an error is only going to make this exponentially worse."
Vaught, who worked at Vanderbilt University Medical Center in Nashville, was convicted in the death of Charlene Murphey, a 75-year-old patient who died from a drug mix-up in 2017. Murphey was prescribed a dose of a sedative, Versed, but Vaught accidentally withdrew a powerful paralyzer, vecuronium, from an automated medication-dispensing cabinet and administered it to Murphey.
Prosecutors argued that Vaught overlooked many obvious signs that she'd withdrawn the wrong drug, and did not monitor Murphey after she was given the deadly dose. Vaught owned up to the error but said it was an honest mistake ― not a crime.
Some of Vaught's peers support the conviction. Scott Shelp, a California nurse with a small YouTube channel, posted a 26-minute self-described "unpopular opinion" that Vaught deserves to serve prison time. "We need to stick up for each other," he said, "but we cannot defend the indefensible."
Shelp said he would never make the same error as Vaught and "neither would any competent nurse." Regarding concerns that the conviction would discourage nurses from disclosing errors, Shelp said "dishonest" nurses "should be weeded out" of the profession anyway.
"In any other circumstance, I can't believe anyone ― including nurses ― would accept 'I didn't mean to' as a serious defense," Shelp said. "Punishment for a harmful act someone actually did is justice."
Vaught was acquitted of reckless homicide but convicted of a lesser charge, criminally negligent homicide, as well as gross neglect of an impaired adult. As outrage spread across social media, the Nashville district attorney's office defended the conviction, saying in a statement it was "not an indictment against the nursing profession or the medical community."
"This case is, and always has been, about the one single individual who made 17 egregious actions, and inactions, that killed an elderly woman," said the office's spokesperson, Steve Hayslip. "The jury found that Vaught's actions were so far below the protocols and standard level of care, that the jury (which included a longtime nurse and another health care professional) returned a guilty verdict in less than four hours."
The office of Tennessee Gov. Bill Lee confirmed he is not considering clemency for Vaught despite a Change.org petition that had amassed about 187,000 signatures as of April 4.
Lee spokesperson Casey Black said that outside of death penalty cases the governor relies on the Board of Parole to recommend defendants for clemency, which happens only after sentencing and a board investigation.
But the controversy around Vaught's case is far from over. As of April 4, more than 8,200 people had joined a Facebook group planning a march in protest outside the courthouse during her sentencing on May 13. Among the event's planners is Tina Visant, the host of "Good Nurse Bad Nurse," a podcast that followed Vaught's case and opposed her prosecution.
"I don't know how Nashville is going to handle it," Visant said of the protest during a recent episode about Vaught's trial. "There are a lot of people coming from all over."
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).