The fear of prison time may the latest thing making healthcare workers wonder if they're better off in another line of work.

Former Vanderbilt University Medical Center nurse RaDonda Vaught was sentenced to three years in prison but granted probation Friday for committing a medication error that killed a patient. In March, a jury convicted Vaught of negligent homicide and abusing an impaired adult when she accidentally administered the wrong drug to 75-year-old Charlene Murphey in 2017. On Friday, a judge in Nashville, Tennessee, handed down the sentence for those felonies. Former nurse RaDonda Vaught gets probation for fatal drug error

Legal experts don't expect the Vaught case to trigger more criminal prosecutions of healthcare professionals who make errors, but seeing a colleague nearly sent to prison has shaken workers, including those in the crowd gathered outside the Nashville courthouse to protest.

"Nurses don't need to go to prison for doing our jobs. We were heroes two years ago, and now are being threatened with going to jail," Bobbi Martin, a nurse and president of the Global Nurse Network, said at the rally. "We need the support from the public to make sure that they know what we do is dangerous every day, and that the hospitals that employ us put us in this situation."

Criminal convictions of nurses like Vaught mark a departure from the typical disciplinary pathway via state licensing boards.

"This adds another layer of burden to our already exhausted clinical team," said Janet Tomcavage, executive vice president and chief nurse executive at Geisinger.

While the case will spur communication that hopefully improves patient safety, punishing employees doesn't solve systemic problems, industry leaders and workers said. Healthcare professionals, already plagued by stressful working environments and staffing shortages exacerbated by the COVID-19 pandemic, say they are afraid to do their jobs.

"It will make nurses more scared," said Tanya Leshko, an attorney at Buchanan Ingersoll & Rooney. "The way you make patients safer is to improve systems. What they did here, for whatever reason, is approach an individual incident in a very punitive manner."

Nurses are expected to do more with less and don't feel supported by their employers, said Maria Nunez, an intensive care nurse at St. Francis Medical Center in Lynwood, California, and a member of the United Nurses Associations of California/Union of Health Care Professionals.

"They only care about productivity, moving patients out and whatever is most cost-effective for them," Nunez said. "Things have gotten worse."

Many of her peers have stepped away from nursing because of burnout or fear of making a mistake, Nunez said. She has considered taking time off to rethink her own career after 20 years in the field, she said.

Nurses and others rallied outside a Nashville, Tennessee, courthouse on May 13 prior to a sentencing hearing for RaDonda Vaught, a former nurse convicted of two felonies for a fatal medication error.

Addressing the root of the problem

The healthcare industry has historically struggled to foster transparent and open workplaces. The pandemic is compounding these longstanding challenges as caregivers work longer hours amid difficult working conditions.

Convicting Vaught of felonies does nothing to address systemic issues, said Dr. Marcus Schabacker, president and CEO of ECRI, a patient safety organization.

"We don't believe that penalizing an individual that publicly is going to help a single patient. I think it's going to be quite the opposite," Schubacker said. "It's going to have the effect of people trying to cover up their potential mistakes or near misses."

The healthcare sector should follow the lead of the aviation and nuclear power industries, Schubacker said. These businesses created systems of redundancies and cultures in which employees feel empowered to speak up, he said. That includes using technology to safeguard against inevitable human errors and analyzing mistakes and near misses for opportunities to improve, he said.

Staffing levels and workers' mental health top ECRI's list of the 10 biggest patient safety concerns this year. "When you are short-staffed, you're going to multi-task, you're going to run at a higher risk profile," Schubacker said.

Danville, Pennsylvania-based Geisinger convened a team after Vaught's conviction to answer nurses' questions. Many asked whether Geisinger would have their backs in similar situations, Tomcavage said.

Leaders from Geisinger's nurse, physician, advanced practice practitioner, legal, human resources and communication leaders met with employees. They reviewed the Vaught case, described how Geisinger has handled previous incidents and explained the health system's protocols and communications strategy, Tomcavage said. The company also delivered memos on these subjects, had managers discuss workers' concerns during rounds and had its attorneys participate in nurses' meetings, she said.

"We have fail-safe processes that don't allow nurses to be put in those spots," Tomcavage said.

Geisinger is using artificial intelligence to handle more electronic health record inputs and minimize manual errors. The health system has locked medicine carts in the radiology department. Two people need to sign off when medications are used off-label.

To ease nurses' workload, Geisinger is using unlicensed logistics coordinators to retrieve medicine, restock linens and outfit patient rooms. Geisinger hopes that more of its senior staff will stay on if they ask them to participate in virtual, team-based care models via telehealth, Tomcavage said.

"Nurses told me, 'As long as you continue to support staff when mistakes are made and you have a thoughtful and careful approach to change care processes aimed at supporting the team, I think we will have the same level of reporting,'" Tomcavage said.

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Denise Duncan, president of the United Nurses Associations of California/Union of Health Care Professionals, said the union has fielded a lot of calls and text messages from nurses concerned about the Vaught case. More workers are being disciplined for medication errors in recent years, said Duncan, a registered nurse.

Supporters of former nurse RaDonda Vaught advocate for the healthcare safety strategy known as "Just Culture" outside a courthouse in Nashville, Tennessee, on May 13.

"We are seeing more adversarial attempts by different employers," Duncan said. For years, workers have championed something known as Just Culture, under which healthcare facilities and employees work together to identify system failures. The concept, although not the term, was popularized by the Institute of Medicine's 1999 report, "To Err is Human," which identified system change as key to improving patient safety.

The Alliance of Health Care Unions struck a deal with Oakland, California-based Kaiser Permanente last year to include Just Culture language in its contracts, said Charmaine Morales, vice president of the United Nurses Associations of California/Union of Health Care Professionals, which is one of 21 labor organizations that make up the alliance.

Union members and Kaiser Permanente managers formed a national committee that will meet for the first time on May 18 to start designing a Just Culture framework that each site can use as a guideline. The eventual goal is for new Kaiser Permanente employees to learn about Just Culture on their first day on the job, Morales said. The group plans to meet monthly and have a strategy in place by the end of the year, she said.

It's unlikely that this case will spur similar criminal charges every time someone makes a medical error, said Carol Michel, a partner at Weinberg Wheeler Hudgins Gunn & Dial. But that doesn't mean it won't be on caregivers' minds, she said.

"There is a heightened visibility and risk of making a medical error. Now, you are looking at a criminal prosecution on top of losing your license," Michel said. "Pile that on top of a stressful job as a healthcare provider, particularly as we have been going through the pandemic and a national nursing shortage."

While copycat cases are unlikely, nursing groups may lobby state lawmakers to erect safeguards shielding healthcare professionals from criminal charges when they weren't acting maliciously, recklessly or negligently, Michel said.

State licensing boards would typically intervene and determine whether to discipline nurses. If a board penalizes caregivers, they could appeal.

"The prosecutor says the arm of the state didn't respond properly, so we have another to choose from," Leshko said. "They happened to choose the worst one in the toolbox."

Vanderbilt University Medical Center removed paralyzing agents from its medicine cabinets, including vecuronium, the drug Vaught mistakenly used on Murphey. The system required all managers, clinical staff leaders, nurses, respiratory therapists and paramedics to complete an educational course on its medication policy, according to its corrective plan. The hospital declined to comment.

"If you can't trace the root cause of mistakes and can't fix the systems that allow you to make them, then people aren't going to be honest and open," Leshko said. "In terms of fixing a systemic error and building a better system, this doesn't really help."

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