Assuming Risk in Communicating Against the Most Vocal in the Court of Public Opinion

Nurse RaDonda Vaught

Scott Shelp knew he was venturing out into unknown territory when he decided to communicate some controversial analysis on an emotional story in the news and then publish it as a video on his YouTube channel — Nurse Scott. This feature is as much about the risk assessment, the communication and all that went into it as it is about the topic of the video.

RaDonda Vaught worked at Vanderbilt University Medical Center in Nashville, Tenn. and was convicted in the death of Charlene Murphey, a 75-year-old patient who died from a drug mix-up in 2017. How did it happen?

“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,” report Brett Kelman and Hannah Norman at NPR.

“Prosecutors argued that Vaught overlooked many obvious signs that she'd withdrawn the wrong drug, and did not monitor Murphey after she was given the deadly dose.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.”

This story understandably become very big in healthcare, especially as you might imagine, among nurses. Shelp noticed the debate as well as the upset, fear and anger nurses were communicating about the legal decision against Vaught. They also talked about quite possibly being them one day, being vilified for a mistake under incredible pressures and lack of support in the profession.

Shelp was moved to enter the conversation yet in a way that was different and risked extreme negative reaction. He expressed some questions in his video.

RaDonda Vaught was convicted, should she had been convicted?
Should she had ever been charged?
Is the hospital to be blamed?

Shelp knew that what he had to say was not going to be well received by everyone in nursing, saying early on, “I have to admit I’m a little nervous making this video. I just think it’s important to hear different viewpoints…,” adding, “I’m open to discussion and willing to change my mind.”

He respectfully discussed what had happened in the story leading to criminal charges and spoke eloquently of the higher standards nurses must insist on and be held to since life and death is so often in their hands. Many critics of the verdict took the final judicial ruling on the Vaught case as an attack on them.

The District Attorney’s office tried to be clear though and sent News4 Nashville a statement.

Scott Shelp

Did you have trepidation or not about voicing your detailed, professional opinion? Was there ever a point before or during communication that you thought, I'm not sure about the risk of saying what I know to be important? 

‘Trepidation’ isn’t quite the right word. I knew I had to be careful about what I said and how I said it. If I alienated the nurses I was disagreeing with, they’d never seriously listen to my points.

I didn’t feel there was too much actual risk of saying how I felt in a too-long video (more than 26 minutes) on a brand new YouTube channel with only three subscribers — now 165 by the way. There was always the option of deleting the video and pretending nothing ever happened.

My mindset wasn’t ‘I know what I have to say is important and far-reaching and noble.’ It was more like, ‘What the hell? Are they really saying this was just a med error? Someone’s gotta call bullsh*t. Why not me?’

What went through your mind in the decision-making process before communicating publicly?

I started by brainstorming my thoughts on paper in no particular order, stream-of-consciousness style. And as is typical for me, I had a lot of thoughts all at once. Then I organized them to flow one into another and added reasons why I was saying what I was saying.

I looked up details I wasn’t sure of. I watched other videos about this case and noted any discrepancies. A couple of times I surprised myself. Then I organized them to flow one into another and added reasons why I was saying what I was saying.

The comparison to the (police officer) Kim Potter case, for example. It just came to me that here was another public servant entrusted to use her tools safely and because of one bad decision, ended up in criminal court.

One commenter called it ‘just brilliant.’ I thought it was good but ‘brilliant?’ Why, thank you!

I read my script out loud and made a lot of stylistic changes, to sound more conversational. I was always asking myself, ‘Is that what I want to say?’

I also listened back for any hint of snobbishness. I especially didn’t want to give off a holier-than-thou attitude. Despite this, one person did call me ‘sanctimonious.’ Oh well.

I cut out good chunks from the script, like where after I admitted that I too had made med errors. I went on to describe a couple of them. ‘This isn’t about me,’ I thought, and I just let my simple admission stand on its own.

And of course there was the decision whether to use a script at all. I don’t have a teleprompter so I knew if I were reading, I’d lose eye contact with the viewers. I decided that I would make an effort to look into the camera as much as I could. A script helped ensure I didn’t forget anything or get a fact wrong. I think it was a good compromise.

One moment was actually scripted although it sounded off-the-cuff. It’s when I addressed RaDonda directly. I started with a heavy breath, shook my head and said, ‘RaDonda, honey, I’m so sorry this is happening to you….’

I got called out by a few commenters for this. My response to them was, ‘Yes, I called her honey. I’m gay. We do that sometimes.’ I had intended it to sound personal and folksy. I knew it was a risk but, by god, I’m gay and sometimes I just have to act like it.

What did you most want to accomplish by communicating strongly, yet respectfully, about the story? What was the mission? 

At first, I just wanted to say, ‘For heaven’s sake, stop defending bad nursing practice!’ Before putting any opinion out there in the public square, I researched the case to be sure I wasn’t missing something. And as it turns out, nothing I read changed my mind.

Tragically, RaDonda Vaught was solely responsible for her error. As I said in a follow-up video, ‘Reading a label doesn’t depend on a hospital’s technology or policies.’

I had no grand plan, I simply wanted to voice my opinion and hoped that maybe other nurses would agree with me. I’m really very pleased to see a robust, civil dialogue emerge from the comments. I’ve responded to over 300 comments on my video and on others. I’ve probably typed more in the last week and a half than I have in the past five years.

As that conversation continued, the focus of my message changed. At first my mission was to oppose the nurses who were defending RaDonda Vaught. I was especially outraged by comments like, ‘Medication errors happen all the time,’ and ‘This could have happened to any of us,’ and ‘Nurses are only human.’ I’m disappointed that the American Nurses Association and other professional groups are publicly saying similar things.

Now, as I express in my most recent video, the third on this subject, I think the most important thing I want to do is call upon nurses, regardless of their opinion on this case, to stop the hysteria and fear-based rhetoric and to take this opportunity to rededicate ourselves to nursing and its standards. Or as I said in the video, ‘Let’s lift each other up instead of scaring the bejeezus out of each other!’

I also want us to nurture our nursing students, encourage them not to give up and not scare them off. I am calling for nurses to encourage people to enter nursing. And finally I want nurses to reassure the public that we have professional standards and we enforce them. The trust they put in us nurses is not misplaced.

The initial reaction from so many nurses ‘standing with RaDonda Vaught’ seemed so inexplicable and potentially harmful that I just had to speak up.

I thought I’d put my ideas into a video on my new little YouTube channel and If all I got was criticism and attacks, then maybe I was wrong. I could take down the video and move on.

Of course that didn’t happen. I was surprised and pleased that It seemed I had given a voice to so many people that disagreed with the very vocal majority, which I’m not sure now it really is a majority—just vocal.

Right after you published your video on your YouTube channel, did you feel good or were you somewhat anxious about how it might be received by nurses and any media that might come across it or be alerted to it?

I watched the unedited video right after I recorded it and I was satisfied that I had said what I wanted to say in the way I wanted to say it.

I wanted my points to be easy to understand and supported with facts and-or logic. It was also important to me that I come off as a concerned colleague and not some pontificating outsider.

I never considered it might get picked up by the media. I’m glad I chose my words very carefully, and wore a nice shirt.

You know, it’s such a gift of getting older that I’ve come to trust my instincts and my ability to express myself clearly and appropriately. I guess I’ve had it in me all along. I look back at my first television interview in 1989 when I was 21 and, aside from being embarrassed by my braces, I feel pretty good about how I did in front of the camera.

Talk about a risk. That interview was essentially my ‘coming out’ on my small, southeastern Missouri college campus — in the ’80s. I was fortunate to receive great feedback from that. I got very little negative reaction for being gay and more respect for the bravery it took to be visible.

How would you describe the dialogue you created, about such an important topic? What do you hope will come from it?

I’m thrilled. This is exactly what I wanted: a polite — mostly— exchange of ideas about this very important case. It has made me think and refine my opinion. I hope it had done the same for others.

I had hoped that the nursing community, professional nursing organizations, and the public would hear my message. And it looks like many have and will thanks to the coverage in the NPR/KHN article and the interview I did for the NBC affiliate news station in Nashville.

This interview was edited for length and clarity.