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The trial of a nurse facing criminal charges for a deadly medical error got underway in Nashville, Tennessee this week, and it's raising concerns among nurses about the precedent it could set -- particularly at a time when they're struggling with lingering burnout and exhaustion.

RaDonda Vaught, 38, was charged in 2019 with reckless homicide and impaired adult abuse after she allegedly gave 75-year-old Charlene Murphey the paralytic vecuronium when she was meant to give her the sedative midazolam (Versed) for her anxiety ahead of a PET scan. Murphey went into cardiac arrest and died on Dec. 27, 2017.

Prosecutors are expected to focus on how Vaught overrode several warnings from an electronic medicine cabinet. Vaught allegedly typed in "VE" for Versed, but when nothing came up, she hit an "override" that brought up more medications, according to . She searched "VE" again and the cabinet produced the paralytic vecuronium.

Vaught had to override at least five warnings or pop-ups alerting her to the fact that she was withdrawing a paralytic, prosecutors allege. She also allegedly did not recognize that midazolam is a liquid, while vecuronium is a powder that needs to be mixed into liquid.

The also notes that Vaught was talking to another person whom she was supposed to be orienting while she was typing the medication into the system.

During a nursing board hearing last year, Vaught stated that overrides are part of normal operating procedures.

"Overriding was something we did as part of our practice every day," she said, according to . "You couldn't get a bag of fluids for a patient without using an override function."

The NPR report describes Vaught's prosecution as a "rare example of a healthcare worker facing years in prison for a medical error," as such errors are typically handled by licensing boards and civil courts. It also states that the trial will be watched closely by nurses across the U.S., who are worried that a conviction may set a precedent -- particularly at a time when nurses are exhausted and demoralized, which can make them more prone to error.

Nurses have previously rallied in support of Vaught. , about a dozen supporters -- some in scrubs -- gathered in the courtroom during opening arguments on Tuesday.

, the American Nurses Association said that COVID-19 "has already exhausted and overwhelmed the nursing workforce to a breaking point. Nurses are watching this case and are rightfully concerned that it will set a dangerous precedent. ANA cautions against accidental medical errors being tried in a court of law."

"ANA believes that the criminalization of medical errors could have a chilling effect on reporting and process improvement," the statement said. "The Code of Ethics for Nurses states that while ensuring that nurses are held accountable for individual practice, errors should be corrected or remediated, and disciplinary action taken only if warranted."

"Transparent, just, and timely reporting mechanisms of medical errors without the fear of criminalization preserve safe patient care environments. ANA maintains that this tragic incident must serve as reminder that vigilance and open collaboration among regulators, administrators, and health care teams is critical at the patient and system level to continue to provide high-quality care."

Vaught was fired from Vanderbilt University Medical Center in early January 2018, according to the . The Tennessee Board of Nursing revoked her license in July 2021, according to a . Both her disciplinary hearing and the trial had been delayed by the COVID-19 pandemic.

In early 2018, the hospital negotiated an out-of-court settlement with Murphey's family that required them not to speak publicly about the death or the error, the Tennessean reported. However, the hospital didn't report the error to state or federal officials or to the Joint Commission at that time.

It wasn't until October 2018 when an reported the error and death to state and federal health officials, the Tennessean reported.

If convicted, Vaught faces up to 12 years in prison -- though Murphey's family said she would forgive the nurse if she were alive today, according to the Tennessean.

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