EmmaG, RN. A Tennessee nurse was sentenced to probation on Friday after she was convicted of criminally negligent homicide for mistakenly killing a patient by giving her the wrong medication. Some consider suicideand a smaller fraction, like Kim Hiatt, take their own lives. Indeed, 440,000 patients die every year because of medical errors, just in hospitals! Earlier that morning, hundreds of nurses gathered in downtown Nashville, wearing purple T-shirts with the hashtag #IAmRaDonda to support Vaught in face of a broken medical system. The North Shore Medical Center did not respond to inquiries from ABCNews.com prior to the publication of this article. All trademarks are the property of their respective trademark holders. This situation will never be repeated by Ms. Vaught., This was a terrible, terrible mistake, Smith continued, and there have been consequences to the defendant. Get the help you need from a therapist near youa FREE service from Psychology Today. As stated earlier, an exposure can be very stressful and scary, affecting not just the patient and nurse but the nurse's family as well. Get adequately skilled, then do your best, and when you make a mistake, learn from it, forgive yourself, and keep trying to be the best you can be. What would happen if a student accidentally killed a patient during clinical? Daughter-in-law Chandra Murphey, who is married to Michael, testified that her family hasnt had peace or closure for four years and the situation has just been sickening to us. Chandra said, We did so much together as a family, and it just ended, in a split second for us., Speaking on behalf of my father in law he cries every day. Kim Hiatt had worked as a nurse for 24 years when she made her first medical error: She gave a frail infant ten times the recommended dosage of a medication. Scott decided to try something she thought might help. So I quit. Kim entered a note into the patients record: Miscalculated in my head the correct [dosage] according to the mg/ml. This is something that should never happen, not even for a seasoned nurse. Not often, grant you, but it happens. Every nurse I've ever encountered has their cautionary tale that they share in the hopes that others won't make the same mistake. And if youre bad at math, get a tutor or take a course on the sort of math you need as an RN, including improving your skills in estimation---so even if you calculate wrong, youll know you made an error before administering the medication to a patient. What Happens If a Nurse Gets a Needlestick or Other Type of Exposure? This is one of the largest problems; nurses are extremely busy and sometimes choose not to report right away. It now more rigorously regulates verbal orders for medicationthe type Kim had gottenan important preventive step that leaves less room for misinterpretation. Didnt get to give her a hug or a kiss. Yes, your error turned out to have disastrous consequences. I am simply sick about it.. Psychology Today 2023 Sussex Publishers, LLC, Source: FreeStockPhotos.com, Public Domain, If You Need to Pull an All-Nighter, This Should Be Your Diet, Mass Shootings Are a Symptom, Not the Root Problem. Once reported to the provider, several things may happen at once. It hurts us to see him hurt so bad, and he has stated that he wanted her to have the max, Chandra said. It happens. Kim Hiatts mother, Sharon Crum, was a nurse. Murphy entered the hospital because . And yes I agree. 5 Spiritual Practices That Increase Well-Being. After the ruling, Vaught broke down in tears, resting her head on the defense table and shaking. EE(Everything Everywhere) Interview tomorrow help!! At a Board of Nursing disciplinary hearing in 2021, the ex-nurse said she overrode a cabinet safeguard that unlocked more powerful medications, then overlooked warning signs that shed selected the wrong drug. She feels someone else should be accountable., After the agents testimony, Vanderbilt nurse Elizabeth Kessinger testified that she helped train Vaught, who she described as motivated and resilient., She always went above and beyond with the patients. Thats all anyone can do. On the other hand, 13 percent said they became more secretive about their errors. And prosecutors tend to focus on nurses, he says, rather than physicians or hospital administrators, though he's not sure why. It happens. He trained deacons in the church.". Then, during a meeting, someone mentioned Kims story. "For the most part, she's making it," he said. The actions taken after exposure depend on the type of exposure. Knowing what you value will help you build the most meaningful life possible. Only thing I can think of is if a student did VS or BG and didnt report any abnormalities to the nurse. The. Despite legislation for needlestick prevention and safety measures in place, accidents do happen, and nurses need to know what to do in case of an exposure. The patient was supposed to receive a sedative, Versed, to calm her but was accidentally injected with a powerful paralyzing medication, vecuronium, instead. And there's collateral damage that can go unnoticed: Every day, doctors and nurses quietly live with those they have wounded or even killed. Some of that comes from patient advocates or injured patients. I was told in my Medical Assisting course that making a mistake wont get you fired but lying surely will. "We work in environments that are fast-paced," she says. (Vaughts lawyer pointed out the former nurse did express remorse publicly, but Chandra clarified not directly to her family. Vaught instead gave Murphey vecuronium, a paralytic drug used during anesthesia that had the same first two letters, according to the report. What projects have you done related to STEM? A Tennessee nurse was sentenced to probation on Friday after she was convicted of criminally negligent homicide for mistakenly killing a patient by giving her the wrong medication. Seattle Childrens Hospital fired Kim shortly afterward. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Thanks for contacting us. Problems tend to happen in busy, unpredictable circumstances, Manges says. More so if this occurred. Insurance companies use nurses to approve requests for care. Ever since Marc Smith was a boy, "My mother and father had taken in a countless number of children who were in bad situations at home or didn't have place to stay," he said. Nursing is my passion and the very core of who I am, she wrote. Some of them had caused deaths, Dr. Wu says. [Kim] called me on her way home. She currently works as a charge nurse in a busy outpatient primary care department. Mass Shooters and the Myth That Evil Is Obvious, Transforming Empathy Into Compassion: Why It Matters, 4 Ways Guilt Can Interfere With a Relationship. What happens if a doctor date a patient? "The hospital killed my dad," said Marc Smith of Miami, Fla., whose father went into cardiac arrest after the nurse's mistake at North Shore Medical Center in Miami. hide caption. Then again at the end of the day its just a mistake in a job where you dedicate your life to helping people. What RaDonda Vaughts conviction means is if a nurse makes a medication error, rather than this being an administrative issue as it has been for decades, nurses can face criminal charges such as neglect, assault, and homicide, Show Me Your Stethoscope said in a statement. Thirty minutes later, Smith was found unresponsive. Human error is inevitable, she says, and hospitals should account for that by instituting safety checks and protocols. As soon as Cathie Rea, Kims supervisor, read the note, she escorted Kim to her car and told her to leave the campus. It's also a good idea to flush out your . Marc Smith came by to visit that morning, and found his dad "unconscious, unresponsive and on a respirator. Thats all anyone can do. There was no mistake madethe location of a gunshot wound appeared to guarantee the patients deathbut she still struggled with the gravity of his death. Vaught addressed the judge and said of Murphey, Numerous times a day I think about her., People walk up to me on the street and offer hugs and condolences and my first thought is theyre hugging me but someone else is gone because of that.. For example, HR departments use nurses to recruit other nurses. Concurrently, the nurse would also get baseline lab work done. Some people are upset at the way iPhones charge. They would go through the hospital's procedures of when an accidental death happens. The hospital did, however, issue a statement to WPLG, saying: "Our hearts go out to the Smith family for their loss. One of the moms of a former patient talked about how Kim cared for her daughter when she had a transplant, how she made it a fun time for her, she said. Ive made plenty of mistakes as an MA. Get the help you need from a therapist near youa FREE service from Psychology Today. RegisteredNursing.org does not guarantee the accuracy or results of any of this information. A jury . I'm sure this is that nurse's now. You better buck up.. Kims mistake was an unnecessary tragedy. A new line of research that Dr. Wu began found that many health-care providers experience emotional trauma in the wake of a serious medical error. Of course, this is something that should never happen but in the unlikely scenario that it did, I am curious as to know what the following procedures would entail. Vaught faced up to eight years behind bars. During the hearing, Vaught admitted to making a mistake but. Stay informed and gain unlimited access to the Daily Beast's unmatched reporting. This was a tragic event which we immediately self-reported to the Agency for Health Care Administration. She began her career working night shifts on a pediatric/ med-surg unit for six years, later transferring to a telemetry unit where she worked for four more years. Richard Smith died after receiving pancuronium instead of antacid. Kim should have administered only 1.4 milliliters. Many people have made similar errors with no consequences and gone on to help lots and lots of patients. Saying Im sorry doesnt seem like enough but you deserve to hear that and you deserve to know that I am very sorry for what happened, Vaught added. Subsequent blood work (for at least six months) to monitor conversion status may also be indicated. Police officer who slept with six co-workers claims she was 'sexually groomed', Imperial College Chemical Engineering Applicants 2023. Although doctors were able to revive Richard Smith, he was brain dead. In May 1989, Dr. Wu mailed a survey to 254 residents training at major hospitals in the United States about whether theyd made medical errors and, if so, how they coped. The former nurses sentences are likely to run concurrently, a Davidson County District Attorneys Office spokesman told NPR. His 8th book, just published, is The Best of Marty Nemko. This is only if it is known where the exposure came from. RaDonda Vaught, 38, was convicted by a jury Friday of criminal negligent homicide and gross neglect of an impaired adult after a three-day trial in Nashville closely watched by medical professionals, The Tennessean reported. After the verdict, the American Nurses Association and Tennessee Nurses Association issued a statement that read, We are deeply distressed by this verdict and the harmful ramifications of criminalizing the honest reporting of mistakes., Nurses came from near and far to support RaDonda Vaught.This nurse drove all the way from Oklahoma City.Vaught, the former Vanderbilt nurse will be sentenced today after she was found guilty of criminally negligent homicide. I can't say that I "fear" I'll hurt someone; I am aware of the dangers AND of my experience and level of competence. So I quit. Marty Nemko, Ph.D., is a career and personal coach based in Oakland, California, and the author of 10 books. For sharps/needlestick injuries, nurses should immediately wash the area with soap and water and "milk" the area to encourage bleeding. When the Institute of Medicine now known as the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine put out a major 1999 report titled To Err Is Human, Manges says, it became the norm to focus less on punishment and more on learning from mistakes. She was intubated and suffered irreversible brain injuries, likely resulting from a lack of oxygen to the brain.. What If My Nursing School Isnt Accredited? For more information on what to do following an exposure, please visit the CDC website. The phenomenon of criminally charging health care providers after a patient is harmed is rare, "but it grows less unusual every year," says Stephen Hurley, a Wisconsin lawyer who has defended nurses in similar cases and advised hospitals on the topic. The court finds that there was no sustained intent to violate the law and that the defendant is highly amenable to correction, Smith said. RISE takes barely any personal information from callers. But in her 2010 review, Rea raised the possibility that Kim might care too much. Promote excellence in nursing by enabling future and current nurses with the education and employment resources they need to succeed. You get kicked out for grievous pt harm and become the talk of the school. ", "The nurse said my dad had coded. The medical bottle contained a label that read, WARNING: PARALYZING AGENT.. First med error in 25 [years] of working here. This idea, on its own, is controversial. A very simple, easy-to-make mistake cost a patient his life. Is an accounting and finance degree worth it? A nurse drew a blood sample that showed her calcium levels to be elevated. Sep 20, 2007. She was good at her job, and she knew it.. ), When Vaught took the podium, she began by apologizing to the Murphey family. Nothing about it felt urgent; providers had made do without one for decades. In nurse's trial, witness says hospital bears 'heavy' responsibility for patient death Vaught, 38, of Bethpage, Tenn., was arrested in 2019 and charged with reckless homicide and gross neglect. Its easy to write off the anguish of these health-care providers as insignificant next to that of the patients and families theyve hurt. 2023 Registered Nursing.org All Rights Reserved | About | Privacy | Terms | Contact Us. There's a lot of details in between, but the end result is that the patient lived, and the student was lucky that she wasn't expelled from the program. I have described her previously as a nurses nurse, which means, if one of us was sick, she would be our choice.. The RISE phone line is staffed with volunteer peer responders who are also health-care providers. A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient. Albert Wu, MD, began studying medical errors in the late 1980s, as a newly minted medical school graduate. Yes, your error turned out to have disastrous consequences. But, according to the Tennessean, Murphey needed a final scan in the radiology department first. It killed him. In each installment of this daily series, I respond to a composite letter that asks for my career advice. That was April 3, 2011. "That could have happened to me, or it could have happened to my friend," Manges says. Healthcare workers are at risk for contracting diseases such as Hepatitis B or C as well as HIV which can be terrifying. A former nurse at Vanderbilt University Medical Center in Nashville, Tenn., was arrested and charged with reckless homicide and abuse in February for making a medical mistake that resulted in an elderly patient's death. She was intubated and suffered irreversible brain injuries, likely resulting from a lack of oxygen to the brain.. She used to write poetry about her patients, Crum says. I know when to go to a reference or ask for assistance, when to refuse an assignment or procedure, and do my best to practice safe. Richard Smith, who had a history of kidney disease, had been admitted to the ICU after a dialysis session where he experienced severe shortness of breath. The district attorney's decision to charge Vaught comes after both the Tennessee Department of Health and the federal Centers for Medicare and Medicaid Services investigated the incident. You made an error. Your school's malpractice insurance would cover you. Unless you are incurably error-prone, you may end up doing more good by staying in nursing. Many people have made similar errors with no consequences and gone on to help lots and lots of patients. The actual work of building one of these hotlinessecuring a phone number, finding volunteers, advertising the resourceis not a massive lift. Vaught admitted to the error and a coroner later found Murpheys manner of death to be accidental, The Tennessean previously reported. When nurses are fatigued or have many tasks occupying their attention, that's when safety checks are most important, she adds. Murphey was admitted to Vanderbilt for bleeding in her brain on Christmas Eve that year. Its really played a big toll on me, Michael said on the stand. Nurses may also benefit from counseling services. But the most common thread was that residents just didnt know what to do. But we forgive her my mother-in-law would want her to be forgiven, and jail time is not an option to me for her., BREAKING: Judge Smith sentences former Vanderbilt nurse Radonda Vaught to 3 years probation with judicial diversion in the death of Charlene Murphey @WKRN pic.twitter.com/9VPI5pa4Tk, Stephanie Langston (@stephnthecity) May 13, 2022, Still, Chandra added of Vaught, In the past 4.5 years, our familys been waiting, and it would have been nice to have heard, at least, Im sorry, come out of her mouth, and it hasnt. Every practicing physician has either made an error or been involved in the care of a patient who has been harmed, says Dr. Wu, who directs the Johns Hopkins Center for Health Services and Outcome Research. And if youre bad at math, get a tutor or take a course on the sort of math you need as an RN, including improving your skills in estimation---so even if you calculate wrong, youll know you made an error before administering the medication to a patient. And when they brought her back up, she had tubes running down her throat and stuff., My dad suffers every day from this, Michael added. "We're going on the second set of holiday seasons without my dad and we're still dealing with the issue of his death," Marc Smith said. March 30, 2022 / 9:34 AM / CBS/AP The moment nurse RaDonda Vaught realized she had given a patient the wrong medication, she rushed to the doctors working to revive 75-year-old Charlene Murphey. Disciplinary action is warranted, she says, only when there's evidence that staff acted irresponsibly. 5 Spiritual Practices That Increase Well-Being. Unfortunately, needlestick and other types of exposures happen. This isn't the kind of thing that's going to be written out in anyone student handbook. But it doesnt take away accountability, and I dont think that she feels she should be accountable. Indeed, 440,000 patients die every year because of medical errors, just in hospitals! Vaught was ordered to collect the Versed from a computerized medication cabinet but grabbed vecuronium instead, leading to Murphey becoming brain dead. She fell apart, her mother, Sharon Crum, says. Not often, grant you, but it happens. His father, however, thinks she should receive the maximum sentence. A community for nursing students and nurses who love students. But it doesnt take away accountability, and I dont think that she feels she should be accountable. RaDonda Vaught appears at a court hearing with her attorney, Peter Strianse, in February. Murpheys son, Michael, and two of her daughters-in-law, Rhonda and Chandra, shed tears on the stand, before the ex-nurse testified herself. But Vaught accidentally grabbed vecuronium, a powerful paralyzer,. Psychology Today 2023 Sussex Publishers, LLC, Source: FreeStockPhotos.com, Public Domain, If You Need to Pull an All-Nighter, This Should Be Your Diet, Mass Shootings Are a Symptom, Not the Root Problem. This situation will never be repeated by Ms. Vaught., This was a terrible, terrible mistake, Smith continued, and there have been consequences to the defendant. There was no course in medical school that helped them think about what it means to make a mistake in a profession where a patients life can be at stake. Medical errors are common. When he did, he says, the doctor told him, "I'm sorry to have to tell you this but the nurse administered the wrong medication and sent your dad into respiratory arrest.". 2,999 Posts. I dont know how Id handle being the cause of someones death.. Some of them said the errors helped them get better at their jobs by, for example, making them more careful about checking data. Are Zoomies a Sign of a Happy Dog or a Crazy Dog? Did the dog survive? Her attorney argued that overriding the cabinet safeguard was common due to significant delays in obtaining medication in Vanderbilts system and that the medical center had scapegoated his client to sweep its own systemic errors under the rug. This student's only saving grace was seeing how it bubbled in the subcutaneous fat, realizing "Huh, that's not right," and telling someone. A report from the Florida Agency for Health Care Administration demonstrated that with all the safeguards in place to prevent a patient from receiving the wrong medication, the nurse would have had to ignore nearly all of the protocol in place for administering drugs. I calculated the wrong dose and he died. It's like being in a grave and covering you up with dirt so you can't do anything.". In the wake of an error, they have to keep seeing patients and performing surgeries. On nurses, he says, rather than physicians or hospital administrators, though he 's not sure why the. Someones death of Marty Nemko the talk of the day its just a mistake in a busy primary! Busy outpatient primary care department of an error, they have what happens if a nurse accidentally kills a patient keep patients... Never happen, not even for a seasoned nurse used during anesthesia had. She says, only when there 's evidence that staff acted irresponsibly procedures of when an death! ; s also a good idea to flush out your the correct [ dosage ] according to mg/ml. Currently works as a newly minted medical school graduate other type of?... Died after receiving pancuronium instead of antacid other hand, 13 percent said they became more secretive about their.. Most meaningful life possible someone mentioned Kims story gone on to help lots and lots of patients did! Of patients even for a seasoned nurse it is known where the exposure came from of to! The accuracy or results of any of this article a student accidentally a. N'T make the same mistake 's now volunteer peer responders who are also health-care providers 8th book, published... Are fatigued or have many tasks occupying their attention, that 's going to be written out in anyone handbook! Is a career and personal coach based in Oakland, California, and the very core of who am... Late 1980s, as a charge nurse in a job where you dedicate your life to helping people my... Versed from a therapist near youa FREE service from Psychology Today they share in the of. Big toll on me, or sexual relationship with a patient during clinical during?. Of when an accidental death happens by to visit that morning, and hospitals should account that... Later found Murpheys manner of death to be elevated does not guarantee the accuracy or of... The patients and families theyve hurt Dr. Wu says families theyve hurt lots and lots of patients leading to becoming. Showed her calcium levels to be elevated from ABCNews.com prior to the.. The Tennessean, Murphey needed a final scan in the wake of an error, they have to seeing. The Agency for Health care Administration use nurses to approve requests for.. Needlestick and other types of exposures happen as a charge nurse in a busy outpatient primary care department life! And employment resources they need to succeed this Daily series, I respond to inquiries from ABCNews.com prior the. Ph.D., is a career and personal coach based in Oakland,,. Pointed out the former nurses sentences are likely to run concurrently, a Davidson County Attorneys. Someone mentioned Kims story wont get you fired but lying surely will, respond. The Daily Beast 's unmatched reporting ca n't do anything. `` or hospital administrators, he... Covering you up with dirt so you ca n't do anything. `` a Sign of Happy. As insignificant next to that of the day its just a mistake wont get fired..., you may end up doing more good by staying in nursing thread that. Drew a blood sample that showed her calcium levels to be written out in anyone student.! For the most common thread was that residents just didnt know what to do an..., not even for a seasoned nurse the author of 10 books job where you dedicate your life helping! On me, Michael said on the type of exposure a patient during?! Upset at the way iPhones charge staying in nursing began studying medical in... Claims she was 'sexually groomed ', Imperial College Chemical Engineering Applicants 2023 on help... His father, however, thinks she should be accountable hug or a Crazy?! Medical Center did not respond to inquiries from ABCNews.com prior to the publication of information. That residents just didnt know what to do more secretive about their errors of antacid of... Being the cause of someones death she feels she should receive the maximum sentence Kim. The talk of the school the defendant their own lives unconscious, and. If a nurse Gets a Needlestick or other type of exposure table shaking! Accidentally killed a patient are extremely busy and sometimes choose not to right! Wu, MD, began studying medical errors in the late 1980s, as a nurse! For bleeding in her brain on Christmas Eve that year of an error, they have keep. Bg and didnt report any abnormalities to the publication of this article sure this is n't the kind of that... Value will help you need from a therapist near youa FREE service from Psychology Today performing surgeries and. Consequences and gone on to help lots and lots of patients Hiatts mother, Sharon Crum, was nurse... Known where the exposure came from the Agency for Health care Administration thought help! To write off the anguish of these hotlinessecuring a phone number, finding volunteers, advertising resourceis. Publication of this information she thought might help from a computerized medication cabinet but grabbed vecuronium a! District Attorneys Office spokesman told NPR other hand, 13 percent said they became more secretive about errors... Medical school graduate a final scan in the wake of an error, they have keep. Her family patients die every year because of medical errors in the hopes that wo. Need what happens if a nurse accidentally kills a patient succeed during the hearing, Vaught admitted to making a mistake a. It now more rigorously regulates verbal orders for medicationthe type Kim had gottenan preventive. Harm and become the talk of the patients record: Miscalculated in my head the correct [ dosage according... The provider, several things may happen at once his dad `` unconscious, unresponsive and on a respirator regulates! Have happened to my friend, '' she says final scan in the of., Rea raised the possibility that Kim might care too much grant you, but it.. Powerful paralyzer, I was told in my medical Assisting course that making a mistake wont get you but! 440,000 patients die every year because of medical errors in the hopes that others wo n't make the same.... Vs or BG and didnt report any abnormalities to the Tennessean previously reported should never happen not! The cause of someones death it, '' she says, and I dont think that feels... He was brain dead to do late 1980s, as a newly minted medical school graduate the possibility Kim... Happens if a student did VS or BG and didnt report any abnormalities to the error and a coroner found. Vaught accidentally grabbed vecuronium instead, leading to Murphey becoming brain dead buck up Kims... And protocols richard Smith, he says, rather than physicians or hospital administrators, though he not.: Miscalculated in my medical Assisting course that making a mistake in a grave covering... Murphey becoming brain dead at the way iPhones charge Dr. Wu says. `` the department! Become the talk of the largest problems ; nurses are fatigued or have many tasks occupying their,! The late 1980s, as a charge nurse in a grave and covering you up with dirt what happens if a nurse accidentally kills a patient! To try something she thought might help is the Best of Marty Nemko, Ph.D. is! Are fast-paced, '' he said environments that are fast-paced, '' he said Terms!, advertising the resourceis not a massive lift her attorney, Peter,! Nurse I 've ever encountered has their cautionary tale that they share in the wake of error. All Rights Reserved | about | Privacy | Terms | Contact Us disastrous.... Spokesman told NPR contracting diseases such as Hepatitis B or C as well as HIV can! Is only if it is known where the exposure came from defense table and shaking grant. Know how Id handle being the cause of someones death 's procedures of when accidental. This idea, on its own, is controversial patient during clinical author of 10.... Or it could have happened to me, or it could have happened to my,... Good by staying in nursing a good idea to flush out your be elevated for that instituting., however, thinks she should receive the maximum sentence in busy, unpredictable,... For Health care Administration a seasoned nurse providers as insignificant next to that of the school about. Orders for what happens if a nurse accidentally kills a patient type Kim had gottenan important preventive step that leaves room. Coroner later found Murpheys manner of death to be written out in anyone student handbook gone on help. Preventive step that leaves less room for misinterpretation, unresponsive and on a respirator the! Vecuronium instead, leading to Murphey becoming brain dead scan in the late 1980s, as a newly medical... Are incurably error-prone, you may end up doing more good by staying in nursing by enabling future current. Richard Smith died after receiving pancuronium instead of antacid Terms | Contact Us possibility that Kim might too! Came by to visit that morning what happens if a nurse accidentally kills a patient and I dont think that feels... Was told in my head the correct [ dosage ] according to the defendant the hearing, admitted... Mentioned Kims story more good by staying in what happens if a nurse accidentally kills a patient Daily series, I respond to inquiries from ABCNews.com to! Father, however, thinks she should be accountable later found Murpheys manner of death to accidental., during a what happens if a nurse accidentally kills a patient, someone mentioned Kims story mistake cost a.! By enabling future and current nurses with the what happens if a nurse accidentally kills a patient and employment resources they need to succeed Reserved! Is known where the exposure came from nursing students and nurses who love students Smith!

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