Such mistakes usually end in malpractice lawsuits, but criminal prosecutions are rare. After Vaught was indicted in 2019, the Institute for Safe Medical Practice issued a statement saying it had “concerning implications for safety.”

“In an age where we need more transparency, cover-ups will dominate because of fear,” the statement read. “Even when errors are reported, effective incident investigation and learning cannot be done in a culture of fear or blame.”

Liz Stokes, director of the American Nurses Association’s Center for Ethics and Human Rights, said many nurses “are already at their breaking point … physically and mentally exhausted after two years caring for a COVID patient.” Water’s indictment gives them, she said, Another reason to quit.

“It could be me. I’m also a registered nurse,” she said. “It could be any of us.”

Vaught was steeped in Just Culture’s philosophy and said she had “zero regret” about telling the truth, but her candor was used against her at the trial. Assistant District Attorney Brittany Flatt closed the argument by citing her interview with a Tennessee Bureau of Investigation agent: “I should definitely pay more attention. I should have called the pharmacy. I should not have overstepped my authority because this is not Emergency situations.”

It’s easy to judge Walter’s behavior in retrospect, Lambert said, but coverage and workarounds are an extremely common part of health care, saying: “It was typical, not unusual or odd behavior.”

Meanwhile, Walter’s candor about his mistakes has led to improved safety, not just at Vanderbilt. Because vecuronium can only be used on patients with breathing tubes inserted, some hospitals have removed it and other paralyzing drugs from automatic dispensing cabinets.

“In my hospital, they changed the policy so they put paralyzed people in rapid intubation kits,” said Janie Harvey Garner, who founded the nurse advocacy group Show Me Your Stethoscope. She said Murphy’s death “could have saved lives” because of Walter’s admission of the mistake.

While Murphy’s death may be a cautionary tale for other nurses, Walter, who is now awaiting a sentence of up to eight years, told The Associated Press in an interview that she thinks about her patients every day .

Water, 37, found she and Murphy lived in the same small community in Bethpage, about an hour northeast of Nashville, and shared friends with Murphy’s family. It was only a matter of time before she met one of them in person.

“I’ve imagined countless times how I would feel if this were my grandmother, my family, my husband,” she said.

Recently, when she was shopping for farm implements, she was talking to the young man behind the counter who recognized her and told her he was Murphy’s grandson. Instead of blaming her, he comforted her and patted her on the shoulder, she said.

“He was very kind. He was very kind,” Walter said. “I took his grandma away, and he kept telling me to take care of myself. There are still good people in this world.”