My wife is a nurse in end of life care. I've just shown her this. Her opinion is that this woman is either insane, or that American nursing is in a very bad way.

I'd go with the latter. She's turned up to court neatly dressed, apparently alert, has understood the charges and entered a plea.

I would assume that the home owners had a policy forbidding staff to call a doctor because of the cost. Instead, the nursing staff probably carried out diagnosis, prescribing and minor procedures themselves. This was a necrotic limb, but the elderly regularly lose toes due to poor circulation. Frequently nurses will tidy up, log it and tell the doctor later. At this point, life expectancy is measured in days, and full surgery is lethal.

Basically, this wasn't a completely anomalous event, but the extreme end of a spectrum. She should do time for it, but so should the people who set the initial conditions.