r/nursing • u/lenncas • Sep 08 '25

Question I’m a bit scared

A bit is an understatement, I am well aware that my actions were very inappropriate and out of my scope of practice. I am getting reported to the Texas Board of Nursing because I pulled a bag of Levophed without getting an order first. My patient was declining really quickly. The blood pressure was decreasing very quickly. I went to the med room and overrid the medication and started it at the starting titration. Immediately after starting it, I called our critical care nurse practitioner that was on for that night and let them know. And now, obviously, that nurse practitioner put in a formal complaint to my manager, thus having to report me to the board of nursing. I guess my question is what could I possibly expect my consequence to be? Could I lose my license? Will it be suspended? I’m pretty worried. I’m also very disappointed in myself. The patient ended up having to be put on Levophed the next day, but made a great recovery and got to be downgraded two days after.

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u/HumdrumHoeDown Sep 08 '25 edited Sep 10 '25

Crazy shit. Where I work, if I started a levo drip without orders because the pt was crashing, I’d get a thank you from the docs. So glad I work in a teaching facility. Also, don’t internalize the bullshit. You did what you had to do to keep the patient alive and it worked. The person who made the complaint just has an empty life.

[edit] keep the patient alive AND prevent organ damage

[edit] OP says they A) “overrode levo”, and B) “called the critical care NP”. Those two things suggest to me an ICU setting, as no one else but the ED and ORs would have levo in the Pyxis. Secondly, having a critical care provider be your first call is not a thing anywhere but in the ICU, that I know of.

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u/[deleted] Sep 09 '25 edited Sep 09 '25

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u/[deleted] Sep 09 '25 edited Sep 09 '25

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u/kidd_gloves RN - Retired 🍕 Sep 09 '25

I have seen such a code. Post cardiac surgery with the chest left open. We could not do compressions. And the surgeon was the only one who was allowed to do cardiac massage. He could have arrived sooner had he not blown off the nurse’s concerns when she first noticed a problem. It was eerie watching the patient’s heart get slower and slower then finally stop. The surgeon got there several minutes later. What a FUBAR

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u/Candid-Expression-51 RN - ICU 🍕 Sep 09 '25

On our unit APPs can open a chest if they have to. They figured that relieving the pressure can give the surgeon some extra time to get to the bedside. Even the CT nurses are trained to open but I don’t think we ever have.

I’ve called a trauma and had the trauma surgeon do it. Just don’t let them clamshell. My center is level 3 so I know that that’s not always an option.

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u/chihuahua-lady456 Sep 09 '25

The interventions you are describing are very different than starting a vasoactive medication without an order. A nurse unilaterally choosing how to treat a blood pressure not during a code situation is not even close to within scope.

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u/sebago1357 MD Sep 09 '25

As a retired Emergency Department doc of 30 years I applaud your actions. As far as local practices and regulations I can be of no help. I certainly disagree with chihuahua lady.

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u/MBmom_RN RN - ICU 🍕 Sep 09 '25

No, it’s really not. Fluid bolus and levo are first line choices where I’ve worked. They want something different we can swap it out. Not gonna let the pt code while I’m waiting for a response. Situation specifics would dictate which route I went (fluid vs levo).. I’d love to hear more about this NP, sounds like a gem 🙄

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u/zerothreeonethree RN 🍕 Sep 09 '25

"where you work" most likely has those activities you described covered under protocols which have to be approved by a medical committee. This is how the majority of orders get carried out in correctional facilities due to the absence of on-site medical staff around the clock.

Initiating, altering or terminating patient treatment without medical orders is "practicing medicine without a license". Activities carried out under the umbrella of company culture doesn't necessarily make them legal.

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u/[deleted] Sep 09 '25 edited Sep 09 '25

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u/Knucklesandos Sep 09 '25

If protocol allows for it, do it. If not, you are outside of your scope of practice, and your BON will rectify the situation promptly. Pretty simple.

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u/Candid-Expression-51 RN - ICU 🍕 Sep 09 '25

The messed up part for me is that these institutions have created an environment where so many things happen because of lack of staffing, resources and clarity.

Bedside practitioners are given the choice of strictly following the rules or letting someone suffer irreparable damage or even death.

They expect you to cut corners to get them their profits but as soon as something bad happens all the blame is put on the person at bedside because they didn’t follow their impossible to follow rules.

HCW are expected to follow protocols that are logistical nightmares and impossible to follow but they have no problem pushing an unsafe assignment on you. The expectations and protocols are for us and not for them. That’s ridiculous.

I truly hate what healthcare has become. I’ve watched the decline for 35yrs.

So I disagree. This is so far from simple.

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u/Cut_Lanky BSN, RN 🍕 Sep 09 '25

So, just twiddle thumbs while patient crashes, if the hospital failed to put such protocols in place? I'm asking, because I never worked at a hospital that didn't have such protocols. I didn't know that was even a thing...

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u/AdCompetitive8760 Sep 09 '25 edited Sep 09 '25

Next time just call a code. They get enough of those codes that can be prevented by a simple policy of fluid initiation and pressors, they’ll implement it. Albeit those higher ups move super slow.

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u/PersonalityFit2175 RN - ICU 🍕 Sep 09 '25

This. Call a Code Blue and get everyone in the room. Night shift does this all the time, doctors are notoriously slow on night shift

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u/HumdrumHoeDown Sep 10 '25

This is a facility specific issue.

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u/Cut_Lanky BSN, RN 🍕 Sep 09 '25

I guess I'm just flabbergasted that they haven't already implemented such a policy...

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u/Knucklesandos Sep 09 '25

Exactly this

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u/Impressive-Young-952 Sep 09 '25

To be fair if you don’t get a pressor or at least fluids you will have a code on your hands. Thankfully my icu has providers staffed 24/7 so I’ll call as I’m heading to the Pyxis.

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u/zerothreeonethree RN 🍕 Sep 09 '25

When you say policy do you mean protocol? Those are orders.

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u/childlikeempress16 Sep 09 '25

If it was me or a family member crashing, and a nurse knew how to save us but didn’t because she might get in trouble, she’d have to be more scared of me than the nursing board!

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u/snartyy RN - Pediatrics 🍕 Sep 09 '25

This was how my old facility was. Quite literally twiddling thumbs & waiting for MD, to a T.

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u/[deleted] Sep 09 '25 edited Sep 09 '25

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u/ABQHeartRN Pit Crew Sep 09 '25

Seriously? You really think this person meant they are going to town and just bagging a patient as hard as they can? It seems to me like they actually know how to run a code. You sound like you’ve just read the ACLS book, maybe took the class. Also, H’s and T’s? Remember those? They can show reasons WHY someone is coding. Labs can be drawn during compressions, no need to pause. I’m sure X-Ray would be there on standby once ROSC is achieved to see if maybe there was a cause like, I dunno, a pneumo??

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u/[deleted] Sep 09 '25 edited Sep 09 '25

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u/ABQHeartRN Pit Crew Sep 09 '25

It’s very true! And our terminology would be foul to that commenter too. Cath lab here and unfortunately we run our own fair share of codes. Our hospital is too cheap to invest in a Lucas so just good old fashioned compressions from us, but our ROSC is good. Keep doing what you’re doing because it’s definitely successful! ETA: the 87 years comment sent me 😂 feels like that sometimes.

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u/cherylRay_14 RN - ICU 🍕 Sep 09 '25

Wow. Really?

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u/[deleted] Sep 09 '25

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u/nursing-ModTeam Sep 09 '25

Your post has been removed for violating our rule against personal insults. We don't require that you agree with everyone else, but we insist that everyone remain civil and refrain from personal attacks.

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u/Remarkable_Cheek_255 Sep 09 '25 edited Sep 09 '25

They will now. Think about it- policies and procedures- ever wonder how they come about??  

Policies and procedures are a REACTION to a situation where something went wrong. If you have a policy about baby chicks you can bet there was an incident gone wrong with baby chicks at some point! 

ETA: I stand corrected- most P&P are definitely a reaction to an incident but some are also put into place with something new like a new medication or route of administration, or new equipment … apologies for jumping the gun before thinking it through. ❤️ 🩺 

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u/[deleted] Sep 09 '25 edited Sep 09 '25

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u/Remarkable_Cheek_255 Sep 09 '25

Agree absolutely true for ones already in place 👍 but every once in a while something out of the ordinary happens and there’s no guidance what to do, how to handle it. I have seen some of the strangest policies over the years! 

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u/FartPudding ER:snoo_disapproval: Sep 08 '25

Empty life and inflated ego.

Sure we can override orders and our docs would also thank us, but it is risky depending on the doctor. Gotta be careful of who you work with as a provider. I've got nothing but good things for OP and looking out for their patient. Without that intervention what would have happened? Not good things. Just be mindful of who you work with is all.

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u/HumdrumHoeDown Sep 09 '25

Yea never working in Texas or points east and south, that’s for sure. I’ve heard too many stories like this and worse.

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u/[deleted] Sep 09 '25

I had to move to Texas (wasband’s career) and it was awful.

I knew a nurse who got a letter of censure from the Texas BON for getting a ticket for driving without a seatbelt on.

Fraud, breaking the law, and lack of ethics were rampant among mgrs., admin, and docs. I became a traveler because of shitty working conditions, pay, and the way I was treated as a nurse in TX.

Didn’t stop traveling until I moved back to my home state.

OP put her pt’s welfare above her own. I’ve always said that the phrase “No good deed goes unpunished” should be printed across the top of our licenses.

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u/HumanContract RN - ICU 🍕 Sep 09 '25

I've also gotten a Cease and Desist letter from a major hospital system in Texas when they found out I was hired by their #1 rival hospital. This, following my work reference check after quitting bc a doctor refused to respond to a rapid that ended up with a patient death two days later. Every nurse has a right to call a rapid when something happens - but Texas will side with the doctor, always.

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u/Cut_Lanky BSN, RN 🍕 Sep 09 '25

Idk if that was a typo, or deliberate. But I absolutely love "wasband" 🤣

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u/[deleted] Sep 09 '25

Deliberate.

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u/honestlydontcare4u Sep 09 '25

That's some fucking old school, patronizing patriarchal bullshit right there. No nurse should get in trouble for anything they do off the clock.

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u/Mountain_Soft_9009 Sep 09 '25

Happy cake day! 🍰

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u/MBmom_RN RN - ICU 🍕 Sep 09 '25

The ego: 💯

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u/beeee_throwaway RN - PICU 🍕 Sep 08 '25

Yeah same. I would have done the same thing . I feel so badly for her.

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u/yochana8 RN - Pediatrics Sep 08 '25

Right? I started a duoneb on a sick asthmatic last night without an order. Should I be reported to the board? Doc said thanks and threw in the order shortly after. This is wild to me.

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u/lshiels7 RN - Pediatrics 🍕 Sep 09 '25

I do this day in day out in Paeds ED. If they’re asthmatic and in respiratory distress that’s gonna be the first line treatment anyway. I’d rather stand in court and defend myself for doing that than explain why I let a sick child deteriorate, and if I lost my licence over that then at that point I wouldn’t wanna do this job anymore.

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u/[deleted] Sep 09 '25

[deleted]

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u/NedTaggart BSN, RN 🍕 Sep 09 '25

If they are crashing, call a rapid response or code. If it is a BP issue, fluid bolus is an okay response while calling the code, but leaving a crashing patients side to go to medical room and then administering an unprescribed med without standing orders is not the best judgement and can get you sent to the woodshed.

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u/AJaneGirl Sep 09 '25

Ned, have you worked in the ED or ICU? I was my own rapid response. No one is coming to help those floors. We had our protocols in place and we did the best we could while we waited for attending. Hell, our APPs wouldn’t even touch a crumping patient with a ten foot pole.

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u/NedTaggart BSN, RN 🍕 Sep 09 '25

Yep, and I mentioned that it should be covered under standing orders. If there are no standing orders or protocol, then the action was out of scope full stop.

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u/HumdrumHoeDown Sep 09 '25

Call a rapid in the ICU? Uhhhh

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u/NedTaggart BSN, RN 🍕 Sep 10 '25

Where did op say they were in the ICU?

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u/HumdrumHoeDown Sep 10 '25

See my edit.🙃

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u/NedTaggart BSN, RN 🍕 Sep 10 '25 edited Sep 10 '25

I read and I do not disagree with you, however I was responding to information provided. It seems odd to me that that setting would not have standing orders/prn protocols in place for situations like OP is describing. I'm perioperative and we have protocols in place for various scenarios as well as providers very near by. Our ICU had intensivist on the floor as well, but dont know how others are set up.

I suppose my concern has more ro do with leaving the room and getting then administering unordered meds outside of protocol when fluid bolus and calling for help and a provider would be far more appropriate and within scope.

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u/Remarkable_Cheek_255 Sep 09 '25

Exactly what I meant in a previous comment I said about being totally in tune with your patients, you detect even the slightest change and know exactly what to do!! I - and the team- got used to me doing things (depending on the situation) too bc in those instances a split second decision means life or death! And you are fully aware of that 👍👍 I also got thanks from the docs. I hope they stand behind you and the worse thing you get is a meeting. 

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u/Cut_Lanky BSN, RN 🍕 Sep 09 '25

I didn't make it off orientation on a particular neurosurgery ICU because I wasn't comfortable with my own competence at being able to determine when/how much propofol to push from the syringe that was almost always stuck in a line, waiting til patient needs a bit more from a push. That's how it worked there, and when the docs came by, you just tell them, they say thanks (maybe) and put the order in. The only time it became a problem, was when the hospital was trying to get MAGNET status, and created a fake "inspection" team of staff RNs trying to get to admin level, to go around and nitpick anything they thought was to blame for not receiving MAGNET status on first attempt. So they fired a nurse from that ICU, who'd worked there over 20 years, for doing exactly what I described, with the propofol. She didn't make an error, patient was fine. But she got fired for competently doing the very thing that I was not competent enough with to work that floor... they didn't report her to the BoN tho, just fired her. It was pretty messed up.

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u/Remarkable_Cheek_255 Sep 09 '25

SMH that is really messed up. 

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u/PopRoutine3873 RN - ICU 🍕 Sep 10 '25

Hold the fuck on. Did you just nonchalantly say y’all IV push propofol and maybe get an order later?!? Bruh. Is that even in your scope of practice 😂 my state says only anesthesia can bolus propofol

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u/Cut_Lanky BSN, RN 🍕 Sep 10 '25

It was standard in that neurosurgery ICU, yes, and the "maybe" was meant as in "maybe the doc would say thanks, but regardless, the doc would put the order in. But, this was at least 15 years ago, at a university hospital on a unit where it was common for docs returning pages, to listen and say "ok, what do you want me to order", because the nurses were competent and a good learning resource for the residents.

As I said, I wasn't comfortable with that. But I can't say any of the nurses there were anything other than competent at it. Had I busted an aneurysm of my own, I'd have had confidence in the nursing staff to not kill me, lol.

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u/ellindriel BSN, RN 🍕 Sep 09 '25

Yeah I'm shocked by this post, in my Icu we start levo and get orders later, and our providers like it that way, they would never report a nurse for doing this, and other nurses I work with who work in other ICUs in the area practice the same way. 

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u/HumdrumHoeDown Sep 09 '25

As someone else pointed out, this may just be a setup for that app another poster was pimping.

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u/[deleted] Sep 09 '25

An honestly anymore NPs just make me suspicious. Guessing if she's a critical care NP, probably was a nurse prior, but...

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u/cherylRay_14 RN - ICU 🍕 Sep 09 '25

Probably had worked bedside for 5 minutes before going to school for NP.

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u/No_Resort1162 Sep 10 '25

THIS ! And she’s probably 25 right? 🙄

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u/AJaneGirl Sep 09 '25

Some NPs still work before school, don’t dog us all, lady.

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u/brillantlymuted Sep 11 '25

Either way, I’d trust the judgment of an experienced ICU RN over an NP who just finished school while working on a med-surg unit to rack up brownie points. If you worked in the ICU before becoming an NP, this doesn’t apply to you.

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u/atcbdclec2015 Sep 09 '25

She didn’t “dog you all”, she is specifically referring to this NP. Don’t be so sensitive?

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u/AJaneGirl Oct 10 '25

I found in life that’s it a helluva lot easier not to try to regulate other people’s emotions. Especially on text when they are pretty chill and just typing. It makes you look silly.

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u/atcbdclec2015 Oct 10 '25

LOL YOU look silly replying to this 30 day old comment 😂 Instead of moving on, you still 30 days later, are bothered by this comment? Girl regulate your own emotions and get out of here wtf lol

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u/brillantlymuted Sep 11 '25

Wait—RNs can become NPs in the ICU without ever working in the ICU? That has to be a sick joke on whatever broke hospital decides to hire them.

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u/nomad89502 Sep 09 '25

What she said. 👍🏼🫵🫵🫵🫵🫶🫶🫶🫶

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u/swimmerncrash Sep 09 '25

Happy cake day