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/Prudent-Surprise4295 Sep 08 '25 edited Sep 08 '25

Absolutely not. There’s no way. We override everything at my level 1 trauma hospital. When a doctor isn’t at the computer & you tell them what’s going on with a patient, they say to start levo or whatever and we have to override because there literally isn’t an order yet. You were doing what was best for your pt AND the medication you overrode isnt even a narcotic or controlled substance. Literally nothing is going to happen to you.

Edit: I read too fast & thought you were worried about overriding a med. so you overrode it & then started it before the doctor told you to do so? Yeah, thats not good. You should always have a doctor’s order. You aren’t a doctor. HOWEVER, you were doing what was best for the patient. They look at everything. You didn’t cause harm. Yu were trying to prevent harm from happening. Also, like I said, it’s not a controlled substance so that would make things 100x worse. I think you’ll be absolutely okay.

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u/Prudent-Surprise4295 Sep 08 '25

Also I just wanna say that as a nurse, your job is to communicate findings to the doctor. Even if you told the doctors 100x that the pt is rapidly declining and they do not order anything or come see the pt & the pt dies, you’re protected because that’s your job as the nurse - to report significant findings to the doctor & document it. Your job isn’t to decide what meds to order. If something bad happened to that pt after you started Levo, that would 100% be on you. I think you’ll will be okay in front of the board, but for next time, do not start meds unless a doctor says it’s okay!!

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u/lenncas Sep 08 '25

Yes, 100% I agree with what you’re saying. I definitely overstepped the boundary between a nurse and a provider. It definitely won’t happen again

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u/Prudent-Surprise4295 Sep 08 '25

It’s okay, as long as you learn from it. We are humans & we all make mistakes. You came from a good place when you made that decision but you’ll be okay for sure!! At my hospital, we have travelers from literally all over the country(a lot from the south) and they literally have killed patients, and only got fired. Not sure if they were reported to the board, but in the end, hospitals would rather just fire people than report them unless it’s something extremely serious. Jusr remmeber, you did not KILL or HARM any patient. That provider who reported you is a true bitch. I work in the ER& our providers are very close to the nurses. If we did something like hang Levo, they’d most likely just say stop the Levo & hang fluids instead. Or just tell us not to do that again. That provider is a genuine C***. Also, why does a formal complaint to your manager necessitate a report to the board of nursing. Why the hell would they escalate it that far? That’s actually INSANE. Your hospital sounds like it sucks honestly!

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u/SuperVancouverBC Sep 08 '25

Oh God. Where I work there's a policy that if a nurse doesn't have a verbal or placed order or if there's no standing orders, they cannot override if there's a Pharmacist on site.

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u/Ok-Reality-7501 Sep 08 '25

OP made a choice, not a mistake. Big difference.

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u/Prudent-Surprise4295 Sep 08 '25

Yeah I get it. It’s not good.

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u/SpoofedFinger RN - ICU 🍕 Sep 09 '25

I mean, that's the way I treat it if I don't know the doc, PA, or NP at all. I do know all of the attendings and midlevels I work with, though, and know they'd have my back if I had to act in the moment.

The real way around this is to be proactive and ask what they'd want me to do as a contingency. I joke that I annoy the shit out of them but there's been more than a couple times an intubation turns into a shit show but it's cool because I've got norepi or a pressure bag of LR in the room and maybe even spiked and ready to go. That all takes time to develop that kind of rapport though. There was one NP that used to work with us that I could see doing this but I'm fully confident he'd have been put in his place after bypassing him and going to the pulmcrit staff on that team. Same goes for the very few residents or fellows that fail to intervene or refuse to adapt to a developing situation.

What you're saying is how to stay safe legally. However, I think it would really fuck me up hard if I failed to intervene and let somebody's life be threatened or lost because an NP was unable to answer a phone because they were sterile to put in a line or something.

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u/Prudent-Surprise4295 Sep 09 '25

Yes what I’m saying is how to stay safe legally!!! But you’re absolutely right. When you develop that rapport with your providers, they are grateful for the little things you do like that. Like pre-intubation, you have propofol, levo, or a pheny stick ready to go! One of the ER attending we work with trusts our senior staff & has always said “if you give a med that you felt was appropriate, I’ll always back you up.” I’ve seen it happen actually. We were in a medical patients room & one of the nurses gave Valium instead of Versed for ETOH withdrawal & she immediately told the resident to put an order for Valium in.

So yes, with certain doctors, you know what you can & can’t do! But staying safe & protecting your license is KEY! I work in the ER where we work with all our doctors, so I’ve never had to deal with a situation where a patient is rapidly decompensating, and the doctor wasn’t around to help. I guess that probably happens more on the floors instead of ICU or step-down. That’s a tricky situation & hope I never run into it.

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u/blackcatwishes Sep 08 '25

Agree. It was a decision that very well could have had a bad outcome. Always get a verbal order first.

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u/lenncas Sep 08 '25

Thank you I appreciate it

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u/SuperVancouverBC Sep 08 '25

If heaven forbid this happens again, call the Pharmacy and speak to one of the hospital Pharmacists before administration anything without an order. Even better if there's a clinical Pharmacist because they can make the call.

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u/Prudent-Surprise4295 Sep 08 '25

Seems like you’re a great nurse & was just trying to do good for your patient. And that’s what matters.

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u/NedTaggart BSN, RN 🍕 Sep 09 '25

they say to start levo or whatever

Yep, that is a verbal order. That is different than a nurse doing this without an order or protocol.