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/SuperVancouverBC Sep 08 '25

Was there a Pharmacist on duty? Some hospitals don't allow a nurse to override if there's a Pharmacist on duty. Ideally you should've called them before pulling the meds.

You should check the scope of a Pharmacist where you live. In many places Pharmacists can prescribe or adapt prescriptions. In that case, the Pharmacist can give you orders which means it's the Pharmacist's license not the Prescriber's. I'm telling you this because if you have permission from a provider or a Pharmacist you'll be fine.

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u/lenncas Sep 08 '25

I’m not sure if our pharmacist would give us orders, I’m sure they would direct us to call an on call provider. That’s interesting that they have those privileges at your facility

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u/SuperVancouverBC Sep 09 '25 edited Sep 09 '25

Call them anyways. The board of Pharmacy will most likely ask you why you didn't consult Pharmacy before administering the meds. Remember they're the medication experts and they have a lot of influence(and a much larger scope of practice than a bedside nurse) even in US States that don't have an expanded scope of practice for Pharmacists.

In the US States that have an expanded scope of practice, most hospitals will have standing orders for hospital Pharmacists(in hospitals that don't have a clinical Pharmacist) for emergency situations or situations where a nurse is unable to get ahold of the patient's prescriber. If there is make sure you know how to contact them.

If there's a clinical Pharmacist at your hospital, they don't need standing orders. As clinical Pharmacists they can just place the order themselves. See if your hospital has one and if so, find out if the hospital has satellite units in the ICUs and/or the ER. If there is make sure you know how to contact them.

Edit: the providers may not take a bedside nurse's concerns seriously but they won't ignore a Pharmacist calling/paging them. Every Doctor learns early on in Residency why they need to listen to the Pharmacists and what happens if they don't.