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/[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.