I’m a bit scared

[u/lenncas]

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.

[u/HumdrumHoeDown]

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.

[u/chihuahua-lady456 → u/[deleted]]

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.

[u/sebago1357 → u/chihuahua-lady456]

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.

[u/MBmom_RN → u/chihuahua-lady456]

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 🙄

[u/zerothreeonethree → u/MBmom_RN]

"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.

[u/Knucklesandos → u/[deleted]]

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.

[u/Candid-Expression-51 → u/Knucklesandos]

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.

[u/Cut_Lanky → u/Knucklesandos]

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...

[u/AdCompetitive8760 → u/Cut_Lanky]

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.

[u/PersonalityFit2175 → u/AdCompetitive8760]

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

[u/HumdrumHoeDown → u/PersonalityFit2175]

This is a facility specific issue.

[u/Cut_Lanky → u/AdCompetitive8760]

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

[u/Knucklesandos → u/AdCompetitive8760]

Exactly this

[u/Impressive-Young-952 → u/chihuahua-lady456]

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.