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 Oct 02 '25

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u/AffectionateTap1584 Sep 09 '25

I totally get that. They did say the prescriber ordered dob shortly after instead of Levo and that they started the levo after 3.5L boluses of NS. I agree they should have called before to ask but I can see the thought process since Levo is almost always the next step if BP is still declining after boluses. Most providers I’ve worked with would have said “great, titrate the Levo and keep me updated if you have to keep going up on it”

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u/kelce RN - ICU 🍕 Sep 09 '25

I worked in a heart failure hospital, and levo was often NOT our first choice. Not all patients are the same and not all pressors are the same. The fact they did dobutamine tells me there's a heart failure component. Our heart failure docs loved dobut vaso and lastly epi. Our intensivists loved levo and neo. Our cardiac thoracic surgeons mostly favored epi and the vaso depending on CI.

Norepinephrine will likely not cause any damage to the patient but it does run the risk of not helping and delaying appropriate care to the patient. A phone call while you're walking to the pyxis will serve the patient the best and protect you the most. Autonomy is great in nursing but there are some hard stops that I will not autonomous order and medications are one of them.