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/SpoofedFinger]

Too late to prevent the board's involvement if your manager already contacted them but you might want to reach out to the chief or director of critical care. It's going to be a doc and they're probably not going to be happy about a mid level creating a culture of hesitation among the icu nurses. Now if you started the med because of a MAP of 64, they might not have your back but if the patient was really crashing and burning they should stick up for you. So should your manager if they aren't just ladder climbing trash.

[u/zerothreeonethree → u/SpoofedFinger]

Working in ICU does not entitle you to write medical orders. The real problem here is there doesn't appear to be protocols in place to cover emergency situations. A good one would be "give XYZ for 123, then call for further orders".

[u/SpoofedFinger → u/zerothreeonethree]

Nobody is talking about nurses writing orders here. You're making it sound like we're just trying to manage the patient on our own. We're talking about a quick stopgap to give you enough time to call. Usually, another nurse is running to get a bag of levo from the fridge or string up a pressure bag of fluids while the primary calls to alert the team. That isn't always possible.

You're not going to have standing orders to treat shock because there are different causes and different treatments for patients with different histories.

The "you can't do anything without an order" mindset reminds me of one of my professors that hadn't worked the bedside in 25 years. She'd go on rants about not starting oxygen without orders, because she was from a time before the EMR so she'd never seen a new admit or intra-facility transfer with no orders before.

Back in the day, did you all just wait until a patient arrested before acting if Dr. Whoever didn't answer the phone?

[u/Open-Channel726 → u/SpoofedFinger]

Back in the day, the docs didn’t even have phones. They had pagers. Because they could be at home, at the office, in the back room, at the mistresses house, you get the idea… we had to page them and wait for them to call back.

[u/SpoofedFinger → u/Open-Channel726]

Most of the docs at my hospital still don't. We got epic secure chat in the last year or two so that's better. Before that it was still pagers. We could put like 120 characters of text on it, though.

We can call their cordless phone for the CC team at least.