A health watchdog has referred itself to the Professional Standards Authority after a disciplinary panel failed to strike off a bullying senior nurse.
Helen Lockett, nursing director at the now defunct Liverpool Community Health (LCH), was found guilty of 34 charges.
The Nursing and Midwifery Council (NMC) appointed a fitness to practise panel which suspended her for 12 months.
A review of the independent panel's ruling found it did not fully explain why suspension "was sufficient".
The NMC has now asked the Professional Standards Authority to consider appealing to the High Court.
Labour MP Rosie Cooper had criticised the NMC for not permanently striking off the nurse and said its reputation was in "complete disrepute".
She said: "I hope that Professional Standards Agency will agree to look at this matter with great urgency as the harm being done to victims is being exacerbated by not seeing justice done."
Ms Lockett, who had been director of operations and executive nurse at LCH between 2011 and 2014, was responsible for providing services to 750,000 people on Merseyside.
An independent review of the trust found that patients had suffered "unnecessary harm" after cost-cutting led to severe staff shortages.
The fitness to practise panel found Ms Lockett had failed to take adequate action concerning reports of inadequate staffing and medication administration and she did not properly respond to reports following the deaths of inmates at Liverpool prison.
It was also found that she bullied and intimidated colleagues, including telling one nurse that she had "wasted 35 years of her life in the nursing profession".
The NMC had sought to have Ms Lockett struck off the nursing register, but the panel said "it was not in the public interest to permanently remove such an experienced and respected nurse from the practice".
Clare Strickland, deputy director of fitness to practise at the NMC, said: "We believe the panel took a rigorous approach to this complex case and was right to find Ms Lockett's fitness to practise impaired.
"However, in our view the panel's reasons do not adequately explain why a 12-month suspension order was sufficient in light of the panel's own findings and the NMC's guidance on sanctions."