Despite their vital role in the healthcare workforce, NPs often face malpractice claims comparable to that of physicians. As NPs’ scope of practice expanded, so too have malpractice claims. The Nurse Services Organization (NSO) revealed these claims arose from misdiagnosis, failure or delayed diagnosis, medication-related errors, monitoring failure, injury severity, inadequate physician supervision, or failure to adhere to a standard of care.
According to the National Practitioner Data Bank (NPDB), medical malpractice claims have steadily increased since 1990 from 41 to 486 in 2023. The risk of liability an NP faces varies by allegation, practice location, specialty, and illness or injury. The CNO and NSO Nurse Practitioner Claim Report found that the percentage of closed claims that resolved for between $100,000 and $240,999 increased from 20% in 2012 to 27% in 2017.
According to the NSO, the average cost of medical malpractice claims against NPs has increased to $332,137, up 10.5% since 2017. The increase in claims has been attributed to the growing NP workforce and utilization of NPs working in different specialties.
Examples of Closed NP Medical Malpractice Claims
Case study #1
A family nurse practitioner (FNP) saw a 44-year-old female patient for evaluation of a left breast lump. The patient previously acknowledged a complaint of recurrent boils, cysts, and left axilla regional pain for three years. The NP determined the patient’s lymph nodes were related to armpit swelling and referred the patient to a surgeon who removed one of the lymph nodes. The result was negative.
One year later, a physician saw the patient and ordered a mammogram and ultrasound. The tests results confirmed a left breast mass. She was diagnosed with stage 2B infiltrating ductal carcinoma.
The patient sued the NP and her supervising physician alleging the cancer should have been diagnosed one year prior.
The court returned a verdict of $1.5 million against the NP, but the case against the supervising physician was dismissed.
Case study #2
MW was a 30-year-old male patient with an established history of asthma presented to his primary care NP provider for an asthma checkup, who noted he had neck swelling during his visit. The NP ordered labs and issued a prescription for thyroid medication. MW followed up four days later and was informed his lab work confirmed hyperthyroidism. He was instructed to continue his medication and advised to follow up six weeks later.
MW returned to the clinic five months later with ongoing neck swelling. The NP requested repeat blood work. Lab results indicated significant thyroid level abnormality; however, his spouse alleged that MW was not notified of the abnormal findings and nor did he have changes in his treatment plan.
One month later, MW followed up at the clinic where a new physician provider noted the increase in his thyroid levels and adjusted his medication dosage. MW was advised to undergo a thyroid ultrasound and was referred to an endocrinologist to be seen as soon as possible.
One year later and ten days after his new physician appointment, MW was transported to a nearby hospital for evaluation of nausea, vomiting, and weakness. He died on arrival to the hospital.
MW’s spouse filed a lawsuit against the NP and the medical providers at the clinic. The lawsuit alleged that her spouse’s cause of death was due to failure to diagnose, failure to inform the patient of worsening condition or severity of his condition, and failure to properly treat or change his treatment plan.
A unanimous jury verdict $1.4 million was awarded against the NP for failure to properly treat severe hyperthyroidism leading to MW’s death.
Who Are Nurse Practitioners?
The American Nurses Association and the American Association of Nurse Practitioners defines an NP as a professional registered nurse with advanced graduate education and clinical training that enables them to assess, diagnose, order tests, prescribe medications, manage, and treat a variety of medical conditions.
Collectively, NPs or advanced practice nurses are classified as a certified nurse practitioner (CNP), certified nurse anesthetist (CRNA), certified nurse midwife (CNM), and clinical nurse specialist (CNS). According to the AANP (2024), NPs are licensed to practice independently in 27 states but have reduced or restricted practice that requires physician supervision in the remaining states.
The scope of practice for NPs differs from state to state. NP licensure, prescriptive authority, and scope of practice is governed by legislative and regulatory guidelines at the state, national, and federal levels. The NPs scope of practice may also be defined by collaborating agreement between supervising physicians, certification, and delineation of hospital privileges per bylaw requirements.
State laws mandate that NPs obtain and maintain board certification and continuing education training within their respective specialties. Some areas of NP certification and practice are:
- Adult gerontology acute care
- Adult gerontology primary care
- Family or primary care
- Pediatric care
- Neonatal care
- Psychiatric mental health
- Emergency care
- Maternal child health
- Hospice and palliative care
- Oncology
- Neurosurgery
- Critical care
- Cardiology
- Orthopedic
- Nephrology
- Dermatology
What Services Can an NP Provide that can Lead to Malpractice Claims?
NPs can perform services authorized by their state Nurse Practice Act (NPA). They offer a patient-centered approach and focus on disease prevention, education, and acute and chronic disease management. They often serve as primary care or specialty providers and work in a variety of settings including:
- Private physician offices
- Self-owned NP practices
- Hospitals
- Urgent care
- Long-term care
- Academia
- Mobile units
Services provided by an NP are guided by the education, NPA, specialty, and practice location. NPs have a significant level of responsibility like physicians. They are trained and licensed to assess, diagnose, order, and interpret labs and imaging studies, and treat and manage a variety of conditions. Additionally, they prescribe medications, evaluate outcomes, collaborate with other disciplines, and participate in health policy. Moreover, those with advanced educational preparation are trained to perform and manage invasive and non-invasive procedures.
Specialized training affords the NPs the opportunity to interpret imaging, perform intubations, bronchoscopy, thoracentesis, arthrocentesis, deliver anesthesia, and ultrasound-guided placement of arterial and central venous catheters. However, with these increased roles and responsibilities comes increased risk of malpractice claims.
Dr. Christine Dorman’s chapter, Common Liability Claims Against Nurse Practitioners, provides a detailed analysis of claims. Read it in Patricia Iyer (Editor) Medical Record Analysis, Vol 3. Order at LNC.tips/BuyMRA3.
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