Nurse Practitioners: Expanding Role, Expanding Liability

New York became the 18th state to no longer requireexperienced nurse practitioners to have a written practice service agreement with a physician. Experienced nurse practitioners (who have more than 3,600 hours of practice) will be able to be even more independent. Nurse practitioners’ expanding liability accompanies their expanding role.

As patients receive insurance as a result of the Affordable Care Act (an estimated 1.1 million in New York alone), the availability of nurse practitioners expands choices of care. When compared to physicians, the care delivered by nurse practitioners is equal in quality.

Often the patient satisfaction is higher for nurse practitioners.

But advanced practice comes with a price. At Med League we saw an increase in the requests for nurse practitioner expert witnesses. With an expanded role, nurse practitioners have expanded liability.

The number of suits against nurse practitioners is rising.

A study reported in the Journal for Nurse Practitioners supports what we saw. The top allegations are consistent with the advanced nurse practitioner role.

Most common allegations against nurse practitioners

In a study of over one thousand cases recorded in the National Practitioner Data Bank, reported by Kenneth Miller, the top allegation was “diagnosis related”. The allegations are broadly divided into

• Failure to diagnose
• Delay in diagnosis
• Improper performance
• Failure to recognize a complication
• Wrong or misdiagnosis

According to Diedrich Healthcare, diagnosis related allegations are also the single largest category of complaints against physicians.

Nurse practitioners’ expanding liability – tips for LNCs
Legal nurse consultants helping attorneys with medical malpractice cases involving nurse practitioners will encounter these nuances:

• There are several subspecialties within the nurse practitioner world. Make sure you match the defendant’s specialty if you supply a nurse practitioner expert.
• Some physicians who sign the collaborative agreements with nurse practitioners have been known to drop their malpractice coverage, and in effect leave the nurse practitioner holding the bag.
• Many physicians remain hostile to the idea of nurse practitioners becoming more independent. They argue that removing the requirement for physician oversight will weaken patient safety and quality of care.
• The National Practitioner Data Bank data showed the only .008% of the nurse practitioner cases went to court. The remainder either were yet to be resolved or resulted in settlement.

Pat Iyer MSN RN LNCC is president of The Pat Iyer Group, Inc. She is the editor, along with Barbara Levin, Kathleen Ashton and Victoria Powell, of a book on Nursing Malpractice that includes a chapter on nurse practitioners’ expanding liability.