4 steps for practices to reduce malpractice claims against nurse practitioners

Doctors talking
To reduce the risk of malpractice claims, doctors should adequately supervise nurse practitioners in their practice. (Getty/wmiami)

The liability risks faced by nurse practitioners do not differ greatly from those faced by primary care physicians, a recent study found.

Medical malpractice claims don’t differ radically between the two types of providers, according to a study by The Doctors Company, the country’s largest physician-owned medical malpractice insurer.

The company decided to undertake the study, which was based on almost 1,500 claims filed against nurse practitioners and family medicine and internal medicine physicians from 2011 to 2016, because of the growing number of nurse practitioners delivering care, said David B. Troxel, M.D., the company’s chief medical officer, in an interview with FierceHealthcare.

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Nurse practitioners are expected to make up nearly a third of the family practice workforce by the middle of the next decade, says Troxel, who personally thinks the number could be even higher. That motivated the company to review claims to see whether nurse practitioners face any unique risk management issues. Results were compiled in a new report (PDF).

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David B. Troxel
David B. Troxel, M.D.
(The Doctors Company)

The study found there were very few differences between the two types of providers. Nurse practitioners get sued less often and not as much money is paid out in malpractice settlements, he said. Otherwise, diagnosis-related and medication-related claims were similar for nurse practitioners and primary care physicians.

Many of the malpractice claims brought against nurse practitioners can be traced to clinical and administrative factors, he says. There are a number of steps that practices can take to reduce the liability risks faced by nurse practitioners, risks shared with the physicians who supervise them, he says.

Practices should take the following steps:

Know what your state allows nurse practitioners to do. Individual states define the scope of practice for nurse practitioners, he says: “Not every doctor is familiar with the scope of practice for their nurse practitioners.” Doctors should know what their state regulation allows and supervise nurse practitioners within that scope of practice.

Have a written protocol that spells out what nurse practitioners can and cannot do in your practice. Be sure you provide that policy to newly hired nurse practitioners. Sit down with them and go through the policy so there are no questions.

Be sure to follow your policy and protocols. Even if a practice has a policy, people may not always follow it, he says. People get comfortable and they tend to stray from protocols.

Adequately supervise your nurse practitioners. Be sure they know when to refer a patient to a supervising physician or a specialist. For example, a practice may want to specify that any patient who is having chest pain, for which there’s not a known cause, should always be referred to a supervising physician or the nearest emergency room. Or a practice may want to require that any patient with complex diabetes, which is difficult to manage, be referred to a supervising physician for care.

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Failure to adhere to a nurse practitioner’s scope of practice creates liability, and malpractice claims against nurse practitioners are on the rise, he says. Overall, malpractice claims against nurse practitioners are very low. But while the frequency of claims against physicians has decreased over a nine-year span (from 2008 to 2016), claims frequency has gradually increased for nurse practitioners. The reasons aren’t entirely clear but may be due to the increased use of nurse practitioners in primary care practice or an increase in nurse practitioner risk, the study said.

Payouts from malpractice claims filed against nurse practitioners are also on the rise, according to a report released late last year. The average payouts on cases that were settled for more than $10,000 was $240,471, according to an analysis of claims from CNA Insurance and the Nurses Service Organization.