Nurse Practitioner Liability Increasing, Risk Managers Should Advise
November 1, 2022 4 minutes read
EXECUTIVE SUMMARY
The average total incurred amount of a nurse practitioner malpractice claim has risen sharply over five years. Risk managers can use recent data to help educate nurse practitioners and reduce their risk.
- The cost of defending nurse practitioner complaints has risen even faster than overall costs.
- Diagnosis allegations accounted for most nurse practitioner professional liability claims.
- Professional conduct and prescribing medication were the focus of most licensing board complaints.
Malpractice costs for nurse practitioners are climbing significantly. Risk managers can use the data from a recent claim report to advise nurses on the greatest exposures and how to reduce their risk.
The average total incurred amount of a nurse practitioner malpractice claim is $332,137, according to a claim report from Nurses Service Organization (NSO), the largest provider of individual nurses’ professional liability insurance in the United States.
That figure has risen 10.5% since 2017, the report authors noted. The Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition addresses professional liability claims and license protection matters that closed between 2017 and 2021.
Practice Owners See More Claims
Losses from nurse practitioner claims and licensing complaints are approaching the same level seen by physicians, says Jennifer Flynn, CPHRM, risk manager with NSO.
“The biggest finding in this report is that the average total incurred amount of our nurse practitioners is increasing and has steadily increased over the years,” Flynn says. “Some of the areas where we are seeing top loss are specialty areas like neonatal, pediatric, and behavioral health.”
These are some key findings in the report:
- The average cost of defending complaints against nurse practitioners to the State Board of Nursing is $7,155, a 19.5% increase compared to the 2017 report and a 61.1% increase compared to the 2012 report.
- Family and adult-gerontology primary care constitute 66% of all claims. Most claims involved care provided in the office of a nurse practitioner or physician. Many of the claims stem from diagnosis and medication prescribing failures.
- As in past reports, the neonatal specialty recorded the highest average total incurred of closed claims.
- Diagnosis allegations comprised most nurse practitioner professional liability claims. The two most common resulting injuries were death and cancer, making up more than half the claims.
- Licensing board complaints were most often related to professional conduct and prescribing medication.
There was a big change in the distribution of claims and the average total incurred cost for nurse practitioners who own their practice. “These are providers who have decided to incorporate and open their own healthcare practice, so most likely they are not only the primary provider in that practice but are also taking on other administrative duties, such as hiring, training, and incorporating policies and procedures into the practice,” Flynn says. “We saw that nurse practitioner practices represent about 13% of the claims in this new data set, and that’s up from about 8% in the previous data set.”
The average cost to defend the practices is more than $400,000, well above the average for all nurse practitioners. This is because the allegations against a practice can not only be clinical claims against the provider, but also allegations involving policies and procedures that might have prevented the injury.
Diagnosis-related claims have been the most common allegation against nurse practitioners since NSO started analyzing claims data 20 years ago, Flynn says. They account for 37% of NSO claims.
“When you’re talking about failing to diagnose or delaying a diagnosis with things like cancer, sepsis, or infection — some of these things that can have a severe impact on the patient — that can lead to a costly claim,” Flynn says. “We try to look at these claims and ask if the nurse practitioner had a complete family history, a complete physical assessment, and list of their medications. What was their chief complaint, and how did they present that day?”
Those are some of the many questions that a plaintiff’s attorney will ask, Flynn notes. In many cases in which the plaintiff is successful, it was because the nurse practitioner did not order a diagnostic test or did not address test results in a timely manner.
Flynn says NSO leaders were relieved to see medication prescribing represented in about 17% of claims. In previous data sets, that figure almost doubled from one period to the next, but that number seems to have leveled off.
“I think that is related to the opioid epidemic. In previous studies, we saw claims related to nurse practitioners prescribing opioids that led to injury or death,” Flynn says. “But since then, we have seen states put in controls to prescribing opioids that help prescribers see what a patient is getting from other providers. We were glad to see those controls had an effect on the frequency of these claims.”
Flynn suggests risk managers advise nurse practitioners about the claims data and emphasize the need for a comprehensive clinical history as well as a family and social history. Documentation is always vital, and they should have a good process for advising patients of test results.
Nurse practitioners also must refer patients or seek consults when necessary. “The patients nurse practitioners are seeing these days are complex. They are not always adherent with the treatment plan, so [use] your documentation to record what you told them, what you heard — your entire clinical decision-making process,” Flynn says. “If a plaintiff’s attorney takes a case, the first thing they will do is look in the patient’s record and assess the quality. Is there anything not documented or not well-documented? They are looking for red flags or any ways to poke holes in that record.”
SOURCE
- Jennifer Flynn, CPHRM, Risk Manager, Nurses Service Organization, Fort Washington, PA. Phone: (215) 773-4513. Email: [email protected].
The average total incurred amount of a nurse practitioner malpractice claim has risen sharply over five years. Risk managers can use recent data to help educate nurse practitioners and reduce their risk.
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