The implications for physicians affiliated with Nurse Practitioners (NPs) relating to medical malpractice was recently discussed by Carolyn Buppert, MSN, JD, in Physicians Who Work With NPs: What's the Liability Risk? Current data shows NPs are involved in less than 1% of medical malpractice claims and enjoy lower premiums for liability insurance. Although NPs currently represent less risk, with their rising scope of responsibilities and autonomy, they could soon face more malpractice claims.
Nurse Practitioners often have relationships with physicians through required collaboration or supervision, employment, or in consultative roles. Medical professionals are potentially at risk for facing civil liability resulting from medical negligence. It is possible that malpractice liability stemming from actions of the NP may extend to the physician.
What are NPs?
Nurse Practitioners are classified as Registered Nurses with advanced training and responsibility. The extent of responsibilities and requirements for physician supervision vary according to provisions in the state they practice. NPs may be able to prescribe medication, conduct physical exams, make diagnoses, and other functions typically reserved for physicians. Approximately 20 U.S. states allow NP autonomy, meaning they may practice without physician oversight. The Kaiser Family Foundation estimates NPs are qualified to provide over 80% of the functions that a primary care physician can.
Possible Relationship Models
The ways (forms) that a physician and NP can work together are based on local regulations, type of healthcare setting, and physician willingness to engage and assume liability, including:
- A physician or group hires an NP as an employee or independent contractor. Injured patients typically will bring a malpractice claim against a provider's employer
- Both may be employees of the same larger entity and assigned to collaborate. In the majority of such cases, the physician is less likely to be sued individually, as plaintiff claims likely target the hospital or facility
- NP's in solo practice may, based on state requirements, have a collaborative physician. Such collaborative arrangements are not usually disclosed; therefore, a malpractice victim is unlikely to be aware that a physician collaborator exists or who the individual is.
Buppert's research suggests there are two common outcomes in malpractice claims when both NP's and physicians are named defendants and deemed liable. The first is when the physician had direct involvement in the patient care and is considered liable. The other is when the physician did not have direct involvement in the care; however, the state requires physician oversight, which was determined to be inadequate.
NP On-Call Coverage
Often, NPs contract to provide care for residents or patients in facilities on an “as needed” basis. The keys to limit liability here are consistent communication, formal documentation and maintaining limitations. Each patient should have a physician responsible for their overall plan of care. Information must be communicated in a centralized, pre-determined and confidential manner. If critical information is not available to the responsible physician, opportunities for dangerous liability may arise. On-call NPs should adhere to basic procedural guidelines and recognize their limitations when conditions become complex or unstable.