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Legally speaking: Nurse practitioners and malpractice

Saturday May 17, 2014
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It’s a good time to be a nurse practitioner. Praise abounds for NPs from the patients for whom they provide care. And many published reports about their practice underscore the quality of NPs’ care and the constant focus on primary care.

Regardless of the setting, patient-centered care is the cornerstone of NPs’ practice. And it’s a role NPs may carry out more independently in the future. For instance, the Veterans Health Administration currently is looking into “federal supremacy” for NPs, which would allow them full-practice authority. This would override laws or policies in various states that limit NPs’ scope of practice and responsibilities for patient care by requiring physician collaboration or supervision.

NPs also have a relatively low malpractice rate. Only 2% of NPs have been named as the primary defendant in a malpractice case, according to the American Association of Nurse Practitioners website. Reviewing one such case, decided in 2010, shines light on how NPs practice in a non-negligent manner — and why they should be vigilant in continuing to do so.

Langwell v. Family Practice and Tamely Tyson, FNP, (2010): Patient came to a family practice clinic in North Carolina complaining of three days duration of symptoms such as shortness of breath and coughing up yellow phlegm, some of which was blood-tinged. The patient denied any nausea, dizziness, chest pains and heart palpitations.

The NP established the patient had hypertension, diabetes, elevated cholesterol and was a smoker. After a thorough physical exam, the NP’s diagnosis was community-acquired pneumonia.

The NP gave the patient a DuoNeb treatment, an albuterol inhaler to take home, IM Roceohin and prescriptions for Augmentin and prednisone. She also sent him to the hospital for a chest X-ray that day and instructed him to return to the clinic in two days for a follow-up appointment. That night, his wife drove him to an ED after he began having difficulty breathing and his mental status declined. The patient died on the way to the hospital.

The autopsy revealed few pneumococcus bacteria in the lungs, which indicated the medications given and prescribed had been working. The patient had significant narrowing of the major coronary artery. Pneumonia was listed as the cause of death, although at trial other medical experts testified he died from arrhythmia associated with coronary heart disease.

The patient’s wife sued the clinic and the NP, alleging that her care did not meet the applicable standard of care. An NP nurse expert and a physician expert testified for the NP defendant and said her care met or exceeded the applicable standard of care. Both experts also testified that there was no indication that the patient should have been hospitalized after being seen in the clinic. The trial court’s verdict was in favor of the defendant, and a motion for a new trial was denied.

This case illustrates the importance of NPs meeting the applicable standard of care not only to continue their norm of providing quality care, but also to avoid legal issues that can develop in any healthcare setting.

To see what else is trending, visit www.Nurse.com/Nurse-Practitioners.


Nancy J. Brent, RN, MS, JD, is Nurse.com's legal information columnist and an attorney in private practice. This article is for educational purposes only and is not to be taken as specific legal or other advice. Post a comment below or email specialty@nurse.com.