According to “The 2022 Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition,” claims again nurse practitioners (NPs) are rising.
To find out what this means and what NPs can do about it, Daily Nurse interviewed Georgia Reiner, MS, CPHRM, Risk Analyst, Nurses Service Organization (NSO).
What follows is our interview, edited for length and clarity.
According to the Claim Report, you found that aging services against NPs are up. What did they increase from and to? Why do you think this is happening? Why are more NPs being sued?
NSO’s & CNA’s report entitled, The 2022 Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition, revealed that aging services claims increased from 17.2 percent of the total distribution in the 2017 dataset to 20.3 percent of the total distribution in the 2022 dataset. Specifically, allegations against nurse practitioners (NPs) that occurred most often in the aging services setting included improper or untimely management of a pressure injury and improper prescribing/management of anticoagulants and controlled medications. Three main factors may drive the increase in these claims:
- The number of older Americans is increasing.
- There is a shortage of primary care physicians.
- The number of NPs in the workforce is increasing.
One of the realities of life is that our medical needs increase as we age. And the number of older Americans is steadily growing. According to the Administration on Aging, in 2020, the population of 65 and older numbered 55.7 million. It is projected to grow to more than 80 million by 2040. Many older Americans receive care from aging services facilities across the United States. There are currently about 14 million people receiving some form of long-term care services. That number is expected to double by 2050, according to the U.S. Centers for Medicare and Medicaid Services.
However, aging service facilities need more staffing to meet regulatory and quality of care standards. In addition, risk factors for older adults include increased physical health problems/conditions, side effects from medications, loss of mobility, and social isolation, which may lead to depression. These factors can contribute to an NP’s liability risks as NPs are responsible for diagnosis, medication management, and timely treatment and care.
Injuries the patient or resident sustained can result in allegations against the NP for negligent care.
This increase in claims may also be attributed partly to the overall rise of NPs in the workforce coupled with the expansion of NPs working in underserved specialties, such as aging services, and the steady decline of primary care physicians. In December 2019, the American Association of Nurse Practitioners (AANP) reported that 290,000 NPs were licensed to practice in the United States. In November 2022, the AANP reported that the number of NPs in the workforce had increased to 355,000.
Lastly, experts have warned that a shortage of primary care physicians could lead to challenges in accessing care. According to The Association of American Medical Colleges, by 2030, we will face a physician shortage of 40,000 and 100,000 doctors. As a result, an increasingly common solution is staffing more NPs at offices, clinics, hospitals, and aging services facilities, encouraging patients to receive care from NPs instead of physicians.
Why have malpractice claims – in terms of the amount of money awarded – been increasing?
According to NSO’s & CNA’s new NP report, the average total incurred of professional liability claims in the 2022 dataset ($332,137) increased more than 10.5 percent compared to the 2017 dataset ($300,506). In addition, the findings suggest a continued shift towards larger claim settlements. For example, claims that resolved for over $500,000 represented 21.5 percent of all claims in the 2022 dataset, compared to 13 percent in the 2012 dataset.
The increasing severity of claim costs can be attributed, at least in part, to social inflation, which is the growth of liability/litigation risks and costs. This rate of growth is more rapid than what could be explained by just inflation by itself. Several potential drivers of this growth rate include:
- More sophisticated plaintiff attorney litigation strategies.
- Tort reform rollbacks.
- Litigation funding.
- Other large jury verdicts across the country.
Another possible driver of social inflation is the liability associated with the increasing complexity of patient needs. For example, meeting the needs of high-acuity patients can involve many surgical, restorative, and diagnostic procedures, which can incur significant expenses. And with rising healthcare costs in general, it then follows that it requires more significant verdicts to make plaintiffs whole for their losses.
What were the nursing specialties that you found to have the highest exposures? Why do you think they are sued the most?
NSO and CNA’s Nurse Practitioner Claim Report revealed that in the 2022 dataset, 66 percent of all claims involved NPs specializing in family and adult-gerontology primary care. Family and adult-gerontology primary care have consistently represented the majority of NP claims across 2012, 2017, and 2022 claim report datasets. Most of these claims occurred in the office of an NP or physician, with many involving allegations related to diagnosis and medication prescribing. These specialties likely account for most claims because, according to the AANP, 79.2 percent of licensed NPs in the U.S. are certified in family and adult-gerontology primary care.
What can NPs do to protect themselves from malpractice claims? Please explain.
Below are some proactive concepts and behaviors that NPs can include in their customary nursing practice:
- Practice within the requirements of your state nurse practice act, in compliance with organizational policies and procedures, and within the standard of care.
- Maintain basic clinical and specialty competencies by proactively obtaining the professional information, education, and training needed to remain current regarding nursing techniques, clinical practice, medications, biologics, and equipment.
- Document your patient care assessments, observations, communications, and actions in an objective, timely, accurate, complete, and appropriate manner.
- To help improve the diagnostic process, consider the potential unintended consequences of pursuing a specific diagnosis:
- Are factors present that do not align with the diagnosis?
- Are there symptoms that are inconsistent with the current diagnosis?
- Why are these symptoms not indicative of another diagnosis?
- Are there elements that can’t be explained?
- Is there a condition with similar symptoms to consider?
- If a patient is uninsured or unable to afford necessary diagnostic and consultative procedures, refer them to appropriate organizations or social agencies for financial assistance, payment counseling, and/or free or low-cost alternatives, and document these actions.
- Remind patients to seek emergency treatment if a condition worsens, and document this action.
- If necessary, utilize the chain of command, risk management, or legal department regarding patient care or practice issues.
- Maintain files that can be helpful for your character, such as letters of recommendation, performance evaluations, and continuing education certificates.
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