Nurse Practitioner Closed Claims Study: Top Risks in the Changing Delivery of Primary Care

Gerald Fincken

“This research shows that both physicians and nurse practitioners encounter the same challenges that may lead to adverse events and provides excellent recommendations on limiting risks and enhancing patient safety.”

—Gerald Fincken, DO, family medicine physician at Austin Regional Clinic


By 2025, it’s projected that nurse practitioners will represent almost one-third of the family practice workforce.

Nurse practitioners can help improve medical practice productivity by allowing doctors to see more patients and focus on those patients requiring complex care. Increasingly, the growing need for primary care services will be met with nurse practitioners.

The Doctors Company studied nurse practitioner medical malpractice claims over a six-year period and compared them to claims against primary care physicians (family medicine and internal medicine) to identify risk management issues that may be unique to nurse practitioners.

Key Findings

The most common claim allegations are similar for nurse practitioners and primary care physicians, suggesting that the risk management strategies needed to address top risk areas are similar.

Diagnosis-related claims

Medication-related claims

Many nurse practitioner malpractice claims can be traced to clinical and administrative factors, such as:

  • Failure to adhere to nurse practitioner scope of practice.
  • Absence of or deviation from written protocols.
  • Inadequate physician supervision.

Top factors contributing to patient injury in nurse practitioner claims

Many of these factors can be remedied if physicians are clear about the nurse practitioner laws and regulations within their state and support the nurse practitioner in providing care within the scope of practice.

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There should be agreement on the level of supervision that will be exercised by the physician, including the number and frequency of charts to be reviewed and co-signed. Additionally, nurse practitioners and supervising physicians should agree on specific conditions that, when identified by a nurse practitioner, warrant assessment by the supervising physician.