Strategies for Avoiding Malpractice Claims for Nurse Practitioners

Nurse practitioners (NPs) play an integral role in the Australian healthcare system. They assess patients, diagnose conditions, prescribe medicines, and manage treatment plans across a range of settings, including general practice, aged care, community health services, and specialist clinics.

By recognising malpractice risks, nurse practitioners can protect patients, safeguard their professional career and license.

The most common malpractice includes diagnostic errors, medication errors, scope of practice violation, communication and consent failures.

A clear understanding of these risks and maintaining appropriate level of professional indemnity insurance ensures you continue providing high-quality care knowing you have protection when you need most.

Common malpractice lawsuits against nurses

1. Medication errors

Medication errors are one of the most common causes of malpractice claims in healthcare. Each year, medication errors cause more than 250,000 hospitalisations in Australia, and around 18,000 deaths.

Common causes of medication errors according to these articles are:

• Incorrect dosage or calculation errors
• Failure to check allergies or contraindications
• Transcription or documentation errors
• Miscommunication during handover
• Failure to monitor after administration
• Inadequate patient identification

How to reduce risks:

• Review patient medication histories and allergies
• Use clear, standardised documentation
• Verify patient identity before administration
• Implement structured handover protocols

2. Failure to diagnose

Diagnostic error involves delayed diagnosis, missed follow ups, misinterpretation of results, and failure to escalate deteriorating patients. Continued awareness and education, including regular training, case reviews, and reminders about cognitive bias, helps nurses recognise high risk scenarios early and prevent missed or delayed diagnoses.

How to reduce risks:

• Use symptom checklists for high risk presentations
• Take a thorough history and document red flags and key negatives
• Do a focused physical exam every time
• Use safety netting, clear return instructions and follow up timeframes
• Ensure all test results are reviewed and actioned

3. Patient falls and safety

Falls were the leading cause of injury hospitalisations in Australia in 2023-24. Claims can arise due to incomplete risk assessments or failure to implement prevention strategies.

Common reasons

• Poor mobility, weakness, or balance issues
• Medications that cause dizziness or low blood pressure
• Environmental hazards (wet floors, clutter, poor lighting)
• Inadequate supervision or delayed assistance

Common controls:

• Complete a falls risk assessment and update it regularly
• Keep the environment clear, dry, and well-lit
• Supervise high-risk patients during transfers and toileting
• Review medications linked to falls risk

4. Communication and consent issues

Poor communication is a common factor in professional complaints. Allegations often relate to inadequate explanation of treatment risks or failure to obtain informed consent.

Common reasons

• Incomplete explanation of treatment risks, benefits, and alternatives
• Assumption that the patient understands without confirming
• Poor documentation of consent discussions
• Inconsistent handover between clinicians
• Failure to use interpreters where required
• Communication breakdown during high-pressure situations

Prevention tips

• Use clear, plain language and confirm understanding
• Document consent discussions, including risks and alternatives
• Use structured handover tools (for example, ISBAR)
• Provide written information

5. Scope of practice violations

Practising outside authorised scope significantly increases malpractice exposure. This involves performing procedures without appropriate endorsement, failing to refer complex cases, or exceeding clinical authority. Failure to abide by scope can result in malpractice claim or disciplinary action.

Examples

• Performing procedures without appropriate endorsement or authority
• Prescribing outside authorised formulary or conditions
• Failing to escalate care when clinical limits are reached
• Providing advice beyond recognised qualifications or not permitted by law

Tips

• Practise within legislated scope and endorsement conditions
• Follow employer policies and clinical governance frameworks
• Seek supervision or referral for complex presentations

6. Medical records

Clinical documentation is often decisive in malpractice proceedings. Incomplete, inconsistent, or delayed notes can undermine a defence, even where care was appropriate.

Common risks:

• Missing documentation of clinical findings
• Delayed or retrospective entries without clarification
• Inconsistent medication records
• Lack of documented clinical reasoning

Best practices:

• Record assessments, decisions, and rationale contemporaneously
• Ensure medication charts and updates are accurate
• Maintain secure storage and access controls for patient records

Safeguard your career with Professional Indemnity insurance

Even the most diligent nurses can face claims or regulatory investigations. Clinical environments are complex, patient presentations can change rapidly, and documentation or communication gaps can occur despite utmost care. A single allegation can lead to legal expenses and reputational harm, even if the claim is not proven.

A comprehensive Professional Indemnity policy can help protect your career, finances and licence when allegations of negligence, errors, or omissions arises. Subject to policy terms and conditions, it can cover legal defence costs, compensation payouts and settlements in regulatory proceedings.

When reviewing a policy, consider:

• Compliance with AHPRA registration requirements
• Adequate limit of indemnity for the scope of practice
• Cover for legal defence costs and investigation expenses
• Inclusion of representation for regulatory inquiries or disciplinary hearings
• Run-off cover where required
• Clarity on exclusions and policy conditions

BizCover offers Professional Indemnity insurance for nurses and healthcare professionals. With years of experience, we offer flexible cover options with limits to suit to your scope of practice and employment arrangements.