Reducing Liability Risk When Collaborating With Nurse Practitioners

Carolyn Buppert, MSN, JD


September 01, 2017

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How Can Physicians and Nurse Practitioners Who Collaborate Avoid Malpractice Liability?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

A reader asked for advice on how physicians and nurse practitioners (NPs) who collaborate, when required by state law, can avoid liability for malpractice.

Here are my suggestions:

  1. Be aware of the danger areas. As a clinician, you always want to rule out the worst-case scenario early on in the care process, but be especially diligent with your evaluation and follow up when dealing with high-litigation conditions. The conditions that most often lead to lawsuits are:

    • Diabetes

    • Abdominal symptoms

    • Breast complaints

    • Chronic pain

    • Hypertension

    • Coronary disease, especially acute myocardial infarction

    • Back pain with associated neurologic symptoms

    • Pregnancy[1]

  2. When state law calls for physician oversight of NP practice, whether it be collaboration, supervision, standardized procedures, or chart review, the physician should be involved to the extent required by the state's law. Judges have found physician collaborators liable to an NP's patient when an injury occurred, state law required physician oversight, and there was no sign that the physician evaluated or oversaw the NP's practice at all.

  3. If taking on responsibility for collaborating with an NP, verify that the NP is competent to provide the services required of the job. This may be done through verification of appropriate education and certification, working side by side with the NP for a period of time, regular chart review, case presentations, or witnessing the NP's performance of procedures. If there are deficiencies, provide input and/or educational opportunities.

  4. Set parameters for the NP about when to get a referral or initiate a consultation, either with the collaborating physician or another qualified clinician.

  5. Read and follow the state's requirements for physician collaborators. These may be on the Board of Nursing website, the Board of Medicine website, or the medical society's website. If the requirements seem unnecessary or unreasonable, participate in the process to change the requirements.

In an accompanying article I discuss the level of risk assumed by physicians working with NPs under three different models.

Visit Carolyn Buppert's YouTube channel for more legal issues for nurse practitioners, in small doses.


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