Nurse practitioners at increased risk of claims and complaints, warns MDU

During 2015, the MDU’s nurse practitioner members reported 25 clinical negligence claims arising from their practice, whereas ten years previously, in 2005, there were just two reported.

The MDU, the UK's leading medical defence organisation, says it is seeing a growing number of allegations being made against nurse practitioners in their own right. One claim was settled for more than £2 million on behalf of a nurse practitioner in a case where a patient suffered a stroke after being prescribed a contraceptive.

The MDU helped with over 400 complaints, claims and other medico-legal matters between 2010 and 2015, involving nurse practitioners.

Dr Beverley Ward, MDU medico-legal adviser, said:

“It is well known that complaints and claims against GPs are increasing year on year, but the rise is even steeper among nurse practitioners working in primary care. With an ageing population and more patients with long-term conditions being managed in primary care, many practices have devolved more responsibility to nurse practitioners in their team to cope with the increasing demand. However, in taking on roles such as assessing and diagnosing patients, prescribing medicines, and running minor injury clinics, nurse practitioners are also at an increased risk of patients holding them individually accountable if something goes wrong.  

“Given the rising number of complaints, we encourage nurses to take individual responsibility for their own indemnity and ensure they keep us up to date with the type of work they are doing. This is in line with the NMC requirement to have ‘an appropriate indemnity arrangement in place relevant to your scope of practice’. Doing so will give nurses in more advanced roles the peace of mind to know they can ask for our assistance if they find themselves facing a complaint or claim.”

The commonest reason for cases was wrong or delayed diagnosis which featured in 30% of complaints and 40% of claims, followed by delayed referrals and prescribing errors.

The MDU has issued advice to help nurse practitioners minimise the risk of a claim or complaint, which includes:

• Keep your knowledge up to date and work within your level of competence.

• If there is doubt about a diagnosis, get advice from a medical colleague or refer the patient for further investigations or treatment.

• Clearly communicate with patients including explaining what you are doing and why. Check the patient has understood and ensure they know under what circumstances and timeframe to seek further medical care.

• Tell patients about the risks, benefits and alternative options open to them, including the option of doing nothing, so that they can make an informed choice.

• Keep a record of all discussions with patients, including over the phone. Record positive as well as negative findings.

• If things go wrong, apologise to the patient and explain what has happened, and what can be done to rectify things.