1. Legal Issues of the NP Role
Nursing 870

2. Who determines the NP Scope of Practice?

3. Scope of Practice
Role provided by SBON and Certifying Bodies based on education, role (AANP, AACN)
Regulated by the State Board of Nursing (The law, regulations, “PA Code”)
May be more limiting
(PA Code)
Clinical Practice Sites
May be more restrictive than the law

4. NP Licensure Provided by each State
Provides the APRN legal scope of practice
Recognized roles and titles of APRN
Specific criteria for licensure
Use certification as entry level competency assessment
Licensure considered for public protection
NP certification required for APRN license in most states

5. Legal Aspects of the NP Role
Determined by each State
Scope of Practice determined by:
SBON in most states
SBON and SBOM in 3 states (VA, NC, SD)
Prescriptive Authority
NPs can prescribe independent of physician collaboration in 15 states
NPs can prescribe with some degree of physician collaboration in 34 states
Limitation of prescribing controlled substances; FL, AL

6. Legal Aspects : Malpractice
The failure of a healthcare professional to exercise such care as would a reasonable prudent healthcare professional under the same or similar circumstances
A type of negligence, where a licensed professional fails to provide services as per standards set by the governing body
A medical professional performs their job in a way that deviates from the accepted medical standard of care, causing injury or death.

7. Components of Malpractice
Duty
Breach of Duty
Proximate Cause
Damages

8. Duty Exists when there is a relationship between patient and provider
Includes using standards of care accepted by the medical community

9. Breach of Duty
After this duty of care has been established, the provider is required to exercise reasonable care and treat the patient as would other providers doctors in the field, following procedures and actions accepted by peers
Violations of standards of care

10. Proximate Cause
The providers actions, or failure to act, results in harm/injury

11. Damages
Permanent or substantial damages occur as a result of the malpractice
Placing a value on the harm done to the patient
Damages might include lost wages and medical bills
May also include general damages, such as pain and suffering

12. Malpractice in Primary Care
Primarily sued for drug errors and misdiagnoses
Diagnoses include cancer, MI, meningitis (BMJ Quality and Safety, 2013)
Diagnosis errors cause up to 160,000 death annually in the US (BMJ Quality and Safety, 2013)

13. Malpractice in Primary Care
Common chief complaints that are red flags for malpractice
The top 3 are:
Breast lump, nipple discharge, breast rash or enlarged lymph node in supraclavicular or axillary area
Chest pain in an adult
Lower abdominal pain
Rule out the worst thing first
Ruppert, C. Available at:

14. NP Malpractice Rates remain low; but is climbing
Of all malpractice cases in 2006; 9.6% for NPs
Most often for medications, treatment and misdiagnosis
Wright, W. Malpractice prevention: What NPs and PAs need to know. Available at:

15. Avoiding Malpractice
What can you think of here??

16. Issues in Prescribing Keep abreast of current therapy
CE requirements for State and National certification
Provider lack of time
Inadequate H&P
Pressure from patients
Requesting specific medications

17. Issues in Prescribing Medication confusion
Similar names or spelling
Failure to anticipate drug interactions
CYP 450 interactions

18. Actions to Avoid Malpractice with Medication Use
Write clear prescription
Warn patients about potential side effects or adverse reactions
Monitor for potential side effects
Discontinue medications when no longer needed
Use high risk medications for short periods only
If hx of suicidal ideations only write for a few days; any meds that can result in lethal OD

19. Actions to Avoid Malpractice with Medication Use
Look up unfamiliar medications
Know current standards of care
If using a drug off label; document rationale
From: C. Buppert JD, Available at

20. PA Malpractice In 2012, over 1500 cases of malpractice filed
A decrease of 44.8%
135 jury verdicts
The Unified Judicial System of Pennsylvania, available at:
Breakdown by county

21. Legal Aspects of the NP Role
For annual updates to Scope of Practice and Legislation for NP’s :
Summary published annually in The Nurse Practitioner at:
Updated Jan 16, 2016: