The relationship between reported malpractice cases for nurse practitioners and the type of supervision mandated by state law

Concerns about the safety and quality of healthcare delivered in the United States have become a front line issue taking a strong place alongside traditional concerns about increasing cost and access to health care. Nurse practitioners learn and are expected to incorporate within their own practice high quality care that does not jeopardize patient safety. Beginning in 1990, the National Practitioner Data Bank (NPDB) began collecting information about healthcare practitioners who, as the result of judgments in malpractice suits, have entered into settlements or had to pay monetary awards. The NPDB classifies nurse practitioners as a separately identified category of healthcare professional in the data bank according to the state in which they practice. The purpose of the study was to examine the relationship among reported malpractice rates for nurse practitioners and the types of practice required by state law. For the past 35 years the definition and scope of nurse practitioner practice has progressed towards more independent clinical decision making. The degree to which nurse practitioners can practice independent of physician supervision, delegation or collaboration varies considerably among the states. This retrospective study compared the rates of medical malpractice for nurse practitioners by state to the type of practice required by state law: independent practice verse collaborative practice verse supervisory practice to see if there is a relationship between autonomy in nursing practice and malpractice claims. The rate of malpractice for nurse practitioners in the United States from 1990--2003 was 0.0027. It is the lowest rate compared to physician assistants, certified nurse midwives, certified registered nurse anesthetists, physicians and doctors of osteopathy. For every 100 cases in the NPDB against MD's there are 1.3 cases against NP's. There was not a statistically significant correlation between the scope of practice in each state and the rate or number of events reported to the NPDB. The policy implications of this study are that scope of practice barriers should be removed to allow autonomy in nursing practice. State and federal laws requiring collaboration or supervision need to be modified to allow autonomy in nursing practice.