Nursing Malpractice Statistics

Nurses are licensed health care professionals and can be liable for medical malpractice in the same way as doctors and other health care providers. Of course, medical malpractice claims against nurses tend to fall into different categories and involve slightly different circumstances than malpractice claims against doctors.

In many nursing malpractice cases, the nurse is not even the main financial defendant. If the nurse was working for a hospital or another health care facility when the negligence occurred, the employer may also be legally responsible. But the underlying question is still whether the nurse violated the applicable standard of care and whether that mistake caused an injury.

This page looks at the most common types of nursing malpractice claims and where they occur. We used to focus almost entirely on hospital malpractice in nursing cases because older malpractice data was heavily weighted toward hospital claims.  But the newer data tells a different story. Home health care, nursing homes, emergency care, and other nursing settings now account for a significant share of paid malpractice claims.

Where Does Nursing Negligence Occur?

Negligent nursing care occurs everywhere nurses provide care. Hospitals remain a major source of nursing malpractice litigation, but current claim data makes clear that this is not just a hospital problem.

A review of malpractice cases against nurses also shows something important that people sometimes miss. A specialty having more malpractice claims does not necessarily mean nurses in that specialty are less skilled or make more mistakes. It only means that nursing mistakes in certain settings are more likely to turn into significant malpractice claims.

This often has more to do with the type of patient, the seriousness of the potential injury, and the value of the resulting case than the quality of the nurses themselves.

For instance, imagine 100 nursing mistakes in a relatively low-acuity setting and another 100 mistakes involving surgical or obstetrical patients. The number of mistakes may be identical. But if the second group produces brain injuries, hemorrhage, permanent disability, or death, many more of those incidents are going to become malpractice lawsuits. Those numbers are just an illustration, obviously. The point is that malpractice claim frequency and actual error frequency are not the same thing.

Which Nursing Specialties Generate the Most Malpractice Claims?

The most recent CNA/NSO closed-claim data looks very different from older nursing malpractice studies. Home health care now accounts for the largest share of paid professional liability claims in the report.

There is a very interesting point buried in this data. Obstetrics represents only 3.9% of the paid closed claims in this particular dataset, but it still has the highest average claim severity at $543,305.

This is consistent with what medical malpractice lawyers see in real cases. Nursing malpractice during labor and delivery can result in catastrophic birth injuries that require a lifetime of medical and supportive care. You do not need very many of those cases to drive claim severity through the roof.

Home health care presents the opposite lesson. It now has the highest claim frequency in the report. Nurses increasingly care for very sick patients outside a hospital, sometimes alone and without the immediate backup that exists on a hospital floor. The CNA/NSO data shows home health claims increased in both frequency and severity.

How Does Nursing Malpractice Occur?

Each individual case of nursing malpractice tends to be highly fact-specific and unique. But nursing malpractice claims share enough common features that we can group them into categories.

Older nursing malpractice studies often divided cases into communication errors, drug errors, intervention, assessment, inadequate doctor care, and environmental safety. Those are still useful ways to understand actual lawsuits. But the newer CNA/NSO data organizes the claims somewhat differently.

In the most recent report, treatment and care allegations account for 56.2% of paid closed claims. Patient rights, abuse, and professional conduct allegations account for 18.2%. Assessment claims represent 9.7%, medication administration 8.2%, and monitoring 4.3%.

Failure to Recognize and Report a Change in the Patient’s Condition

One of the classic nursing malpractice cases is still the nurse who sees something important and does not get that information to the physician in time.

Nurses spend much more time at the bedside than doctors. They take vital signs. They monitor oxygen saturation. They see changes in mental status. They watch urine output, bleeding, pain levels, fetal heart tracings, surgical wounds, and countless other pieces of information that can tell you a patient is getting worse.

The nurse does not have to diagnose the disease. But if the patient is deteriorating, the nurse has to recognize it, document it, and get the right person involved.

This is particularly important in labor and delivery. A nurse who sees recurrent late decelerations, prolonged bradycardia, or another concerning fetal heart tracing cannot simply chart it and keep watching while the fetus becomes progressively hypoxic. The obstetrician needs to know. Depending on the circumstances, further escalation may be required.

The same issue comes up after surgery. A patient becomes hypotensive. The heart rate climbs. Pain suddenly becomes much worse. The nurse calls the surgeon and gets an explanation that does not fit what is happening. Is the nurse finished because the doctor was notified? Not necessarily.

Failure to Use the Chain of Command

Nurses sometimes get trapped by the idea that their job is finished once they notify the doctor. It isn’t always.

If a physician does not respond appropriately to a dangerous change in condition, hospital policy and the nursing standard of care may require the nurse to go up the chain of command. That may mean contacting the charge nurse, nursing supervisor, another physician, rapid response team, or emergency services.

The current CNA/NSO report gives a good example. An LPN caring for a woman after cosmetic surgery noted severe pain, hypotension, and tachycardia. The surgeon attributed the symptoms to narcotic medication and ordered Narcan. The patient’s vital signs did not improve. The LPN reported the problem again but did not escalate beyond the surgeon. The patient later suffered a cardiac arrest and died from postoperative hemorrhage.

Nursing experts criticized the failure to invoke the chain of command. The claim against the LPN settled for more than $900,000.

That is a nursing malpractice case even though the surgeon was also involved. A nurse is not relieved of every independent duty just because a doctor made the wrong call.

Negligent Assessment

Negligent assessment occurs when a nurse fails to properly collect, evaluate, or respond to information about a patient’s condition.

This was where the original version of this page literally stopped in the middle of the sentence. But assessment is too important to leave unfinished.

A proper nursing assessment may include vital signs, neurological status, respiratory status, pain, skin condition, circulation, mental status, wound findings, intake and output, fall risk, medication effects, and many other things depending on the patient.

The negligence may be failing to perform the assessment at all. Or the nurse may perform it poorly, chart something inconsistent with the patient’s actual condition, overlook abnormal findings, or fail to appreciate what the findings mean.

In many cases, assessment and communication negligence overlap. The nurse misses the warning sign, so obviously the doctor never hears about it.

Failure to Monitor a Patient

Monitoring is different from performing one assessment. A patient’s condition changes over time. That is why nurses keep checking.

A nurse may commit malpractice by failing to monitor:

• blood pressure and heart rate after surgery;
• oxygen saturation in a patient with respiratory problems;
• neurological status after a head injury;
• a patient’s response after receiving narcotics or sedatives;
• blood glucose in a diabetic patient;
• a fetal heart rate during labor;
• a patient at risk for falls;
• a wound or pressure injury;
• IV lines, drains, feeding tubes, or catheters; or
• a patient showing signs of sepsis or internal bleeding.

A lot of bad medical malpractice cases develop slowly. There may be three or four hours where the chart is basically screaming that the patient is getting worse before anyone acts.

Medication Errors by Nurses

Medication error refers to the negligent or incorrect administration of prescribed drugs to patients. This includes administering the incorrect dose, failing to administer a drug, giving the wrong drug, giving medication to the wrong patient, using the wrong route, or failing to properly monitor a patient after the medication is given.

Medication administration accounts for about 8.2% of the paid closed professional liability claims in the current CNA/NSO dataset.

Some medication errors are harmless. Others are catastrophic. Ten times the intended insulin dose, an opioid given to the wrong patient, failure to administer an ordered antibiotic in a septic patient, or giving a medication despite a documented allergy can cause profound injury or death.

There can also be multiple layers of negligence. The doctor writes the wrong order. The pharmacy does not catch it. The nurse administers it despite an obvious problem. More than one health care provider may be responsible.

Negligent Nursing Intervention

Nursing intervention negligence involves situations where a nurse is negligent in the actual performance of a nursing procedure.

These cases can involve:

• improper placement or management of a tube or catheter;
• incorrect IV placement or management;
• failure to properly perform wound care;
• improper suctioning;
• failure to follow sterile technique;
• errors involving drains or feeding tubes;
• incorrect preparation or handling of surgical equipment; or
• failure to follow a physician order or nursing protocol.

The newer claims data puts many of these cases inside the much larger “treatment/care” category. Within that category, improper management of a medical patient or complication and improper technique or negligent performance of treatment make up a significant portion of the cases.

Labor and Delivery Nursing Malpractice

Labor and delivery nurses no longer represent the largest percentage of nursing claims in the current CNA/NSO dataset. But they still generate the most expensive claims on average.

That is hardly surprising.

A labor and delivery nurse may be responsible for recognizing fetal distress, interpreting fetal monitoring information, notifying the obstetrician, increasing monitoring, changing maternal position, stopping Pitocin when appropriate, initiating other nursing interventions, and escalating care when the response is inadequate.

When those failures contribute to prolonged fetal hypoxia, the injury can be cerebral palsy, hypoxic-ischemic encephalopathy, permanent neurological disability, or death. The cost of caring for a severely brain-injured child can run into millions of dollars over a lifetime.

So obstetrics provides a good example of why claim frequency does not tell the whole story. It represented only 3.9% of the claims in the current report but had an average total incurred of $543,305, the highest of any nursing specialty listed.

Home Health Nursing Malpractice

Home health is now the largest nursing specialty in the CNA/NSO paid-claim dataset, accounting for 21.7% of claims.

This makes sense when you think about how health care has changed. Hospitals discharge patients sooner. People who once would have remained in an inpatient bed are now recovering at home with wounds, feeding tubes, IV medications, serious chronic disease, dementia, mobility problems, or other complex medical needs.

The home health nurse may also be the only health care professional physically present. There is no physician down the hallway and no rapid response team one floor away.

Home health cases can involve failure to assess wounds, pressure ulcers, falls, medication mistakes, failure to report deterioration, infection, inadequate documentation, or failure to obtain emergency care.

The current report found an average total incurred of $301,031 for home healthcare claims, up substantially from the prior reporting period.

Emergency Department Nursing Malpractice

Emergency nurses work in an environment that is almost designed to produce difficult malpractice questions. Patients arrive with incomplete histories, unknown diagnoses, and symptoms ranging from trivial to immediately life-threatening.

Nursing errors in an emergency department can involve triage, failure to repeat vital signs, failure to recognize sepsis, failure to identify neurological deterioration, delayed medication, failure to notify a doctor about a critical result, or letting a seriously ill patient sit in a waiting room while the condition gets worse.

The current CNA/NSO data shows emergency and urgent care claims accounted for 6.4% of paid closed claims and had an average total incurred approaching $300,000.

Nursing Home and Aging Services Negligence

Gerontology and aging services accounted for 12% of the current paid closed nursing claims.

Nurses in nursing homes and assisted living settings are responsible for patients who are often medically fragile, cognitively impaired, unable to advocate for themselves, and at high risk for falls, pressure injuries, infection, dehydration, and medication complications.

These cases frequently involve a combination of nursing negligence and facility-level problems. Chronic understaffing matters. So does poor communication between shifts. If one nurse has responsibility for more residents than any human being could reasonably monitor, the eventual lawsuit may be about more than one individual nursing mistake.

Documentation Errors

The medical chart has two jobs. It helps everyone caring for the patient know what is happening, and later, if there is a lawsuit, it tells the lawyers and experts what supposedly happened.

Bad documentation does not automatically prove malpractice. But missing or inaccurate nursing records can make an otherwise defensible case much harder to defend.

If a nurse claims that she repeatedly assessed a patient and saw nothing concerning but there are no assessments documented for six hours, everyone is going to have questions.

Conversely, detailed records can protect a nurse who did everything right. CNA/NSO has reported malpractice cases where nurses were dismissed without an indemnity payment largely because the chart clearly documented assessments, monitoring, physician notifications, and the actions taken.

How Much Are Nursing Malpractice Claims Worth?

The CNA/NSO report lists an average total incurred of $236,749 for professional liability claims with indemnity payments of at least $10,000.

Do not call that the “average nursing malpractice settlement.” It isn’t.

Total incurred includes the financial cost associated with resolving and defending the insured nurse’s claim. The dataset also excludes paid claims under the report’s $10,000 indemnity threshold. And in a real medical malpractice lawsuit there may be several defendants, including a hospital, physician, practice group, or other health care provider whose payments are not reflected in the amount attributed to the nurse.

The report does tell us that nursing malpractice claims are becoming more expensive. The average total incurred increased 12.5% from the previous CNA/NSO dataset, and 7.9% of paid closed claims had indemnity payments above $750,000.

The real settlement value of a nursing malpractice case still depends primarily on the injury. A medication error that causes temporary nausea is not worth the same thing as a failure to recognize fetal distress that leaves a child with cerebral palsy. The negligence may be equally obvious. The damages are not remotely equal.

Common Nursing Malpractice Claims