I’m worried—and you should be, too. Nurse practioners are increasingly likely to be sued for malpractice. It’s not because we’re practicing bad medicine, of course, but because we’ve got targets on our backs.

Let me explain. </p?

Recently, a man in his 20s showed up at a local clinic with respiratory symptoms, fever and a cough. He was diagnosed with influenza by the supervising physician, who prescribed OTC decongestants and bronchodilators. Several days later the patient was seen on follow-up by the clinic’s NP, who examined him and advised him to continue the physician-prescribed plan of care.


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Back home, the patient relapsed. Late one night, he presented at a hospital emergency department where he suffered respiratory arrest. After a week in the ICU, he died. The patient’s family filed suit against several hospital staffers and the NP. The charges included negligence and failure to perform a more thorough diagnostic workup, which, family members claimed, would have revealed pneumonia and permitted timely and lifesaving treatment. The family did not name the supervising physician in the suit because he didn’t carry malpractice insurance!

As more physicians “go bare,” plaintiff’s lawyers are increasingly targeting NPs, according to the National Practitioner Database. That’s because in most states NPs—unlike physicians—must carry malpractice insurance in order to work.

What angers me most about this situation is that states frequently place NPs in this precarious position through the enactment of unfair laws. It’s ironic that we have to maintain liability coverage even though many insurance companies have stopped offering policies to NPs, or are lowering maximum coverage levels while at the same time raising premiums. The result is a catch-22 in which coverage is either unavailable or prohibitively expensive.

We must begin to protect ourselves.

How? First, all NPs who work in group practices should become fully aware of the type and level of coverage carried by others in their practice. In a best-case scenario, NPs are covered under a joint policy that protects both them and their collaborating physicians. Sometimes, however, NPs may find, after purchasing their own policies, that their collaborating physicians are insured at a far lower rate or, in the worst cases, are “going bare.”

If you find that your supervising physician’s coverage differs substantially from yours, it may be prudent to seek legal counsel now—before a lawsuit is filed. Reasonable actions might include changing jobs or at least adjusting your insurance coverage so that it matches that of the physicians in your practice.Of course, a permanent solution requires both legal and political change. Tort reform that would limit punitive damages, coupled with regulations mandating uniform coverage for all health-care providers, is definitely needed.

To effect these changes, NPs must take the initiative. We need to contact our state legislatures, write letters to influential decisionmakers, and participate in state nursing associations and professional organizations to make our concerns known. These organizations work through state lawmakers, and state nursing associations hire lobbyists that can fight for reform.

So, my fellow NPs, now is definitely the time to take a look at that target on your back—and to make sure that no one scores a bull’s eye at your expense.

James Whyte, MSN, ND, NP, is a primary- and acute-care nurse practitioner and an assistant professor at Florida State University School of Nursing in Tallahassee.