Family Nurse Practitioners and Professional Liability Insurance

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According to the American Journal of Managed Care, the United States had some 234,000 licensed nurse practitioners in 2018. This number has been growing in recent years as nurse practitioners assume an ever more important role in family medicine, taking over primary care duties when physicians have retired or are otherwise unavailable, such as in rural areas.

Increased responsibility and employment opportunities for FNPs are mostly positive—but there is a downside. Today’s FNPs are more exposed than before to malpractice suits arising from issues such as negligence, mistakes, and poor medical outcomes. Potential awards are in the millions of dollars, meaning that FNPs need to protect themselves by any means possible, including the proper use of nurse practitioner liability insurance.

Good academic nurse practitioner programs teach more than medical concepts. They also help students understand the importance of insurance aspects of the nurse practitioner field. One such program is Duquesne University’s Family (Individual Across the Lifespan) Nurse Practitioner online MSN. Also offering Post-Master’s Certificate programs to meet the needs of all healthcare providers, Duquesne’s online master’s in nursing prepares candidates to cope with the practical aspects of a future FNP position or other MSN careers.

Danger Areas

Not all FNPs are equally at risk for malpractice suits. The Nurses Service Organization (NSO), America’s biggest provider of nursing liability insurance, released a study in late 2017 that compiled information about liability exposures. Key trends discussed in the study included:

Your specialty matters.

Some specialties are much more prone to legal action than others. According to this study, 80.9 percent of all claims occurred within four specialties: adult medical/primary care, family practice, behavioral health, and gerontology. Smaller but still significant percentages occurred in aesthetics/cosmetics (3.1 percent) and emergency medicine (5.7 percent).

Big payouts.

Average insurance payouts, too, varied depending on the specialty. The three areas with the biggest payouts were neonatal, women’s health (obstetrics), and emergency medicine. In neonatal and obstetrics, particularly, many awards were in the mid- to high six-figure range.


Three types of locations accounted for 65.1 percent of all claims: physician office practice, NP office practice, and aging services facilities. Much smaller percentages were seen in other practice locations such as hospitals, emergency departments, schools, behavioral health settings, or retail clinics.

Allegation category.

Allegations of malpractice focused overwhelmingly on three categories: diagnosis/screening, medication, and treatment/care management. Alleged mistakes in these areas accounted for 84.5 percent of all legal actions.

Risk Management

Family nurse practitioners in high-risk areas of medicine—and, indeed, FNPs in any area—can somewhat mitigate the risk of legal action by practicing proactive risk management. On its website, the NSO recommends a list of actions for all nurse practitioners to take.

Know the laws.

FNPs should study and understand the medical malpractice laws that apply in their state of operation. To help in this process, FNPs may wish to talk with professional association representatives or discuss potential liability risks with insurers.

Know your employer.

FNPs must feel comfortable with their employer’s policies and procedures. Before accepting employment, investigate a workplace’s website. Ask direct questions during the interview process to learn about the organization’s commitment to quality, the scope of care, and policies toward the patient population.

Speak up.

If at any point you encounter incompetent management or poor clinical care by licensed professional staff, speak up. Don’t hesitate to contact regulatory agencies and professional licensing organizations, if necessary.

Write it down.

Document everything you do with patients. Things you should note include assessment findings, how these findings were arrived at, who you told about the findings, and what suggestions you made for additional tests or evaluation.

Buck the chain.

If you have concerns regarding patient care, treatment, or safety, always go through your organization’s internal chain of command first. But if you cannot get results through proper channels, blow the whistle. Most states permit anonymous reporting of medical issues. Even if you have to identify yourself, however, it’s worth it to shield yourself from liability when patients are receiving shoddy care.

Insurance Issues

The best risk management practices in the world will not always protect FNPs. Things go wrong, and lawsuits may be the result. In these situations, a good liability insurance policy is a family nurse practitioner’s best friend.

The organization Florence Health, an information clearinghouse catering to the healthcare field, offers tips for family nurse practitioners to keep in mind when considering liability insurance options:

Understand your exposure.

Many FNPs believe that they cannot be sued if they are working under a physician’s direction. This is not the case. Even if you are following a physician’s orders, you may be held legally responsible for your actions.

ALWAYS have insurance.

Many healthcare organizations offer some liability insurance as part of their employment package. If they don’t, or if the provided insurance seems inadequate, get your own.

Look out for numero uno.

Don’t assume that your employer has your best interests at heart. If a claim is filed against you, your employer may join in if the circumstances warrant it. Be prepared to take your own stand.

Know the details.

Make sure you understand exactly what your liability policy does and does not cover.

Moonlight responsibly.

Many healthcare providers moonlight to make extra cash. If you do so, you probably won’t be covered by an employer-provided liability insurance policy. Make sure to buy whatever additional coverage you need.

Speak to insurance agencies.

Agencies that specialize in liability insurance are a wealth of information. Find an agent you trust and let him or her walk you through the intricacies of the liability minefield.

In FNP practice, malpractice suits are always a possibility. But by knowing the risks, taking steps to reduce them, and having the appropriate insurance in case disaster strikes, FNPs can minimize their chances of encountering career-ending legal trouble.

About Duquesne University’s Online MSN-FNP and FNP Post-Master’s Certificate Programs

As a leader in online nursing education, Duquesne University has helped RNs and APRNs learn skills, strategies, and evidence-based practices to become FNPs. The coursework is presented entirely online, so students can maintain their careers and personal lives while pursuing their education goals.

Graduates are prepared to successfully complete the American Academy of Nurse Practitioners Certification Board (AANPCP) and American Nurses Credentialing Center (ANCC) Family Nurse Practitioner certification examinations.

For more information, contact Duquesne University today.




Number of nurse practitioners and growing importance – American Journal of Managed Care

Danger areas – Nurses Service Organization

Risk management – Nurses Service Organization

Insurance issues – Florence Health