Nurses spend more time with patients than any other clinician, which puts them at the center of most care-related claims. Sometimes a nurse is named personally; more often the allegation is against the hospital, clinic, home health agency or staffing firm that employs or places them. Either way, nursing practice drives a large share of medical professional liability exposure for health care organizations. This article covers where nursing claims come from, the licensing and data bank exposures that sit alongside lawsuits, how multistate licensure changes the picture, and how coverage typically responds.
Where nursing claims come from
Allegations against nurses tend to cluster in a handful of areas. Each one has practical controls.
Assessment and monitoring
Failure to recognize or act on changes in a patient's condition: rising early-warning scores, post-operative bleeding, respiratory depression after opioids.
Communication and escalation
Not notifying the provider, notifying without conveying urgency, or not using the chain of command when a concern is dismissed.
Medication administration
Wrong drug, dose, route, time or patient, including errors with high-alert medications and infusion pumps.
Falls and pressure injuries
Missed risk assessments, care plans not followed, turning and repositioning not documented.
Documentation
Gaps, late entries and charting that does not match what happened. The record is the nurse's main defense.
Scope of practice
Tasks outside a license or competency, delegation to unlicensed staff without supervision, or following an order that should have been questioned.
Many of these come down to systems rather than individual effort: staffing, handoff structure, alarm management and order sets. Our articles on safe patient handoffs, preventing medication errors and staff competency assessment go deeper on each.
Practice habits that protect patients and nurses
- Escalate with structure. Use a standard format such as SBAR when calling a provider, state the specific concern and what you need, and document the call, the response and the time.
- Use the chain of command. If a concern is not resolved, go to the charge nurse, supervisor or house physician. Organizations should publish the escalation path and support nurses who use it.
- Chart contemporaneously. Document assessments and interventions as close to the time as practical. Label late entries as late entries with the current date and time; never alter an earlier note.
- Document objectively. Record what you observed and did, not opinions about colleagues or blame. Incident details belong in the incident reporting system, not the chart.
- Question unclear orders. Clarify and document orders that are incomplete, illegible or outside usual parameters before acting on them.
- Know your scope. Check the nurse practice act and your organization's policies before taking on unfamiliar tasks or delegating to assistive personnel.
- Report events. Near misses and errors reported through the organization's patient safety reporting system help fix the systems that cause them.
Licensing board complaints and the data bank
A nurse can face a licensing complaint without a lawsuit, or alongside one. In Washington, nursing licenses are overseen by the Washington State Board of Nursing. Board complaints can come from patients, families, employers or colleagues, and the outcome affects the nurse's ability to work.
The National Practitioner Data Bank (NPDB) adds another layer. Under NPDB guidance, any entity, including an insurer or self-insured organization, that pays to settle or satisfy a written malpractice claim on behalf of a health care practitioner must report the payment within 30 days. A practitioner must be named or sufficiently described in both the written claim and the settlement release or judgment; a payment on behalf of an entity alone that does not identify an individual is not reported. State licensure actions are also reportable to the data bank.
Why this matters for coverage. How a claim is settled, and whether an individual nurse is named in the release, can determine whether a data bank report is made. Defense counsel, the insurer and the organization should discuss this before settlement, and nurses with their own policies should know who controls the settlement decision.
Multistate practice and the Nurse Licensure Compact
Travel nursing, telehealth triage and border-area practices all raise the question of which state's license applies. Washington joined the Nurse Licensure Compact (NLC) in 2023. Nurses holding an active, unencumbered multistate license from another compact state could begin practicing in Washington on July 24, 2023, and the Board began issuing Washington multistate licenses on January 31, 2024 to nurses whose primary state of residence is Washington.
- RNs and LPNs only. The compact covers registered nurses and licensed practical/vocational nurses. Washington does not offer a multistate license for advanced registered nurse practitioners (ARNPs), who still need a Washington ARNP license.
- Telehealth. A multistate license allows practice, including telehealth, for patients located in other compact states without additional licenses. Nurses must follow the practice rules of the state where the patient is located.
- Employer reporting. Since September 1, 2023, Washington employers must report nurses practicing on a multistate license to the Board within 30 days of hire.
For physicians, psychologists and other licensed staff, the rules are different. See multi-state practice and telehealth licensing.
How coverage typically responds
Employed nurses are usually covered as insureds under their employer's medical professional liability policy for work within the scope of employment. That coverage protects the organization's interests first, and its limits are shared across everyone it covers. Individual nursing policies are designed to fill gaps around that.
| Exposure | Employer's policy (typical) | Individual nurse policy (typical) |
|---|---|---|
| Malpractice claim from work duties | Covered within the scope of employment, shared limits | Separate limits; often excess over employer coverage |
| Licensing board defense | Often not included for individual nurses | Commonly included, usually with a sublimit |
| Volunteer or side work | Not covered outside employment | Often covered if within the nurse's license |
| Contract or agency assignments | Depends on the staffing agreement and the facility's policy | Fills gaps when contracts are unclear |
| Deposition or subpoena representation | Varies | Often included with a sublimit |
These are general patterns only. Forms, definitions of who is insured, sublimits and exclusions vary by carrier and policy, and some employers require their nurses to carry or not carry individual coverage.
What employers should review
Hospitals, clinics, home health agencies, adult family homes and staffing firms carry the bulk of nursing exposure. A short review each year helps:
- Who is an insured. Confirm that employed nurses, students, volunteers and agency staff are treated the way you intend under your healthcare professional liability program.
- Staffing contracts. Read the indemnity and insurance clauses in staffing agreements. Ask for certificates and confirm limits and additional insured status where required.
- Multistate licensing. Track which nurses work on multistate licenses and report them on time. Confirm your policy territory covers telehealth patients in other states.
- Competency records. Keep orientation, skills validation and annual competency documentation; it is evidence in a negligent supervision or credentialing claim.
- Employment practices. Nurses who escalate safety concerns are protected by whistleblower laws in many situations. Retaliation claims are an employment practices exposure, not malpractice; see our EPLI page.
When to call a broker
Talk to your broker when you add a new service line such as home health or telehealth, take on agency or travel staff, expand into another state, or receive a licensing complaint or attorney letter involving a nurse. As a broker, we compare options across the market and help you structure coverage so organizational and individual exposures fit together. Contact us to review your program.