Nurse Practitioners + Delegating: What’s Your Liability Risk?

The medical assistants in the emergency department where I work are incredibly helpful. They check vital signs, perform ECGs, and most importantly in my book, splint fractures. Splinting can be time intensive and isn’t always easy. With backgrounds as EMTs, paramedics, and first responders, medical assistants in the ER have experience with splinting and are admittedly more adept than myself at the task.

While providers in my department are fortunate to have help, the rule in our emergency department is that a nurse practitioner or physician must check each and every splint before the patient leaves the hospital. Why is this rule routinely emphasized?

As healthcare providers, nurse practitioners, physician assistants, and physicians alike, are legally liable for the manner in which patient care tasks are delegated, the quality of care delivered as a result, and the outcome of such care. In the case of the splinting example above, the nurse practitioner may be held liable for any complications that result from placing a splint, even if the NP was not the individual applying the immobilization device. Ultimately, if your name is on a patient’s chart, as a nurse practitioner, you are at least partially responsible for the care of that patient. Responsibility for actions or interventions performed by another staff member can still fall on you.

Legal Logistics

Several general legal doctrines apply to the relationship between nurse practitioners and other members of the patient care team. The three main principles that apply to nurse practitioners are as follows:

1. Employment – Employers can be held legally liable for the actions of employees, even if the employer has done nothing wrong. This is referred to as Respondeat Superior. 
2. Supervision – Individuals supervising others in the workplace may be held liable for the actions of supervisees, regardless of if an employer-employee relationship exists. This is referred to as the Borrowed Servant Doctrine.
3. Statutory Law – States also address supervisory relationships and delegation of patient care tasks as part of written law. Nurse practitioners are accountable to uphold laws regulating delegation in the state where the NP is licensed.

Overall, nurse practitioners may be held at least partially responsible for tasks delegated to another member of the healthcare team regardless of the employment relationship between the NP and team member.

Which Tasks Can Nurse Practitioners Delegate?

In the interest of time, efficiency, and cost, it is essential that nurse practitioners delegate some patient care tasks to other members of the healthcare team. In doing so, NPs must consider scope of practice and ability of the individual performing the task. Most state laws require that the following conditions are met to delegate:

1. The individual performing the task is qualified and properly trained
2. The activity is within the scope of practice of the individual performing the task

A license to work in a certain profession does not necessarily make a nurse, medical assistant, or other staff member qualified to perform certain patient care activities. Nurse practitioners must consider the skill set of each individual team member to delegate properly. The task must also be within the legal scope of practice of the individual as outlined by state law. Typically, tasks involving clinical judgment, diagnosis, or treatment, should be left to NPs, PAs, or MDs.

Nurse practitioners work in a leadership role when it comes to patient care. As a result, managerial responsibilities like delegation are required. Sharing the responsibility of patient care leads to a more efficient practice, but must be done with vigilance and careful consideration.

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