In this blog I’ll be reviewing the most common nursing malpractice claims, common causes of nursing litigation, common plaintiff allegations, common defenses for nursing liability claims, and ways to mitigate risk. 

The Role of the Healthcare Consumer: Our society is evolving into savvy healthcare consumers who are increasingly more aware, frequently relying on their electronic devices to capture events, and for some, have adopted the notion that hospitals are “deep pockets” when it comes to litigation. 

Most Common Nursing Malpractice Claims: The Nurses Service Organization (NSO), the largest provider of nurses’ liability insurance in the United States, and CNA, the liability insurance underwriter, published a report of nursing malpractice claims from 2006 to 2010.  While the claim history range is not current, the findings are applicable in regards to what lessons we can learn from the report.  I’ll be comparing some of the findings from the 2011 report to the most current NSO nurses’ claim report. 

The 2011 report reviewed 3,222 closed claims against nurses insured by CNA through NSO. The total payment on behalf of the RNs was approximately $80 million. 

  • The average cost of a registered nurses’ malpractice claim (payment per case) was approximately  $170,000.
  • Insurers paid approximately $8.6 million in indemnities related to medication administration. 26% of the claims were related to wrong medication dose, 20% to improper technique, 18% to wrong medication, and 13% to failure to properly monitor and maintain the infusion site.

In comparison to the most current nurses’ claim report (5-year study) (NSO, 2021),  

Over $90.3 million was paid for malpractice claims over a 5-year period by CNA. This is 10.3 million dollars more that what was reported in 2011.

  • The average cost of a registered nurses’ malpractice claim is $201,916. This is $31,916 more than what was reported in 2011.  
  • Death is the most common patient injury that results in a lawsuit.  It accounts for 44.3% of all malpractice claims against nurses.
  • Comas resulted in the highest severity among patient injury claims, averaging $620,833.  They were often due to medication errors.  The high cost reflects the need for lifelong medical care. 
  • Allegations related to treatment and care continue to represent the highest percentage (45.9%) of all malpractice claims asserted against nurses. 
  • Lawsuits against nurses due to medication errors were reduced by nearly half, while the claim cost almost doubled since the last 5-year study. 
  • The number of license defense paid claims increased by 15.4% since the last study in 2011.
  • Unprofessional conduct resulted in the majority of license complaints (24.2%) made against RNs.  The majority of complaints against LPN/LVNs involved medication errors
  • Experience as a nurse does not equate to less risk of malpractice claims.  The majority of nurses (85%) who experienced a malpractice claim had been in practice at least 16 years. 

Common Causes of Litigation:

  • Professional malpractice
  • Unprofessional conduct
  • Professional negligence
  • Involuntary manslaughter

Common Plaintiff Allegations:

  • Failure to assess and monitor the patient
  • Failure to administer a medication
  • Failure to provide treatment and care
  • Failure to maintain patient advocacy
  • Failure to respond to a change in condition
  • Patient abuse or neglect

Common Defenses for Nursing Liability Cases:

  • Physician was informed
  • Care was provided consistent with the standards of care
  • Care was provided within the scope of nursing practice
  • Death was related to the patients pre-existing condition and co-morbidities

Ways to Reduce Nursing Liability Risk:

  • Practice within the regulations of your State Nurse Practice Act, remain in compliance with your professional organizations and facilities policies and procedures, practice within national standards of care
  • Maintain clinical competencies
  • Clarify your direct care assignments and responsibilities
  • Document in real time to the best of your ability, objectively, accurately, completely, and legibly.  Document all patient assessments, re-assessments, observations, communications, and actions.  Comply with your employer’s documentation standards.
  • Do not alter the medical record for any reason after the fact, unless necessary for patient care.  If you must add to the medical record after the fact, be sure to label the entry as a late entry.
  • Maintain signed and dated copies of employer contracts
  • Maintain effective communication with your work team
  • Utilize the chain of command (communication) when necessary to advocate for interventions with significant change in patient status

Having an awareness of common causes of nursing litigation, as well as plaintiff allegations may help reduce risk.  Being armed with knowledge reduces risk of potential litigation, and improves patient outcomes.

P.S. Comment and share your role in mitigating nursing, or APRN (APP) liability risk


CNA Healthpro and Nurses Service Organization. Understanding Nurse Liability, 2006–2010: A Three-Part Approach.

Nurses Service Organization. 2021. 10 Surprising Facts from the Nurses Claim Report.