Nurse practitioners face multiple investigations into single incident

A review of nurse practitioner cases notified to leading medical defence organisation, the Medical Defence Union (MDU), has found nurses now face a similar range of medico-legal investigations into incidents as doctors.

Between 2017 and 2021, the MDU helped 400 nurse members with medico-legal processes including complaints, claims, disciplinary procedures and NMC investigations. The MDU found it is common for a number of different investigations to be launched into a single incident, known as multiple jeopardy.

The number of cases notified remained steady overall compared to a previous five-year period. This is despite claims arising from primary care incidents after 1 April 2019 not being included in the figures as they are now dealt with by NHS Resolution.

Dr Ellie Mein, MDU medico-legal adviser said:

“As NHS services seek to recover from pandemic disruption, nurse practitioners are increasingly taking on expanded roles and are critical to the recovery.

“Multiple jeopardy is common among the types of cases we see. Investigations into a single clinical incident involving nurse members can include patient complaints, disciplinary inquiries, NMC investigations, inquests/fatal accident enquiries, claims for negligence and even criminal investigations.

“It is important to realise that state back indemnity schemes only cover clinical negligence claims. MDU support extends to these other types of medico-legal investigation. Having the wrap around membership offered by the MDU gives nurses the peace of mind to know they can ask for our assistance if they find themselves facing one of these stressful investigations.”

Reasons given for complaints from most to least common

1. Wrong or delayed diagnosis. Cancer was the most common missed condition, closely followed by a serious infection, then fractures.
2. Communication failure or ‘poor attitude’. This issue could be seen in isolation or as part of a wider complaint. It was cited as an issue in several NMC investigations.
3. Delayed referrals or investigations.
4. Prescribing errors – many of these being vaccine-related.
5. Complications following procedures such as suture removal, phlebotomy, cervical smears and injections.
6. Contraceptive advice or treatment complications.
7. Inadequate wound care, especially in patients with diabetes or patients who were bed-bound.

Read more about the case analysis along with advice on how nurse practitioners can minimise the risk of complaints on the MDU website.