By: Jennifer Flynn, CPHRM, Vice President of Risk Management, Nurses Service Organization (NSO)

Nurse practitioners (NPs) are integral to patient care. Most NPs understand their legal risks if, for example, they improperly prescribe medication or perform a procedure and a patient sustains an injury. However, they may be surprised to learn that they also can be held accountable by a State Board of Nursing (SBON) for responsibilities and professional services that are clinical or nonclinical in nature – such as substance abuse, unprofessional conduct or billing fraud. The findings by the SBON from these allegations can affect their licensure status and ability to practice.

Nurses Service Organization (NSO) together with insurance carrier partner CNA, have published the industry resource, Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition. Part 2 of the report analyzed 250 paid license protection matters against NPs, student NPs, and NPs covered through a CNA-insured healthcare business over a five-year period (2017-2021). Disciplinary matters amounts in the NSO program represent the cost of providing legal representation to an NP in defending such actions, rather than indemnity or settlement payments to a plaintiff. Here are the key takeaways related to license protection.

Analysis of NP License Protection Paid Claims

A SBON serves to protect the public and promote the progress of the profession. SBON investigations are serious matters and require a significant investment of an NP’s time and effort until they are resolved. Legal representation in these matters is highly recommended.

The cost to defend license matters is increasing. The average cost of defending complaints made against NPs to a SBON is $7,155, a 19.5% increase compared to the 2017 report and a 61.1% increase compared to the 2012 report.

Key findings in the 2022 dataset related to NP SBON complaints are:

  • Professional conduct, medication prescribing, and scope of practice complaints accounted for more than half of all license protection closed matters (58.4%).
  • License board complaints related to the professional conduct category specifically were driven in large part by matters categorized as professional misconduct as defined by the state, such as unprofessional conduct with patients or coworkers, termination from employment due to unspecified performance issues, and professional boundary issues with patients.
  • Approximately 43% of SBON matters led to some type of action against an NP’s license. Common SBON actions included probation (12%), public reprimand (11.2%), consent order or stipulation (6.4%), and a fine (3.6%). The more severe SBON decisions – such as surrender of license (2%), revocation (2.4%), and suspension (2.8%) – are less common, but can effectively end an NP’s career.

Risk Control Recommendations

Listed are some proactive concepts and behaviors to include in your customary nursing practice, as well as steps to take if you believe you may be involved in a SBON matter related to your practice of nursing:

  • Practice within the requirements of your state nurse practice act, in compliance with organizational policies and procedures, and within the national standard of care.
  • Document your patient care assessments, observations, communications and actions in an objective, timely, accurate, complete, and appropriate manner. If additional information related to the patient’s care emerges after you become aware that a SBON action is pending, discuss the need for additional documentation with your manager, the organization’s risk manager and your legal counsel.
  • Maintain files that may be helpful with respect to your character. Retain copies of letters of recommendation, performance evaluations, thank you letters from patients, awards, records of volunteer work and continuing education certificates.
  • Immediately contact your professional liability insurer if you become aware of a filed or potential professional liability matter against you, receive a subpoena to testify in a deposition or trial, and/or if you have any reason to believe that there may be a potential impingement on your license to practice.
  • Refrain from discussing the matter with anyone other than your defense attorney or the professionals managing your matter.
  • Promptly return calls from your defense attorney and other professionals involved in the matter. Contact your attorney or designated professional before responding to calls, e-mail messages or requests for documents from any other party.
  • Never testify in a deposition without first consulting your insurer or legal counsel.

In Summary

When a complaint is asserted against an NP to a SBON, NPs must be equipped with the resources to adequately defend themselves. Being unprepared may represent the difference between an NP retaining or losing their license. An NP’s license is their livelihood, so protecting it is paramount.
To download the complete report, please visit:

This article is provided for general informational purposes only and is not providing individual guidance. Readers shall be responsible for how they use the information and resources referenced in this article.