Yesterday, I discussed the liability risk nurse practitioners face when delegating clinical tasks to nurses, medical assistants, and others on the patient care team. Spreading out patient care responsibilities exposes nurse practitioners to medical malpractice liability. Understanding how to establish an effective supervisory relationship with coworkers mitigates this risk allowing patient care run smoothly. Here are a few practical tips nurse practitioners should implement in making day to day delegation decisions. 

1. Know your coworkers

State laws typically specify that healthcare providers should delegate exclusively to individuals who are properly trained and qualified to carry out the task. Graduating from a specific type of program or holding a healthcare license does not necessarily make one capable of practicing to their full scope. So, observe the nurses and medical assistants you work with. Become familiar with each individual’s level of competency before outsourcing patient care duties.

2. Familiarize yourself with state scope of practice laws 

Nurse practitioners must not only understand the laws outlining their own scope of practice, but also those of other members on the healthcare team. Before asking a medical assistant to assist with a procedure or provide patient education, make sure the task falls within that individual’s scope of practice as outlined by state law. Delegating outside of scope of practice guidelines can land nurse practitioners in legal trouble.

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3. If it seems like your job, it probably is

It may be tempting to train other employees to perform some of the more time consuming or tedious tasks you deal with as a nurse practitioner. But, use caution. Responsibilities requiring clinical judgment or decisions about diagnosis and treatment are best left to NPs, PAs, and MDs. If you aren’t familiar with scope of practice specifics and something seems like it’s your job, it probably is. Err on the side of caution.

4. Represent staff members correctly

State laws require that members of a healthcare team are referred to by their appropriate title. This means that you should not, for example, tell a patient a nurse will be coming to clean a wound, when the job will be performed by a medical assistant. Misrepresenting yourself or other staff members may result in disciplinary action.

5. Examine your malpractice insurance plan

Not only do scope of practice laws specify the types of tasks nurse practitioners may delegate, some malpractice carriers do as well. Liability insurance plans, for example, may require that nurse practitioners delegate patient care tasks only to medical assistants who hold a certain level of credentials.

6. Check your work

As a nurse practitioner, responsibility for patient outcomes ultimately falls on you. So, check your coworkers’ work. If you as a medical assistant to clean and dress a wound, for example, assess the wound once the wound care task is complete. Do the results measure up to your standards? If not, additional training and coaching may be in order. Follow up on the tasks you delegate to ensure they are complete and meet your expectations.

Nurse practitioners are right to fear litigation when it comes to being held responsible for the actions of others involved in patient care. Understanding the rules and regulations surrounding delegation, taking appropriate precautions, and familiarizing yourself with the skill level of individuals on your team helps mitigate this risk.


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