Nurse practitioners: Texas law and medical malpractice

Nurse practitioners are mid-level providers that are an increasingly common part of medical care, both in office practices as well as hospitals.

While many people may be most familiar with nurse practitioners providing primary care, they also participate in other specialty areas, including post-operative care for surgical patients.

Under Texas law, the Nursing Practice Act refers to nurse practitioners as Advanced Practice Registered Nurses (APRNs). While nurse practitioners are allowed to see patients independently, the Nursing Practice Act requires them to have a written collaborative practice agreement with at least one medical doctor.

These practice agreements delegate physician authority to an APRN to make medical diagnoses and prescribe medications. In Texas, a physician may supervise up to seven nurse practitioners. The law also requires periodic face-to-face meetings between APRNs and their delegating physicians to discuss patient care.

As you might imagine, there has been considerable tension between physician associations and nurse practitioner groups over their respective scopes of practice. Nurse practitioners have aggressive lobbyists who advocate for “full practice authority” through the removal of the requirement of collaborative agreements. In other words, the goal of the nurse practitioner movement is for nurse practitioners to be able to practice medicine with “no strings attached,” meaning without any physician supervision.

Education and experience

At a minimum, nurse practitioners have earned a master’s degree in a nursing program, in addition to meeting the qualifications to obtain a registered nurse (RN) license.

Nurse practitioners going into a primary care field typically have 500 to 1,500 hours of clinical training by the time they began seeing patients on their own.

In comparison, primary care physicians have completed an undergraduate degree, four years of medical school, and residency training of three to four years. By the time these primary care doctors start seeing patients independently, they typically have 12,000-16,000 hours of patient care training.

Nurse practitioner medical malpractice

As a Houston, Texas medical malpractice lawyer, I continuously handle cases where nurse practitioner care was involved. When I take the deposition of nurse practitioners in these cases, they typically take the approach that they play “second fiddle” to physician care and are almost totally reliant on input from their supervising doctor in order to make any treatment decision.

On other occasions, though, nurse practitioners testify that they are basically running the show. I recently deposed a nurse practitioner at Mainland Medical Center, in Texas City, Texas. This bedsore (decubitus ulcer) medical malpractice case involves a patient who was admitted to the hospital’s inpatient rehabilitation unit following a total knee replacement.

Through the process of written discovery in the lawsuit, I obtained a copy of the nurse practitioner’s practice supervision agreement. During the relevant time period, she had entered into an agreement with nine different physicians from various specialties. In my client’s case, she participated in the care both as a wound care consultant and, separately, covered for the physical medicine and rehabilitation physician.

The nurse practitioner cleared the patient for discharge from the hospital’s inpatient rehabilitation unit. Within 24 hours, he was admitted to another facility and found to have a very serious sacral pressure ulcer that required immediate surgery. He faced 100 days of admissions to hospitals or skilled nursing facilities.

The medical and nursing expert witnesses that we retained to review the care provided to our client in this case concluded that the nurse practitioner made the wrong diagnosis and treatment for this patient.

This type of criticism is typical for medical malpractice claims against nurse practitioners.

A medical malpractice insurance company recently completed a study of closed claims involving allegations of negligence against nurse practitioners. The study indicated that 48% of claims against nurse practitioners or diagnosis related, alleging the failure, delay, or wrong diagnosis. Treatment-related negligence claims account for another 16% of medical malpractice lawsuits against nurse practitioners.

Information in the study went even further.

The top diagnosis related nurse practitioner claims include myocardial infarction (heart attack), colon cancer, breast cancer, lung cancer, pneumonia, pulmonary embolism/infarction, and sepsis/SIRS.

The study also analyzed the most common medical malpractice claims against nurse practitioners by patient injury. The top injury was death, accounting for 33% of claims. The next spot, at 22% each, was tied between adverse medication reactions and malignancy. Respectively, the next most common patient injuries include need for surgery, hospitalization, infection, cardiac or pulmonary arrest, emotional trauma, embolism/thrombosis, heart or brain infarction, reduced life expectancy, metastasis, need for ambulatory care, and sensory impairment.

We are here to help

If you have been seriously injured by care provided by nurse practitioner or a physician, call the experienced medical malpractice attorneys at Painter Law Firm PLLC, in Houston, Texas, at 281-580-8800, for a free consultation about your potential claim.


Robert Painter is a medical malpractice and wrongful death lawyer at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence lawsuits against hospitals, doctors, nurse practitioners, and other healthcare providers. In 2017, H Texas magazine named him as one of Houston’s top lawyers. In the same year, the Better Business Bureau honored Painter Law Firm with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.