Overview

Negligence is a failure to act as a reasonably prudent person would; malpractice is professional negligence — negligence committed by someone with a professional duty of care. To prove nursing malpractice, all four elements must be established: duty, breach, causation, and damages. Miss one link and the claim fails. The standard is peer-based: what a reasonably prudent nurse with similar training would do in the same situation — not merely what a facility protocol requires. An outdated protocol does not shield a nurse if it falls below the professional standard.

The four elements of malpractice — all four must be proven

DutyA nurse-patient relationship existed, creating an obligation to meet professional standards
BreachFailure to act as a reasonably prudent nurse would (deviation from standard of care)
CausationThe breach directly caused the patient's injury — not just that harm occurred
DamagesActual harm resulted — physical, emotional, or financial

Interpretation

Distinguish unintentional torts (negligence/malpractice) from intentional torts. Malpractice requires an unintentional breach of the standard of care; intentional torts require a deliberate act. A deliberate act against a patient's wishes is an intentional tort, NOT negligence — even when therapeutic intent is present.

During — Monitoring

Medication errors

e.g., giving a drug without checking allergies or the wrong dose

Falls

e.g., failure to raise side rails or address fall risk

Failure to assess or monitor

Missing a critical change in the client's condition

Failure to communicate

Not notifying the provider of significant findings

Failure to document

No factual record of assessments and interventions

Failure to follow policy

Deviating from accepted standards of care

Patient Teaching

Meet the standard of care

Act as a reasonably prudent nurse — the nurse's strongest defense

Document factually and timely

Objective, real-time entries of findings and actions

Avoid late or defensive entries

Reconstructed or self-protective charting raises suspicion

Never reference incident reports in the chart

Internal risk-management documents; charting one makes it discoverable

Incident report documents facts

Not an admission of liability

Personal malpractice insurance

Separate from employer coverage; protects the individual nurse

Report Nowescalate immediately

Event causing or risking patient harm Hallmark

e.g., wrong-dose medication discovered after administration

Ensure patient safety first

Assess the client for adverse effects before any administrative step

Notify the provider

So corrective orders can be initiated promptly (e.g., protamine for heparin)

Complete an occurrence report

After the client is assessed and provider notified

Document objectively

Factual record of the event, response, and times

Clinical Pearl

Duty -> Breach -> Causation -> Damages: like a chain, break one link and the malpractice claim falls apart. A bad outcome alone is never enough — thorough assessment, communication, and factual documentation are the nurse's best defense.

Malpractice, Negligence & Liability

Overview

Interpretation

During — Monitoring

Patient Teaching

Every nurse carries personal legal liability for patient harm — and "I was just following orders" is not a defense. Knowing the four elements of malpractice can protect your license and your patient.

Key Distinctions

Clinical Pearl

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