Legal Implications of Nursing: What Every Nurse Needs to Know

By Dianne Harris, EdD, MSN, RN, CNE 

In today's healthcare environment, understanding the legal responsibilities of nursing practice is more critical than ever. With sentinel events continuing to occur in healthcare settings and high-profile cases making headlines, nurses must be vigilant about their professional obligations and the potential legal consequences of their actions—or inactions. 

Can Nurses Be Sentenced for Malpractice? 

The short answer is yes. Nurses can face both civil liability and, in extreme cases, criminal charges for malpractice and

Scales of Justice

negligence. Understanding the distinction between these two concepts is essential for every practicing nurse. 

Nursing Negligence vs. Malpractice 

While these terms are often used interchangeably, they have distinct meanings in the legal context: 

Nursing Negligence refers to the failure to provide the standard of care that a reasonably prudent nurse would provide in similar circumstances. It involves unintentional errors or omissions that result in patient harm. 

Nursing Malpractice is a form of professional negligence that occurs when a nurse fails to meet the accepted standard of care, resulting in injury to a patient. Malpractice specifically involves professional misconduct or unreasonable lack of skill in the performance of professional duties. 

Understanding Sentinel Events 

According to The Joint Commission, a sentinel event is a safety event that reaches a patient and results in death, permanent harm (regardless of severity), or severe harm (regardless of duration). Importantly, this definition excludes outcomes resulting from the natural course of illness or an underlying condition. 

Categories of Sentinel Events 

The Joint Commission also considers the following situations as sentinel events: 

• Abduction of any patient 

• Discharge of an infant to the wrong family 

• Any elopement (unauthorized departure) leading to harm or death 

• Neonatal hyperbilirubinemia ≥ 30 mg/dL 

• Unanticipated death of a full-term infant 

• Homicide of any individual within the organization 

• Self-inflicted injurious behavior while in a healthcare setting or within 7 days after discharge from inpatient, behavioral health, or emergency department services 

Top Ten Sentinel Events in 2023 

Based on The Joint Commission's 2023 annual review, the leading sentinel event types were: 

1. Falls - The most frequent sentinel event 

2. Wrong surgery 

3. Unintended retention of a foreign object 

4. Assault, rape, sexual assault, or homicide 

5. Delay in treatment 

6. Suicide 

7. Fire or burns 

8. Medication management 

9. Perinatal events 

10. Self-harm 

Falls consistently remain the number one sentinel event, highlighting the critical importance of fall prevention strategies in healthcare settings. The data shows a concerning trend in patient falls over recent years, making this a priority area for nursing vigilance. 

Patient Harm Outcomes 

The 2023 data reveals that sentinel events continue to result in serious patient harm, with death being a frequent outcome. These statistics underscore the vital importance of maintaining high standards of care and adhering to established safety protocols. 

The Four Key Elements of Nursing Malpractice and Negligence 

For a successful malpractice or negligence claim to be established, four key elements must be proven: 

1. Duty: The nurse accepts responsibility for the patient and a nurse-patient relationship exists 

2. Breach: The standard of care was not met due to the nurse's action or inaction 

3. Causation: The injury was the result of the nurse's breach 

4. Damages: The injuries sustained warrant compensation 

All four elements must be present for a claim to succeed. If even one element is missing, the case typically fails. 

Real-World Cases: Learning from Breach of Duty 

Case Study #1: The Fall Risk Assessment Failure 

An 87-year-old female was admitted with dizziness, nausea, unsteady gait, and a history of four falls at home that day. She was determined to be at risk for falls, but no formal fall scoring system was completed. Additionally, there were no functioning bed alarms in the facility—a situation that had persisted for an entire year. 

On day five of her admission, the patient was found on the bathroom floor. She was taken to the emergency room, evaluated by a neurosurgeon, underwent x-rays, was intubated, air-transferred to a higher level of care, and expired the following day due to an intracranial bleed. 

The family filed a lawsuit alleging nursing malpractice for failure to utilize a formal fall risk assessment. 

Result: The court entered judgment for the defendant hospital because the plaintiff's expert did not demonstrate that the standard of care was breached. This case illustrates that even when outcomes are tragic, malpractice must be proven through demonstration of a breach in the standard of care. 

Case Study #2: The Unrecognized Post-Fall Injury 

A patient was in the recovery room following knee surgery and sustained a fall from bed. Three days later, the patient reported a clicking sound and pain. The nurse documented the symptoms but did not report them to the provider. One week later, a physical therapist reported the complaints to the provider. 

The provider identified a previously undiagnosed nondisplaced left tibial fracture that had avulsed, requiring two additional surgeries. The patient became disabled, wheelchair-confined, and suffered chronic pain. 

A lawsuit was filed claiming negligence and asserting a claim for loss of consortium on behalf of the spouse and family—the loss of companionship, conjugal relations, support and services, and marital quality. 

Result: The jury awarded damages totaling $2,391,620, consisting of: 

• $791,620 for future medical care 

• $800,000 for past noneconomic damages 

• $500,000 for future noneconomic damages 

• $300,000 for loss of consortium 

This case demonstrates the critical importance of proper communication with providers and the potential for massive financial liability when nursing responsibilities are not fulfilled. 

Case Study #3: The Fatal Medication Error 

This high-profile case involves an emergency room nurse who was also serving as the "help all" nurse while orienting a new nurse. She was called to administer Versed in radiology for a patient undergoing a PET scan. 

Several system failures contributed to the tragic outcome: 

• The medication cabinet was programmed to display only generic names, leading to an initial override 

• The nurse retrieved vecuronium instead of Versed 

• Barcode scanners were not available in the radiology department 

• No second nurse witnessed the administration 

• No post-administration monitoring was conducted 

The patient was found unresponsive, a code was called, and the patient expired the following day. 

Result: The nurse was found guilty and convicted of criminal negligent homicide and abuse of an impaired adult due to harm that resulted in the death of a patient. The nurse was terminated, her license was rescinded, and she was sentenced to three years of supervised probation. 

This case shocked the nursing community and raised important questions about individual accountability versus system failures. It also demonstrated that in extreme cases, nurses can face criminal charges, not just civil liability. 

Recognizing Breach vs. No Breach 

Understanding what constitutes a breach of duty is essential. Let's examine several scenarios: 

No Breach Scenario 

A nurse receives report on five patients following a handoff of duties. In the middle of the shift, the nurse resigns and departs the facility immediately. 

While this is unprofessional and abandonment of duty, if no harm comes to patients as a result, there is no malpractice (though there are certainly professional and employment consequences). 

Potential Breach Scenario 

A nurse documents: "Bed in low position and call light within reach. Patient is high risk for falls." However, the nurse fails to document that side rails were raised. 

This represents a potential breach because complete documentation of safety measures is essential. While side rails may have been raised, the lack of documentation could create liability if an adverse event occurs. 

Clear Breach Scenarios (Duty and Harm) 

Medication Administration Error: A nurse administers newly prescribed lisinopril and documents: pulse 78, respirations 20, temperature 98.3°F, and pain = 2 (1-10). One hour later, the patient experiences a syncopal episode, sustains a femur fracture, and is taken to surgery for repair. 

The breach here is the failure to assess and document blood pressure before administering an antihypertensive medication. This omission directly contributed to the patient's fall and injury. 

Inadequate Monitoring: A patient admitted for Guillain-Barré Syndrome had a care plan that included respiratory assessments and tracheostomy care every 2 hours and as needed. On day 2, the patient was found unresponsive without a pulse and respirations and expired. The nurse's documentation revealed assessments at 0800 and 1600, but then nothing until 2000 when the patient was found unresponsive. 

This represents a clear breach of duty. The 4-hour gap in assessment and documentation, combined with the patient's high-risk condition, demonstrates failure to meet the standard of care. The patient's death was potentially preventable with appropriate monitoring. 

Key Takeaways for Nursing Practice 

1. Document thoroughly and accurately: If it's not documented, legally it didn't happen. Complete documentation protects both patients and nurses. 

2. Follow established protocols: Standards of care exist for a reason. Deviating from established protocols increases liability risk. 

3. Communicate effectively: Report changes in patient condition promptly to providers. Failure to communicate can result in delayed treatment and patient harm. 

4. Advocate for system improvements: If you identify safety hazards (like non-functioning bed alarms), document your concerns and escalate through proper channels. 

5. Never skip safety checks: The extra 30 seconds it takes to check a blood pressure before giving an antihypertensive or to verify a medication through barcode scanning can prevent catastrophic outcomes. 

6. Maintain competency: Stay current with evidence-based practice and continue your professional education. 

7. Practice within your scope: Know your limitations and seek assistance when needed. 

The Learning Opportunity 

As Henry Ford wisely stated, "The only real mistake is the one from which we learn nothing." 

Every sentinel event, every near-miss, and every adverse outcome provides an opportunity for learning and improvement. Rather than fostering a culture of blame, healthcare organizations must focus on system improvements while still maintaining individual accountability. 

For nurses, this means remaining vigilant, following established protocols, documenting thoroughly, communicating effectively, and always putting patient safety first. Understanding the legal implications of nursing practice isn't about practicing defensively out of fear—it's about providing the highest quality, safest care possible for every patient, every time. 

The cases presented here serve as sobering reminders that nursing actions—and inactions—have real consequences. By learning from these examples and maintaining unwavering commitment to professional standards, nurses can protect both their patients and their professional licenses. 

For additional information, please visit:

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December 14, 2025