A recent review of MDU nurse files over the last five years highlighted the top reasons for complaints against MDU nurse practitioner members.

While it's inevitable that most nurse practitioners will face a complaint at some point in their career, there are steps you can take to minimise the risk.

Remember, MDU members can contact us for advice at any time.

Refer patients to a medical colleague if the diagnosis is unclear

With the prevalence of complaints against nurse practitioners alleging wrong or delayed diagnosis, careful history-taking and examination is essential in reaching an accurate diagnosis.

Clearly communicate with patients

Numerous complaints were directly about poor communication, or a perceived uncaring attitude of the nurse practitioner. Many more cases included alleged communication failings. Always take care to explain what you are doing and why, and check the patient has understood.

Take particular care when providing safety netting advice such as under what circumstances and timeframe the patient should seek further medical care.

Keep up to date and ensure you work within your level of competence

Clinical errors including prescribing errors are easily made and reasonably common. Ensure you are aware of and follow local and national guidelines as well as practice policies and procedures.

If unsure, seek advice from your colleagues or refer for further investigation or treatment.

Respect patient confidentiality

Confidentiality is easily breached inadvertently. Don't discuss patients where you might be overheard, or leave written records where they might be seen. Do not assume that a competent child or adult would be happy to share information with a close family member or spouse. Avoid leaving messages on answer machines or voicemail unless you have specific consent from the patient to do so.

Don't share information about patients on social media, even if the details seem to be unidentifiable. Take special care if communicating by email with patients, ensuring you follow practice policy.

Get informed consent

Always ensure you explain fully what you intend to do before examining a patient, prescribing, performing a procedure, or referring. Tell patients about the risks, benefits and alternative options open to them, including the option of doing nothing, so that the patient can make an informed choice.

Offer a chaperone for intimate examinations regardless of whether the patient and nurse are the same or different genders. This is in line with local and national guidance, and record in the notes full details of your discussions .

Keep detailed records

Accurate and detailed records are essential for good clinical care, but they are also vital when responding to a complaint or claim. Make sure you keep a record of all your discussions with patients including those over the phone.

Include negative as well as positive findings such as an absence of fever or neck stiffness. You have an ethical and legal responsibility to ensure the records are detailed and accurate.

Check your indemnity

It's important to take individual responsibility for your own indemnity and ensure you keep the MDU up to date with the type of work you are doing. This is in line with the NMC requirement to have 'an appropriate indemnity arrangement in place relevant to your scope of practice '. Doing so will give nurses in more advanced roles the peace of mind to know they can ask for our assistance if they find themselves facing a complaint or claim.

What to do if something goes wrong

If you become aware of a potential problem, here's our advice.

Be open and honest. Apologise to the patient where appropriate and explain what has happened, and what can be done to rectify things.
Document carefully in the records what has happened, and what you have explained to the patient.
Log any incident in accordance with your employer's policies, which should comply with the statutory duty of candour.
Reflect carefully on what has happened and see what you can learn, for example by discussing with a colleague. Document your reflections and any additional learning or CPD you do as a result in your appraisal folder and discuss at your next appraisal. NHS England has devised an 'e-form' for general practice staff (currently being beta tested) to submit patient safety incident reports to the National Reporting and Learning System (NRLS), the NHS national patient safety incident database.
Take an active part in dealing with any complaints process.
If you're unsure what to do or need advice, contact your medical defence organisation.

Minimising complaints risk for nurse practitioners

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