Nurse Practitioner License Protection Case Study: Failure to obtain authority to prescribe under state scope of practice

Nurse Practitioners and License Protection Case Study with Risk Management Strategies

Presented by NSO

A State Board of Nursing (SBON) complaint may be filed against a nurse practitioner (NP) by a patient, colleague, employer, and/or other regulatory agency, such as the State Department of Health. Complaints are subsequently investigated by the SBON in order to ensure that licensed NPs are practicing safely, professionally, and ethically. SBON investigations may lead to outcomes ranging from no action against the NP to revocation of the NP’s license to practice. This case study involves a family nurse practitioner (FNP).



The insured FNP had been practicing as a nurse for more than 20 years and practicing as an NP for approximately three years. The FNP and her husband were in the process of divorcing, so she moved herself and her three children to a neighboring state in order to be closer to her aging parents. The FNP applied for licensure in the new state and opened a new family medicine clinic as an FNP and practice administrator under a Temporary Advanced Practice Permit.

The FNP was distracted by her move, her new practice, her family, and her divorce. During this time, she inadvertently overlooked the results of her certification exam. The FNP felt good about the test and assumed that her results were reported to the SBON.

Following a patient complaint, the SBON opened an investigation into the conduct of a registered nurse who was an employee of the insured FNP at her family medicine clinic. The FNP failed to consult an attorney during the investigation of her employee, and she failed to respond to a request by the SBON for critical documentation in a timely manner. As a result, the SBON asserted that the FNP was withholding information and opened an investigation into the insured’s conduct.

SBON investigators found that, while working as an FNP/administrator at the family medicine clinic, the FNP failed to notify the SBON that she failed to pass the state certification exam for FNPs. Although she was working under a Temporary Advanced Practice Permit, the FNP did not complete all of the requirements necessary to practice. The FNP had continued to assess, diagnose, treat, and prescribe medications to patients for several months after her temporary permit expired, during which time she was licensed solely as an RN.



The SBON ruled that the insured FNP practiced beyond the scope of her license and prescribed medication without prescriptive authority. As a result, her RN license and her Temporary Advanced Price Permit were suspended for 3 months, following which she was placed on probation for 3 years.

After notifying her home state SBON that her license had been suspended by a neighboring state, the FNP’s home state opened its own investigation into the FNP’s conduct. Given the action taken by the other SBON, the SBON for the FNP’s home state considered revoking the FNP’s license. The FNP decided to voluntarily surrender her licenses to practice nursing in her home state in order to retain the privilege to petition for reinstatement of her RN or APRN license in that state at a later date.

The total expenses paid to defend the insured’s licenses in these two SBON matters was $25,000.


Risk Management Recommendations

  • Know and comply with the licensing requirements in the state(s) where you practice. Nurse Practice Acts and administrative rules vary from state to state, and some may have additional licensure requirements for endorsement.
  • Know the parameters of your state’s/states’ Nursing Scope of Practice Act(s), and your employer’s policies and procedures, related to medication prescribing and/or administration. 
  • Maintain files that can be helpful with respect to your character. Retain copies of letters of recommendation, performance evaluations, thank you letters from patients, awards, volunteer records, and CE certificates.
  • Never ignore a subpoena, whether it involves releasing clinical records, appearing for a deposition or testifying in court. Failure to respond to a subpoena may result in fines, penalties or waiver of your rights.



These are illustrations of actual claims that were managed by the CNA insurance companies.  However, every claim arises out of its own unique set of facts which must be considered within the context of applicable state and federal laws and regulations, as well as the specific terms, conditions and exclusions of each insurance policy, their forms, and optional coverages. The information contained herein is not intended to establish any standard of care, serve as professional advice or address the circumstances of any specific entity. These statements do not constitute a risk management directive from CNA. No organization or individual should act upon this information without appropriate professional advice, including advice of legal counsel, given after a thorough examination of the individual situation, encompassing a review of relevant facts, laws and regulations. CNA assumes no responsibility for the consequences of the use or nonuse of this information.

This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. This information is provided for general informational purposes only and is not intended to provide individualized guidance. All descriptions, summaries or highlights of coverage are for general informational purposes only and do not amend, alter or modify the actual terms or conditions of any insurance policy. Coverage is governed only by the terms and conditions of the relevant policy. Any references to non-Aon, AIS, NSO, NSO websites are provided solely for convenience, and Aon, AIS, NSO and NSO disclaims any responsibility with respect to such websites. This information is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information.

Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc., a licensed producer in all states (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc., (CA 0G94493), Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.


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