Three things decide what happens to a nurse after something goes wrong: what was delegated and to whom, what the record shows, and who carries the liability. They are usually discussed separately and they are the same subject.
Delegation
Delegation is transferring the performance of a task to someone else while retaining accountability for the outcome. The national guidelines produced jointly by the regulators' organisation and the American Nurses Association set out the structure.
Two roles matter. The employer decides which tasks may be delegated at all, through policy consistent with state law. The delegating nurse decides whether this task, for this patient, at this moment, may go to this person.
The delegating nurse assesses the patient's needs and stability, the complexity of the task, the competence of the person receiving it, and the supervision available. The person receiving the task must have demonstrated competence, not merely have been trained at some point. And the nurse remains accountable for the nursing judgement even though the other person is accountable for their own actions.
The consequence is the sentence every board says in some form: the nurse cannot delegate assessment, nursing judgement, or evaluation of the outcome. Those are the licence.
What may be delegated in practice varies by state and by setting, which is why an assistant who performs a task in one state may not in another. See scope of practice, levels of nursing and state boards of nursing.
Documentation
The record serves four masters at once: continuity of care, billing, regulation, and evidence. Nurses write it for the first and are judged on it by the fourth.
Three principles recur in board findings and in litigation.
If it is not recorded, proving it happened is difficult. This is a statement about evidence rather than about reality, and it is why the maxim is usually phrased too strongly. A nurse who charted nothing may still testify, but a contemporaneous note is worth more than a recollection years later.
Late entries are legitimate and alterations are not. Adding an entry that is labelled as late and timed accurately is normal practice. Changing an existing entry, or writing over one, converts a defensible case into an indefensible one faster than the underlying error would have.
Copying forward is the modern hazard. Electronic records make it easy to carry an assessment from one shift to the next, which produces a chart that shows a patient who never changed while their condition did.
Liability
Nursing malpractice claims turn on four elements: a duty to the patient, a breach of the standard of care, causation, and damages. The standard of care is what a reasonably prudent nurse with similar training would have done in similar circumstances, established through practice standards, employer policy and expert testimony.
Most claims against nurses fall into a small number of patterns: failure to monitor or to recognise deterioration, failure to escalate to a physician, medication error, falls, and documentation that does not support the care described.
Payments made on malpractice claims against licensed practitioners are reported to the National Practitioner Data Bank, and its public use data file is where researchers get the underlying counts.
Insurance, and the argument about it
Employers carry liability insurance that covers nurses acting within the scope of their employment. That coverage protects the employer's interest, which is aligned with the nurse's most of the time and not always: an employer may settle in a way that leaves the nurse named, or take a position in which the nurse is the one who failed.
Individual professional liability policies are inexpensive and cover the nurse rather than the employer. The point most often missed is that they typically include licence defence coverage for board proceedings, which is a separate and more likely risk than being sued. A board complaint is the thing most nurses will actually face. See peer assistance and licence trouble.
The argument against personal coverage, that it makes a nurse a more attractive defendant, is widely repeated and thinly evidenced. The argument for it is concrete: the employer's lawyer is not the nurse's lawyer.
Where the two systems diverge
A malpractice case is about compensating a patient. A board case is about protecting the public by acting on a licence. They run on different tracks, at different times, with different standards of proof, and one can end without affecting the other.
That divergence is why nurses are advised not to give a board a full narrative account on the assumption that being helpful will end it. See nurse workplace rights.
Related
- Scope of practice
- Levels of nursing
- Nurse practice acts and boards of nursing
- Peer assistance and licence trouble
- Nurse workplace rights
- The nursing process
Sources
- National guidelines for nursing delegation. National Council of State Boards of Nursing and American Nurses Association. Accessed September 9, 2026.
- Delegation. National Council of State Boards of Nursing. Accessed September 9, 2026.
- National Practitioner Data Bank and its public use data file. Health Resources and Services Administration. Accessed September 9, 2026.
- Nursing: scope and standards of practice. American Nurses Association. Accessed September 9, 2026.