The nurse practitioner profession began in 1965 in response to the increased patient load generated by the introduction of Medicare. It has grown to well over 125,000 practitioners and continues to increase by an estimated 6,000 new practitioners a year. However, this growth is not without controversy and concerns. The definition of nurse practitioner is left to the states. Nursing organizations handle accreditation issues.

At the present time, there is a push to expand the services nurse practitioners may provide because of the lack of health care services in rural and inner city areas. However, this push is causing the American Medical Association to push back. It contends that the state-by-state approach and alternate accreditation methods do not work, especially where nurse practitioners do not limit themselves to rural and inner city care, resulting in their expanding into specialties that pay more.

This specialty is expected to grow at a rate of at least 22% over the next 10 years but the actual rate may be considerably higher.

Nurse practitioners are registered nurses with advanced degrees who have taken and passed accreditation exams in their selected specialties. Nurse practitioners used to be simply adjuncts to physicians in the family care specialty. They soon expanded to OB/GYN and now practice in specialties as diverse as acute care, oncology, geriatrics, and pediatrics, to name a few.

The role of the nurse practitioner continues to expand, the most recent of which is into urgent care treatment centers. These centers may be stand-alone facilities or clinics within a drug store. They provide stop-gap care for individuals who can't get appointments with their primary care physician. In some cases, they are a family's primary care facility.

Here is a possible scenario:

Presley and Mavis go to the urgent care clinic at their local drug store. Both present cold-like symptoms including body aches, sneezing, coughing, and tightness of the chest. In addition, Mavis has a slight temperature and is experiencing chills. Chris, the nurse practitioner, diagnoses both with colds and recommends rest, plenty of fluids, and acetaminophen for the fever. Chris also asks them to call if the fever persists. Four hours later, Mavis' temperature spikes at 105 degrees and she begins convulsing. She is rushed to the emergency room where she is diagnosed with H1N1 and is hospitalized for three days. Mavis sues Chris for the costs of the hospital stay and the mental distress she endured because of an incorrect diagnosis.

According to our experts, the major carriers that provide coverage for nurse practitioners are Evanston, CNA, USLI, Admiral, Fireman’s Fund, Hiscox, MedPro, Markel, RSUI, Nurses Service Organization and Healthcare Providers Service Organization. According to Richard J. Sullivan, Jr. chief executive officer at CM&F Group, Inc., AIG was a major player until recently.

According to Don Tejeski, senior vice president at AmWINS Healthcare, coverage is written on both an admitted and nonadmitted basis, on both occurrence and claims-made forms. Beginning in 1987, nurse practitioner policies were occurrence-based and on an admitted basis, according to Mr. Sullivan. As time went on and their losses tracked with those of other health care delivery systems, the occurrence approach was re-examined and many carriers adopted the claims-made approach. Now that the market is more stable, it is more of a blend of the two but he believes that occurrence-based coverage is the preferred option.

Nurse practitioners are involved in many different health care disciplines. As a result, there is no one set market or premium for the entire category. Joseph Schneider, professional liability manager of Jimcor Agencies, explains, “Nurses who specialize in more difficult areas of practice go to the wholesale level markets. Examples are OB/GYN and pediatric." Mr. Sullivan says, “There is a trend among competitors to not write coverage for self-employed advanced practice nurses. They prefer to write those employed by hospitals.”

The frequency and severity of losses varies according to the type of practice. According to Tony Armor, commercial underwriter at Roush Insurance Services, Inc., "Nurse practitioners within the family practice and adult/geriatric areas tend to have more frequency issues, probably due to the fact that these practitioners most often provide health care services on a primary care basis and see more patients.” Mr. Schneider and Mr. Tejeski agree that OB/GYN is where claims are historically more severe than in other areas.

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