The Elements of Malpractice in Nursing

I solemnly pledge myself before God and in the presence of this assembly

to pass my life in purity and to practice my profession faithfully.

I will abstain from whatever is deleterious and mischievous, and will not

take or knowingly administer any harmful drug.

I will do all in my power to maintain and elevate the standard of my profession

and will hold in confidence all personal matters committed to my keeping

and all family affairs coming to my knowledge in the practice of my calling.

With loyalty will I aid the physician in his work, and as a missioner of health,

I will dedicate myself to devoted service for human welfare.

So as the 1935 revised version of the Florence Nightingale Pledge goes.

As nurses, it is our duty to help save lives. However, even as we struggle to fulfill that aim, there are instances that stop us from doing so and instead of helping our patients recover, we may even end up harming them. Some might take this lightly, reasoning out that a single simple mistake wouldn’t make much difference, but this should not be the case as even the littlest of mistakes can result to serious and even life-threatening consequences.

But how does one identify nursing malpractice? How will you be able to know if someone is already committing one? And how can one file anything against another? Below are the four common elements of nursing malpractice that must be satisfied before filing anything:

  • Duty
  • Breach of duty
  • Damages
  • Causation



Nursing duty includes interpreting and following physician’s orders and a duty undertaken must be performed correctly.

A duty must have been owed to a patient by a healthcare practitioner charged with that patient’s care. The doctor-patient relationship is a common example of a situation where that duty would exist.

Breach of Duty

The healthcare practitioner who had the duty of care for that patient must have failed in his/her duty by not exercising the degree of care or medical skill that another healthcare professional in the same specialty would have used in an equal situation. (This is when an expert is often called in to testify as to what an appropriate standard of care would be.)


Damages occur as a result of the breach. The patient must have suffered emotional or physical injury while in the care of the healthcare practitioner. The injury can be a new one, or an aggravation of an existing injury.

For example, the patient falls out of that bed and breaks an arm, incurring damages. If the patient falls but is not injured, no damages occur.  This may be poor patient care, but does not satisfy the element of damages.


There must be solid proof that the breach of duty by the healthcare practitioner caused the patient’s injury.

For example, a fentanyl and Marcaine epidural was ordered during labor. The mother received a mislabeled epidural of morphine, resulting in an overdose. This necessitated Narcan reversal for the baby. No expert was able to determine that “but for the mother’s overdose,” the baby would not have subsequent developmental issues. In this case, causation is not satisfied.

The burden of proof is on the plaintiff, the party with the complaint. If any of the four elements is not satisfied, malpractice is not proven. With this knowledge about the four elements of nursing malpractice, you, the nurse, may be able to protect yourself from unjustified claims of medical malpractice in the nursing profession.



Liane Clores, RN MAN

Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.

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