Nursing Negligence 101: What It Is, How It Happens, and What to Do About It 

Medication Errors

Medication errors are one of the most common and serious forms of nursing negligence. Nurses are often the final checkpoint in the medication administration process, which makes attention to detail critical.

Negligence related to medication errors can occur in several ways:

• Administering the wrong drug or dosage
• Giving a medication to the wrong patient
• Missing or skipping doses
• Administering medications at incorrect times
• Failing to check for known allergies or interactions

Medication errors often stem from distractions, understaffing, or a breakdown in communication. But regardless of the cause, nurses are expected to follow safety protocols like scanning barcodes, double-checking identifiers, and asking questions when orders seem unclear.

Example Scenario:

A nurse is managing a busy hospital floor and accidentally gives a patient their roommate’s pain medication. The error isn’t caught until the patient begins showing signs of respiratory depression. Although the nurse didn’t intend harm, this is a clear case of negligence. The nurse had a duty to verify the medication but failed to follow the six rights of medication administration. That failure directly led to the patient being harmed.

Key Takeaway:

Nurses can protect themselves by slowing down (even when under pressure) and sticking to institutional protocols, especially when it comes to medications.

Failure to Monitor or Respond to Changes

Nurses are often the first to notice when a patient’s condition changes. Failing to monitor or respond to those signs can cause treatment delays that may lead to poor outcomes. Whether it’s forgetting to take vital signs, dismissing a patient’s reported symptoms, or simply failing to follow up or send details to a physician as quickly as you should, this form of negligence can be difficult to defend. If your documentation is incomplete or unclear, arguing your side of the story becomes even more challenging.

Common instances of this type of negligence include:

• Missing early signs of infection, stroke, or internal bleeding
• Failing to follow up on abnormal vitals or lab results
• Not escalating care when a patient’s status deteriorates
• Ignoring or dismissing a patient’s complaints

Example Scenario:

An exhausted nurse on the night shift receives a post-op patient who reports chest tightness and shortness of breath several hours after arriving on the unit. The nurse acknowledges the complaint but doesn’t document it or notify the physician because they assume it’s post-surgical anxiety.

Since they have an assignment with six other patients, they don’t return to check on the patient until the next scheduled assessment.

Hours later, the patient goes into cardiac arrest and cannot be revived. The nurse’s failure to escalate care or perform further monitoring will likely be considered negligence, especially if earlier intervention could have changed the outcome.

Key Takeaway:

Patient monitoring should be ongoing. When a patient’s condition changes, that should be quickly documented, communicated to a provider, and followed up on. Timely responses can save lives and protect your license.

Inadequate Patient Communication or Education

Clear, compassionate communication is essential to safe nursing care. When patients leave the hospital or clinic without understanding their treatment plan or medication regimen, the results can be dangerous.

The same is true when they are in the hospital. For instance, if a patient doesn’t know they should fast, they might have a necessary surgery delayed. Or if someone in an in-patient situation is a fall risk and hasn’t been told about relevant safety measures and procedures, they could injure themselves trying to get to the bathroom because they didn’t know to hit the call light for assistance. In some cases, liability may fall on the nurse who failed to educate them.

Negligence in communication can look like:

• Giving vague or incomplete discharge instructions
• Failing to explain medication side effects or usage
• Ignoring language barriers or hearing impairments
• Not confirming patient understanding of their care plan
• Failing to document that education was provided and how it was communicated

Example Scenario:

A newly diagnosed diabetic patient is discharged with a prescription for insulin. The nurse assumes someone else explained how to use the prescribed insulin pen but never asks if the patient understands how to use it. Or, a nurse doesn’t have their patient perform a return demonstration to show the nurse they are capable of injecting their medication.

Two days later, the patient is admitted to the ER with life-threatening hypoglycemia after administering too much insulin because they were confused about the instructions. The nurse’s failure to assess their understanding before discharge and provide adequate education is a clear lapse in duty.

Key Takeaway:

Education is an irreplaceable part of nursing care. Always assess your patient’s understanding, use plain language, and document the education you provide. Be sure a translator or interpreter is present when working with patients who need them. Never assume they know something just because they don’t ask questions.

Poor or Missing Documentation

Accurate, timely documentation is one of the most frustrating parts of being a nurse. When you have a busy day, you’d probably much rather spend time providing hands-on patient care.

However, documentation isn’t just paperwork. It is a legal record of patient care and is one of the best tools nurses have to defend themselves if something goes wrong. Additionally, incomplete or missing notes can lead to miscommunications that result in duplicated medications, delayed treatments, and serious liability issues. If a patient suffers harm and there’s no written proof of what you did (or didn’t do), you could face repercussions.

Documentation negligence might include:

• Failing to chart assessment findings, interventions, or patient complaints
• Recording care after the fact without accurate timestamps
• Using vague, subjective language (e.g., “the patient seems fine”)
• Not noting a patient’s refusal of care or deviations from orders

Example Scenario:

A nurse administers a pro re nata (generally called PRN, or as-needed) opioid pain medication but forgets to document it. During shift change, the patient asks the incoming nurse for something to help with his pain. Seeing no record, the nurse gives another dose.

Soon after, the patient experiences severe sedation and labored breathing. When the hospital investigates, they find no documentation to verify the timing or dosage of the first nurse’s medication, so she is held responsible.

Key Takeaway:

“If you didn’t chart it, it didn’t happen.” This isn’t just something nursing school professors love to say (although they do love saying it). Documentation is your safety net, and you can’t afford to neglect it. Be thorough and do it right away; don’t assume you’ll remember it later.

Breaching Patient Privacy or Confidentiality

Patient trust is built on privacy. Breaching that confidence, whether intentionally or accidentally, can result in serious professional consequences. With HIPAA laws in place, even casual comments or innocent social media posts can violate confidentiality in a legal sense and lead to disciplinary action.

Common breaches include:

• Sharing patient details with unauthorized individuals
• Discussing cases in public or semi-public areas like the cafeteria
• Accessing another nurse’s patient records for curiosity, not to provide care
• Posting about patients on social media, even without names or photos

Example Scenario:

A nursing student posts a vague TikTok story about the “wildest ER case tonight” after their clinical shift. They don’t use names but mention enough details about the case that co-workers and others can identify the patient because their story was shared on the local news. Another nurse reports the video to HR, and an investigation follows.

Despite the lack of names, the nursing student is found in violation of HIPAA and hospital policy. As a result, they lose their clinical spot and are forced to retake the semester, delaying their graduation date by several months.

Key Takeaway:

Privacy breaches aren’t always intentional or immediately obvious. The best way to avoid them is to simply not share patient information. Keep conversations private, put your phone away, and leave work at work when you go home.

Performing Tasks Outside the Scope of Practice

Nurses have a strictly defined scope of practice based on their license, training, and facility protocols. What you can and cannot do also varies from state to state, so it’s essential to have a strong understanding of your scope of practice. Even if your intentions are good, stepping outside that scope can cause serious patient harm. You can also be liable for violating your scope of practice even if you are unaware that you’re doing so.

Scope of practice violations can include:

• Initiating certain treatments or tests without an order from a licensed provider
• Performing procedures not covered by your state’s nursing license
• Making medical diagnoses (not nursing diagnoses)
• Supervising or delegating tasks to an employee you don’t officially supervise

Example Scenario:

An eager new nurse is caring for a patient with influenza who complains of worsening shortness of breath. Instead of notifying the physician, the nurse independently adjusts the oxygen flow rate beyond the ordered amount and starts a nebulizer treatment that wasn’t ordered. Although the patient stabilizes, the nurse’s actions come under review by the hospital’s safety team. Since the nurse administered a medication without a provider’s order—outside their authorized scope—they are disciplined and required to complete additional training.

Even though the nurse was acting in what they thought was the patient’s best interest, they are still liable because they operated outside their scope of practice. Doing so is never acceptable, even in time-sensitive situations.

Key Takeaway:

Know your job’s limitations and respect them. When you’re unsure if a task or procedure is within your scope, ask. Breaching it, even with good intentions, can put your patients and your license at risk.

Legal & Career Consequences of Nursing Negligence

A single instance of nursing negligence can trigger serious consequences, both legally and professionally. It can alter the course of your entire career—or even end it. Beyond the paperwork and penalties, the emotional toll of knowing a patient was harmed by your actions can be devastating.

If you are found negligent, you might face:

Legal Consequences

• Civil lawsuits brought on by a patient or their family for damages
• Criminal charges in cases of gross negligence (this is rare, but does happen)
• Fines or court-mandated settlements

Career Consequences

• Loss of your nursing license or having it suspended for an extended period
• Mandatory training or supervision while at work
• Possible termination from your job, resulting in a hard time finding future employment

Personal Consequences

• Emotional distress or burnout
• Reputational damage among your peers
• Financial strain from legal fees or lost income

Knowing what’s at stake is the first step to avoiding mistakes. It reinforces why diligent, compassionate care matters in every moment of your practice.

• Report the incident to your supervisor or HR team immediately.
• Write down everything you remember while the incident is still fresh, including dates, times, witnesses, and the actions you took.
• Cooperate with the investigation, but don’t speculate or make assumptions in written or verbal statements. Let your documentation speak for you.
• Consult with a lawyer to understand your rights.
• Avoid discussing the case with co-workers or on social media.
• Seek support. Being accused of negligence can take a serious emotional toll, so consider reaching out to a therapist or employee assistance resources.