Can a Physician Testify on Nursing Standard of Care?

Sometimes, depending on where the case is filed. Courts and legislatures have taken different approaches: some hold that a physician, however experienced, is not qualified to testify about the nursing standard of care because nursing is a separate profession; some allow a physician who shows real familiarity with nursing practice in the same setting to give that opinion; and some expert qualification statutes require the expert to share the defendant's profession or specialty. In most nursing negligence cases the safer course is a nurse expert for the nursing standard and a physician for causation. Check the statute, rules and case law that govern your case before you decide.

Why the question comes up

Many malpractice cases involve both physicians and nurses, often with the hospital responsible for the nurses it employs. One physician expert covering everything looks efficient, and physicians do see nursing care every day: they write the orders nurses carry out and rely on nurses to report changes.

But nursing has its own licensure, education, scope of practice and professional standards. The nurse decides how often to reassess, when a change is significant enough to call about, when to escalate past an unresponsive provider, and how to protect a patient at risk of falling or skin breakdown. Courts generally ask whether a proposed expert has the knowledge, skill, experience, training or education to speak to that specific standard, and the answer for a physician is not automatic. What is the nursing standard of care? sets out what that standard covers.

What a nurse expert brings to the record

Even where a physician could qualify, a nurse expert usually reads the nursing record more closely. A nurse who has worked the same kind of unit knows:

• how flowsheets, MARs and charting-by-exception conventions work, and what a blank field does and does not mean;
• what a realistic assignment looks like on that unit, and what a charge nurse is expected to do when the workload climbs;
• how nurses reach providers in practice (pages, calls, secure messages) and what a complete report of a change in condition contains;
• what the chain of command looks like from the bedside, and when a nurse is expected to use it.

Those details are often where the breach is found, and where a jury needs the most help understanding it.

The general approaches

Whatever the qualification rule, the testimony must also meet the reliability standard your jurisdiction applies. Daubert and Frye challenges to nurse experts covers how those motions generally work.

The other direction: nurses and causation

The same logic often runs the other way. Many jurisdictions do not allow a nurse to testify on medical causation (whether a deviation caused the injury), treating it as a question of medical diagnosis. Some permit it in narrow circumstances. Rules vary.

That is why a nursing negligence case typically needs two experts working in sequence:

1. The nurse expert testifies that the standard required, for example, notifying the provider of a falling blood pressure and rising heart rate when they were charted, and that the record shows no notification until much later.
2. The physician expert testifies to what a timely notification would likely have led to (an evaluation, fluids, a transfer, surgery) and whether that would have changed the outcome, to the degree of certainty your jurisdiction requires.

Each opinion stays within the witness's profession, which makes both harder to attack.

Advanced practice nurses

When the defendant is a nurse practitioner, certified nurse-midwife or nurse anesthetist, the question gets harder. Courts differ on whether the standard is the advanced practice nurse's own or the standard for physicians performing the same task, and on who can testify to it. Where the roles overlap, some cases need an expert from the same advanced practice role, and others a physician from the overlapping specialty, or both. Get the jurisdiction's rule from counsel before retaining anyone.

Certificates and affidavits of merit

Many states require a certificate or affidavit of merit early in a malpractice case, and some specify who may sign it for claims against nurses. Depending on the state, a nurse's affidavit may be required, accepted, or not sufficient on its own. Do not assume a physician's affidavit covers nursing defendants; see certificate of merit in medical malpractice.

Practical choices

1. Identify each defendant's profession and specialty early, including the nurses whose conduct the hospital answers for.
2. Retain a nurse expert witness matched to the setting: an ICU nurse for ICU care, a labor and delivery nurse for labor management. Check any requirements on licensure and recent clinical practice or teaching; choosing a nurse expert witness walks through the vetting.
3. Retain a physician expert for causation and for any physician defendants.
4. Keep the opinions in their lanes. The physician addresses medical care and causation; the nurse addresses nursing care.
5. If a physician must address nursing, build the foundation in detail: years working alongside nurses in that setting, supervision of nursing staff, familiarity with the nursing policies and standards involved. Expect a motion.
6. On the defense side, look closely at the other side's experts. A physician offering nursing opinions, or a nurse offering causation opinions, may be open to challenge.

A consulting legal nurse consultant can screen the case and identify which experts it needs before anyone is designated to testify; legal nurse consultant vs nurse expert witness explains the two roles.

Next step

Request a nurse expert matched to the specialty and setting of your case, and consider a physician expert for causation. Records stay private until you hire.

General information for legal professionals, not legal advice. Rules and deadlines vary by state; check the statute and local rules that govern your case.