By Matt Wynn

Doctors aren't the only ones who get to worry about malpractice. A report from insurance firm CNA, looked at closed liability claims against nurse practitioners to find out what practices most often resulted in payouts.

First, the bad news: Since 2009, average payouts are up about 30%, from $186,000 to more than $240,000. While indemnity payments less than $100,000 accounted for more than half of all settlements in 2009, in 2016 they made up only 39%. Payments over $500,000 meanwhile, ballooned from 8% of all cases to 18%.

The good news, though, is that those numbers weren't evenly distributed between specialties. Neonatal, women's health, and emergency department nurses accounted for the highest average payouts, many in the mid- to high-six-figure range. Emergency medicine was also notable in that it grew as a proportion of settlements, from 3.5% in 2012 to 5.7% in 2016.

The findings were based on 287 claims involving NPs, NP practices, or NP students closed in 2012-2016 and had indemnity payments of at least $10,000. They were compared to the last version of the report, which used data covering 2007-2011 and had 200 such cases.

Four specialties accounted for the lion's share of all payouts. Primary care/family practice nurses made up more than half the payouts, with behavioral health and gerontology behind at 15% and 12%, respectively. The location of a nurse's work also affected the regularity of payouts. Physician offices, nurse practitioner offices, and nursing homes had the highest frequency of claims.

Maybe the most important question is the kind of actions that were most likely to result in claims. Diagnosis, medication, and treatment came up as most often mentioned in the cases analyzed. Monitoring, however, was far and away the biggest driver of large payments, with an average payment of $450,000.

The report made three suggestions for nurses to protect themselves:

1. Practice within the requirements of your state's nurse practice regulations

2. Document patient care

3. Never alter a record after the fact