Should I Carry Nursing Malpractice (Liability) Insurance?

[sirI]

This question comes up frequently and is asked of me quite often, "should I carry malpractice protection?"

What is Malpractice?

Simply put, it is a failure to adhere to a standard of care or conduct by a professional such as a Physician, Nurse, Attorney, etc. Malpractice occurs when it can be proven that the professional had a duty to provide a standard of care/conduct, breached that duty, an injury or damage resulted, and the injury/damage was caused by the breach.

No matter how educated, confident, and careful the Nurse is, unintentional mistakes can and will happen. Accidents will occur. And, unfortunately, willful neglect can be an issue. Injury and death very often are the results of mistakes, accidents, and neglect. Families want to know what happened. Even in the best scenario, the Nurse feels embarrassed and ultimately fears what the damage could do to a perfect professional reputation. Nurses must have the option of protecting their professional reputations and personal assets. Having individual Liability Insurance is a smart solution.

Nurses will often make the following statement

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My employer covers me so I don't need my own malpractice/liability policy.

Yes, your employer's policy may cover you, but only up to a point. Remember: Your employer's policy is created to fit their specific needs and protects them first. You may even be told (by your employer HR) that you do not need your own policy. What they do not tell you is that they want you to be represented by their attorneys. They do not want "outside" representation for they know that their best interests will not be first and foremost.

All malpractice liability insurance policies have limits of liability. If you are only covered by your employer's insurance, other defendants employed at your entity may and probably do share your liability limits under the same policy. If you, as well as others, are named in a suit, your legal costs, including any settlement, could exceed your employer's shared liability limits. This would mean out-of-pocket expenses for you.

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What type of policy and how much coverage do I need as a Nurse?

These are questions that are very important when considering a policy.

Two Popular Policies

• Occurrence-based - any covered incident occurring while the policy is in effect even if the policy is now canceled and/or you have retired
• Claims-made - any covered incident only while the policy is in effect

The cost of a policy is economical and reasonable. For example, the annual premium could cover the first hour billed by Attorney. $1,000,000/$6,000,000 coverage premiums are approximate $100/year in most states for the Registered Nurse (RN) as well as for the Licensed Practical/Vocational Nurse (LPN/LVN).

Links of Interest

• CM&F Nursing Medical Malpractice Program
• American Nurses Association
• Nurses Service Organization

One major benefit of an individual policy that is often overlooked or taken for granted when considering coverage is license protection. Nurses need to be aware that this will extend beyond their employer's coverage and includes discipline issues that can be brought up by the individual Nurse's Board of Nursing (BON). Many Nurses do not have the financial ability to go against the BON, therefore, license protection is a must.

Another all-important beneficial consideration is that policies normally will include coverage regarding libel, slander and patient confidentiality, including HIPAA issues. These issues can be troublesome and include a great cost for the Nurse.

Finally, a common statement that is incorrect and based on myth ...

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Malpractice liability insurance will make me a target and I'll be named in a lawsuit.

When being named in a lawsuit, no one knows you have your own personal policy unless you have revealed this information. Only after a lawsuit is filed and only during the period of the discovery phase is this information available.

So, do you carry your own individual malpractice/liability insurance? In the end, the question of whether or not the Nurse should carry malpractice/liability insurance is a personal one and should be seriously considered.

The peace of mind knowing that you are covered is overwhelming.

The peace of overwhelming reassurance.

[lamazeteacher]

Quote from Post# 120 by Reidob

"I hate the idea that I am paying even a dime for something that is not worthwhile. I have been perplexed on this question for my entire career. "

Right above the space for this reply, is an ad for Liability Insurance for massage therapists for $165/year. They don't usually make as much as nurses do, as they're on their own and have overhead.

The one economically reasonable insurance company for nurses has lower premiums, but I have heard that you get what you pay for, with them. In the thread about 2 nurses in Texas who were sued by a doctor who they reported, there was a post stating that the legal representation through that insurance company is sketchy.

I do know that malpractice lawyers generally sue everyone in sight of a medical maltreatment case, and they'd even sweep up the floor sweeper if they thought that might provide a larger purse. Doctors have lamented their legal vulnerability and the huge premiums they pay for coverage, but in all the years I've worked (about 50), none of the sincerely personable ones with insurance have been sued to any extent. It's the nasty types that get sued more. Communication skills and patient involvement in decisions, is key! Premiums are so high because there are too many incautious errors made, that damage patients considerably and are quite costly in human life and the quality of existance. Where there is no damage, there is no case.

A friend of mine who was an OB/GYN (now deceased) had a sign in his waiting room that said, "I have NO malpractice insurance. If you sue me, you might get whatever my old, rundown house is worth. My children have college funds, which are untouchable, and my wife has one fur stole." He had a wonderful sense of humor and a very caring attitude (not so, his partners), and was never sued in 40 years of practice (his partners had lots of them).

I used to have the insurance that was available for $67/year, but it really never gave me peace of mind. What did give me that, was the knowledge at the end of each shift, that I'd performed the tasks assigned to me, to the best of my ability, gave the right medications in the correct dosage to the right patients, and showed them that I cared about their wellbeing, calling their attention to their well located call buttons, frequently. I never held back on pain meds as ordered, giving them in a timely and judicious manner; and called their doctors for higher doses of it, and/or a synergistic med when appropriate. If I thought a wound was supperating, I took VS and a culture of it, and got an order for that later, when antibiotics were ordered. I made sure that all tubes and wires were connected correctly, IVs dripped away through those newfangled pumps and that skin pressure areas were clear, etc., etc., etc. (as the King of Siam would say).

It's not what you do, but how you do it that will spare you considerable ire.

[elkpark]

"The one economically reasonable insurance company for nurses has lower premiums, but I have heard that you get what you pay for, with them. In the thread about 2 nurses in Texas who were sued by a doctor who they reported, there was a post stating that the legal representation through that insurance company is sketchy."

And the reason for that was discussed in that thread -- the charges against the two nurses had nothing to do with their nursing practice, so they were not covered for that by their professional Liability Insurance. Malpractice doesn't provide coverage for any legal charges/complaints that might ever happen to you -- it covers you for charges/complaints related to your clinical practice, just like your automobile insurance doesn't cover you for anything other than automobile accidents. That situation had nothing to do with the services provided by the insurance company being "sketchy." As with any kind of insurance, it's important to understand what the policy you're purchasing covers and what it doesn't.

[sirI, MSN, APRN, NP]

And, to add to that. It will not cover you in criminal litigation. No policy will cover for that.

[lamazeteacher]

Response to Elkpark's post # 123

I didn't agree when someone posted the excuse given (? by the malpractice insurance company), that the event wherein a doctor's medical ethics were reported as objectionable, by 2 nurses (only the one who sent in a written complaint was sued by the doctor for doing that). The location at which that happened was in a remote part of west Texas, where there may not have been an attorney the insurance company could recommend/hire. I'd buy that, sooner than I'd believe that fulfilling a nurses' obligation to report aberrant practise of patients by another health care provider. That is something within the role of being a patient advocate, which nurses are.

Automobile insurance covers many things other than accidents: theft or vandalism to the car, theft of the car's contents or outer decorations (like the symbol/figure of the manufacturer on the hood), damage that occurs when a permitted, licensed person borrows a car with permission. Harm that occurs to anyone in the car, due to being kidnapped in it, crowds that rock the car, causing damage, cracks to the windshield caused by a stone (although if the policy's deductable is greater than the cost to repair/replace the windshield, the owner may elect not to report that), etc.

Automobile insurance also covers the cost of a rental car for the owner, usually while repairs of damage caused by an accident or other occurence such as those above, occurs. There's usually a period of time given for renting a car, based on the extent of repairs needed, and how long the repair should take. The tax and extra insurance offered by the car rental company, isn't paid by the insurance company.

I refused the extra insurance (it comes at a high price) when I rented a car while my car was repaired after an accident, and I was rear ended by an uninsured motorist. There were only scratches on the back bumper (which is quite flimsy) and the rental company insists that their body shop with which they have a contract - which involves a monthly minimum number of cars brought to that shop (I went there to get some idea of what their charge might be). They said that since it was their car, the had the right to choose where the repair is done. The cost of the repair done at their choice of body shops was over 3 times that of another body shop. The car rental company also charged a $100 "executive fee", in the bill I was sent.

I'm sharing the above, although this thread is certainly not about insured car repairs, because nurses rely heavily on their vehicles, especially when working in Home Health. Perhaps my experience will forewarn other nurses of the excessive charges that can occur despite insurance coverage.

[NRSKarenRN, BSN, RN]

Judith Cipriano

All professionals incur the risk of being sued and of losing a substantial judgment. Often guilt or innocence has less to do with the outcome than does the public's perception of a plaintiff's needs. Risk is real. The issue is how one should efficiently manage risk, including its transfer to institutions skilled at managing it. And healthcare professionals' risk is increasing because of a number of factors ...

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To purchase or not to purchase, that is the question

Many nurses believe that if they purchase professional liability insurance, they will increase their chances of being named in a malpractice suit. Many employers encourage this notion, as it is easier and more economical for an employer to manage a liability claim if the interests of individual employees are not being individually protected. The fact is, however, that most. Lawsuits are filed before a plaintiff's attorney has any knowledge of whether a defendant has insurance or not. It is only during the discovery phase that this information is learned. And, in today's world, the plaintiff's attorney will name everyone who is remotely connected to a patient's care in order to have the largest sum of money available as possible to satisfy a damage award. If you have signed the chart, you will probably be named, even if the care provided is tangential to the events which actually caused the injury.

Other nurses believe that their employer's professional liability insurance provides all of the coverage needed. While this is certainly true in the majority of cases, there may be instances in which the interests of an individual may be in conflict with that of the employer. In fact, if the event leading to a malpractice claim was contrary to the policies and protocols established by the employer and the employer is sued, the employer can file a claim against the practitioner to recover awarded damages and attorney fees.

A third reason for considering the purchase of personal professional liability protection is for acts performed outside of the scope of employment. As an example, if a nurse accepts a moonlighting position, a full-time employer's insurance plan will not cover any adverse events. Nurses are commonly called upon by friends, neighbors, and relatives to assess a medical situation and to provide care or to suggest a course of action. If erroneous advice or care is given, the nurse can be sued for the resulting injury. Again, the employer's policy would not respond as the event did not occur in the course of employment activities; the nurse would be personally liable for all resulting expenses. And what about good samaritan acts such as stopping to assist in an automobile accident or attending to a person who falls on the street? While most states have good samaritan statutes which prevent making a claim against an individual who assists another without being remunerated for care given in an emergency situation, individual events such as a claim for gross negligence could waive the protection afforded by such a statute. And, furthermore, these statutes, although providing some protection against loss, do not protect against being sued and incurring the cost of defense.

If, after understanding the limitations of employer supplied liability insurance, a nurse makes an informed decision to rely on this risk transfer vehicle, he/she should investigate the nature of the policy/plan affording the protection. It might also be advisable to request a copy of your employer's policy/plan and have it reviewed by an insurance professional.

[elkpark]

Lamazeteacher -- you are certainly correct that auto Liability Insurance covers all those things, in most cases. However, all those things are still related to owning and operating your car. Professional liability (malpractice) insurance covers you for issues related to your professional practice. In the case of the two nurses in Winkler, TX, while they were certainly advocating for the hospital's clients and we all agree that advocating for clients is part of nursing's role, in this particular case, they were charged with a felony (criminal charges) -- misusing medical information, specifically -- not sued for malpractice by anyone. As sirI noted already, no insurer's malpractice coverage covers you for criminal charges. (Likewise, most automobile liability policies include an exclusion for criminal acts -- if you have an automobile accident while using your car to commit a criminal act, you're not covered). Certainly, when considering purchasing any kind of insurance, it's v. important to be aware of the policy covers and what it doesn't.

[wbc]

I always carried my own malpractice liability. I saw some instances where nurses without their own insurance were thrown to the wolves by the hospital. Thank goodness I never had to use my insurance.

Winona

[are n]

What is appropriate insurance for private duty nurses?

[sirI, MSN, APRN, NP]

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what is appropriate insurance for private duty nurses?

Check out the links on the first page for Liability Insurance companies.

[Nurse Attorney]

Contact an insurance company to find out what coverage would suit your needs best. One that you can check out is the Nurses Service Organization (NSO / CNA) at Professional Liability Insurance for nurses, nursing medical malpractice..

As I have posted in the past, the primary reason that I advocate that nurses should have their own Liability Insurance is not because of the risk of being sued for malpractice, but rather because the policy covers attorney fees for license protection. The number of complaints against nurses (usually by the nurse's employer) to the state boards of nursing are on the rise. This fact makes it much more likely that a nurse may be the subject of a complaint and nursing board investigation rather than a defendant in a malpractice lawsuit. Most nurses know at least one nurse who has had to face potential disciplinary action against their license by the board. Just look at your State Board of Nursing's website for the statistics. Even first time DUIs are now being investigated by some nursing boards and may jeopardize a nurses' license. Your license is your livelihood. If you were being investigated by a nursing board, wouldn't you want an attorney to represent you? Legal representation for a board action, depending on the complexity, can cost thousands of dollars. NSO's license protection provides up to $25,000 for legal fees and costs. I'd say that's well worth the $100 premium.

[DougMSNRN]

Hi-

I've read a good number of replies here. And, I'm writing this from the perspective of someone who has managed litigation in a large medical center where nurses (including the nurse executive (yes, cnos can be held culpable for nursing care in their departments)) were named as defendants. so, here is the input from my perspective.

Most risk managers will tell you that you do not need to carry PL (professional liability) insurance because you are covered under the policy of the institution you are working. Generally, this is true. There are caveats to this, like if you're a mid-level provider (NP, CNM, CNS, or CRNA, for instance). But, most institutions will cover you under their policy. Here's where it may get 'sticky':

- Are you an agency nurse? if you are, the organization you work for needs to have $1m/$3m limits. However, some agencies have 'issues' with their coverage and limits. Also, agencies have gone after their staff (that has since moved on) for damages awarded to plaintiffs if anything the nurse did as a registry staff was questionable. If you are an agency nurse, you are an idiot if you don't have this type of protection.

- Do you work in a highly litigious specialty? Labor and Delivery, OR and ED are very heavy with malpractice allegations. who's going to compensate you for deposition/discovery time, travel time, time off work, etc. If the malpractice claim was opened 4 years ago and you've since moved on?

- Do you believe the 'If I have insurance it's just a reason to be named as a defendant' motto? Don't. While it's true that if you have PL coverage and you are named, the organization you are a co-defendant with may attempt to collect part of the defense costs w/ your pl carrier, this is a small draw-back from knowing you have participated in the defense effort. And, what happens if during the course of discovery the organizations defense strategy doesn't mesh with yours? If you have your own PL coverage, your carrier is able to secure you separate defense council.

- And, the big one: What happens if your license is called into question? No organization is going to willingly provide you with counsel for this type of hearing. Your PL carrier will (depending on the coverage you purchase).

Bottom line: Nurses are being called more often to provide aggressive nursing care. Simply stating "I called the doctor" isn't cutting the mustard any longer. As society has gotten older and the healthcare system has become more burdened, nurses have moved from 'custodial' roles to 'professional' roles. This makes having PL coverage a no-brainer.

[Nurse Attorney]

I still believe the risk of a nurse being named as a defendant in a malpractice case is remote. I have practiced law for over 17 years now. In the past I handled medical malpractice cases - both defense and plaintiff - in California and Nevada. I have never seen a staff nurse named individually in a lawsuit. The hospitals are named as defendants because (1) they are legally responsible for the actions and negligence of their employees, including nurses; and (2) their insurance policy will cover any claims for negligence. Thus, there is no reason to name the nurse individually, even if he/she carries his/her own malpractice insurance. Further, an attorney cannot discover whether a particular nurse has insurance until a lawsuit has been filed against that nurse. Therefore, the fact that a nurse has insurance is not the determining factor of whether or not they will be named in the lawsuit. However, nurses are usually called as witnesses in malpractice cases since they have knowledge and information regarding the alleged negligence and care of the patient. In any event, if a nurse is either named as a defendant or as a witness, if they have their own Liability Insurance, they will be able to hire their own lawyer to protect their interests, which, depending on the facts, may be adverse to the hospital's interests. Nurses often mistakenly believe that the hospital's attorney is "their" attorney - - nothing could be further from the truth. The hospital attorney is hired to protect the hospital, not the nurse.