Litigious Areas of Nursing and the Nurse's Liability

**sirI**, MSN, APRN, NP

Vulnerable areas of nursing include anesthesia and obstetrics/midwifery. RNs in OB (L and D), those working solely in monitoring capacities (fetal heart, telemetry, etc.), and medication administration (including long term care) are also included in more litigious areas.

Of course, the Advanced Practice Registered Nurse (APRN) other than CRNA and CNM are subject to increased litigation, but the latter two are more vulnerable. And, the Neonatal Nurse Practitioner (NNP) seems to be at high risk secondary to "pain and suffering" issues.

As of recent reports from the 2020 CNA/NSO: Nurse Professional Liability Exposure Claim Report: 4th Edition, Home Care services claims have been on the increase. Issues related to treatment/care are the most frequent allegations.

From the above report:

Quote

The average total incurred of professional liability claims in the 2020 claim report ($210,513) increased more than 4 percent compared to the 2015 claim report.

Many Liability carriers in many states will insure the Nurse Practitioner, but not insure the Certified Nurse Midwife

In some states, APRNs have stricter professional liability requirements whereas their physician counterparts can choose to be uninsured. This can present a problem for the APRN because they can, in turn, be targeted in lawsuits when the physician with whom they work has no coverage.

But, nurses in general can be and often are, at risk.

"The number of Adverse Action Reports (license defense issues) against nurses nearly doubled between 2003 - 2012." - Proliablility

Major Reasons Why more Lawsuits are Being Made Against Nurses

Our responsibilities have increased in complexity
Higher levels of Standards of Care (SOC)
Increased patient expectations
Pressure to increase productivity and increased patient load
Society has become highly litigious

Most Common Issues

Failure to abide by the Nurse Practice Act (NPA)
Failure to follow the SOC
Failure to adhere to policy/protocol/procedure
Failure to document, including lack of documentation, altered documentation, missing or "lost" documentation, incomplete documentation
Failure to recognize change in patient condition
Failure to appreciate the change in patient condition
Failure to report change in patient condition
Failure to follow up change in patient condition
Failure to communicate across the healthcare provider spectrum
Failure to monitor
Failure to act as patient advocate
Failure to provide a safe environment
Failure to respect patients' rights to privacy and confidentiality

Common Reasons for Errors

Job overload (poor nurse-patient ratio)
Inexperience
Ignorance
Inadequate patient monitoring
Poor nursing judgment/critical thinking
Hesitation
Faulty communication
Ignoring patient complaints
Fatigue
Breaks in concentration
Flaws in the system
Inadequate staff training
Improper delegation
Provision of services beyond scope of practice
The nursing shortage
Drug diversion and/or substance abuse

Ways to Ensure Safe Practice and Avoid Litigation

Be familiar with our individual NPA
Adhere diligently within our Scope of Practice (SOP)
Know the SOC for our specialty area(s)
Question authority
Educate ourselves regarding evidenced-based practice
Stay abreast of changing trends in nursing through continuing education
Educate ourselves regarding medical-legal issues
Make sound, safe, and practical nursing judgments for all our patients

A kind word and non-defensive attitude with a patient turns away many a lawsuit.

On a final note...

Protect yourself. Purchase liability insurance.

Litigious Areas of Nursing and the Nurse's Liability

Major Reasons Why more Lawsuits are Being Made Against Nurses

Most Common Issues

Common Reasons for Errors

Ways to Ensure Safe Practice and Avoid Litigation

About sirI, MSN, APRN, NP

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