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  1. 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 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. 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 Affordable 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 ... 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.
  2. MountainGoatRN

    Is malpractice insurance worth it?

    I work for a large hospital system as a floor nurse. I'm curious to know if getting insurance is a good thing to have. I have been given mixed reviews about it. Higher ups (at work) say it's not needed if you follow protocol to a t (I understand that and try to do so!). However, I've also heard that you're a target for malpractice if the other party learns that you have insurance- you're an even bigger target and on a radar. I'll take any stories/experiences you want to share.
  3. I'm so frustrated. I'm trying to get my RN license back in BC (Surrey) and have been approved for a sponsorship from a local health authority, unfortunately I'm required to obtain a 5 million/occurrence professional liability and third party liability insurance citing local health authority as an extra insured. CNPS lawyer says it doesn't exist, private insurance broker says there is no such insurance (he tried over 10 days and all insurance companies told him the coverage was enough through CNPS). To do the supervised practice experience, I'm required to provide documents that don't exist.... anyone heard of this? I will have 10 million $ /occurrence with a provisional license once I get a sponsorship (ie if I get this ? non existent insurance). Anyone know where I can to a supervised practice experience in greater Vancouver, preferably Surrey/New West/Burnaby where my BCCNP/CNPS liability insurance is enough? VCH doesn't allow supervised practice experiences and FHA is the one asking for these two extra liability insurances.
  4. Nursing licensure has been on my mind lately. I just taught an NCLEX test prep course to some recent RN grads, and there are always test questions on licensure and negligence. I had a lively discussion with my students about being reported to the board of nursing. Recently, in my role as an editor for a nursing textbook company, I was tasked with writing questions on licensure, negligence and malpractice. I woke up this morning to a newsletter1in my email in-box from Lorie Brown, RN, MN, JD about a nurse facing criminal charges in the death of a patient.2It feels like the universe is telling me to write about protecting your license! YOUR NURSE-ATTORNEY Last year I had the chance to interview Lorie for my podcast. She is both a Registered Nurse and an Attorney. I originally contacted Lorie because I was fired from my job as a home health nurse, and reported to the board of nursing. It was a terrible time in my life, and I didn't know where to turn or what to do. There is so much talk these days about support for second victims - but that only occurs if you are still working in your facility - there are few resources for those of us who are no longer affiliated with a healthcare institution. Lucky for me, it all turned out ok - there was no disciplinary action and no harm to the patient, but the experience left lasting emotional scars. I will write more about that soon. I think it's important to talk about getting fired, loss of licensure, and making mistakes...talking about it helps those of us who have been through it, it removes shame and stigma, and it gives us all additional resources. In the interview, Lorie told me the story of a client who was accused of patient abuse. The client sent a patient to the morgue, still soiled from a bowel movement that occurred during the process of dying. Lorie described how she interviewed the nurse, what questions she asked, and more importantly, what questions she asked of the other nurses who were present for the preparation of the body. She was able to save the nurse's license. It was fascinating to learn how Lorie's nursing knowledge of how to turn and clean a body led her to the discovery that another nurse was involved in the incident. PROTECTING YOUR LICENSE I asked Lorie to tell me the most important thing a nurse can do to protect their license if there is a complaint or report, and she said, "don't do it alone". The board of nursing and the facility where the complaint occurred have attorneys, and so should you. Lorie is a member of the American Association of Nurse Attorneys (TAANA.org). There are about 300 members who practice in many different areas. You can contact Lorie at YourNurseAttorney.com for a free consult, or go directly to TAANA for help. We talked about how nurses are treated and some of the challenges we face. One thing that surprises new graduates and seasoned nurses alike is that most states are "employment at will" states. What this means is that they can terminate you at any time, for any reason, or for no reason at all. Lorie let me know that nurses get fired all the time. Of course we want to see a nurse terminated if they are being unsafe, committing a crime, or harming a patient, but many people assume that if you were fired, it was because you did something wrong - and that just isn't true. Lorie spoke about the idea of a "graceful exit" which basically means "quit before you are fired". Lorie has negotiated resignations for nurses in return for uncontested unemployment applications and a neutral reference. Lorie warns that if you get suspended, you will probably get fired. The best advice she gave me, which we can't always take due to family and finances, is to leave a job in which you feel unsafe or unwelcome. If staffing levels are bad, leave. You can get another job, but you can't get another license. REPORTS TO THE BOARD Did you know anyone can report you to the board of nursing? And did you know that an employer can put anything they like into your employment record? Once it has been entered, it is no longer considered "hear-say" and it becomes part of the business records. If you arereported to the board, Lorie tells her clients to make a list of all the good things they have ever done. The board will have your complete employment record, and it may include things you aren't aware of. Your employer isn't required to tell you when they place things in your employment file. I had three patient complaints in my employee record that I didn't recall, and the board asked me about them. I am glad I was honest in stating, "I don't remember that" - Lorie says no matter what, you must be honest in all dealings with the board of nursing. Lorie recommends that any time you ARE told about something going in your employment record, be sure to write a response and have it placed in your record as well, don't just sign on the dotted line. In addition, your employment record belongs to your employee, so they don't have to show it to you. In essence, all rights are with the employer. After learning this, it really makes sense to have an attorney on your side if you are dealing with the board of nursing. CONSEQUENCES Something unique to nursing is the consequence of disciplinary board action. If you have action from the board of nursing it goes right next to your name in a public, permanent record. Lorie works with healthcare professionals from many disciplines and says that other healthcare professions don't experience this - pharmacists and physicians for example, are often told after reports, "don't do it again", but nothing goes in their record against them. As a patient safety specialist that horrifies me. Imagine the number of physicians and pharmacists out there with no record of facility or patient complaints. As a consumer of health care, that really frightens me. It is so important for the public to know the safety record of the healthcare professionals on your team. However, I also don't agree with leaving disciplinary action on a nurse's record for life. Lorie and I agreed that there should be a time limit, and there should be processes in place for removing disciplinary action from your record. THREE THINGS TO PROACTIVELY PROTECT YOUR LICENSE 1. Keep your address current with the board. Many nurses forget to tell the board they have moved. The first thing that will happen in an investigation is that you will get a letter from the board. You will have an opportunity to respond to the letter and meet with an investigator, but if they don't have your current address, they can take action without you. 2. Be honest on your job applications. If you were terminated, you have to say you were terminated. Even if you were only there a few months, when you sign an application, you are affirming under penalty of perjury that you have given all the information and that it is true and correct. Just because you only worked at someplace a short time you can't omit it. You can say you will discuss the termination in the interview. 3. Be honest on license renewal application. If you don't understand the question, ask. If you have been arrested or pled guilty or no-contest to a criminal matter, if you have had a DUI and you are on diversion for a year and it is dismissed you have to report it. Ask someone who practices before the nursing board if your interpretation is correct. Don't call the board of nursing. The clerks who answer the phone don't necessarily understand the process or know the answer and cannot give legal advice. Lorie finished up with this statement: "We are the largest number of healthcare providers, comprising 80% of the workforce and we have 0% of the power. If we stand together, think of what we can do to change the profession, improve it and improve patient care. I believe nurses have the answers to all the problems in healthcare, but we don't speak up. But we have the answers, we just need to speak up, stand together and get them implemented!" You can listen to the podcast of my interview with Lorie on Stitcher HERE4. References Criminal Charge For Nurse In Patient's Death - Brown Law Office Nurse Christann Gainey charged in death of former Trump adviser H.R. McMaster's father - CBS News Safety Rules by Kristi Miller, RN, PhD, CPPS, HNB-BC on Apple Podcasts Safety Rules - Three things you need to do to keep your nursing license safe Ep1 | Listen via Stitcher Radio On Demand
  5. "I don't need it, Nurses are never or hardly ever sued". So, does the Nurse actually need Liability insurance? If so, why? A couple of questions that should be considered while making this decision would be: "Would my policy provide an attorney to defend me and reimburse me if I incurred costs ... and, "Would my policy include coverage for any disciplinary action taken by the Board of Nursing?" What do you think? Does the Nurse really need his or her personal liability insurance? Do you have one? And, if so, what was the main reason you obtained a policy? For information on how to protect yourself visit our Nursing Malpractice Liability Insurance page.
  6. Vulnerable areas of nursing include anesthesia and 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. 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 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 The nursing shortage 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 Finally, a kind word and non-defensive attitude with a patient turns away many a lawsuit.
  7. I am often asked to answer this question: "As a nurse, should I buy my own malpractice insurance?" My short answer is if it makes you sleep better at night, it is worth it, but be aware of some significant coverage limitations that the people who sell insurance (NSO/HPSO and ProLiability) don't tell you about and they have a vested financial interest in selling you insurance. An interesting side note to this question is that in recent years, more and more physicians are now employees of hospitals, healthcare facilities or systems, and they never ask about, are marketed to, or purchase their own malpractice insurance to supplement the insurance provided through their employment. This is almost entirely a nursing concern. By way of background in answering this question, I have been working in healthcare risk management, patient safety and malpractice claims defense since the early 1980's. I have worked in the lawfirm, medical malpractice insurance company, hospital, medical group and integrated healthcare system settings. I am board-certified in insurance, risk management and healthcare risk management. In addition to my private consulting practice, my day job is as a healthcare risk and quality manager. At any one time, I have several malpractice claims that I am working on, and I have handled dozens of malpractice claims involving nursing care. I have years of experience at the malpractice insurance company interpreting insurance policies and applying them to coverage questions. Because each legal jurisdiction has unique statutory, regulatory and case law that can apply to malpractice and insurance issues, I am speaking in generalities and principles of broad application for this subject for a nurse employed by a hospital or healthcare facility. There may be unique statutory, regulatory or case law where you live and practice that make my opinions more or less applicable to you. You should always ask a risk manager or healthcare attorney experienced in malpractice insurance or malpractice liability as to how things work in your jurisdiction. Not all risk managers or healthcare attorneys have this expertise, but they should be able to refer you to someone who does or someone at the insurance company for the hospital or healthcare facility. Most nurses buy their own coverage for two main reasons: malpractice and licensure defense coverage. My professional opinion is that for the typical nurse who only provides nursing care through his/her employment and does not engage in ethically-questionable conduct, you will likely never have to use it, and have to decide if the cost is worth the potential benefit. However, it only costs around $ 100/year for the typical nurse, and clearly if you don't buy the policy, you will never have coverage under it, whereas if you do buy the policy, you might have coverage under it. If your employer does not have liability coverage for your professional duties, you are an independent contractor or you provide professional services outside the scope of your employment with a hospital/healthcare facility, then I strongly advise you to buy your own individual nursing liability policy. In these situations, your own liability policy will be primary, instead of excess coverage. There are also other coverages in the standard individual nursing liability policy that may be useful to you. A key thing to bear in mind is the reason why it is so cheap is that the insurance companies make few payouts under the policy due to policy clauses that deny or limit coverage for most malpractice claims or licensure defense claims. The overwhelming majority of nursing malpractice claims are covered by the insurance of the hospital/healthcare facility who employs the nurse. Most BON investigations do not result in filing formal charges, and the licensure defense coverage only starts if formal charges are filed. Individual nursing liability policies are very profitable for the insurance companies due to the low combined loss ratio: few claims are paid out, reserved or incur defense costs in comparison to the premium being collected. The people who sell the insurance do not mention any of this. The majority of individual nursing malpractice policies in the USA are written by two companies: CNA and Liberty Mutual. The two largest nursing insurance agents are NSO and ProLiability. These agents sell insurance, just as do your local insurance agent, and you can buy other insurance products from NSO and ProLiability. The agents are not the actual insurance companies. The agents collect approximately 15% of the insurance premium as commission to place the actual insurance coverage with CNA in the case of NSO, and with Liberty Mutual, in the case of ProLiability. NSO is owned by Aon, a large insurance company, and ProLiability is owned by Marsh, a large insurance broker. Out of your $ 100 insurance premium, about $ 85 of that goes to buy the actual insurance. Think about how few claims must be paid, in order to provide $ 1 million of coverage for only $ 85. Compare this to an Ob/gyn paying over $ 100,000 per year in Philadelphia for $ 1 million of coverage. In the medical malpractice insurance industry, the best proxy for the risk of paying claims under the policy is the insurance premium charged. The higher the premium, the more risk to the insurance company and the higher chance of paying claims. In the malpractice insurance industry, individual nursing policies are low risk and high profit for the insurance company. The insurance policies have pretty standard language in them, and they issue various endorsements to modify the coverage or to meet the unique requirements of a given jurisdiction. One of the best pieces of advice I can give you for any insurance product is to read the policy when you get it. Have a good understanding of what the policy covers and what are the restrictions, before you need to use it. Look online or ask the insurance agent for a sample policy before you buy it, so you clearly understand what coverage you are paying for and the situations in which coverage may be invoked. Ask the agent to explain any policy clauses that you don't understand. Most nurses buy their own individual malpractice insurance policies to have coverage for malpractice and BON actions. The purchasers think that having their own policy gives them unconditional coverage for these two events and they will have an attorney representing them for these situations. Here is where the significant potential limitations come in. You need to read and understand the policy definitions and clauses that limit coverage, and they are usually called the 'availability of other coverage', or 'other insurance' clauses and 'license defense', or 'license protection' clauses. Unless your policy provides coverage, you will not have your own attorney. Here is the standard 'availability of other coverage' clause from the CNA policy: The practical effect of this clause is that your individual insurance only kicks in if the insurance coverage available through your work does not apply or those policy limits are exhausted. If you are employed by a hospital or healthcare facility that has insurance, your own insurance will not be your primary coverage. It is excess coverage over your employer's insurance. If your own individual coverage is not triggered, you will not have your own attorney representing you. Your own individual coverage will not be triggered unless someone is making a claim or filing a lawsuit naming you individually, and your employer's insurance limits have been exhausted, or their insurance company has notified you that you have no coverage, though a denial letter or reservation of rights letter. This does not happen for the typical nursing malpractice claim or suit. For the overwhelming majority of malpractice claims involving nursing care, the hospital/healthcare facility's insurance policy defends the facility and all employees involved in the suit. The typical hospital/healthcare facility also has lots of insurance coverage (up to several millions) and so the limits would not be exhausted by a settlement or award. The hospital's insurance coverage likely also has an 'other insurance' clause, and this is often the subject of litigation: if both the hospital/facility and the nurse have malpractice insurance policies with an 'other insurance' clause, which insurance policy is primary and responds? Each jurisdiction probably has appellate case law on this subject, and most of the decisions are that the hospital/facility insurance is primary, while other decisions are that the hospital/facility and the nursing insurance policy splits the responsibility to respond, and a small number of decisions are that the nursing policy is primary. Your own individual coverage may be triggered if you are in one of the states providing that if both the hospital/healthcare facility and the individual nurse both have malpractice coverage, each insurance policy responds as primary coverage. One could argue that in these cases, having your own insurance policy results in a higher chance of adding you as a defendant, to access another set of insurance policy limits. In most jurisdictions across the country, the employer, such as the hospital or healthcare group or facility, is legally liable for the acts of their employees under the legal principles of 'respondeat superior' and 'vicarious liability' or 'agency'. This means that if the employee makes a mistake, the employer is responsible for it. Only in rare circumstances would the employer be able to escape legal liability for the acts of the employee. Each jurisdiction has their own case law on the subject, but typically, you may be able to avoid employer liability for criminal acts of the employee or acts outside the scope of employment. For example, if a nurse at the hospital is diverting narcotics, provides them to a family member and that family member dies, the hospital's insurance company may be able to successfully argue that their malpractice policy does not apply since the act of diversion was criminal and outside the scope of her employment. The individual nursing malpractice policy would also likely deny coverage on the basis of the criminal act. For the hospital, they may have insurance coverage under employment liability practices, that they negligently hired, supervised or retained the nurse who committed the diversion. Many nurses strongly believe that if they make a mistake, the employer will say they were not following procedure, therefore are not covered by the liability insurance and throw the nurse under the bus. Again, due to 'respondeat superior', the hospital/healthcare facility is most likely still legally liable for the actions of the nurse, and from the hospital's perspective, they want that insurance coverage to pay for the nursing liability. It makes no sense for the hospital to not have insurance coverage, since the hospital would then have to pay any settlements or awards out of pocket, rather than from the insurance company. I also point out that unless the hospital is self-insured, it is the insurance company, not the hospital, that is managing the claim. Another consideration for any malpractice payouts is the lack of a 'consent to settle' clause in the nursing liability policy. Most physician malpractice policies have a clause requiring the consent of the insured to settle any case. Since claim settlements can be reported to the National Practitioner Data Bank and/or the state disciplinary agency, most physicians want to be involved in the settlement decision. The standard individual nursing malpractice policy does not have this clause. The insurance company will make a decision as to settling the case or not, and this decision may be driven primarily on what is cheaper to the insurance company: defending the case or settling it, regardless of the wishes of the insured nurse. In regards to representation before the BON, if you read the CNA policy, coverage is only triggered if the BON actually files charges against you. Typically, the policy provides up to $ 25,000 reimbursement for legal expenses. You have to find an attorney, usually pay them up front, and apply for reimbursement from the insurance company. Coverage is not triggered and there is no reimbursement if the BON is only investigating you. If you want an attorney representing you during the investigation, you will pay for this out of pocket. Although there is much concern over the BON, the majority of investigations and charges typically involve allegations of diversion, theft from patients, substance abuse, boundary violations, criminal acts, and quality of care issues. Most nurses go their entire career without dealing with the BON, although this certainly varies from state to state. This has been a high-level overview of a complex subject and insurance coverage and claim issues will always revolve around the facts of a given case, the language of the insurance policy and the unique statutory, regulatory or case law in a particular jurisdiction. If you think you might be involved in a malpractice, licensure defense or any other type of claim that you think is covered by your policy, contact your professional liability carrier, ask them to open a claim file and describe the situation to the claims manager. The company will use the facts of the case, apply it against the coverage agreement in the policy, and officially notify you if you have any coverage or not. If not, they will send you a coverage denial or a reservation of rights letter, and this is your notice of no coverage or coverage with conditions attached. If you have coverage, they will send you a letter confirming this and assign a claims manager to work with you. Tell them I said hello. In summary, I would recommend purchasing your own individual nursing malpractice liability policy, but don't necessarily expect that the policy will automatically provide coverage for any malpractice or licensure issues that you are involved in.
  8. dragonfire123

    Pros and cons of nursing insurance

    I have been working as an RN for a few years now, and in that time I have always held nursing insurance, discounted through my membership with my state nursing association. However, most of my coworkers are uninsured and question why I even have it. They say that I would be covered under my facility's nursing insurance and lawyer in the event of a malpractice suit involving me and that having insurance puts me at greater risk of getting sued, should be uncovered that I am insured. Funnily enough, my spouse (also a nurse) also feels the same way -- that I am spending money needlessly and putting us both at risk. I have kept the insurance because I was always under the impression that should I ever be involved in a case, my employer would protect me but its lawyers would always be primarily concerned with protecting the facility (not me) and that my license would be at risk (with the board of nursing), should my license be called into question. While I feel I am a safe and thoughtful nurse, I have held the insurance to afford me some peace of mind. I don't see $100 a year as a needless expense and I am inclined to think that the notion of me being 'more' at risk of getting sued for personal assets is more of a myth. Any thoughts and opinions (informed by experience) would be greatly appreciated. Thanks.