Professional Liability Insurance

Many nurses do not carry their own professional liability insurance or what is also called malpractice insurance. They have been given misinformation and many believe what they have been told about not carrying the insurance. There are many reasons that nurses do not carry malpractice insurance. Most of the reasons are related to beliefs about carrying this type of insurance that are not true. Many nurses regret not having this coverage when they need it most like when a malpractice suit is filed by a patient.

Malpractice insurance can be invaluable to a nurse because malpractice suits can cause a lot of money loss, a lot of lost time and loss of confidence for the nurse.

There are some common myths about malpractice insurance for nurses that might be keeping them from purchasing a policy. One reason that the insurance is not bought is that nurses tend to think that nurses are not sued; they believe that only physicians can be sued.

Nurses also think that they can only be sued if they make a mistake, when they can be sued if it is perceived that they are responsible for a certain outcome(Pohlman, 2015). Another falsehood is that they are covered by their employers’ policy.

These insurance policies have gaps in coverage, policy exclusions and if the employer believes the nurse is responsible, the employer can bring a claim against that nurse(Pohlman, 2015). If a hospital is sued, the hospital’s attorney is representing the hospital’s interests. A nurse should have a separate attorney to represent them because a nurse’s interest may conflict with the hospital’s (Starr, 2019).

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Still some nurses think that if they carry their own insurance, they are more likely to be sued. To discredit this myth, insurance status cannot be found out until a claim is filed (Pohlman, 2015). There is an expectation from the patient that a nurse will provide competent and safe care. If a nurse fails to provide that care, a patient, or their family could decide to sue. In addition, healthcare facilities are holding individuals accountable for their own actions or lack thereof making it easier for nurses to be sued.

Malpractice insurance affects nurses in many ways. Having a personal malpractice policy gives benefits that the employers’ insurance alone would not. These personal policies would cover assault, HIPPA violations, libel, slander, property damage and license protection. Personal malpractice insurance policies provide attorneys to keep the nurses’ specific interests protected. Some insurance companies provide continuing education and risk management services (Pohlman, 2015). There are even policies for student nurses. There are different types of policies as well. There is an occurrence-based policy. In an occurrence-based policy, every policy year limits are restored, and incidents are covered as they happen. A claim-based policy is where there is one set of limits during the life of the policy. These policies premiums increase yearly until they reach maturity. Most nursing malpractice insurance that is bought is occurrence-based (Pohlman, 2015).

Another way that having a malpractice policy can affect the nurse is by saving time and money if a claim is filed against a nurse. A lawsuit can take years to be settled. The nurse can spend hours reviewing documentation and policies, not to mention the time spent worrying and meeting with investigators and lawyers(Butler & Lostritto, 2015). Having a malpractice policy can help with the time spent because a nurse’s lawyer will tell that nurse what needs to be done and when. The insurance could possibly save money with the only expense being that of the premium and deductible (Butler & Lostritto, 2015).

Whether a nurse carries malpractice insurance does not seem to affect the quality of care, patient outcomes or mortality rates of patients. According to a review of 37 studies focused mostly on inpatient care, there is no association between measures of malpractice risk and health care quality and outcomes. The findings suggested that liability was not associated with improved quality of care (Mello, Frakes, & Blumenkrantz, 2020). Although having malpractice insurance may not affect patient outcomes, it may give nurses some relief. Helping nurses to not worry about possibly losing money to lawsuits. Having a malpractice policy could help stop worry about making a mistake that could cost them not only money, but their license if they were not covered. On the other hand, lawsuits can affect the nurse negatively which could affect the patient. A lawsuit could damage the nurse’s reputation, making the nurse feel discouraged, or question her training and judgement (Ryll, 2015). Thus, affecting the patient that often rely on the quick thinking and judgement of that nurse.

As a nurse considering policies for herself and thinking about the experiences that have been had it would greatly benefit a nurse to carry malpractice insurance. With the experience in clinical nursing over the last three years, it would be beneficial to nurses in all fields. In this nurse’s experience, verbal orders can be written wrong or other mistakes can be made. Certain policies can be written by people that are not qualified to write those policies, but nurses would be expected to follow said policies. The best example in my experience has been medication refills. It is out of a nurse’s scope of practice to prescribe medications. A procedure was written that most doctors in the office signed off on. It was then explained to nurses that following this procedure would protect their license because the doctors have signed off on it. There are many questions in these situations. What if a medication has been discontinued and not removed from a medication list? When the refill request comes in, how does the nurse know not to refill? There is always the option to ask the client, but often they cannot tell what medications they are on.

There are many situations where a nurse could question the accuracy of what a non-clinical supervisor is asking to be done where the supervisor does not understand the scope of a nurse. Having critical thinking skills and possibly a malpractice policy is invaluable. Another reason malpractice insurance is worth it is the cost. According to CNA and Nurses Service Organization Claim Report in 2015, Adult med/Surg nurses have the highest percentage of closed claims at 36% with the average paid settlement at $138,346 (CNA & NSO, 2015). In comparison the yearly premium from one malpractice insurance company called Berxi states that a student nurse’s premium could be as little as $12 per month (‘Medical Malpractice Insurance,’ n.d.). Although, just like any other insurance, the amount of the premium depends on the amount of coverage, deductible, and level and experience of the nurse.

Malpractice insurance can save the nurse money, time and heartache. Having insurance may not affect the patient statically, but it can affect the nurse and their practice which can ultimately affect the patient. Purchasing malpractice insurance is an individual decision that should not be made based on myth. An ethical question that could be posed is: Should everyone involved in healthcare carry malpractice insurance, should it be illegal not to have it? The nurse should weigh the risk vs the cost and decide based on their own research and situation.

References

1. Butler, K., & Lostritto, M. (2015, March). Malpractice 101: Strategies for Defending Your Practice. Journal of Radiology Nursing, 34(1), 13-24. https://doi.org/https://doi.org/10.1016/j.jradnu.2014.12.006
2. CNA & NSO. (2015). Nurse Professional Liability Exposures: 2015 Claim Report Update. Retrieved from : https://www.cna.com/web/wcm/connect/e05b5d91-cf38-444d-8727-ab65f25f8f6a/RC_Health_Nurses_Claim_Report_Update_101615.pdf?MOD=AJPERES&CACHEID=e05b5d91-cf38-444d-8727-ab65f25f8f6a
3. Medical Malpractice Insurance. (n.d.). Retrieved from https://www.berxi.com/insurance/medical-malpractice/
4. Mello, M., Frakes, M., & Blumenkrantz, E. (2020, January 28). Malpractice Liability and Health Care QualityA Review. JAMA, 323(4), 352-366. https://doi.org/10.1001/jama.2019.21411
5. Pohlman, K. (2015). Why you need your own malpractice insurance. Retrieved from https://www.myamericannurse.com/need-malpractice-insurance/
6. Ryll, N. (2015, March). Living Through Litigation: Malpractice Stress Syndrome. Journal of Radiology Nursing, 34(1), 35-38. https://doi.org/https://doi.org/10.1016/j.jradnu.2014.11.007
7. Starr, K. (2019, August). You’ve been served: Responding to a malpractice summons. Nursing 2020, 48(8), 11-12. https://doi.org/doi: 10.1097/01.NURSE.0000541395.59728.a4