Nurses have an impact on patients’ lives from the moment they step in the door to the moment the patient returns home.
In a profession with a high amount of contact with patients, nursing also has a potential for liability, according to Nurse.com legal information columnist Nancy J. Brent, MS, JD, RN.
Because of this, “Every nurse should have his or her own insurance,” Brent said.
We sat down with Brent, who offers useful insights about professional liability insurance, aka medical malpractice insurance, that every nurse should know.
Q: Do most nurses have primary coverage through their employers?
Employees of healthcare facilities are often automatically included as part of a group. However, you should always ask to make sure.
Q: Why should nurses consider obtaining their own individual professional liability insurance?
A: I’ve always supported nurses carrying their own professional liability insurance policy as individuals because nurses are so involved in patient care. Nurses are pivotal. They carry a great deal of potential liability on their backs because they’re there 24/7. While it’s nice when your employer provides you coverage under a group policy, having a policy that only applies to you has benefits. You’re the only one who is covered under your personal policy, which means you have access to additional limits and other policy protections.
Q: How does individual insurance coverage differ for a nurse practitioner?
A: Nurse practitioners are in an expanded role of practice. For example, in many states, they can diagnose, treat, and prescribe. So their role in patient care is much more involved than that of an RN. In some states, they have full independence in treating their patients. If you are a licensed NP, your liability insurance policy should specifically acknowledge that increased skill level so your policy will cover you for your full scope of practice if you are sued.
Q: What type of coverage should individual professional liability insurance include? And how can nurses assure it covers them adequately?
A: There are several different factors a nurse should consider if they’re going to purchase their own malpractice insurance.
The first thing to consider would be the type of policy they’d want to have — in other words, whether you’d want a claims-made policy or an occurrence policy.
A claims-made policy will only cover a claim that is made while the insurance policy is in effect. So, if a suit gets filed after the nurse leaves an employer, it isn’t going to be covered because the claim wasn’t filed when the policy was in effect. An occurrence policy is less complicated, but they’re more expensive, because they cover a claim so long as the alleged injury arose during a period of time that the policy was in effect. That’s very important to look at.
The other issue is the amount of coverage the nurse will need.
The limit of liability is how much a policy will pay for a settlement or judgment that results from a claim. The best rule of thumb is to ensure that you have limits that are consistent with others in your profession and in your region.
Another feature to look for is if the nurse has a say in whether the case settles rather than going to trial. In employer policies, this authority would not be included.
Nurses can be assured that the policy they select adequately covers them by carefully reading the proposed policy before signing it, doing research into what different insurance companies include in professional liability policies, checking with colleagues who have purchased their own policies, and by asking questions of a qualified insurance professional.
Open lines of communication with the insurance representative helps to ensure peace of mind and adequate coverage for his or her particular area of practice.
Q: What about exclusions, rights, and obligations related to professional liability policies?
A: Regarding exclusions in the policy, many insurance policies will not cover criminal allegations against a nurse. They will not cover punitive damages, which are sometimes awarded above and beyond the actual damages the plaintiff is owed for particularly reckless or intentional conduct. They also will not cover any services performed that are outside the nurse’s scope of license.
The nurse also has rights and obligations under the policy. There’s usually a duty to notify the insurance company (employer or individual) if there might be a suit or there is a suit filed. There’s a duty to cooperate with the insurance company by providing documents, if requested, and assisting with the defense.
The insurer’s obligations include a duty to defend, a duty to notify the policyholder of any policy changes, and a duty to pay out expenses and judgments that are covered by the policy.
Q: Does having individual professional liability coverage help nurses in disciplinary cases with boards of nursing?
A: Yes. They are the named insured. One of the biggest things that an individual policy provides a nurse that an employer policy does not is a defense against board investigations. That means for the price of the policy, you are getting an attorney to represent you. This is a major benefit. Disciplinary proceedings are costly, especially if the case goes to a hearing, and can drag on for a long period of time.
In the years that I’ve been doing defense work in professional liability actions, I would say only half of the nurses I’ve represented had their own liability policy. Others did not, so all costs as a result of the proceedings, including attorney fees, came out of their own pockets.
Q: What disciplinary actions could be brought against nursing professionals?
A: Board investigations can be initiated about patient care or documentation errors – whether or not they result in injury to the patient – mishandling of patient records, breach of confidentiality obligations, drug diversion, practicing outside the scope of one’s professional practice, not conforming one’s practice to established standards of nursing practice, and unprofessional conduct.
It is interesting to note that some boards of nursing may investigate unethical conduct that is not related to patient care. One example out of California involved a nurse who was convicted of driving under the influence of alcohol. The nurse’s defense was that the conviction had nothing to do with nursing. The state’s board of nursing disciplined the RN, holding that when one is a professional, one’s conduct must be professional at all times.
Editor’s note: The information contained in this article is designed for educational purposes only and are not to be taken as legal or other advice. Please consult an attorney if you need legal advice.