should a new nurse get malpractice insurance?

summary: yes, you should get insurance. you would be crazy not to.

note; be sure to click on the links!

I decided to write this because of a recent experience on a FaceBook page in which a nurse was saying, “no you don’t need it, nurses never get sued and my husband is a malpractice attorney so he should know!”  I vehemently disagreed and was a bit surprised to be belittled and insulted. Be that as it may, the internet is a public square…. I was surprised to learn that the person who flamed me about it also  had a PhD in nursing and was employed as an administrator.  It reinforces some negative stereotypes about administrators and educators in terms of being in touch. Most are actually well informed and have been educated as to the laws governing nursing in their state, and their own legal and ethical responsibilities.

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insurance covers more than just malpractice

It may be very well be true that nurses are not often targeted in lawsuits and are therefore not likely to be sued. (disclosure: I have had insurance for decades but I have never been sued.) BUT, malpractice insurance covers more than just being sued for malpractice. It covers something called “license protection” – and this is of vital importance.

Sad and shocking, but true

here is the sad story. There was a case a number of years ago which became known as “The Death Angel” – a nurse named Charles Cullen who practiced in NJ and PA and OH for more than ten years and jumped from job to job. When he was bored he would inject potassium into his patients, causing their heart to stop so that a Code Blue could be called. The investigators finally concluded he probably killed ( yes, murdered!) forty or more patients that way.  One estimate said 400 – in which case he would be the most prolific serial murderer in US history. There have been other such nurses, just google the term and you can find the details.

Proactive approach needed

we can read the post-event details of how the criminal justice system tracked these people down, but these highly publicized cases served to cause all the State Boards of Nursing to ask how this could have been prevented. There were three Boards involved, shouldn’t they have caught him somehow? And one commonality was that the perpetrators of these crimes were often people who skipped from job to job, leaving each under a cloud of suspicion. Charles Cullen was the prototype. He had ten jobs in sixteen years in three different states, usually working night shift in ICU.

Once this became known, more than thirty states adopted regulations that require all employers of nurses to report a nurse to the State Board if they are discharged from employment due to concerns about competence and a threat to the public. The National Council of State Boards of Nursing is a resource on this issue, and at their website they list the types of complaints against nurses that can result in being reported to the Board of any given state.

You can even get a state-by-state interactive map that shows how many nurses have been disciplined – i.e, had action against their license. For example, in 2012 there were 109 RNs in New York state, and 44 in Maine. That’s only the ones who were “guilty” – not the total of complaints. The NCSBN publishes a model nursing practice act, and on pages 8 and 9 you can see that the intent is to make it easy easy for a nurse to be reported to state board.  I think all 50 states now use the Model Act.

Here is where it gets tricky

I am certainly in favor of tracking down any future Death Angels; and also am in favor of excellent practice. I personally have reported suspicions about fellow nurses to my employer(s) and ultimately these persons got reported to the Board. But, just because you are reported does not mean that you are a threat to the public.  Maybe it means that you were a bad fit for the organization or hospital where you worked. But you will be reported nonetheless. and it’s your bread-and-butter which is at stake. You are entitled to Due Process and a fair hearing.

In Maine, where I was State President of the Nurses Association, we would get calls from nurses asking for advice. there was one particular employer that had a highly questionable pattern: they seemed to find ways to fire their RNs, long-time employees, when they got within a year of being vested in the pension program.  Nobody could prove that was truly what they were doing; but it seemed suspicious. They would trump up some sort of reason.  there was also a unionised hospital in Maine which tried to fire one of the leaders of the nurses union when she gave two aspirin to a patient in the middle of the night without a doctor’s order. (Management was watching every move she made, just looking for a reason to fire her. in that case, the Board threw the case out since it was obviously retaliation). and of course, we have all heard of doctors who reported nurses to the Board when the nurse stood up and advocated for their patient. I think the State Boards have a good record of supporting nurses in those cases. Read here for more information about a case in Texas that should make you stop and think.

“Don’t let the door hit you on the way out”

an unintended consequence of the reporting law is that it gives employers another weapon to use as a threat against activist nurses such as the union activist or those two nurses in Texas. They can compel you to go to the Board and defend your license, which costs money. that’s where License Protection comes in. Even if you never get sued for malpractice, most policies include license protection insurance, and this can save you the $10,000 it would have cost out-of-pocket to defend yourself.  ask yourself if you wish to be protected against nuisance complaints?

I like to attribute good motivations to administrators and I like to think that a nurse-administrator would always be acting out of a sense of justice. Every reader can ask themselves if they have ever met a nurse-administrator who chose to be “tough” somehow – and use this as a way to twist the knife when an employee parts company. There are ample war stories out there. Not every work culture is healthy.

As a parting thought – every agency needs to make certain that their administrators know the details of the mandatory reporting law. we all have a stake in protecting the public.

if you wish to share below, let me know.

oh yes, and please click the blue section for a link to my book about nursing in Nepal.