(APR 23, 2014) So your staffing agency offers some kind of liability insurance. That’s enough, right? Think again, says Edith Brous, RN, Esq., a registered nurse and attorney who concentrates her practice in representing and advocating for nurses. She says all nurses—even those covered under their employer’s insurance plan—should have their own liability insurance. This is especially true for travel nurses.Travel nurses are subject to varying state licensure requirements and rules, depending on how many states in which they are licensed. Reciprocity adds another layer of confusion. And, however unfair, travel nurses are often a target when a problem arises.
“There is a higher index of suspicion for travel nurses,” Brous says, adding employers are more likely to go to bat for someone they have known for a long time. “If something goes wrong, the first person you look to is the travel nurse.” Who is at risk? There is no safe place in the nursing profession without professional liability insurance, and at about $100 per year for a full-coverage policy, Brous says it shouldn’t even be an expense nurses question. “It is so inexpensive it’s shameful,” Brous says. “Think about how much you spent to put those letters after your name.” Brous says for that price, coverage can include $1 million per malpractice case or up to $6 million for the year, plus $25,000 in coverage for licensure claims. “That’s a lot of coverage for $2 per week,” she says.
According to a 2011 study from CNA Healthpro and the Nurse Service Organization (NSO), 92% of the 516 professional liability claims reviewed for the report involved RNs, compared to 8% involving LPNs—a difference likely caused by an RN’s higher degree of responsibility and likelihood of working in an acute care setting, the report notes. RNs and LPNs who provided services as independent contractors or through staffing agencies made up a quarter of all the claims in the study. Temporary staffing agency nurses made up 60% of those claims, with nearly $12 million in indemnities paid. Experience doesn’t help keep claims from popping up, either. According to the study from CNA and NSO, 69% of the nurses surveyed who had had claims made on the professional liability policies had 21 years or more of experience at the time of the claim, although most cited only being in their current position against which the claim was made for three to 10 years. Additionally, nurses with bachelor’s degrees experienced more claims against them than nurses from either lower or higher degree programs.
Malpractice
Malpractice is the first type of liability that comes to mind when discussing insurance for healthcare providers.
For claims with paid indemnities of more than $10,000, the average indemnity for RNs was $168,438, and the average expense paid was $43,489, for a total average claim payment of around $211,000. The 516 claims examined for the study totaled about $80 million in paid indemnity for RNs, and nearly $3.5 million for LPNs.
Specialties with the highest average paid indemnities are obstetrics, neurology/neurosurgery, and plastic/reconstructive surgery, according to the report.
Aesthetic services are now emerging as another risky area due to possible burns and scarring. Additionally, complaints involving scope of practice issues resulted in some of the highest paid indemnities. But assessment, monitoring, treatment and care, and medication administration issues made up were the categories in which the most allegations against nurses were made that resulted in a claim. Licensure and disciplinary This is the big one, Brous says. While malpractice claims are the first thing to come to mind, licensure complaints can sink you. “The real risk that nurses have is in having their board of nursing take disciplinary action on their license,” Brous says. It may cost a lot of money to defend a malpractice complaint, but a licensure complaint could take away your livelihood, she adds. Most employers—even staffing agencies—will offer some kind of insurance, mostly to cover themselves and what happens in the workplace. But Brous, who has worked as a travel nurse, says a lot of things can happen outside of the workplace that can come back to cause harm.
“The other thing that nurses don’t understand is that there are a lot of things that can bring a nurse to the attention of the licensing board—a single DUI, a conviction of anything,” Brous says. In New York, for example, any conviction at all—even if it is unrelated to clinical practice not even related to clinical practice, like a speeding conviction or defaulting on a loan—is considered professional misconduct. And every state board is connected. The National Council of State Boards of Nursing maintains a system in which state board are alerted to any disciplinary action of a licensee in any other state. Brous tells the story of one client, a travel nurse, who was originally licensed in New York. She obtained a license in Pennsylvania for a job she ended up not taking, then moved along to Texas, Arizona, Ohio and Florida before finally working and settling in California. At some point, she received a letter from New York’s licensing board directing her to appear for an investigative interview regarding a misconduct complaint. Since she did not intend to return to New York to practice, she was advised by an uncle who was a real estate attorney to ignore the letter.
As a result of not responding, her New York license was revoked. She was then notified by California that her license there would be revoked because of the disciplinary action in New York. Her attorney was able to work out a deal to have her revocation stayed, the rescinded after a two-year probationary period, but then every other state in which she had ever been licensed followed suit with an investigation. When state gives license, they are saying you are ethical and follow rules. But once a state issues a license, it gives the state lifelong jurisdiction over the person who got license, even if not renewed or expires. The state still has authority.
“The thing that travel nurses need to understand is there is also reciprocal issues. I was licensed in 10 states as a travel nurse, so if I ever got in trouble with one state, I have nine others coming after me,” Brous says.
Many times, travel nurses get caught up in minor differences in regulations from state to state. One state might allow an RN to delegate duties to an LPN that another does not. “You may be used to doing things that you do, that in that state you cannot legally do,” Brous says, leading to scope of practice violations. “That’s why (insurance for disciplinary actions) is particularly important for travel nurses.” CNA and NSO reviewed more than 1,100 licensure claims made against nurses between 2006 and 2010. Nearly 85% were made against RNs compared to 15.5% against LPNs. Claim payments made in cases involving RNs totaled more than $3.2 million, according to the report.
More than half of the RNs who experienced licensure defense claims most often worked in a hospital setting, and the most common allegations against the nurse’s licensure involved professional conduct (23.5%), improper treatment and care (21.1%), medication administration errors (19.7%), and abuse or violation of patient rights (13.7%). Professional conduct allegations most often involved drug diversion and/or substance abuse, criminal acts such as driving under the influence charges. In half of the licensure cases, no action was taken by the state board, but 14% of cases ended in probation, 8% in reprimand, 5% in suspension and almost 5% in surrender or revocation.
Weighing policies
When reviewing your options for insurance, Brous says it’s important to find out if a plan is occurrence or claims made. Occurrence policies offer protection based on the incident date. As long as you were insured when the incident occurred you are covered, whether you have an active policy when the complaint is made or not. Claims made policies only cover claims if the incident occurred when the policy was in effect and if the claim for that incident was made when the policy was in effect. Check to make sure licensure claims are covered, Brous says. Not all plans offer this coverage. Two big players that do are NSO, the nation’s largest professional liability provider for individual nurses, and Mercer Consumer (formerly known as Marsh), which is offered at a discounted rate to members of the American Nurses Association.
Brous also recommends looking for a company that uses nurse attorneys, who she believes are better able to defend nurses before a licensing board and are more cost effective, achieving better outcomes in fewer hours.
“We save more licenses than attorneys who don’t have a nursing background,” Brous says. “I can look through a medical record and find something much, much faster than a lawyer who has never been a nurse can.”
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Posted By: Jen Fad
Thursday, April 24th 2014 at 2:51PM
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