Traveling Nurses Must Have Appropriate Professional Liability Insurance

8 Indest-2008-5By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

We are often asked what we consider to be the biggest problem that a nurse has in defending herself in a complaint against her license.  In our opinion, it is not having the financial resources to retain the services of an experienced attorney to defend her.  Because of this, we believe that any nurse, especially traveling nurses working at a hospital, skilled nursing facility, home health agency, assisted living facility, medical group, or any other organization must have her own personal professional liability policy that provides ample insurance coverage for professional license defense expenses.

Most Complaints Made Against Nurses are Filed by Employers.

In our experience, most of the complaints filed against nurse professionals come from employers.  In many cases, a patient will complain to the employer and the employer will file the complaint.  In others, the employer initiates the complaint because of substandard performance, documentation problems, allegations of theft or drug diversion, allegations of falsification of documents or records, etc.  When this happens, in most cases the employer terminates the nurse.  This is why we say that a nurse must have her own professional liability insurance policy.

We see a great many more complaints filed against a nurse’s license that she then must defend, than we ever see civil claims for damages.

Many nurses work under the incorrect assumption that they are “insured” by their employer or their agency or that their employer’s or agency’s insurance covers them.  This is a fallacy, especially when it comes to defending against a complaint made against one’s nursing license.  If your employer or agency is the one that files the complaint against you, you don’t really think that your employer or agency is going to cover the legal expenses associated with your defense, do you?

Some hospitals and health organizations are notorious about firing nurses who have any discrepancies in drug counts or who have documentation errors.  This often results in a complaint to the Department of Health (DOH) against the nurse’s license.

Furthermore, we are all aware of the phenomenon with the traveling nurse, the person who is no longer there, getting all of the blame for any problem or incident that come up.  The ones that are still at the facility, the ones who are conducting the investigation on the incident, are far less likely to find blame with their friends and colleagues who are still there.

Just when you need it the most, you may find yourself out of a job, with no income, and no money to pay for a legal defense.  This may ultimately lead to your losing your nursing license and your ability to ever work as a health professional again.

If You Don’t Have Personal Professional Liability Insurance-Get It.

Professional liability insurance policies for nurses are very cheap.  Often policies are only about ten dollars a month.  Usual limits of coverage for this small premium payment are one million dollars of coverage for civil suits and $25,000 or more coverage for professional license defense.

But wait, it is not as simple as just purchasing the first professional liability insurance policy you find.  Many professional liability insurance policies do not offer license defense coverage.  Or, if they do, it is limited to only complaints where there is also the threat that a patient is going to sue for money.  Still others provide such low limits of coverage for license defense expenses (e.g., $5,000 or $10,000) that it is not worth the money paid for it, while others do not allow you to choose your own attorney.

Insurance Companies We Recommend.

We usually tout insurance companies such as that provided by Nurses Service Organization (NSO) and Healthcare Professionals Service Organization (HPSO) as providing great bang for the buck.  But here lately, we’ve been seeing (and hearing) more and more about CPH & Associates insurance.  Not only does it provide one million dollars in coverage if you are sued in a civil court, but it also provides up to $35,000 in coverage for professional license defense.  Additionally, for a very small additional payment, with CPH & Associates Insurance you can increase that coverage to $100,000 for professional license defense.  The other company we hear good things about is Lloyd’s of London.

If you have a complaint filed against your nursing license and you have to prove your innocence through a formal administrative hearing (trial), this can be very, very expensive.  Additionally, if you lose at this level, you may have to appeal the results to a higher court.  These expenses can easily cost $75,000, even if you win.  And you are not ever assured that you will get any of this money paid back to you, even if you are innocent and you win the case.  Inexpensive insurance coverage is the only thing that makes since.  Buy it!

In Conclusion.

We urge all nurses, especially traveling nurses, to purchase and maintain their own personal professional liability insurance policy.  It’s tax deductible.  But check to make sure you have coverage for professional license defense, even when there is no claim for damages expected from a patient.  Additionally, pay the extra premium to purchase a higher limit of coverage for professional license defense cases, or buy a second insurance policy for this additional coverage.

Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Do you have personal professional liability insurance? Will you consider purchasing a personal policy now? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Legal Responsibilities of Nurse Supervisors

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Although a nursing supervisor is liable for her own negligent acts, the employer is liable for the negligent acts of all employees, including nursing supervisors. Supervisors are not generally liable under the doctrine of respondent superior for the negligent acts of those being supervised, unless they can be shown to be independently negligent in how they supervise or fail to supervise. They have the right to direct the nurses who are being supervised. In a health care facility, the supervisor’s powers are derived directly from the facility’s right of control.

A supervisor who knowingly fails to supervise an employee’s performance or assigns a task to an individual he or she knows, or should know, is not competent to perform can be held personally liable if an injury occurs. The employer will be liable under the doctrine of respondent superior as the employer of both the supervisor and the individual who performed the task in a negligent manner. The supervisor is not relieved of personal liability even though the employer is liable under respondent superior.

In determining whether a nurse with supervisory responsibilities has been negligent, the nurse is measured against the standard of care of a competent and prudent nurse in the performance of supervisory duties. Those duties include the setting of policies and procedures for the prevention of accidents in the care of patients.

I. Failure to Properly Supervise.

Nursing supervisors must properly supervise the care rendered to patients by their subordinates.

A. Special Duty Nurse.

A special duty nurse is a nurse hired by the patient or the patient’s family to perform nursing care for the patient. An organization and its supervisors are generally not liable for the negligence of a special duty nurse unless a master-servant relationship can be determined to exist between the organization and the special duty nurse. If a master-servant relationship exists between the organization and the special duty nurse, the doctrine of respondent superior may be applied to impose liability on the organization for the nurse’s negligent conduct.

Like a staff physician, a special duty nurse may be required to observe certain rules and regulations as a precondition to working in the organization. However, the observance of organization rules is insufficient to establish a master-servant relationship between the organization and the nurse. Under ordinary circumstances a special duty nurse is employed by the patient, and the organization has no authority to hire or fire the nurse. The organization has the responsibility to protect the patient from
incompetent or unqualified special duty nurses.

B. Student Nurses. 

Student nurses are entrusted with the responsibility of providing nursing care to patients. When liability is being assessed, a student nurse serving at a health care facility is considered an agent of the facility. This is true even if the student is at the facility on an affiliation basis. Student nurses are personally liable for their own negligent acts and the facility is liable for their acts on the basis of respondent superior. Students must be supervised by a registered professional nurse who is either the direct agent of the student’s nursing school or one who has been designated by the school to serve in that capacity. A student nurse is held to the standard of a competent professional nurse when performing nursing duties. The courts, in several decisions, have taken the position that anyone who performs duties customarily performed by professional nurses is held to the standards of professional nurses. Each and every patient has the right to expect competent nursing services even if the care is provided by students as part of their clinical training. It would be unfair to deprive the patient of compensation for an injury merely because a student was responsible for the negligent act. Until it is demonstrated clearly that student nurses are competent to render nursing services without increasing the risks of injury to patients, they must be supervised more closely than graduate nurses.

II. Unlicensed Assistive Personnel.

Every time you delegate tasks to unlicensed assistive personnel (UAPs), you’re legally accountable for the outcome. What can you do to reduce your malpractice risk? Here are some tips:
1. Assess the patient’s needs, the staff available to meet those needs, and the
level of supervision required for a UAP to safely perform any task you
delegate;

2. Know the training and qualifications of the UAPs you supervise;

3. Assign the right person to carry out a task, based on her competence and
the patient’s condition;

4. Provide clear directions for the task you want performed. Ensure that the
UAP understands your expectations and knows to ask for help if questions
or problems arise;

5. Monitor the UAP’s performance of the task and the patient’s response; and

6. Accurately document the care provided.

Once a UAP is hired, the supervisor must delegate tasks appropriate to the UAP’s training,
credentials, and experience. If the tasks exceed the UAP’s competency level, the employer may be liable for negligent training. Furthermore, under the theory of vicarious liability nurses, physicians, facilities, or agencies may be held responsible for UAPs’ actions. In essence, a supervisor is liable if she assigns inappropriate tasks to anyone who lacks the skill or training to perform them. A good way to prepare UAP’s is to provide standardized training or testing in basic skills and to assign only tasks in which the UAP’s have shown competency.

III. Inadequate Staffing.

Health care organizations must continuously monitor their staffing needs in order to provide adequate care. The organization’s leaders, including nurse supervisors, define for their respective areas the qualifications and job expectations of staff and to evaluate the degree to which expectations are satisfied. Under federal law nursing facilities must have sufficient nursing staff to provide nursing and related services adequate to attain and maintain the highest practicable physical, mental, and psychosocial wellbeing of each resident, as determined by resident assessments and individual plans of care. Nursing facilities must provide 24-hour nursing services that are sufficient to meet the total nursing needs in accordance with patient care plans. 42 C.F.R. § 483.20 (1989). As nursing facilities are increasingly filled with older, disabled residents with ever-increasing complex care needs, the demand for highly educated and trained nursing personnel continues to grow. Inadequate career ladders and wage scales lower than those found in acute care hospitals, make it difficult for long-term care facilities to attract nurses.


Nursing Law Manual.

This blog post came from The Florida Nursing Law Manual.

The Florida Nursing Law Manual and the forms and information contained in it is for general information and education only. It is not intended to be and does not constitute the provision of legal advice. Every case, every individual, and every set of circumstances is different. You should always consult with your own attorney when making any legal decision. We recommend that you only use an attorney who is Board Certified by the Florida Bar in the Legal Speciality of Health Law and who is experienced in the legal matters at issue.
Contact Health Law Attorneys Experienced in Representing Nurses.

The Health Law Firm’s attorneys routinely represent nurses in Department of Health (DOH) investigations, in appearances before the Board of Nursing in licensing matters and in many other legal matters. We represent nurses across the U.S., and throughout Florida.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.