Recently, Nurses Service Organization (NSO), the largest provider of nurses' liability insurance in the United States, and CNA Healthpro, the liability insurance underwriter, published an analysis of nursing malpractice claims from 2006 to 2010. This report is significant because it helps us to identify and manage risk exposures relevant to our practice.
The report reviewed 3,222 closed claims against nurses insured by CNA through NSO. Inclusion criteria included claims against RNs (not including advanced practice nurses), LPNs, or LVNs that involved significant patient injury or financial loss and resulted in a judgment or settlement payment of $10,000 or more.
The demographic findings of the report are quite interesting: Most (nearly 92%) of the claims were against RNs compared to LPNs/LVNs. Thirty-eight percent of the defendants had a bachelor's degree and 31% had an associate's degree. Almost 40% of the defendants were between ages 51 and 60; 30% were 60 or older. Nearly half (46%) of the defendants had been practicing nursing for more than 21 years.
The total payment on behalf of the RNs was almost $80 million, with an average payment per case of almost $170,000. Payouts were almost doubled ($26,000 compared to $14,000) in the cases of nurses who didn't have a mentor or preceptor during their first 2 years working as a nurse.
Insurers paid nearly $8.6 million in indemnities related to medication administration. Twenty-six percent of the claims were related to wrong dose, 20% to improper technique, 18% to wrong medication, and 13% to failure to properly monitor and maintain the infusion site. The highest average paid indemnity, $151,386, was related to administering the wrong medication.
The report offers these risk control recommendations:
- Know your state's nurse scope of practice, nurse practice act, and facility policies and procedures.
- Follow documentation standards of your professional organization and comply with your employer's standards.
- Emphasize ongoing patient assessment and monitoring.
- Develop and maintain effective communication.
- Use the chain of command when necessary to advocate for interventions with significant change in patient status.
- Maintain clinical competencies.
- Clarify your direct care assignments and responsibilities.
Are you doing everything you can to reduce your liability risk? Spend some time reviewing this report and thinking about what it means to you. Also think about what you can do to reduce the risk for nurses you precept and mentor. Remember, these actions are really about providing outstanding patient care, not simply reducing your liability risk.
Until the next time, be healthy, be happy, be great advocates for your patients, and take steps to reduce your risk for liability...it will ultimately improve your patient outcomes!
AnneMarie Palatnik, MSN, RN, APN-BC
CNA Healthpro and Nurses Service Organization. Understanding Nurse Liability, 2006–2010: A Three-Part Approach. http://www.nso.com/nurseclaimreport2011