Malpractice Insurance for Nurses: Do You Need It?

Deborah Chiaravalloti - 03/15/19

There are many different opinions about malpractice insurance and whether it is important for nurses to carry it. Some nurses believe they will never be sued because they are not the doctor in charge of the patient’s case. Others believe that they are covered by their healthcare organization’s malpractice policy. Yet others believe that it is not important and that even if an adverse event occurs, they will be safe from lawsuits. Certainly, it's each nurse’s personal decision whether to carry malpractice insurance or not but each of these beliefs carry some degree of personal risk for nurses. Here are the facts you need to make an informed decision.

First, let’s define malpractice. According to the legal dictionary, “The failure to meet a standard of care that is recognized by a profession reaches the level of malpractice when a patient is injured or damaged because of error. Among physicians, malpractice is any bad, unskilled, or negligent treatment that injures the patient. A majority of states define the standard of conduct as that degree of skill and learning ordinarily possessed and used by other members of the profession. A doctor who has met the standard, as established by expert testimony at trial, cannot generally be found negligent.” says that applies directly to nurses as well saying, “No matter how educated, confident, and careful the nurse is, unintentional mistakes can and will happen. Accidents will occur. Unfortunately, willful neglect can be an issue. Injury and death very often are the results of mistakes, accidents, and neglect.” Their conclusion is that malpractice insurance is the “nurse’s advocate as it provides essential legal and financial security”. 

Now to the various beliefs regarding malpractice insurance and whether it is necessary for protection. 

Belief #1: I am not the doctor; therefore, I will not be sued in the event that a patient is injured or dies.  

Reality: To address this issue we went directly to the source to discover what nurses’ experiences are in this regard. We found that nurses definitely can be sued as part of the healthcare team. Nurses in an forum weighed in on the issue saying: 

“As a nurse who has been through a lawsuit, I can vouch for the fact that not only can nurses be sued, but they can lose their livelihood over a lawsuit, whether they were guilty of any infraction. Malpractice insurance helps with some of the expenses associated with a lawsuit and/or defending oneself with the nursing board, but it doesn’t make up for the loss of a job and loss of one’s professional reputation.” 

“As a paralegal, I can tell you anyone can file a suit; whether they have standing and can prove their case is another story. Being a nurse does not preclude you from being sued. But then, so can the maintenance man when he forgets to dry a wet spot on the floor and a patient slips and falls, along with nurse (Why wasn’t the nurse assisting the patient to the bathroom when the patient called for him/her three times?), the doctor (Why didn’t the patient have a Foley?), the hospital (What was the procedure of the hospital regarding wet floors?) and so on. Nobody, absolutely nobody, is immune to litigation.”

Some reports show that nurses are sued less than physicians, but that doesn’t diminish the need to be protected by insurance. An article in Nurse Journal reports that the number of lawsuits filed against advanced practice nurses such as nurse anesthetists, nurse-midwives, nurse practitioners and clinical nurse specialists are “low in comparison” to physicians. They theorize that the nature of nurses’ work may prevent the misunderstandings and resentment that can lead to lawsuits through:

  • Communication skills and open dialogue 
  • Positive relationships developed over the course of the patient's care
  • Education that is appropriate for the level of the patient and family

Despite this, Nurse Journal reaches the conclusion that even after doing everything possible to avoid problems, nurses can still be sued. “Areas of practice in which lawsuits are more prevalent are in the specialties of anesthesia, obstetrics, pediatrics and neonatology. Ultimately, malpractice insurance is necessary for the advance practice nurse and should be paid for by the advance practice nurse.”

Belief #2: I don’t need to carry malpractice insurance because my hospital (healthcare organization) covers me. 

Reality: Nurse Journal weighed in on this issue and cautioned nurses to rely on employer malpractice coverage saying, “Hospitals will protect themselves first and may not vigorously defend their employees. If an individual health care provider is sued and found guilty there is the possibility of financial ruin especially if a settlement is reached.  Purchasing malpractice insurance is a potential shield.” is even more blunt in their assessment of the effectiveness of an employer’s malpractice coverage saying, “Remember: your employer's policy is created to fit their specific needs and protects them first. You may even be told by your employer that you do not need your own policy. What they do not tell you is that they want you to be represented by their attorneys. They do not want "outside" representation for they know that their best interests will not be first and foremost.

Another important point is that the employer’s malpractice coverage may include more employees than just one nurse. That greatly diminishes the protection. points out, “If you are only covered by your employer's insurance, other defendants employed at your entity may and probably do share your liability limits under the same policy. If you, as well as others, are named in a suit, your legal costs, including any settlement, could exceed your employer's shared liability limits. This would mean out-of-pocket expenses for you.”

What is the best malpractice insurance? 

Deciding which type of malpractice insurance to buy is a personal decision. There are two types of malpractice policies: 

  • Occurrence-based: It covers any incident occurring while the policy is in effect even if the policy is now canceled and/or you have retired. However, if the policy is no longer active, it will cover claims for incidents that occurred while the policy was in effect, only if the issuing insurance company is still in business.
  • Claims-made: It covers any incident only while the policy is in effect. That means you must continue to pay for the policy to cover any future claims. recommends carrying both types of insurance simultaneously. They also encourage nurses to be very being clear about the details of the coverage because some policies do not cover legal fees. In some policies legal fees are in addition to the limits of liability covered by the policy. In that case, the individual would be responsible for all legal fees which can cost hundreds of thousands of dollars.

Individual malpractice insurance policies also offer several other types of important coverage:

  • License protection. Should discipline issues be brought before the Board of Nursing, this part of the policy will pay for legal fees and other costs of defending one’s license.
  • Patient confidentiality: Policies can cover lawsuits alleging HIPAA violations

You can review malpractice insurance at the site and the Nurses Service Organization, among others. Your professional nursing association may offer malpractice insurance as well.

The bottom line is that you worked hard to become a nurse. Protect yourself, your livelihood, and your career by purchasing malpractice insurance that will protect you now and in the future.