Malpractice coverage Although the healthcare organization for which the nurse works may cover them under the organization’s malpractice insurance policy, it is important that all nurses understand the kinds of events and financial limitations covered by the policy. Nurses should regularly check their employer’s coverage of its nurses to be sure that coverage has not changed or been discontinued (Wacko Guido, 2020). Nursing consideration: If the nurse and their employer are both named as defendants in a lawsuit, even if the nurse is covered by the employer’s malpractice insurance, the interests of the nurse and the employer may be contradictory. It is possible that the employer could claim that the nurse failed to act within the scope of their employment and is consequently not covered by the employer’s malpractice policy (Wacko Guido, 2020). Here are some questions nurses need to ask regarding malpractice coverage (Wacko Guido, 2020): ● Am I covered by my employer’s malpractice insurance? If so, what are the monetary limits of this coverage? ● What kinds of events and actions does the malpractice insurance policy cover? ● How many claims per year does the malpractice insurance policy cover? ● Does the malpractice insurance policy cover me if the incident that triggered the malpractice lawsuit occurred while Understanding malpractice insurance A number of myths surround nursing malpractice insurance. Below are some reasons why a nurse should carry their own individual liability insurance (Wacko Guido, 2020): 1. Defending against a lawsuit is expensive and the healthcare agency’s insurance may not cover all the nurse’s legal expenses. 2. Nurses with private professional liability insurance are not sued more frequently. A plaintiff does not know if the individual has individual liability insurance until after the lawsuit is filed. Types of malpractice insurance and their coverage Occurrence-based policies cover nurses for events that occurred while the policy was in effect (e.g., the policy period). This is true even if the policy has expired but the claim was from an incident within the time period where the policy was enforced. Claims-made policies only provide for claims made within the active policy period and when the lawsuit has been filed with the courts, and when the insurance company is made aware of the lawsuit. If the lawsuit is filed after the policy has expired, the nurse is not covered (Wacko Guido, 2020). Policies usually cover defense costs; covered injuries, which can include bodily injury,
I was an employee, but was not an employee by the time legal action was taken? In other words, does my protection stop if I am no longer employed by the organization, even though the incident occurred during my time as an employee? ● Does my employer’s malpractice insurance cover the cost of an attorney to represent me? ● What are the laws in the state in which I practice concerning malpractice coverage? Are certain professionals mandated to have coverage? If so, how much coverage is mandated? Employer’s insurance relates to malpractice litigation. However, suppose a complaint is filed against a nurse by the state BON or other regulatory body. Legal representation is still necessary. An employer’s policy will cover only malpractice representation. The nurse is on their own when dealing with the BON or other regulatory body complaints unless covered by personal malpractice insurance that includes such coverage (Wacko Guido, 2020). Nursing consideration: If the nurse and their employer are both named as defendants in a lawsuit, even if the nurse is covered by the employer’s malpractice insurance, the interests of the nurse and the employer may be contradictory. It is possible that the employer could claim that the nurse failed to act within the scope of their employment and is consequently not covered by the employer’s malpractice policy (Wacko Guido, 2020). 3. Costs may be relatively inexpensive, depending on where the nurse works. 4. Malpractice is not synonymous with incompetence or guilt. Sometimes, untoward events do occur placing the patient at risk, which can place the nurse at risk of being named in a lawsuit. 5. Should the institution decide to sue the nurse for reimbursement, the nurse has coverage for this. 6. A nurse can be sued, even if standard of care was followed. The patient’s or family’s perception that an error has occurred may be sufficient to trigger a lawsuit. mental anguish, property damage, libel, slander; and economic damages (Wacko Guido, 2020). Policies will include limits of liability (individual claim, and overall [aggregate]). Some policies will not cover criminal actions, incidents under the influence of drugs or alcohol, “physical assault, sexual abuse, molestation, habitual neglect, licentious and immoral behavior toward patients whether intentional, negligent, inadvertent, or committed with the belief that the other party was consenting,” and finally actions that violate state nursing practice acts (Wacko Guido, p. 188, 2020).
JUST CULTURE
understanding the behavior leading up to a person’s choice. Behaviors that could lead to errors would be “at-risk” behaviors, where the risk is not recognized or is believed to be justified. There can also be reckless behavior, which is a conscious decision to disregard the risk that is substantial and unjustifiable (Paradiso & Sweeney, 2019). Once an error or near miss has been reported, the organization should conduct a root cause analysis (RCA) or failure missed and effects analysis (FMEA) to truly understand how the error occurred and what change is needed to prevent this in the future (Schroeder, Parisis & Foster, 2019). Systems are not infallible. Even with all the checks and balances in US healthcare systems (electronic medical records, orders etc.), mistakes still occur (Paradiso & Sweeney, 2019).
A just culture is one that supports a safe haven for the reporting of errors and near misses in healthcare (Paradiso & Sweeney, 2019). It is the organization that is ultimately accountable for systems they design and the analysis of the incident, not the individual. The organization realizes errors are a sequence of events with multiple opportunities for correction, as opposed to occurring in a vacuum (Paradiso & Sweeney, 2019). There is not one definition of just culture; however, a generally accepted one is “organizational accountability for the systems they’ve designed and employee accountability for the choices they make” (Paradiso & Sweeney, 2019). The first pillar of a just culture is the adoption of a nonpunitive, non-blaming system for the reporting of errors. The goal of the organization is to improve patient outcomes but not blame the individual (Paradiso & Sweeney, 2019). The second pillar is
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