It Is All About Relationships

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• Dr. Barbara Resnick

For the past 10 years, I have had the opportunity to work with the Nurse Service Organization (NSO), which provides professional liability insurance for nursing professionals. This coverage is underwritten by the American Casualty Company of Reading, Pennsylvania, a CNA company. With over 40 years of experience providing quality professional liability insurance to health care professionals, CNA has an outstanding reputation for handling claims quickly and fairly. I have been impressed, and truthfully amazed, by the dedication of the organization and its employees to nursing and to helping keep nurses safely and effectively engaged in practice. It is the personal relationships that NSO cultivates with its clients (us nurses!) that makes this group the premier choice for coverage among many of us at the individual level, and I anticipate it is the reason why multiple nursing organizations continue to endorse this group.

So, what is it that NSO does that other liability insurance groups do not do? Well, before listing out what they do for their insured, I will delineate what they do for nurses in general. It has been a leader in developing educational materials about liability. Specifically, it has provided information about how to protect ourselves professionally across a variety of high-risk situations, and it has delineated what to do when a claim made against a nurse. For example, it provides information that differentiates employer coverage versus personal coverage and the pros and cons to each. Quite simply, it describes 6 significant gaps in an employer's malpractice insurance policy that can leave providers at serious financial risk if we do not also have our own personal liability coverage (Table 1). Educational resources are available to all nurses on the NSO Web page (www.nso.org) and include the following: A series developed by Melanie L. Balestra, NP, Esq., that covers such things as employer contracts, independent contractors, malpractice and disciplinary action, risk management recommendations, billing information and maximizing revenue, and pitfalls in practice. In addition, there are general education materials for nurses that give an overview of malpractice.

Table 1. Employer Coverage Versus Personal Coverage

Throughout the year, NSO also posts on its Web page new materials in its newsletter, the NSO Risk Advisor. Topics over the past year have addressed the following challenges: dealing with substance abuse, dealing with patients with low literacy skills and what our responsibility as nurses is to these patients, avoiding medication errors, managing the risk of noncompliant patients, risks in retail clinics, when to refer or not to refer and understanding the risks and benefit of each, and a case study focused on following a standard of care.

Recently, NSO went a step further with regard to education and developed an extremely comprehensive Toolkit for Educators. This toolkit, also available for free on the Web, includes resources that educators can use (in academic or institutional settings) to teach students and nurses in the workforce about professional liability. Specifically, “Tools for Your Classroom” includes PowerPoint presentations and handouts, as well as articles, quizzes, and links to sites that may be helpful. New features are continually added as appropriate such as cases to review or new articles of relevance. In the near future, the Toolkit for Educators will have resources that are geared toward advanced practice nurses.

Over the past 5 years, NSO has partnered with CNA to support and complete several Nursing Professional Claims Studies. Although these studies are based on data from NSO insured nurses, the findings provide an exemplary review of nursing malpractice claims nationally and across all specialty areas. This information is critical to help guide us all in protecting ourselves and our patients from risk. The first CNA's Nurse Claims Study is available online in an easy-to-use booklet. The data for this study were derived from a sample of 8151 professional liability claims from the CNA/NSO nurses insurance program and covered events that occurred between January 1, 1997 and December 31, 2007. To focus on the most significant nurse claims and to manage the aggregated data from a reporting and analysis perspective, the study was limited to professional liability claims involving licensed nurses with indemnity payments or reserves equal to or greater than $10,000. Driven from the findings, a series of risk management recommendations for nurses was developed around scope of practice, nursing competencies, patient health information records, documentation, informed consent, diagnosis, advance directives, cancer screening and diagnosis, treatment activities, medications, equipment risk management, and specialty nursing areas.

The first of CNA's Nurse Practitioner Claims Study¹ was done in 2004 based on 841 claims occurring between January 1994 and December 2004; it was recently replicated using subsequent data through 2009. This new Claims Study will be available online by early 2010. As with the nurses claim study, the nurse practitioner studies provide an overview of the claims in a defined time period, the frequency and severity of those claims, specialty-specific claims data, and recommendations for how nurse practitioners can protect themselves, and their facilities and employers, from risk. In addition to describing claims, the most recent nurse practitioner study compares nurse practitioners who had and had not been involved in a claim to consider educational differences, practice setting differences, regulatory differences (e.g., working under a collaborative agreement or independently), and differences in experience among other things.

Okay, so all this is well and good, but what does NSO do for those insured in the event that a claim occurs? Depending on your state and your situation, your NSO professional liability coverage will cover up to $6,000,000 aggregate or up to $1,000,000 for each claim. A defendant expense benefit in which up to $10,000 coverage is provided, deposition representation of up to $5,000 aggregate, and coverage for care provided during medical emergencies is referred to as a First Aid Benefit. This benefit is for up to $2,500 aggregate for expenses you incur in rendering first aid to others. This coverage is provided 24hours a day, 7 days a week. Your protection remains in effect even if you change jobs, during a period of unemployment, or if you travel to Puerto Rico or Canada.

Although we all wish it were not so, malpractice issues in health care continue to overshadow how we practice, where we practice, and, in some cases, even if we practice. I am thankful to groups like NSO and CNA for the support they provide in protecting us, and mostly because they care. Moreover, I am glad to know that if I ever need the help and support, there will be someone there to hear my story and provide the guidance and support I know I will need at the time.

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Reference 

1. CNA's Web Page for Claims Studies. Available at www.hpso.com/business-owners/resources/claim-studies.jsp. Cited November 2009.
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