Post a total of 3 substantive responses over 2 separate days for full participation. This includes your initial post and 2 replies to classmates or your faculty member. Substantive responses offer new info and add to the conversation. *Responses are substantive by incorporating literature to support statements. Use one literature resource for your weekly response and in at least one of your replies to a classmate or faculty. You can use the same source of literature each time or different sources. Check rubric for more details.
Due Thursday
Review
Nurse Professional Liability Exposures: 2015 Claim Report Update
to understand some of the most common legal allegations. As you read, think about ways to mitigate the risks listed in the report.
Respond to the following in a minimum of 175 words:
- What struck you most about the report or the allegations discussed?
- Select 1 example or illustration from 1 of the claims categories and explain what could have been done to mitigate the risk that led to the claim.
- How does this affect you or your work place?
FYI – I work in oncology /infusion where we infuse chemo and these meds are life threatening meds in case you need to add
Nurse Professional
Liability Exposures:
2015 Claim Report Update
A COMPARATIVE ANALYSIS FROM
CNA AND NURSES SERVICE ORGANIZATION
PART 1 Nurse Professional Liability Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Database .and .Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Data .Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Analysis .of .claims .by .licensure .type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Analysis .of .severity .by .year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Nurse .closed .claims .with .expense .payments .only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Analysis .of .severity .by .nurse .specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Analysis .of .severity .by .location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Analysis .of .Severity .by .Allegation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Allegation .by .category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Analysis .of .Allegation .Sub-categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Allegations .related .to .assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Allegations .related .to .monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Allegations .related .to .treatment .and .care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Claim Scenario: Delay in Implementing Provider Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Allegations .related .to .medication .administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Claim Scenario: Medication Error Resulting in Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Allegations .related .to .patients’ .rights, .patient .abuse .and .professional .conduct . . . . . . . . . . . . . .28
Analysis .of .Severity .by .Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Analysis .of .fatal .injuries .by .underlying .cause .of .death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Analysis .of .severity .by .cause .of .death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Analysis .of .obstetrics-related .injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Analysis .of .severity .by .disability .outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Analysis .of .director .of .nursing .(DON) .closed .claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35
Claims .related .to .agency .nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Claim Scenario: Successful Defense of a Nurse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Licensed .practical/licensed .vocational .nurse .closed .claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Summary .of .Closed .Claims .with .a .Minimum .Indemnity .Payment .of .$1 .Million . . . . . . . . . . . . . . . . . . . .39
Risk .Control .Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Patient .safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Assessment .and .monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Treatment .and .care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Chain .of .command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Scope .of .practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Risk .Control .Self-assessment .Checklist .for .Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Claim .Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Everyday .practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Once .you .become .aware .of .a .claim .or .potential .claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
PART 2 Nurses Service Organization’s
Analysis of License Protection Paid Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
License .Defense .Paid .Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Analysis .of .claims .by .licensure .type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Analysis .of .claims .by .location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Analysis .of .claims .by .allegation .class . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Average .payment .by .allegation .class . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Claims .by .Allegation .Class .Sub-Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Allegations .related .to .sub-category .of .professional .conduct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Allegations .related .to .sub-category .of .patients’ .rights .and .patient .abuse . . . . . . . . . . . . . . . . . . . .54
Allegations .related .to .sub-category .of .improper .treatment .and .care . . . . . . . . . . . . . . . . . . . . . . . .55
Allegations .related .to .sub-category .of .medication .administration . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Licensing .Board .Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Comparison .of .2011 .and .2015 .distribution .of .licensing .board .actions . . . . . . . . . . . . . . . . . . . . . . . .57
Explanation .of .Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
General .Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
PART 3 Highlights from Nurses Service Organization’s
2015 Qualitative Nurse Work Profile Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61
Summary .of .Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Topic .1: .Respondent .Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Nursing .licensure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
Pre-licensure .nursing .program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Origin .of .education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
Additional .certifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Years .in .practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Topic .2: .Current .Practice .Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Technology .and .rapid .access .to .information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Technology .and .patient .records .access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Managing .technology .and .time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Technology .and .information .verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Usage .of .electronic .patient .notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Access .to .evidence-based .data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Staff .development .opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Employment .practice .periodic .checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Topic .3: .About .the .Claim .Submitted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
Working .situation .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
Employment .status .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72
Years .in .practice .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Magnet™ .designation .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
Substance .abuse .procedure .in .place .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Tenure .in .position .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74
Topic .4: .About .the .Facility .Where .the .Incident .Occurred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Technology .in .the .workplace .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
How .long .were .you .using .technology .at .the .time .of .the .incident? . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Perceived .patient .benefit .of .technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
Rapid .response .team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
PART 1 Nurse Professional Liability Exposures
CNA Five-year Closed Claims Analysis
(January 1, 2010-December 31, 2014)
and Risk Control Self-assessment for Nurses
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 6
Introduction
For .over .30 .years, .CNA .and .our .business .partners .at .Nurses .Service .Organization .(NSO) .have .been .
committed .to .helping .nurses .insure .themselves .against .loss .by .providing .specialized .insurance .
coverage .and .working .to .enhance .their .risk .awareness . .Our .joint .professional .program .is .the .nation’s .
largest .underwriter .of .professional .liability .insurance .for .individual .nursing .professionals, .with .more .
than .550,000 .policies .in .force . .CNA/NSO-insured .nurses .provide .healthcare .in .an .increasingly .
broad .array .of .locations .and .specialties, .including .hospitals, .aging .services .facilities, .outpatient .and .
ambulatory .centers, .practitioner .offices, .schools, .community .and .retail .health .settings, .spas .and .
aesthetic/cosmetic .centers .
Purpose
In .collaboration .with .NSO, .we .are .pleased .to .present .our .third .report .on .nurses’ .risk .exposures, .
which .examines .CNA .nurse .claims .that .closed .between .January .1, .2010 .and .December .31, .2014 . .
Our .goal .is .to .identify .liability .patterns .and .trends .in .order .to .help .nurses .understand .their .areas .of .
greatest .vulnerability, .in .order .to .take .appropriate .action .to .protect .patients .from .harm .and .reduce .
the .risk .of .potential .litigation .
When .possible, .this .report .compares .CNA/NSO .nurse .professional .liability .closed .claims .that .occurred .
between .January .1, .2006 .and .December .31, .2010 .with .the .corresponding .set .of .closed .claims .dating .
from .January .1, .2010 .through .December .31, .2014 . .The .two .groups .of .closed .claims .are .referred .to .
as .the .2011 .and .2015 .closed .claim .reports, .respectively . .This .comparison .provides .a .broader .historical .
perspective .on .claim .characteristics, .including .trends .in .exposures .and .severity .
The .report .also .summarizes .individual .claims .with .settlements .or .judgment .awards .equal .to .or .
greater .than .$1 .million . .Detailed .case .studies .illustrate .failure .to .comply .with .professional .standards .
of .care, .resulting .in .patient .injury .and .consequent .claims .of .negligence . .Finally, .risk .control .recom-
mendations .and .a .self-assessment .checklist .are .included .to .assist .nurses .in .reviewing .their .custom .
and .practice .in .relation .to .the .risks .identified .in .the .report .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 7
Database and Methodology
The .report .includes .only .those .CNA .professional .liability .closed .claims .that:
– Involved .a .registered .nurse .(RN), .licensed .practical .nurse .(LPN) . .
or .licensed .vocational .nurse .(LVN) .
– Closed .between .January .1, .2010 .and .December .31, .2014 . .
(although .they .may .have .been .reported .earlier) .
– Resulted .in .an .indemnity .payment .of .$10,000 .or .greater .
These .inclusion .criteria .were .applied .to .10,639 .reported .adverse .incidents .and .claims .that .closed .
during .the .designated .time .period . .The .final .primary .database .comprises .549 .nurse .closed .claims, .
which .were .subsequently .reviewed .and .analyzed .
In .addition .to .the .primary .dataset .of .claims .that .closed .from .January .1, .2010 .to .December .31, .2014 .(the .
2015 .dataset), .a .dataset .consisting .of .claims .that .closed .between .January .1, .2006 .and .December .31, .
2010 .(the .2011 .dataset) .was .utilized .in .this .report .to .draw .comparisons .and .identify .trends . .Since .
both .of .these .datasets .include .closed .claims .from .2010, .it .is .important .to .note .that .the .two .datasets .
are .not .fully .independent . .Nevertheless, .by .comparing .the .two .datasets .we .can .see .how .the .average .
paid .indemnity .amounts .associated .with .various .claim .characteristics .are .changing .over .time .and .
better .identify .patterns .in .nurse .claim .activity .and .litigation . .The .2011 .dataset .includes .516 .professional .
liability .claims, .while .the .2015 .dataset .includes .549 .professional .liability .claims .
As .this .report .has .unique .data .inclusion .criteria, .readers .should .exercise .caution .about .comparing .
the .findings .with .similar .publications .from .other .sources .
Scope
The .focus .of .the .analysis .is .on .the .severity .of .nurse .closed .claims .that .satisfied .the .inclusion .criteria .
described .above . .Claim .characteristics .examined .within .the .report .include .location .of .the .event, .
nurse .specialty, .type .of .allegation, .and .harm .or .injury .
Unless .specifically .noted, .the .tables .and .charts .in .Part .I .of .this .report .include .both .RN .and .LPN .nurses .
closed .claims . .See .Figure .20 .on .page 38 .for .a .comparative .analysis .of .RN .and .LPN/LVN .closed .claims .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 8
Terms
For .purposes .of .this report only, .please .refer .to .the .terms .and .explanations .below:
2011 claim report .– .A .reference .to .the .prior .CNA .study, .titled .“Understanding .Nurse .Liability, .
2006-2010: .A .Three-part .Approach,” .www.cna.com/healthcare .
Agency nurse .– .Any .RN .or .LPN/LVN .who .provides .nursing .services .as .an .independent .contractor .
or .as .an .employee .of .a .staffing .or .placement .service .
Aging services .– .Specialized .facilities .or .organizations .that .provide .healthcare .to .a .senior .population . .
Aging .services .facilities, .which .also .may .be .referred .to .as .long .term .care, .include .but .are .not .limited .
to .nursing .homes, .assisted .living .centers .and .independent .living .facilities .
Average total incurred .– .Indemnity .plus .expense .costs .paid .by .CNA, .divided .by .the .number .of .
closed .claims .
Expense payment .– .Monies .paid .in .the .investigation, .management .and/or .defense .of .a .claim .
Incurred payment .– .The .costs .or .financial .obligations, .including .indemnity .and .expenses, .resulting .
from .the .resolution .of .a .claim .
Indemnity payment .– .Monies .paid .on .behalf .of .an .insured .nurse .in .the .settlement .or .judgment . .
of .a .claim .
Practitioner .– .A .licensed .independent .healthcare .provider .such .as .a .physician, .dentist, .advanced .
practice .nurse .or .physician .assistant .
Severity .– .The .average .indemnity .amount .of .CNA .nurse .closed .claims .included .within .the .dataset .
Limitations
The .data .analysis .within .this .report .is .subject .to .the .following .limitations .and .conditions:
– The .database .includes .only .closed .claims .against .nurses .insured .by .CNA .through .the .NSO .
program, .which .does .not .necessarily .represent .the .entire .spectrum .of .nurse .activities .and .nurse .
closed .claims .
– Noted .indemnity .payments .are .only .those .paid .by .CNA .on .behalf .of .its .insured .nurses .through .
the .NSO .program .and .do .not .reflect .additional .amounts .paid .by .employers, .other .insurers .or .
other .parties .in .the .form .of .direct .or .insurance .payments .
– The .process .of .resolving .a .professional .liability .claim .may .take .many .years . .Therefore, .claims .
included .in .this .report .may .have .arisen .from .an .event .that .occurred .prior .to .2010, .yet .closed .
during .the .period .of .the .report .
http://www.cna.com/healthcare
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 9
Data Analysis
Analysis of claims by licensure type
– Of .the .549 .nurse .closed .claims, .88 .5 .percent .involve .RNs .and .11 .5 .percent .involve .LPNs/LVNs . .
These .percentages .reflect .the .overall .proportion .of .CNA/NSO-insured .nurses . .While .the .distri- .
bution .of .licensure .types .within .the .CNA/NSO .book .of .business .varies .somewhat .over .time, .the .
current .ratio .of .our .in .force .business .represents .89 .percent .RNs .to .11 .percent .LPNs/LVNs .
– Claims .asserted .against .LPNs/LVNs .resulted .in .a .58 .percent .increase .in .average .total .incurred, .
compared .with .the .2011 .closed .claim .report . .The .higher .severity .was .driven .by .several .closed .
claims .that .settled .for .$250,000 .or .more, .involving .infant .and .pediatric .patients .with .tracheos-
tomies .who .suffered .adverse .outcomes .in .their .homes, .as .illustrated .by .the .following .examples:
– An .LPN .with .significant .geriatric .experience .accepted .a .weekend .position .as .a .home .
health .nurse .to .earn .extra .income . .The .home .health .agency .requested .that .the .nurse .take .
an .assignment .providing .one-on-one .care .to .a .two-year-old .child .on .a .ventilator . .The .LPN .
told .the .agency .that .the .only .experience .she .had .with .ventilators .was .assisting .geriatric .
patients .with .tracheotomy .care . .The .agency .told .the .nurse .to .meet .the .child .and .“give .
caring .for .the .child .a .try .” .On .the .second .visit, .the .child .suffered .an .apneic .episode . .The .
nurse .called .911 .but .then .panicked .and .could .not .remember .the .proper .procedure .for .
removing .the .child .from .the .ventilator . .Manual .resuscitation .was .initiated .using .a .bag .
valve .mask . .The .patient .experienced .an .anoxic .brain .injury .and .suffers .from .seizures .
– An .experienced .pediatric .home .health .LVN .arrived .at .the .home .of .a .ventilator-dependent . .
one-year-old .girl .and .found .the .child .to .be .playful .but .not .quite .herself . .The .health .record .
notes .indicated .that .the .child .was .cranky, .her .color .was .not .normal .and .her .oxygen .satura-
tions .were .between .91 .and .93 .percent . .Eventually, .the .child .was .placed .in .the .crib .for .a .
nap . .When .she .woke .up, .the .ventilator .alarm .sounded . .The .child .was .suctioned .and .some .
material .was .retrieved, .but .the .child .continued .to .exhibit .respiratory .difficulties . .The .nurse .
removed .the .tracheostomy .tube .and .passed .a .suction .catheter .through .the .tracheostomy, .
encountering .no .obstruction .or .material . .She .reinserted .the .tracheostomy .tube .and . .
suctioned .again, .but .nothing .was .retrieved . .Via .ambulance, .the .patient .was .taken .to .the .
emergency .department, .where .eventually .the .tracheostomy .tube .was .reinserted .correctly . .
Due .to .the .lack .of .sufficient .oxygen .during .the .nurse’s .attempt .to .reinsert .the .tracheostomy .
tube .and .the .delay .in .recognizing .the .child’s .respiratory .difficulties, .the .child .suffered . .
profound .neurological .brain .damage . .The .patient’s .experts .testified .that .according .to .the .
documentation, .the .child .was .already .having .respiratory .difficulty .prior .to .the .nap . .
Therefore, .the .nurse .should .have .been .more .proactive .
– For .additional .analysis .of .LPN/LVN .closed .claims, .see .Figure .20 .on .page 38 .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 10
1A CLOSED CLAIMS BY NURSE LICENSURE TYPE
(Indemnity .and .Expenses .for .Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Licensure type
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Average paid
expense
Average total
incurred
Registered .nurse 88 .5% $80,428,847 . $165,491 . $36,424 . $201,916 .
Licensed .practical/ .
vocational .nurse 11 .5% $9,928,686 . $157,598 . $42,173 . $199,771 .
Overall 100.0% $90,357,533 $164,586 $37,084 $201,670
1B COMPARISON OF 2011 AND 2015 CLAIM DISTRIBUTION
BY NURSE LICENSURE TYPE
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) . . n .2011 n .2015
Registered nurse
88.5%
91.9%
Licensed practical/vocational nurse
11.5%
8.1%
Analysis of severity by year
– Figure .2 .displays .severity .and .average .paid .expense .for .nurse .closed .claims .from .2010-2014 .
with .an .indemnity .payment .of .$10,000 .or .greater . .The .year .with .the .highest .severity .was .2013, .
during .which .17 .claims .(10 .4 .percent) .resulted .in .an .indemnity .payment .of .$500,000 .or .above .
– Although .the .graph .lines .fluctuate .throughout .the .noted .time .period, .the .overall .cost .of . .
managing .and .defending .a .nurse .claim .over .the .past .five .years .appears .to .be .stable .
2 SEVERITY AND AVERAGE PAID EXPENSES BY YEAR CLOSED
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) .
$50,000
$100,000
$150,000
$200,000
2010 2011 2012 2013 2014
Average paid indemnity
Average paid expense
Average total paid
Linear (average paid indemnity)
Linear (average paid expense)
Linear (average total paid)
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 11
Nurse closed claims with expense payments only
– Figure .3 .displays .average .paid .expenses .for .nurse .closed .claims .with .no .indemnity .payment .
and .paid .expenses .of .one .dollar .or .greater .over .five .years, .with .the .highest .average .paid .
expense .occurring .in .2013 .and .2014 .
– The .chart .depicts .closed .claims .that .were .successfully .defended .on .behalf .of .the .nurse, .dismissed .
or .withdrawn .by .the .plaintiff .during .the .investigative .or .discovery .process, .or .terminated .by .
the .court .in .favor .of .the .defendant .prior .to .trial . .An .example .of .a .successful .defense .against .a .
nurse .resulting .in .no .indemnity .payment .can .be .found .on .page 37 .
3 AVERAGE PAID EXPENSE FOR CLOSED CLAIMS
(No .Indemnity .Paid .by .Year .Closed .with .Paid .Expenses .≥ .$1 .00) .
$4,000
$6,000
$8,000
$10,000
2010 2011 2012 2013 2014
Average paid expense
Linear (average paid expense)
Figure .4 .reveals .that .for .both .the .2011 .and .2015 .claim .analyses, .the .highest .percentage .of .closed .
claims .have .a .paid .indemnity .between .$10,000 .and .$99,999 . .The .two .analyses .show .similar .percent- .
ages .of .closed .claims .in .the .$750,000-$999,999 .and .$1,000,000 .paid .indemnity .categories .
4A COMPARISON OF 2011 AND 2015 CLAIM DISTRIBUTION
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) . n .2011 n .2015
$1,000,000
3.1%
3.5%
$750,000 – $999,999
2.7%
2.1%
$500,000 – $749,999
3.8%
2.1%
$250,000 – $499,999
10.6%
11.2%
$100,000 – $249,999
20.9%
24.8%
$10,000 – $99,999
58.8%
56.2%
4B COMPARISON OF 2011 AND 2015 AVERAGE PAID INDEMNITY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) . . n .2011 n .2015
Average paid indemnity
$164,586
$161,501
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 12
Analysis of severity by nurse specialty
– The .nurse .specialties .consistently .experiencing .the .highest .severity .in .both .past .and .present .
CNA/NSO .closed .claim .reports .are .neurology .and .obstetrics, .due .to .the .cost .of .lifelong, .one-
on-one .nursing .care .required .by .the .injured .party . .Examples .of .these .closed .claims .include:
– Failure .of .a .nurse .to .monitor .and .timely .report .blood .levels .on .a .30-year-old .patient .
receiving .anticoagulation .therapy . .The .patient .suffered .an .eight-centimeter .hematoma .
within .the .right .frontal .lobe .of .her .brain .due .to .the .delay, .leaving .her .permanently .and .
totally .disabled .
– Improper .management .of .an .obstetrical .patient .by .a .nurse .who .attempted .to .reinsert .a .
prolapsed .umbilical .cord .prior .to .delivery .
– The .adult .medical/surgical .specialty .continues .to .represent .the .highest .percentage .of .closed .
claims . .However, .as .predicted .in .the .2011 .claim .report, .claim .frequency .has .increased .in .non- .
hospital-based .specialties .such .as .home .health/hospice, .reflecting .the .overall .migration .of .
healthcare .toward .outpatient .settings . .One .consequence .of .this .shift .is .that, .more .than .ever, .
home .health/hospice .nurses .must .be .in .frequent .communication .with .the .patient’s .practitioner, .
as .illustrated .by .the .following .closed .claims:
– The .home .health .nurse .failed .to .notify .the .practitioner .of .the .patient’s .medical .decline . . .
The .patient .was .on .intravenous .antibiotics .for .bacterial .endocarditis, .and .on .two .visits .to .
the .patient’s .house, .the .nurse .failed .to .notify .the .referring .cardiologist .of .the .patient’s .
extremely .abnormal .vital .signs .
– Against .practitioner .orders, .the .nurse .delayed .administering .pain .medication .to .a .hospice .
patient, .resulting .in .unnecessary .suffering .
– There .were .two .occupational/employee .health .closed .claims:
– One .closed .claim .involves .failure .to .properly .assess .and .advise .an .employee .with . .
a .history .of .uncontrolled .high .blood .pressure .and .a .severe .headache .to .seek .medical .
treatment . .The .nurse .instructed .the .employee .to .go .home, .take .over-the-counter .pain .
medications .and .rest . .Later .that .night .the .patient .suffered .a .severe .cardiovascular .accident .
– The .second .closed .claim .involves .the .nurse’s .failure .to .properly .maintain .correct .infection .
prevention .practices .while .administering .an .influenza .intramuscular .injection, .causing . .
an .employee .to .suffer .from .cellulitis . .The .nurse .neither .cleaned .the .injection .site .nor .used .
gloves .during .the .injection .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 13
5A SEVERITY BY NURSE SPECIALTY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Nurse specialty
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Neurology/neurosurgery 0 .4% $1,077,000 $538,500
Occupational/employee .health 0 .4% $827,980 $413,990
Obstetrics 9 .8% $21,441,467 $397,064
Neonatal/nursery .- .well .baby 1 .1% $1,325,000 $220,833
Plastic/reconstructive .surgery 1 .6% $1,752,332 $194,704
Emergency/urgent .care 10 .7% $10,750,689 $182,215
Home .health/hospice 12 .4% $11,794,067 $173,442
Pediatric/adolescent 2 .0% $1,710,250 $155,477
Behavioral .health . 2 .4% $1,850,249 $142,327
Adult .medical/surgical 36 .1% $27,392,453 $138,346
Wound .care .in .an .office .setting 0 .7% $435,250 $108,813
Gerontology .- .in .aging .services .facility 16 .4% $7,736,782 $85,964
Correctional .health 3 .6% $1,501,639 $75,082
Aesthetic/cosmetic 2 .4% $762,375 $58,644
Overall 100.00% $90,357,533 $164,586
5B COMPARISON OF 2011 AND 2015 CLAIM DISTRIBUTION
BY NURSE SPECIALTY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) . n .2011 n .2015
Obstetrics
9.8%
10.3%
Emergency/urgent care
10.7%
9.7%
Home health/hospice
12.4%
8.9%
Adult medical/surgical
36.1%
40.1%
Gerontology – in aging services facility
16.4%
18.0%
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 14
Analysis of severity by location
– The .locations .with .the .highest .distribution .of .closed .claims, .accounting .for .58 .5 .percent .of .all .
closed .claims, .are .hospital-inpatient .medical, .aging .services, .patient’s .home .and .hospital .– .
inpatient .surgical .service-related . .These .findings .are .consistent .with .the .2011 .claim .report .
– The .closed .claims .with .the .highest .severity, .excluding .obstetrics .- .inpatient .perinatal .services, .
tend .to .be .relatively .infrequent . .Several .claims .arose .from .services .provided .in .non-traditional .
settings, .such .as .the .nurse’s .residence .or .a .hotel . .These .closed .claims .usually .involve .failure .to .
fulfill .the .core .responsibilities, .duties .and/or .expectations .of .licensed .nurses, .as .the .following .
examples .illustrate:
– A .patient .underwent .several .plastic .surgeries .in .one .day . .After .more .than .12 .hours .of . .
surgery, .the .patient .was .released .to .the .care .of .a .nurse, .who .tended .to .her .in .a .local .
hotel .room . .The .nurse .stayed .with .the .patient .overnight, .but .failed .to .notify .the .attend- .
ing .practitioner .and .family .members .of .meaningful .changes .in .her .condition .and .failed . .
to .react .to .emergent .conditions .requiring .timely .transfer .of .the .patient .to .an .acute .care . .
facility . .The .nurse’s .delay .in .care .and .failure .to .recognize .changes .in .the .patient’s .medical .
condition .was .the .ultimate .cause .of .the .patient’s .death .
– A .registered .nurse .was .hired .by .a .not-for-profit .organization .to .train .patient .care .tech- .
nicians .to .care .for .disabled .children .participating .in .an .overnight .field .trip . .The .nurse .
failed .to .explain .to .the .patient .care .technicians .how .to .properly .set .up .the .continuous .
positive .airway .pressure .machine .for .one .child, .who .died .in .her .sleep .
– Many .of .the .closed .claims .in .the .obstetrics .location .involve .permanent .neurological .damage, .
resulting .in .an .indemnity .payment .at .full .policy .limits . .Additional .obstetrics-related .closed .claims .
are .analyzed .in .Figure .15 .on .page 33 .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 15
6A ANALYSIS OF SEVERITY BY LOCATION
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
* . .“Other” .claim .locations .include .working .as .an .independent .contractor .for .a .patient .recuperating .in .a .hotel .following .extensive .plastic .surgery, .and .
working .as .a .consultant .for .a .not-for-profit .organization .
Location
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Occupational .health .center 0 .4% $827,980 . $413,990 .
Obstetrics .- .inpatient .perinatal .services 8 .2% $17,993,967 . $399,866 .
Nurse .residence/home 0 .5% $1,040,000 . $346,667 .
Hospital .- .obstetrics .
(Cesarean .suite .or .PACU) 1 .1% $1,772,500 $295,417 .
*Other 0 .4% $550,000 . $275,000 .
Telemetry .unit .- .hospital-based 0 .2% $218,750 . $218,750 .
Hospital .- .(PACU) 1 .3% $1,372,500 . $196,071 .
Hospital .- .nursery 0 .9% $925,000 . $185,000 .
Emergency .department .- .hospital-related 10 .6% $10,725,689 . $184,926 .
Radiology .- .inpatient .diagnostic 0 .4% $330,000 . $165,000 .
Transport .services . 0 .2% $162,500 . $162,500 .
Patient’s .home 12 .6% $10,970,067 . $158,986 .
Hospital .- .inpatient .medical .services 17 .7% $15,336,650 . $158,110 .
Hospital .- .inpatient .surgical .services 11 .3% $9,508,085 . $153,356 .
Behavioral/psychiatric .health 2 .4% $1,850,249 . $142,327 .
Spa 0 .7% $460,000 . $115,000 .
Aging .services 16 .9% $9,735,782 . $104,686 .
Practitioner .office .practice 4 .6% $2,579,677 . $103,187 .
Correctional .health .- .inpatient .or .outpatient 3 .8% $1,812,639 . $86,316 .
Ambulatory .surgery 2 .9% $1,169,498 . $73,094 .
School .(preschool .through .university) 1 .1% $407,000 . $67,833 .
Hospital .- .operating .room/suite 1 .5% $490,000 . $61,250 .
Dialysis .- .freestanding 0 .2% $50,000 . $50,000 .
Clinic .- .hospital .outpatient 0 .2% $45,000 . $45,000 .
Freestanding .specialty .care .facility . .
(non-ambulatory) 0 .2% $24,000 . $24,000 .
Overall 100.0% $90,357,533 $164,586
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 16
6B COMPARISON OF 2011 AND 2015 CLAIM DISTRIBUTION
BY LOCATION
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) . n .2011 n .2015
Emergency department – hospital-related
10.6%
9.3%
Patient’s home
12.6%
8.9%
Hospital – inpatient medical services
17.7%
20.2%
Hospital – inpatient surgical services
11.3%
10.3%
Aging services
16.9%
18.4%
The percentage of closed claims involving
medication administration has declined
by half since the 2011 claim report, while
severity has approximately doubled.
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 17
Analysis of Severity by Allegation
Figures .7A .and .7B .contain .the .average .and .total .paid .indemnities .for .all .allegation .categories . .
Allegation .subcategories .are .listed .in .Figures .8-12 .
Allegation by category
– The .percentage .of .closed .claims .involving .medication .administration .has .declined .by .half .since .
the .2011 .claim .report, .while .severity .has .approximately .doubled . .This .decrease .in .frequency .
correlates .with .recent .technological .advances .and .error-reduction .initiatives, .such .as .bar-coding .
of .medications .and .computerized .order .entry . .However, .the .existence .of .these .highly .publicized .
drug .safety .efforts .may .make .it .more .difficult .to .defend .medication .administration-related .claims .
where .nurses .bypassed .such .controls, .as .illustrated .by .the .following .examples:
– An .agency .nurse .working .in .an .emergency .department .gave .16 .milligrams .of .undiluted .
hydromorphone .in .three .minutes .by .intravenous .push .instead .of .an .intravenous .drip .over .
several .hours . .When .the .nurse .returned .30 .minutes .after .giving .the .hydromorphone, .the .
patient, .who .was .not .on .a .cardiac .monitor, .was .pulseless .and .not .breathing . .Despite .
resuscitation .efforts, .the .patient .died . .The .nurse .testified .that .she .was .unfamiliar .with .the .
potency .of .hydromorphone .and .misread .the .practitioner’s .orders .
– A .geriatric .nurse .working .in .an .aging .services .setting .ignored .the .facility’s .policies .and .
procedures .on .medication .administration .and .gave .a .methadone .injection .to .the .wrong .
patient, .which .caused .fatal .respiratory .arrest .
– Allegations .related .to .treatment .and .care .continue .to .represent .the .highest .percentage .of .
closed .claims . .Claims .in .this .category .occur .in .all .specialties .and .locations, .but .the .highest .
percentage .of .closed .claims .involve .adult/medical .surgical, .gerontology, .home .health/hospice .
and .obstetrics .
– During .the .evening .shift, .an .intensive .care .unit .(ICU) .patient .being .weaned .off .the .venti- .
lator .became .agitated .and .had .difficulty .maintaining .her .oxygen .saturation .levels . .The .
nurse .spent .most .of .his .time .caring .for .the .patient, .making .several .telephone .calls .
throughout .his .shift .to .the .practitioner .for .additional .orders . .The .nurse .administered .a . .
sedative, .per .practitioner .orders, .and .stepped .away .from .the .patient .to .attend .a .meeting . .
in .the .unit’s .conference .room . .As .a .result, .the .cardiac .monitor .alarm .sounded .for .eight .
minutes .before .the .nurse .heard .it . .When .he .returned, .the .patient .was .in .asystole .and .
later .died .
– A .38-year-old .female .patient .was .admitted .to .the .medical .intensive .care .unit .with .a . .
diagnosis .of .pneumonia .and .an .extensive .and .complicated .history .of .cardiac .illness, .
including .endocarditis . .She .was .receiving .a .large .amount .of .diuretics .for .fluid .retention . . .
Her .practitioner, .believing .she .was .stable, .allowed .her .to .use .a .bedside .commode . .
while .on .a .cardiac .monitor . .When .the .patient .ambulated .to .use .the .commode, .the .cardiac .
monitor .would .indicate .the .patient .was .in .ventricular .tachycardia, .but .when .the .nurse .
checked .on .the .patient, .she .appeared .fine . .The .nurse .discussed .the .rhythm .with .her .
charge .nurse, .and .both .agreed .that .the .change .in .the .cardiac .rhythm .was .associated . .
with .patient .movement .rather .than .ventricular .tachycardia . .However, .a .few .hours .later, . .
the .patient’s .cardiac .monitor .indicated .the .patient .was .in .ventricular .fibrillation . .When . .
the .nurse .went .to .check, .the .patient .was .observed .to .be .cyanotic, .with .distended .neck .
veins . .A .code .team .was .called, .but .the .patient .expired .
– Many .of .the .closed .claims .in .the .patients’ .rights/patient .abuse/professional .conduct .category .
involve .falls, .which .occurred .because .a .nurse .failed .to .follow .fall-prevention .policies .polices, .
thereby .violating .the .patient’s .right .to .a .safe .environment .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 18
7A SEVERITY BY ALLEGATION CATEGORY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Allegation category
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Medication .administration 8 .0% $9,372,227 . $213,005 .
Monitoring 13 .8% $13,977,772 . $183,918 .
Treatment/care 45 .9% $45,053,823 . $178,785 .
Scope .of .practice 2 .9% $2,458,777 . $153,674 .
Assessment 15 .7% $11,099,510 . $129,064 .
Documentation 0 .5% $368,334 . $122,778 .
Patients’ .rights/patient .abuse/ .
professional .conduct 13 .1% $8,027,090 . $111,487 .
Overall 100.0% $90,357,533 $164,586
7B COMPARISON OF 2011 AND 2015 CLAIM DISTRIBUTION
BY ALLEGATIONS
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) . . n 2011 . n .2015
Medication administration
8.0%
14.7%
Monitoring
13.8%
6.8%
Treatment/care
45.9%
58.5%
Assessment
15.7%
12.6%
Patients’ rights/patient abuse/
professional conduct 13.1%
5.4%
Assessment-related closed claims often
involve nurses failing to identify the worsening
of a pressure ulcer or contact the treating
practitioner for additional medical treatment.
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 19
Analysis of Allegation Sub-categories
Figures .8-12 .examine .allegation .sub-categories .in .greater .detail . .Percentages .in .Figures .8-12 .relate .
to .the .indicated .allegation .category, .rather .than .the .overall .dataset .
Allegations related to assessment
– Closed .claims .alleging .failure .to .properly .or .fully .complete .the .patient .assessment .reflect .the .
highest .severity .
– Over .one-third .of .the .closed .claims .in .this .category .allege .a .failure .to .adequately .assess .inmates .
in .a .correctional .facility, .as .illustrated .in .the .following .case .scenarios:
– The .patient .had .an .extensive .personal .and .family .history .of .high .blood .pressure . .After . .
an .altercation .with .other .inmates .and .correctional .staff, .he .complained .of .a .headache, . .
was .drowsy .and .had .slurred .speech . .The .correctional .nurse .was .called .to .evaluate .the .
patient .and .did .so .hurriedly, .because .the .patient .was .in .a .secured .area . .The .nurse .
obtained .orders .for .a .baby .aspirin .from .the .facility’s .medical .director .and .had .the .patient .
transferred .to .the .infirmary . .Thirty .minutes .later, .the .patient .was .unable .to .follow .com-
mands .or .open .his .mouth, .and .his .movements .were .spastic .with .weakness .in .both .hands . .
He .was .sent .to .the .local .emergency .department .and .was .diagnosed .with .a .large .left .
basal .ganglia .bleed .due .to .uncontrolled .hypertension . .The .patient .is .now .in .a .permanent .
vegetative .state .
– The .insured .was .an .admission .nurse .working .in .a .correctional .facility, .where .she .would .see .
up .to .400 .patients .a .month . .Her .responsibilities .included .obtaining .information .from .
patients .by .conducting .a .brief .medical .assessment .and .then .referring .patients .to .the .
medical .director .for .any .medication .needs .and .follow-up . .One .patient .complained .of .leg .
weakness .upon .admission, .but .the .nurse .failed .to ument .his .statement . .Two .days .
later, .the .patient .claimed .that .he .could .not .walk . .When .he .was .examined .by .the .facility .
medical .director, .the .patient .was .found .to .have .a .spinal .abscess .requiring .immediate .
medical .intervention .
– Most .of .the .assessment-related .closed .claims .involve .a .failure .to .asses .the .need .for .medical .
intervention . .These .closed .claims .often .involve .nurses .failing .to .identify .the .worsening .of .a .
pressure .ulcer .or .contact .the .treating .practitioner .for .additional .medical .treatment .
8 SEVERITY OF ALLEGATIONS RELATED TO ASSESSMENT
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Allegation
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Failure .to .properly .or .fully .complete . .
the .patient .assessment 19 .8% $4,454,555 . $262,033 .
Delayed .or .untimely .patient .assessment 3 .5% $380,000 . $126,667 .
Failure .to .assess .the .need . .
for .medical .intervention 60 .5% $5,656,080 . $108,771 .
Failure .to .consider/assess .patient’s . .
expressed .complaints/symptoms 11 .6% $482,375 . $48,238 .
Failure .to .reassess .patient .after .any . .
change .in .medical .condition 4 .7% $126,500 . $31,625 .
Overall 100.0% $11,099,510 $129,064
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 20
Allegations related to monitoring
– Failure .to .monitor .and .timely .report .patient .vital .signs .represents .the .highest .severity .in .the .
monitoring .sub-category, .including .two .claims .that .closed .at .policy .limits . .Both .closed .claims .
involve .nurses .who .failed .to .monitor .vital .signs .after .patients .returned .from .surgery, .as .
described .below:
– A .nurse .cared .for .a .patient .who .had .an .emergent .appendectomy .and .coded .afterward . .
in .the .PACU . .The .patient .was .admitted .to .a .regular .unmonitored .hospital .bed .during .the .
evening .hours .and .was .not .placed .on .any .cardiac .or .pulse .oximetry .monitoring . .The .
nurse .made .few .entries .during .the .night .regarding .the .patient .and .failed .to .record .any .
vital .signs . .The .patient .coded .again .and .the .family .insisted .the .patient .be .transferred .to .
another .hospital .to .recover .
– A .nurse .failed .to .request .a .continuous .pulse .oximetry .monitor .for .the .patient .after . .
surgery . .The .patient .was .at .high .risk .for .decreased .oxygen .levels .related .to .surgery, .
increased .hydromorphone .levels .and .a .self-reported .history .of .sleep .apnea . .The .nurse .
assessed .the .patient .every .15 .minutes .for .the .first .hour, .per .organizational .policy, .without . .
any .problems . .However, .after .the .nurse .switched .to .every-30-minute .assessment, .the .
patient .was .found .pulseless .and .unresponsive . .He .later .died .in .the .ICU .due .to .compli- .
cations .of .anoxic .brain .injury .
– Claims .alleging .failure .to .monitor .and .timely .report .blood .levels .for .medications .involve .nurses .
who .neglected .to .properly .watch .patients .on .high-risk .drugs .such .as .insulin .and .anticoagulants, .
as .described .below:
– A .critically .ill, .intubated, .diabetic .patient .was .admitted .to .the .ICU .on .a .glycemic .control .
insulin .infusion .protocol . .The .nurse .signed .the .orders, .but .failed .to .check .the .patient’s .
blood .glucose .level .every .two .hours .per .protocol . .Four .hours .elapsed .before .the .nurse .
realized .that .she .had .not .performed .a .finger-stick .blood .sugar .test .on .the .patient . .When .
the .levels .were .checked, .the .patient’s .glucose .was .11 .mg/dl .and .emergency .hypogly- .
cemic .measures .were .initiated . .The .patient, .who .suffered .from .metabolic .encephalopathy .
secondary .to .hypoglycemia, .later .died .
– A .patient .in .an .acute .care .rehabilitation .facility .following .knee .replacement .surgery .was .
placed .on .Coumadin® .as .a .result .of .her .immobilization, .as .well .as .Septra® .to .treat .a .urinary .
tract .infection . .The .nurse .was .responsible .for .monitoring .the .INR .levels .but .was .unfamiliar .
with .the .interaction .of .Septra® .and .Coumadin® . .She .neither .monitored .the .blood .levels .
nor .contacted .the .prescribing .practitioner .to .obtain .an .order .for .a .new .antibiotic .for .the .
patient . .The .patient .was .given .each .medication .for .three .days .when .the .patient’s .daughter .
noted .a .change .in .her .mental .status . .Suffering .from .an .intracranial .hemorrhage, .the .
patient .was .transferred .to .the .nearest .medical .center .and .died .two .days .later .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 21
9 SEVERITY OF ALLEGATIONS RELATED TO MONITORING
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000) .
Allegation
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Failure .to .monitor .and .timely . .
report .patient .vital .signs 11 .8% $3,395,000 . $377,222 .
Failure .to .monitor .and .timely . .
report .blood .levels .for .medications 11 .8% $2,254,833 . $250,537 .
Failure .to .monitor/report .changes .in .the .patient’s .
condition .for .high-risk .patient .care .areas 52 .6% $6,291,231 . $157,281 .
Failure .to .monitor/report .changes . .
in .the .patient’s .medical/emotional . .
condition .to .practitioner
21 .1% $1,903,375 . $118,961 .
Failure .to .monitor .results .of . .
ordered .tests, .consultations .or .referrals, . .
or .report .them .to .practitioner
2 .6% $133,333 . $66,667 .
Overall 100.0% $13,977,772 $183,918
Closed claims involving the failure to invoke
or utilize the chain of command account
for 7.5% of the treatment and care closed
claims, and have a higher average severity.
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 22
Allegations related to treatment and care
– Closed .claims .relating .to .pregnancy .or .obstetrical .complications .collectively .comprise .19 .0 . .
percent .of .all .treatment .and .care .allegations . .While .the .majority .of .these .closed .claims .involve .
nurses .working .in .labor .and .delivery .units .within .hospitals, .some .incidents .occurred .in .practi-
tioner .offices, .emergency .departments, .ICUs .and .correctional .facilities, .where .nurses .failed .to .
manage .pregnancy .or .obstetrical .complications .due .to .lack .of .training .in .obstetrical .emergencies . .
(Obstetrics .closed .claims .are .analyzed .in .Figure .15 .on .page 33 .)
– Nurses .are .responsible .for .invoking .the .medical .chain .of .command .when .necessary, .in .order .to .
trigger .a .practitioner’s .intervention .for .the .patient . .Closed .claims .involving .the .failure .to .invoke .
or .utilize .the .chain .of .command .account .for .7 .5 .percent .of .the .treatment .and .care .closed .claims, .
and .reflect .a .high .average .severity . .Both .the .frequency .and .severity .of .this .subcategory .have .
increased .slightly .since .the .2011 .claim .report . .Approximately .half .of .the .chain .of .command .
closed .claims .occurred .in .labor .and .delivery .units, .with .nearly .all .injured .patients .either .dying .or .
sustaining .permanent .total .disability .
– In .the .2011 .claim .report, .retained .foreign .body .closed .claims .had .an .overall .severity .of .less .than .
$40,000 .and .represented .less .than .4 .percent .of .the .total .treatment .and .care .allegations . .In .the .
current .report, .retained .foreign .body .closed .claims .comprise .5 .2 .percent .of .the .total .treatment .
and .care .allegations, .and .severity .has .grown .to .more .than .$60,000 . .Retained .objects .included .
intravenous .catheters, .sponges .and .gauze .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 23
Because .of .the .size .and .diversity .of .the .treatment .and .care .allegation .category, this chart is limited to
allegations with a severity of $50,000 or greater . .Thus, .there .are .no .totals .at .the .bottom .of .the .table .
10 SEVERITY OF ALLEGATIONS RELATED TO TREATMENT AND CARE
(Closed .Claims .with .Paid .Indemnity .≥ .$50,000)
Allegation
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Failure .to .timely .report .complication . .
of .pregnancy/labor .to .practitioner 4 .4% $6,354,950 . $577,723 .
Failure .to .identify .and .report .observations, . .
findings .or .change .in .condition . 1 .6% $1,487,500 . $371,875 .
Failure .to .invoke/utilize .chain .of .command 7 .5% $6,698,551 . $352,555 .
Delay .in .implementing .practitioner .orders 0 .8% $690,000 . $345,000 .
Improper .or .untimely .nursing .management . .
of .obstetrical .patient/complication 7 .9% $6,257,916 . $312,896 .
Improper .management .of .assaultive/ .
abusive/aggressive .patient 0 .8% $500,000 . $250,000 .
Failure .to .timely .transfuse .ordered . .
blood/blood .product 0 .4% $218,750 . $218,750 .
Abandonment .of .patient 1 .2% $585,000 . $195,000 .
Failure .to .timely .obtain .practitioner .orders .to .
perform .necessary .additional .treatment(s) 0 .4% $187,500 . $187,500 .
Failure .to .notify .practitioner . .
of .patient’s .condition 5 .6% $2,573,557 . $183,826 .
Improper .or .untimely .nursing .management . .
of .medical .patient .or .medical .complication 11 .9% $5,394,475 . $179,816 .
Improper .or .untimely .nursing .management . .
of .behavioral .health .patient 4 .8% $2,041,667 . $170,139 .
Treatment .and .care .provided .to . .
the .wrong .patient 0 .4% $160,000 . $160,000 .
Failure .to ument .observations, . .
treatment .or .practitioner .contact 0 .4% $140,000 . $140,000 .
Improper .or .untimely .nursing .management . .
of .surgical .or .anesthesia .complication . 4 .0% $1,294,667 . $129,467 .
Failure .to .carry .out .practitioner .orders . .
for .care .and .treatment 4 .4% $1,323,500 . $120,318 .
Improper .nursing .technique .or .negligent . .
performance .of .treatment, .resulting .in .injury 11 .5% $3,363,000 . $115,966 .
Equipment .user .error 5 .6% $1,621,457 . $115,818 .
Failure .to .report .medical .complication . .
or .change .in .medical .patient’s .condition 1 .2% $273,500 . $91,167 .
Failure .to .follow .critical .pathways . 2 .4% $524,741 . $87,457 .
Failure .to .timely .report .behavioral .health . .
complication/change 0 .4% $86,000 . $86,000 .
Improper .or .untimely .management . .
of .aging .services .resident 5 .6% $1,196,349 . $85,454 .
Failure .to .respond .to . .
equipment .warning .alarms 0 .4% $66,660 . $66,660 .
Failure .to .timely .implement . .
established .treatment .protocols 0 .4% $66,500 . $66,500 .
Retained .foreign .body 5 .2% $784,166 . $60,320 .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 24
Claim Scenario: Delay in Implementing Provider Orders
The .patient .was .a .38-year-old .female .admitted .for .a .Cesarean .
delivery .of .twins . .The .babies .were .delivered .without .incident, .
but .the .patient .experienced .excessive .post-operative .vaginal .
bleeding .attributed .to .placental .accreta .
An .emergency .total .abdominal .hysterectomy .was .performed .
in .an .attempt .to .control .the .bleeding . .After .surgery, .the .patient, .
who .appeared .stable, .was .transferred .to .the .ICU .with .blood .
pressure .of .110/60 .mmHG . .The .receiving .ICU .nurse .had .orders .
to .transfuse .the .patient .with .two .units .of .fresh .frozen .plasma .
and .monitor .vital .signs .every .30 .minutes . .After .the .first .unit .of .
plasma .was .given, .the .patient’s .blood .pressure .was .108/59 .
mmHG . .She .was .assessed .by .the .attending .ICU .practitioner, .
who .ordered .a .complete .blood .count .to .be .conducted .after .the .
second .unit .of .fresh .frozen .plasma . .The .ICU .practitioner .noted .
that .the .patient .post-surgical .hemoglobin .and .hematocrit .levels .
were .7 .4 .gm/dL .and .22 .percent .respectively . .However, .one .hour .
after .the .second .unit .of .plasma .was .given, .the .patient’s .hemo-
globin .was .5 .9 .gm/dL, .and .hematocrit .was .17 .7 .percent . .The .
nurse umented .the .results .in .the .health .record, .but .did .not .
notify .the .ICU .practitioner .because .he .assumed .the .practitioner .
was .returning .to .the .unit .to .reassess .the .patient . .Two .hours .
after .the .second .unit .of .plasma, .the .patient’s .blood .pressure .was .
reported .as .63/21 .mmHG . .The .nurse .notified .the .on-call .resident .
of .the .blood .pressure .and .received .an .order .for .stat .transfusion .
of .two .units .of .packed .red .blood .cells . .The .blood .bank .records .
indicated .that .the .blood .was .available .20 .minutes .after .stat .
order .was .received .
One .hour .later, .upon .arrival .of .the .oncoming .shift, .the .ICU .
nurse .reported .to .the .oncoming .nurse .that .the .blood .had .still .
not .been .delivered . .Even .though .both .nurses .were .concerned .
about .the .situation, .neither .nurse .called .to .ascertain .the .blood’s .
location . .Fifteen .minutes .into .the .oncoming .nurse’s .shift, .the .
administration .of .one .unit .of .packed .red .blood .cells .was .started . .
While .the .blood .was .transfusing, .the .patient .went .into .respira-
tory .distress, .and .the .admitting .ICU .practitioner .was .notified .
Later .that .evening, .the .patient .underwent .a .second .abdominal .
surgery . .Due .to .her .extensive .hypovolemia, .she .slipped .into .a .
coma .post-operatively .and .currently .remains .in .a .vegetative .
state . .During .deposition, .the .admitting .ICU .practitioner .testified .
that .he .was .not .informed .of .the .second .laboratory .results .or .
the .patient’s .vital .signs .until .the .patient .went .into .respiratory .
distress . .The .claim .asserted .against .our .nurse .settled .for .greater .
than .$600,000 . .Several .other .healthcare .practitioners .were . .
also .included .in .the .lawsuit, .but .their .settlement .amounts .were .
not .available .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 25
Allegations related to medication administration
Significant .improvements .in .medication .administration .technology .have .occurred .since .1999, .when .
the .Institute .of .Medicine .released .its .groundbreaking .report, .“To Err is Human: Building a Safer
Health System,” .http://iom.nationalacademies.org/reports/1999/to-err-is-human-building-a-safer-
health-system.aspx . .This .publication .created .widespread .awareness .of .drug .administration .errors . .
While .the .percentage .of .closed .claims .involving .this .allegation .has .gradually .decreased, .severity .
continues .to .rise .
– Errors .such .as .wrong .rate .of .flow, .wrong .route, .wrong .dose, .wrong .medication .and .wrong .patient .
are .often .caused .by .poor .communication .with .the .pharmacist .and/or .prescribing .practitioner, .
failure .to .clarify .the .medication .order, .excessive .workload .or .preoccupation/distraction .
– Of .the .44 .medication .administration-related .closed .claims .in .the .dataset, .16 .(36 .percent) .involve .
narcotics, .as .in .the .following .examples:
– During .a .busy .evening .shift, .a .nurse .administered .hydromorphone .to .the .patient . .
intravenously .instead .of .by .mouth, .as .the .practitioner .had .ordered . .The .patient .went .into .
respiratory .arrest .minutes .after .receiving .the .medication .
– A .patient .in .an .aging .services .facility .was .receiving .hospice .care .and .died .after .receiving . .
a .methadone .injection .intended .for .another .hospice .patient .
– Many .of .the .medication .administration .errors .involve .nurses .using .“work-arounds” .to .bypass .
the .facility’s .established .safety .procedures, .such .as .medication .bar-coding .or .other .automated .
processes . .Bypassing .safety .systems .or .failing .to .follow .established .facility .policies .and .proce-
dures .makes .claims .difficult .to .defend, .especially .when .high-risk .drugs .are .involved .
Many of the medication administration errors
involve nurses using “work-arounds” to bypass
the facility’s established safety procedures.
http://iom.nationalacademies.org/reports/1999/to-err-is-human-building-a-safer-health-system.aspx
http://iom.nationalacademies.org/reports/1999/to-err-is-human-building-a-safer-health-system.aspx
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 26
11 SEVERITY OF ALLEGATIONS RELATED TO MEDICATION ADMINISTRATION
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Allegation
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Wrong .rate .of .flow 6 .8% $2,033,480 . $677,827 .
Provision .of .services .beyond .scope .of .practice 2 .3% $500,000 . $500,000 .
Wrong .route 15 .9% $1,898,000 . $271,143 .
Failure .to .immediately .report/record . .
improper .administration .of .medication 4 .5% $538,500 . $269,250 .
Wrong .dose 18 .2% $1,674,667 . $209,333 .
Failure .to .properly .monitor .or . .
maintain .intramuscular, . .
subcutaneous, .or .gastric .tube .site
2 .3% $200,000 . $200,000 .
Failure .to .recognize .contraindication . .
and/or .known .adverse .interaction . .
between/among .ordered .medications
9 .1% $781,250 . $195,313 .
Wrong .patient 9 .1% $655,000 . $163,750 .
Wrong .information . .
provided .or .recorded 2 .3% $121,250 . $121,250 .
Wrong .medication 11 .4% $457,750 . $91,550 .
Failure .to .properly .monitor . .
and .maintain .infusion .site . 2 .3% $90,000 . $90,000 .
Missed .dose 6 .8% $246,500 . $82,167 .
Failure .to .resolve .medication .question . .
with .pharmacist .and/or .practitioner . .
prior .to .administration
6 .8% $155,830 . $51,943 .
Improper .technique 2 .3% $20,000 . $20,000 .
Overall 100.0% $9,372,227 $213,005
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 27
Claim Scenario: Medication Error Resulting in Death
Following .a .recent .hospitalization .for .complications .of .meta-
static .ovarian .cancer, .an .elderly .woman .with .an .extensive .history .
of .bipolar .disorder .was .discharged .to .an .aging .services .facility .
due .to .her .family’s .inability .to .care .for .her .at .home . .Throughout .
her .stay, .her .family .made .several .complaints .to .the .administra-
tion .regarding .the .care .the .patient .was .receiving .and .requested .
that .the .patient .be .transferred .to .another .facility .on .numerous .
occasions .
The .LPN .on .duty .the .evening .of .the .incident .was .an .agency .
nurse .who .had .worked .at .the .facility .previously .and .was .aware .
of .the .facility’s .policies .and .procedures .in .regard .to .medication .
administration . .During .the .scheduled .evening .medication .admin- .
istration .round, .the .nurse .was .in .the .patient’s .room .when .she .
became .distracted .by .a .patient .from .another .room .requesting .
assistance . .When .the .nurse .returned .to .the .patient’s .room, .she .
gave .the .patient .her .nightly .medications . .The .patient .questioned .
the .number .of .pills .the .nurse .was .giving .her, .stating .that .she .had .
never .taken .“purple .pills .” .The .nurse .assured .the .patient .that .the .
medication .was .correct .and .continued .with .the .administration .
An .hour .later, .a .certified .nursing .assistant .notified .the .nurse .that .
one .of .her .patients .was .unresponsive . .The .LPN .found .the .patient .
to .have .a .thready .pulse .and .shallow .respirations . .The .facility .
called .911, .and .when .the .paramedics .arrived .they .administered .
Narcan® .intravenously, .which .instantly .revived .the .patient . .On .
the .way .to .the .hospital, .the .patient .told .the .paramedics .that .
the .nurse .had .given .her .four .“purple .pills” .earlier .that .evening, .
which .immediately .put .her .to .sleep .
On .admission .into .the .hospital, .the .patient .was .responsive .when .
receiving .Narcan®, .but .as .soon .as .the .medication .wore .off, .she .
suffered .from .shallow .respirations .and .became .unresponsive . .
By .day .two .of .the .hospitalization, .the .patient .appeared .to .be .
less .responsive, .but .was .able .to .respond .to .the .voices .of .family .
members . .On .day .three, .she .was .unresponsive .to .painful .stimuli, .
was .found .without .a .pulse .or .heart .rate, .and .pronounced .dead . .
An .autopsy .was .performed, .which .indicated .that .the .primary .
cause .of .death .was .an .overdose .of .morphine . . . . . .
When .the .patient .was .transferred .to .the .hospital, .an .investigation .
at .the .aging .services .facility .revealed .that .the .nurse .had .made .
a .medication .administration .error . .The .morphine .given .was .
prescribed .for .another .patient . .Because .the .nurse .became .dis-
tracted .in .the .middle .of .the .medication .administration .process, .
the .morphine .had .been .entered .into .the .correct .patient’s .medi- .
cation .record .but .given .to .another .patient . .Although .there .
was .no .record .of .the .patient .receiving .morphine, .the .patient’s .
reaction .to .Narcan®, .as .well .as .the .results .of .the .urine .and .
blood .analysis .completed .at .the .hospital .where .the .patient .was .
transferred, .left .little .doubt .as .to .the .medication .administration .
error . .The .claim .resolved .for .greater .than .$350,000 . . .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 28
Allegations related to patients’ rights,
patient abuse and professional conduct
– Closed .claims .alleging .inappropriate .nurse .supervision .have .the .highest .severity . .These .closed .
claims .asserted .against .directors .of .nursing .involve .hiring .practices .related .to .clinical .staff . .
(See .Figures .17-18 .on .page 35 .for .more .information .about .director .of .nursing .claims .)
– Closed .claims .alleging .violation .of .patients’ .rights .include .unauthorized .release .of .protected .
patient .information, .as .well .as .denial .of .care .to .inmates .requesting .medical .treatment .
– Closed .claims .alleging .violation .of .patients’ .rights .to .care .in .a .safe .environment .include .failure .
to .take .necessary .action .to .prevent .falls, .maintain .clear .hallways, .perform .pre-employment .
screening .or .ensure .that .patients .were .treated .with .the .appropriate .level .of .care . .For .additional .
analysis .of .fall-related .closed .claims, .see .Figure .12B .
– In .general, .abuse .allegations .against .nurses .reflect .a .relatively .low .frequency .and .severity, .in .
comparison .to .the .overall .dataset .
– The .average .paid .indemnity .for .falls .($81,972) .is .less .than .the .overall .average .paid .indemnity .
for .nurse .closed .claims . .
– Closed .claims .alleging .injury .due .to .a .failure .to .take .necessary .action .to .prevent .falls .was .a .
recurring .theme, .as .in .the .following .examples:
– A .resident .fell .down .a .flight .of .stairs .because .a .fire .door .had .been .propped .open . . .
The .charge .nurse .was .responsible .for .ensuring .that .all .doors .to .the .unit .were .closed .
– While .in .an .acute .medical .center, .an .elderly .patient .was .given .a .sedative .prescribed . .
by .his .practitioner . .The .nurse .failed .to .engage .the .bed .alarm .and .shut .the .door .of . .
the .patient’s .room . .During .nursing .rounds, .the .patient .was .found .on .the .floor, .where . .
he .apparently .had .been .lying .for .several .hours .
12A SEVERITY OF ALLEGATIONS RELATED TO PATIENTS’ RIGHTS,
PATIENT ABUSE AND PROFESSIONAL CONDUCT
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Allegation
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Inappropriate .nurse .supervision 2 .8% $1,080,000 . $540,000 .
Violation .of .patients’ .rights 5 .6% $1,159,167 . $289,792 .
Violation .of .patients’ .rights .to . .
care .in .a .safe .environment 75 .0% $5,412,832 . $100,238 .
Sexual .abuse .by .nurse . 6 .9% $192,591 . $38,518 .
Verbal .abuse .by .nurse . 2 .8% $55,000 . $27,500 .
Physical .abuse .by .nurse . 6 .9% $127,500 . $25,500 .
Overall 100.0% $8,027,090 $111,487
12B SEVERITY AND FREQUENCY OF FALLS
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Falls
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
No 88 .0% $84,994,659 . $175,972 .
Yes 12 .0% $5,362,874 . $81,256 .
Overall 100.0% $90,357,533 $164,586
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 29
Analysis of Severity by Injury
– The .review .of .claims .in .this .report .reveals .that .comas, .which .were .often .due .to .medication .
administration .errors, .have .the .highest .severity .among .patient .injuries . .The .high .severity .reflects .
the .lifelong .medical .cost .for .patients .in .a .persistent .vegetative .state .who .require .24-hour .nursing .
care . .Examples .include .the .following:
– An .elderly .patient .admitted .to .a .medical .center .for .generalized .weakness .was .given .80 .
milligrams .of .oxycodone, .although .the .drug .had .not .been .ordered .for .her . .The .nurse .
reported .the .medication .administration .error .immediately .to .the .practitioner .and .was . .
told .to .monitor .the .patient .for .a .few .hours . .One .hour .later, .the .patient .was .discovered .to .
be .in .respiratory .distress . .She .suffered .a .left .sub-acute .cerebrovascular .accident, .leaving . .
her .in .a .permanent .vegetative .state .
– A .29-year-old .woman .was .admitted .to .a .behavioral .health .unit .for .an .apparent .attempted .
suicide .by .insulin .overdose . .The .admitting .practitioner .ordered .blood .sugar .checks .every .
four .hours . .However, .the .nurse .was .distracted .by .several .additional .admissions .and .failed .
to .perform .the .checks .during .the .evening .hours . .The .patient .was .found .unresponsive . .
and .suffered .anoxic .brain .injury .from .remaining .in .a .hypoglycemic .state .for .an .extended .
period .of .time .
– Death .(other .than .maternal .or .fetal) .is .the .most .common .injury, .accounting .for .42 .8 .percent . .
of .the .closed .claims . .When .maternal .and .fetal .mortality .are .included, .44 .3 .percent .of .all .closed .
claims .involve .a .patient .death . .(Injuries .involving .death .are .analyzed .in .Figure .14 .on .page 32 .)
– Seizures .have .the .second .highest .severity, .driven .by .two .claims .that .settled .at .policy .limits . .
Closed .claims .in .this .category .involve .allegations .of .failure .to .properly .complete .a .patient .
assessment, .invoke .the .medical .chain .of .command .and .monitor/report .changes .in .the .
patient’s .condition .
– Fractures .and .pressure .ulcers .are .the .second .and .third .most .common .injuries, .together .
accounting .for .12 .6 .percent .of .closed .claims . .Their .frequency .has .increased .significantly .since .
the .2011 .claim .report . .These .injuries .occur .in .a .variety .of .locations, .especially .aging .services .
and .hospital .settings .
– Other .maternal .birth-related .injuries .include .an .emergency .delivery .due .to .premature .labor .and .
complications .resulting .from .the .retention .of .a .sponge .during .an .unplanned .Cesarean .section .
– In .this .report, .“pain .and .suffering”are .defined .as .injuries .of .an .emotional .nature, .such .as .
depression, .anxiety .or .embarrassment . .They .may .involve .temporary .or .permanent .disabilities, .
which .are .discussed .in .greater .detail .in .Figure .16 .on .page 34 .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 30
13 SEVERITY BY INJURY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
* . .“Other .maternal .obstetrics-related .injury” .claims .include .the .failure .to .identify .premature .labor .and .retained .foreign .body .during .a .Cesarean .section .
Injury
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Coma 0 .5% $1,862,500 . $620,833 .
Seizure 0 .7% $2,300,000 . $575,000 .
Neurological .deficit/damage 1 .3% $3,874,792 . $553,542 .
Fetal/infant .birth-related .brain .injury 5 .3% $14,638,551 . $504,778 .
Maternal .death 0 .4% $900,000 . $450,000 .
Spinal .pain/injury .- .cervical .spine .and .neck 0 .2% $375,000 . $375,000 .
Brain .injury .other .than .birth-related . 1 .8% $3,629,167 . $362,917 .
Paralysis 1 .8% $3,464,701 . $346,470 .
Cerebrovascular .accident .(CVA)/stroke 1 .3% $2,355,064 . $336,438 .
Bleeding/hemorrhage 0 .7% $1,261,250 . $315,313 .
Cardiopulmonary .arrest 1 .6% $2,429,001 . $269,889 .
Fetal .death 1 .1% $1,592,450 . $265,408 .
Loss .of .limb .or .use .of .limb 4 .4% $5,364,333 . $223,514 .
Death .(other .than .maternal .or .fetal) 42 .8% $32,649,771 . $138,935 .
Head .injury 0 .7% $475,000 . $118,750 .
Loss .of .organ .or .organ .function 2 .2% $1,314,750 . $109,563 .
Burn 4 .0% $2,284,582 . $103,845 .
Infection/abscess/sepsis . 5 .1% $2,297,188 . $82,042 .
Eye/ear .injury .or .sensory .loss 0 .9% $391,667 . $78,333 .
Pain .and .suffering 3 .1% $1,162,001 . $68,353 .
Fracture 6 .6% $2,452,166 . $68,116 .
Abrasion/bruise/contusion/laceration 1 .3% $446,000 . $63,714 .
Allergic .reaction/anaphylaxis 0 .7% $250,750 . $62,688 .
No .injury .specific .to .nurse .care, . .
but .nurse .is .named 0 .2% $55,000 . $55,000 .
Scar(s)/scarring 1 .1% $326,500 . $54,417 .
Other .maternal .obstetrics-related .injury* 0 .5% $162,500 . $54,167 .
Peripheral .vascular .ulcer/wound 0 .2% $46,250 . $46,250 .
Compartment .syndrome 0 .9% $214,750 . $42,950 .
Pressure .ulcer 6 .0% $1,395,509 . $42,288 .
Increase .or .exacerbation .of .illness 0 .2% $40,000 . $40,000 .
Cardiac .injury .(excludes .heart .attack) 0 .4% $65,000 . $32,500 .
Abuse 0 .7% $123,090 . $30,773 .
Chest .pain/angina 0 .5% $75,500 . $25,167 .
Medication-related .injury . .
not .otherwise .classified 0 .2% $25,000 . $25,000 .
Heart .attack/myocardial .infarction 0 .2% $25,000 . $25,000 .
Sprain/strain 0 .2% $20,000 . $20,000 .
Embolism 0 .2% $12,750 . $12,750 .
Overall 100.0% $90,357,533 $164,586
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 31
Analysis of fatal injuries by underlying cause of death
As .previously .noted, .44 .3 .percent .of .all .injuries .were .fatal . .Figure .14 .provides .additional .insight .into .
the .causes .of .these .deaths .
Analysis of severity by cause of death
– Allergic .reaction/anaphylaxis .represented .the .highest .severity .of .all .fatal .injuries . .The .three .
closed .claims .involve .administration .of .a .higher-than-prescribed .dose .of .Narcan® .or .failure .to .
recognize .the .patient’s .drug .allergies .prior .to .administering .an .antibiotic .
– The .three .most .common .causes .of .death .are .cardiopulmonary .arrest, .pressure .ulcer .and .bleeding/
hemorrhage . .These .results .are .similar .but .not .identical .to .the .2011 .claim .report, .in .which .the .
three .most .frequent .causes .of .death .were .cardiopulmonary .arrest, .infection/abscess/sepsis .and .
bleeding/hemorrhage . .Pressure .ulcers .as .a .cause .of .death .occur .more .often .in .aging .services .
facilities, .where .the .patient’s .comorbidities .may .impede .recovery .
– Suicide .as .a .cause .of .death .is .four .times .more .common .in .the .claims .reviewed .in .this .report .
than .in .the .2011 .claim .report . .All .closed .claims .involve .improper .nursing .management .of .a .
behavioral .health .patient .in .a .variety .of .settings, .from .behavioral .health .and .correctional .facilities .
to .emergency .departments .and .patients’ .homes . .Most .patients .in .this .category .were .on .facility- .
established .suicide .precautions .but .were .allowed .to .retain .unsafe .items .(such .as .plastic .bags, .
combs .or .pens) .or .were .left .in .high-risk .areas .(such .as .bathrooms .and .public .lobbies) .without .
supervision . .The .following .suicide-related .closed .claim .is .just .one .of .several:
– The .patient .was .brought .to .the .emergency .department .by .police .and .family .because . .
of .suicidal .ideation . .On .arrival, .he .was .placed .in .an .observation .room .outfitted .with .two .
video .cameras, .which .had .a .live .feed .to .a .monitor .at .the .nurses’ .station . .While .in .the .
observation .room, .he .hanged .himself .with .a .sheet .and .died .
The three most common causes of death
are cardiopulmonary arrest, pressure ulcer
and bleeding/hemorrhage.
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 32
14 IDENTIFIED CAUSE OF DEATH
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Identified cause of death
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Allergic .reaction/anaphylaxis 1 .2% $925,000 . $308,333 .
Brain .injury .other .than .birth-related . 0 .4% $262,500 . $262,500 .
Fetal .death 3 .3% $2,092,916 . $261,615 .
Congestive .heart .failure 0 .4% $250,000 . $250,000 .
Aneurysm 0 .8% $480,000 . $240,000 .
Cardiopulmonary .arrest 25 .5% $14,301,670 . $230,672 .
Embolism 2 .5% $1,147,600 . $191,267 .
Aspiration 3 .7% $1,601,000 . $177,889 .
Suicide 6 .6% $2,693,583 . $168,349 .
Meningitis 1 .2% $500,000 . $166,667 .
Injury .resulting .from .elopement 1 .2% $456,667 . $152,222 .
Cardiac .injury . 1 .6% $572,500 . $143,125 .
Bleeding/hemorrhage 11 .9% $4,107,200 . $141,628 .
Abrasion/bruise/contusion/laceration 0 .8% $250,000 . $125,000 .
Maternal .death 0 .8% $242,500 . $121,250 .
Heart .attack/myocardial .infarction 0 .8% $170,950 . $85,475 .
Medication-related .injury . .
not .otherwise .classified 0 .8% $163,330 . $81,665 .
Fracture 4 .1% $692,150 . $69,215 .
Infection/abscess/sepsis . 7 .8% $1,195,740 . $62,934 .
Cancer 0 .4% $60,000 . $60,000 .
Hypothermia . 0 .4% $58,250 . $58,250 .
Fetal/infant .birth-related .brain .injury 0 .8% $112,500 . $56,250 .
Pressure .ulcer 13 .6% $1,847,999 . $56,000 .
Dehydration/malnutrition 0 .8% $103,333 . $51,667 .
CVA/stroke 2 .1% $255,000 . $51,000 .
Pneumonia/respiratory .infection 3 .3% $360,833 . $45,104 .
Loss .of .organ .or .organ .function 1 .2% $125,000 . $41,667 .
Coma 0 .4% $37,500 . $37,500 .
Head .injury 0 .4% $26,500 . $26,500 .
Increase .or .exacerbation .of .illness 0 .8% $50,000 . $25,000 .
Overall 100.0% $35,142,221 $144,618
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 33
Analysis of obstetrics-related injuries
Not .all .birth-related .closed .claims .occurred .in .obstetrical .locations . .Injuries .to .the .mother .or .baby .
also .occurred .in .the .emergency .department, .adult .medical/surgical .units, .post-anesthesia .care .units, .
critical .care .units, .outpatient .care .locations .and .patients’ .homes .
– Of .all .obstetrical .injuries, .fetal/birth-related .brain .injuries .demonstrate .both .the .highest .percent- .
age .of .closed .claims .and .the .highest .severity . .In .a .number .of .closed .claims, .the .baby .suffered .
permanent .disability, .requiring .lifelong .ongoing .nursing .care . .These .obstetrics-related .closed .
claims .involve .one .or .more .of .the .following .nursing .errors:
– Failure .to .invoke .the .chain .of .command .
– Failure .to .timely .report .complication .of .pregnancy/labor .to .a .practitioner .
– Failure .to .monitor .and .timely .report .the .mother’s .and/or .baby’s .vital .signs .
– Failure .to .identify .and .report .observations, .findings .or .changes .in .condition .
– Improper .or .untimely .nursing .management .of .an .obstetrical .patient/complication .
– The .maternal .deaths .resulted .from .complications, .as .in .the .following .claim:
– A .patient .with .a .history .of .chronic .hypertension, .preeclampsia .and .HELLP .syndrome .
delivered .a .child .via .Cesarean .section . .While .in .the .recovery .room, .she .developed .new .
symptoms, .became .unresponsive, .and .demonstrated .decreased .saturation .levels .and .
shallow .respiration . .The .nurse .responsible .for .the .patient’s .care .failed .to .timely .and .
appropriately .respond .to .this .change, .which .resulted .in .the .patient’s .death .
– Of .the .three .maternal .obstetrics-related .injuries, .one .occurred .in .an .obstetrician’s .office .and .
two .occurred .in .the .labor .and .delivery .departments . .These .closed .claims .primarily .involve:
– Sepsis .due .to .an .untreated .bladder .infection .
– Complications .from .a .retained .sponge .following .a .Cesarean .section .
– Complications .during .delivery .following .premature .labor .
– The .average .obstetrics-related .closed .claim .severity .of .$432,338 .is .more .than .twice .the .dataset’s .
overall .average .severity .of .$164,586 .
– Page 24 .contains .a .more .detailed .obstetric .case .scenario .
15 SEVERITY OF OBSTETRICS CLAIMS BY INJURY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Injury
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Fetal/infant .birth-related .brain .injury 72 .5% $14,638,551 . $504,778 .
Maternal .death 5 .0% $900,000 . $450,000 .
Fetal .death 15 .0% $1,592,450 . $265,408 .
Maternal .obstetrics-related .injury 7 .5% $162,500 . $54,167 .
Overall 100.0% $17,293,501 $432,338
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 34
Analysis of severity by disability outcome
– Permanent .total .disability .is .the .outcome .with .the .highest .severity . .This .result .is .expected, .as .
permanently .disabled .individuals .require .significant .medical .and .social .support .for .the .remainder .
of .their .lives . .This .finding .is .consistent .with .the .2011 .claim .report .
– Closed .claims .involving .patient .deaths .have .the .second .highest .severity, .which .remains .consistent .
with .the .2011 .claim .report . .The .relatively .high .severity .for .closed .claims .where .the .patient .died .
may .be .associated .with .compensation .to .survivors .and/or .aggravating .circumstances, .such .as .
allegations .that .the .nurse .abandoned .the .patient .or .failed .to .follow .practitioner .orders .
– Injuries .associated .with .permanent .total .disability .include .brain .injuries .(both .non-birth .and .birth- .
related), .paralysis, .loss .of .limb .or .use .of .limb, .and .cardiovascular .accident/stroke . .The .permanent .
total .disability .claims .were .included .in .the .following .allegation .categories:
– Treatment .and .care: .50 .6 .percent
– Monitoring: .16 .5 .percent
– Assessment: .11 .4 .percent
– Medication .administration: .8 .9 .percent
– All .other .categories: .12 .7 .percent
16 SEVERITY BY DISABILITY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Disability
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Permanent .total .disability 14 .4% $33,264,933 . $421,075 .
Death 44 .3% $35,142,221 . $144,618 .
Temporary .total .disability 3 .3% $2,218,250 . $123,236 .
Permanent .partial .disability 22 .6% $13,310,830 . $107,345 .
Temporary .partial .disability 15 .5% $6,421,299 . $75,545 .
Overall 100.0% $90,357,533 $164,586
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 35
Analysis of director of nursing (DON) closed claims
The .majority .of .DON .professional .liability .closed .claims .involve .performance .of .managerial .and/or .
administrative .services, .such .as .hiring . .These .allegations .are .based .upon .the .assumption .that .the .
DON .is .personally .responsible .for .the .actions .of .the .members .of .the .nursing .care .staff .and .for .the .
care .of .each .patient .or .resident . .Of .the .total .nurse .closed .claims, .5 .7 .percent .involve .a .director .of .
nursing, .mostly .in .aging .services .settings .
– The .severity .of .DON .closed .claims .($96,371) .is .significantly .lower .than .the .dataset’s .overall .
severity .($164,586) .
– DON .claims .involving .death .are .both .relatively .common .(67 .7 .percent) .and .costly .($115,275), .
which .is .consistent .with .the .2011 .claim .report .
17 SEVERITY OF DIRECTOR OF NURSING CLAIMS BY NURSE SPECIALTY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Nurse specialty
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Adult .medical/surgical 3 .2% $1,000,000 . $1,000,000 .
Gerontology .(in .aging .services .facility) 96 .8% $1,987,516 . $66,251 .
Overall 100.0% $2,987,516 $96,371
18 SEVERITY OF DIRECTOR OF NURSING CLAIMS BY INJURY
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Injury
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Death . 67 .7% $2,420,766 . $115,275 .
Loss .of .limb .or .use .of .limb 3 .2% $112,500 . $112,500 .
Fracture 9 .7% $249,250 . $83,083 .
Pressure .ulcer 6 .5% $80,000 . $40,000 .
Infection/abscess/sepsis . 6 .5% $80,000 . $40,000 .
Abrasion/bruise/contusion/laceration 3 .2% $25,000 . $25,000 .
Abuse 3 .2% $20,000 . $20,000 .
Overall 100.0% $2,987,516 $96,371
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 36
Claims related to agency nurses
– Agency .nurses .are .involved .in .23 .9 .percent .of .the .closed .claims .
– The .severity .for .agency .nurse .closed .claims .is .$186,430 . .For .purposes .of .comparison, .the .severity .
for .all .non-agency .nurse .closed .claims .is .$157,740, .while .the .severity .for .all .nurse .closed .claims .
included .in .the .report .is .$164,586 .
19 SEVERITY OF AGENCY NURSE CLAIMS BY AGENCY TYPE
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Agency type
Percentage of
closed claims
Total paid
indemnity
Average paid
indemnity
Temporary .staffing .agency 7 .7% $9,034,244 . $215,101 .
Individually .contracted .nurse 4 .6% $4,712,959 . $188,518 .
Home .care .agency 11 .1% $10,195,067 . $167,132
Hospice .care .agency 0 .5% $480,000 . $160,000 .
Total agency 23.9% $24,422,270 $186,430
Total non-agency 76.1% $65,935,263 $157,740
Overall 100.0% $90,357,533 $164,586
Agency nurses are involved in 23.9%
of closed claims, and the severity for
agency nurse closed claims is $186,430.
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 37
Claim Scenario: Successful Defense of a Nurse
It .is .CNA’s .claim .policy .to .pay .covered .claims .involving .actual .
liability .fairly .and .promptly, .while .aggressively .defending .unsub- .
stantiated .claims . .The .following .claim .scenario .demonstrates .
our .aggressive .defense .of .a .CNA/NSO-insured .nurse, .which .
succeeded .despite .the .seriousness .of .the .patient’s .injuries, .
including .pain, .suffering .and .death .
A .registered .nurse .with .19 .years .of .experience .as .an .emergency .
nurse .(including .15 .as .a .certified .emergency .nurse) .was .working .
in .the .triage .area .of .the .emergency .department . .A .34-year-old .
female .patient .was .sent .to .the .emergency .department .from .
the .local .dialysis .clinic .to .have .her .hemodialysis .catheter, .which .
was .bleeding .around .the .insertion .area, .examined .by .the .emer- .
gency .department .practitioner . .The .patient .was .accompanied .
by .her .mother .and .son, .who .appeared .to .be .about .10 .years .old . .
The .nurse .noted .in .the .triage .portion .of .the .medical .record .
that .the .patient .appeared .ill .and .disheveled, .and .she .allowed .
her .mother .to .answer .all .the .medical .questions .
During .the .15-minute .triage .process, .the .nurse .noted .that .the .
patient’s .vital .signs .were .normal, .she .had .plus .2 .pitting .edema .
in .her .lower .extremities .and .her .catheter .seemed .intact .with . .
a .small .amount .of .dried .blood, .but .no .active .bleeding .at .the .
insertion .site . .On .a .five-level .emergency .department .triage .
scale, .the .nurse .rated .the .patient .as .a .“3-urgent,” .meaning .that .
the .patient .should .be .seen .by .a .practitioner .within .15 .to .60 .
minutes .following .triage . .As .there .were .no .available .beds .in .the .
treatment .area .of .the .emergency .department, .the .nurse .asked .
the .patient .and .her .family .to .take .a .seat .near .the .triage .area .
to .facilitate .monitoring .
Shortly .after .the .nurse .performed .the .triage .on .the .patient, .
she .was .relieved .for .her .lunch .break . .She .gave .a .report .to .the .
new .nurse .on .all .the .patients .in .the .waiting .area, .advising .him .
that .the .last .patient .she .triaged .should .be .the .next .patient .to .
be .taken .to .an .available .treatment .bed . .Thirty .minutes .later, .
the .CNA-insured .nurse .arrived .back .at .the .triage .area .and .
noticed .that .the .patient .was .still .in .the .waiting .area . .The .nurse .
re-evaluated .the .patient .per .hospital .protocol, .noting .that .the .
patient’s .status .remained .unchanged .
Ninety .minutes .after .her .initial .triage, .the .patient .was .taken .to .
the .emergency .department .treatment .area . .The .nurse .had .no .
additional .contact .with .the .patient . .The .patient .was .examined .by .
the .emergency .department .practitioner .and .had .sutures .placed .
around .the .catheter .site . .She .was .discharged .home .moments .
after .the .sutures .were .completed .and .told .to .follow .up .with .the .
dialysis .clinic .the .next .day .
The .next .morning, .the .patient .was .found .unresponsive .and .
pronounced .dead .
Experts .were .retained, .who .determined .that .the .nurse .had .
acted .within .her .scope .of .practice .and .in .compliance .with .both .
the .standard .of .care .and .hospital .policy . .Documentation .sup-
ported .the .nurse’s .frequent .checks .of .the .patient .and .the .reasons .
for .not .triaging .the .patient .at .a .higher .acuity .level . .The .case .
against .the .nurse .was .defended .successfully .at .trial, .with .the .jury .
determining .that .the .nurse .was .not .responsible .for .the .patient’s .
untimely .death .
The .claim .took .four .years .and .more .than .$165,000 .in .expenses .
to .resolve . .While .it .may .have .been .less .expensive .to .settle .the .
claim, .the .nurse’s .proper .care .of .the .patient .and .complete .
documentation .made .an .aggressive .defense .not .only .possible, .
but .ultimately .successful .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 38
Licensed practical/licensed vocational nurse closed claims
The .previous .charts .in .the .report .combine .RN .and .LPN/LVN .closed .claims .data . .To .help .LPNs/LVNs .
better .understand .their .unique .risk .exposures, .this .section .compares .the .63 .closed .claims .where .
the .defendant .was .an .LPN .or .LVN .with .the .486 .RN .closed .claims . .The .top .three .results .for .each .of .
the .claim .characteristics .analyzed .are .presented .in .Figure .20, .below .
– LPNs/LVNs .are .defendants .in .11 .5 .percent .of .the .closed .nurse .claims . .The .distribution .of .CNA/
NSO-insured .nurses, .while .fluid, .is .approximately .11 .percent .LPNs/LVNs .and .89 .percent .RNs .
– The .severity .for .LPN/LVN .closed .claims .of .$157,598 .is .similar .to .the .severity .for .RN .closed .claims .
of .$165,491 .
– The .LPN/LVN .specialty .representing .the .highest .severity .is .obstetrics, .while .for .RNs .the .highest .
severity .specialty .is .occupational .health .
– Treatment/care .and .medication .administration .are .among .the .costliest .allegations .for .both .RNs .
and .LPNs/LVNs .
– Permanent .total .disability .had .the .highest .severity .for .both .LPNs/LVNs .and .RNs .
20 TOP THREE HIGH-SEVERITY CLAIM ELEMENTS FOR RNs AND LPNs/LVNs
(Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Professional Designation RN LPN/LVN
Percent of closed claims 88.5% 11.5%
Severity $165,491 $157,598
Specialties Occupational .health
Neurology
Obstetrics
Obstetrics .
Home .care
Occupational .health
Locations Occupational .health .center
Obstetrics .- .inpatient . .
perinatal .services
Nurse .residence
Practitioner’s .office
Patient’s .home
Occupational .health .center
Allegations Medication .administration
Monitoring
Treatment .and .care
Patients’ .rights
Treatment .and .care
Medication .administration
Injuries . Coma
Neurological .deficit/damage
Seizure
Fetal/infant .birth-related . .
brain .injury
Cardiopulmonary .arrest
Coma
Causes .of .death Brain .injury . .
(other .than .birth-related)
Fetal .death
Congestive .heart .failure .
Allergic .reaction/anaphylaxis
Cardiopulmonary .arrest
Injury .resulting .from .elopement
Disabilities . Permanent .total .disability
Death
Temporary .total .disability
Permanent .total .disability
Permanent .partial .disability
Death
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 39
Summary of Closed Claims with a
Minimum Indemnity Payment of $1 Million
The .closed .claims .in .Figure .21 .resolved .with .an .indemnity .payment .of .$1 .million . .Note .that .the .
CNA/NSO .professional .liability .insurance .indemnity .limit .is .$1 .million .per .claim, .although .judgments .
awarded .against .a .defendant .may .be .higher . .The .highest-severity .closed .claims .most .frequently .
involve .treatment .and .care, .such .as .failure .to .comply .with .facility .policies .or .operate .within .the .nurse’s .
appropriate .scope .of .practice . .These .actions .render .the .claims .difficult .to .defend .
21 CLOSED CLAIMS WITH PAID INDEMNITY OF $1 MILLION
Summary Allegation Injury Licensure type Specialty Location
A .nurse .caring .for .a .patient .in .a .hotel .
room .failed .to .assess .patient .for .dehy-
dration .and .hypovolemia .following .
multiple .facial .procedures .
Assessment Death RN Plastic .surgery/
reconstruction
Practitioner’s .
office
A .nurse .failed .both .to .complete .a .full .
assessment .and .to .notice .that .the .
patient .was .pre-eclamptic . .
Assessment Seizure RN Obstetrics .- . .
prenatal
Hospital .- . .
obstetrics, .
C-section .suite
A .nurse .failed .to .monitor .labs, .advocate .
for .patient .and .restart .heparin .accord-
ing .to .practitioner .order .
Monitoring Brain .injury .
other .than .
birth-related .
RN Neurology Hospital .- . .
inpatient .surgical
A .nurse .asked .a .mother .to .hold .her .
child’s .head .while .she .left .to .obtain .
tape .for .the .child’s .tracheostomy .tube . .
The .child’s .tracheostomy .tube .became .
dislodged, .and .when .the .nurse .returned, .
the .child .was .blue .and .unable .to . .
re-intubate .until .20 .minutes .later .
Monitoring Neurological .
deficit/damage
RN Pediatric Pediatric . .
intensive . .
care .unit
A .nurse .failed .to .request .a .continuous .
pulse .oximetry .monitor .for .patient .after .
surgery . .The .patient .was .at .high .risk . .
for .decreased .oxygen .levels .related .to .
surgery, .increase .of .hydromorphone .and .
patient’s .self-proclaimed .sleep .apnea . .
Monitoring Neurological .
deficit/damage
RN Adult .medical/
surgical
Hospital .- . .
inpatient .surgical
A .nurse .failed .to .initiate .policy . .
for .treatment .of .non-reassuring . .
fetal .distress .
Treatment/care Fetal/infant .
birth-related .
brain .injury
RN Obstetrics .- . .
labor .and . .
delivery
Hospital .- .
obstetrics, . .
labor .and . .
delivery
A .nurse .failed .to .monitor .vital .signs .
after .patient .was .given .high .doses .of .
narcotics .while .in .the .PACU .
Monitoring Death RN Adult .medical/
surgical
Hospital .- . .
inpatient .surgical
The .director .of .obstetrical .nursing .
failed .to .provide .proper .administrative .
and .supervisory .support .when .nurse .
caring .for .patient .was .having .difficulty .
obtaining .practitioner .response .
Treatment/care Loss .of .limb RN Obstetrics .- . .
postpartum
Hospital .- . .
obstetrics, . .
postpartum .care
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 40
21 CLOSED CLAIMS WITH PAID INDEMNITY OF $1 MILLION (CONTINUED)
Summary Allegation Injury Licensure type Specialty Location
A .claim .was .filed .against .a .nurse .in . .
her .role .as .manager .of .patient .care . .
The .patient .was .left .in .deplorable . .
conditions .at .home .and .was .not . .
given .seizure .medication . .In .addition, .
the .patient’s .pressure .ulcer .was .left .
untreated, .leading .to .sepsis .
Abuse/ .
patients’ .rights
Seizure/sepsis RN Home .health Patient’s .home
A .claim .was .filed .against .director . .
of .nursing .in .her .role .as .supervisor . .
of .patient .care . .A .patient .given .a . .
narcotic .to .keep .him .quiet, .later . .
died .of .overdose .
Abuse/ .
patients’ .rights
Death RN Home .health Patient’s .home
A .labor .and .delivery .unit .nurse . .
identified .fetal .distress .on .the .fetal . .
heart .monitor, .but .did .not .timely .
report .concerns .to .practitioner .
Treatment/care Fetal/infant .
birth-related .
brain .injury
RN Obstetrics .- . .
labor .and . .
delivery
Hospital .- .
obstetrics, . .
labor .and . .
delivery
The .nurse .gave .undiluted .hydro- .
morphone .in .three .minutes . .
by .intravenous .push .instead .of . .
intravenously .over .several .hours . .
Medical . .
administration
Coma RN Emergency .and .
urgent .care
Hospital .- . .
emergency .
department
A .labor .and .delivery .unit .nurse . .
failed .to .identify .fetal .distress .on . .
the .fetal .heart .monitor .
Diagnosis Fetal/infant .
birth-related .
brain .injury
RN Obstetrics .- . .
labor .and . .
delivery
Hospital .- .
obstetrics, . .
labor .and . .
delivery
A .nurse .working .in .an .obstetrics/ .
gynecology .office .communicated . .
a .message .to .practitioner .that .a .
patient .was .having .problems, .but .
failed .to .explain .that .the .problems .
were .emergent .
Treatment/care Fetal/infant .
birth-related .
brain .injury
LPN/LVN Obstetrics .- . .
prenatal
Practitioner’s .
office
A .nurse .failed .to .initiate .the .chain .of . .
command .when .practitioner .would .not .
respond .to .her .concerns .of .identified .
non-reassuring .fetal .distress .
Treatment/care Fetal/infant .
birth-related .
brain .injury
RN Obstetrics .- . .
labor .and . .
delivery
Hospital .- .
obstetrics, . .
labor .and . .
delivery
The highest-severity closed claims most frequently
involve treatment and care, such as failure to
comply with facility policies or operate within the
nurse’s appropriate scope of practice.
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 41
Risk Control Recommendations
The .following .risk .control .recommendations .are .designed .to .serve .as .a .starting .point .for .nurses .
seeking .to .assess .and .enhance .their .patient .safety .risk .control .practices:
Patient safety
Falls .are .a .common .yet .largely .avoidable .source .of .both .patient .harm .and .litigation . .While .eliminating .
falls .may .not .be .a .realistic .goal, .decreasing .falls .and .mitigating .the .severity .of .fall-related .injuries .
should .remain .a .top .priority .for .nurses .in .any .healthcare .setting . .Fall-related .injuries .include .head .
trauma, .broken .bones .and .death, .with .losses .ranging .into .six .figures . .Over .half .of .the .falls .in .the .
dataset .occurred .in .either .the .patient’s .home .or .an .aging .services .facility, .when .an .unattended .patient .
failed .to .comply .with .caregiver .instructions, .attempted .to .self-transfer .or .self-ambulate, .rejected .
assistance .from .staff .or .maneuvered .into .a .wheelchair .without .assistance .
Nurses .can .help .minimize .falls .and .fall-related .liability .by .following .sound .operational .policies, .
environmental .precautions .and umentation .practices, .especially .with .respect .to .describing .
the .patient’s .condition .and .the .specific .circumstances .of .the .fall . .The .following .suggested .actions .
can .assist .in .reducing .the .liability .associated .with .patient .falls:
– Focus .fall .prevention .programs .and .care .plans .on .the .locations .of .greatest .risk, .such .as .bedside, .
bathrooms .and .hallways .
– Encourage .teamwork .in .the .care-planning .process . .Include .certified .nursing .assistants .in .order .
to .benefit .from .their .unique .knowledge .of .patients .and .families .
– Assess .the .environment .for .potential .hazards, .make .patients .and .families .aware .of .any .dangers .
and .encourage .environmental .modifications, .as .necessary .
– Educate .patients .and .families .about .fall-related .risks .and .preventive .measures . .Encourage .
patients .and .families .to .mitigate .fall .risks .by .addressing .such .issues .as .hydration, .medication .
management .and .environmental .safety .
The .following .organizational .and .agency .websites .provide .a .wide .range .of .information .on .fall . .
prevention .and .gerontological .health:
– American .Academy .of .Family .Physicians .at .www.aafp.org .
– American .Geriatrics .Society .at .www.americangeriatrics.org .
– Centers .for .Disease .Control .and .Prevention .(CDC), .fall .prevention .information .for .older .adults, .
at .http://www.cdc.gov/HomeandRecreationalSafety/Falls/index.html .
– Fall .Prevention .Center .of .Excellence .at .www.stopfalls.org .
– National .Council .on .Aging .at .www.ncoa.org .
– National .Institute .on .Aging, .one .of .the .National .Institutes .of .Health, .at .www.nia.nih.gov .
– American .Physical .Therapy .Association .at .www.apta.org/BalanceFalls/ .
http://www.aafp.org
http://www.americangeriatrics.org
http://www.cdc.gov/HomeandRecreationalSafety/Falls/index.html
http://www.stopfalls.org
http://www.ncoa.org
http://www.nia.nih.gov
http://www.apta.org/BalanceFalls/
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 42
Medication .safety .has .become .a .more .prominent .issue .in .recent .years, .as .national .patient .safety .
initiatives .have .focused .practitioners’ .attention .on .the .need .to .improve .medication .management .and .
error .reporting .processes . .However, .dispensing .and .administration .lapses, .which .are .often .difficult .
to .defend .in .the .event .of .a .malpractice .claim, .continue .to .occur . .By .following .the .suggested .actions, .
nurses .can .assist .in .reducing .the .liability .associated .with .medication .errors:
– Follow .established .medication .protocols . .If .“work-arounds” .persist, .consult .with .the .facility’s .
nursing .leadership .about .methods .to .enhance .staff .monitoring .and .compliance .
– Understand .that .while .bar-coding .scanning .of .the .patient’s .armband .to .confirm .identity .can .
reduce .medication .errors, .this .method .is .not .foolproof . .Consistently .use .the .“six .rights” .when .
administering .medications .to .patients:
– Right .patient
– Right .drug
– Right .dose
– Right .route
– Right .time
– Right umentation
– Know .the .medication(s) .being .administered .to .the .patient . .While .nurses .do .not .prescribe .and .
only .rarely .dispense .medications, .they .are .responsible .for .administering .drugs . .Therefore .they .
must .understand .why .the .patient .is .taking .a .particular .medication .as .well .as .interactions, .side .
effects .or .adverse .reactions .that .may .occur .
Environmental safety .is .another .major .area .of .concern, .especially .as .home-based .medical .care .
continues .to .expand . .Whether .in .an .acute .care .facility .or .their .own .home, .patients .have .the .right .to .
receive .care .in .a .safe .environment . .For .this .reason, .nurses .must .be .cognizant .of .patients’ .surround- .
ings .and .know .how .to .keep .them .out .of .harm’s .way . .
Assessment and monitoring
Accurate .and .timely .assessment .of .patients .and .careful .monitoring .can .mean .the .difference .between .
a .favorable .and .unfavorable .outcome . .The .following .strategies .can .help .nurses .improve .their .perfor- .
mance .of .these .core .nursing .duties:
– Perform .a .timely .head-to-toe .assessment .of .patients . .If .an .assessment .cannot .be .completed, .
document .the .interventions .taken .
– Accurately .communicate .patient .assessments .and .observations .to .other .members .of .the .health- .
care .team .and .convey .any .changes .in .the .patient’s .condition .
– Listen .to .and .consider .patients’ .complaints/concerns .regarding .their .healthcare . .If .necessary, .
report .complaints/concerns .to .members .of .the .healthcare .team .and .the .patient’s .practitioner .
– Recognize .and .report .any .change .in .a .patient’s .condition .to .the .appropriate .practitioner .
– Document .patient .complaints/concerns .in .the .healthcare .record .and .all .steps .taken .to . .
resolve .them .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 43
Treatment and care
The .most .common .allegations .in .this .report .are .associated .with .treatment .and .care .of .patients . .
Specific .issues .included:
– Failure .to .report .patient .complications .to .a .practitioner .
– Improper .nursing .management .of .a .medical .patient .
– Improper .performance .of .a .nursing .technique .
– Failure .to .invoke .the .medical .chain .of .command .
As .a .valuable .member .of .the .healthcare .team .and, .in .most .situations, .the .only .member .that .the .
patient .interacts .with .on .a .regular .basis, .nurses .can .do .much .to .reduce .the .risk .of .treatment .and .
care .allegations . .The .following .measures .apply .to .nurses .in .every .setting:
– Implement .and ument .approved/standardized .protocols .in .a .timely .manner . .If .orders .cannot .
be .followed, .notify .the .practitioner .of .the .delay .
– Track .test .results .and .consultation .reports, .ensuring .that .findings .are .promptly .communicated .
and .acknowledged .
– Maintain .basic .clinical .and .specialty .competencies, .thus .considering .the .responsibility .to .pro-
actively .obtain .the .professional .information, .education .and .training .needed .to .remain .current .
regarding .nursing .techniques, .clinical .practice, .biologics .and .equipment .utilized .for .treatment .
of .acute .and .chronic .illnesses .and .conditions .related .to .one’s .specialty . .Continuing .nursing .
education .programs .represent .an .important .means .to .fulfill .this .responsibility . .If .such .programs .
are .not .routinely .provided .by .one’s .employer, .contact .state .and .local .nurse .associations .for .
information .about .reputable .educational .and .training .offerings .
– Report .any .patient .incident, .injury .or .adverse .outcome .and .subsequent .treatment/response .
Chain of command
Nurses .are .the .patient’s .advocate, .ensuring .that .the .patient .receives .safe .and .appropriate .care .
when .needed . .Advocacy .includes .the .duty .to .invoke .both .the .nursing .and .medical .staff .chains .of .
command .to .ensure .timely .attention .to .the .needs .of .every .patient, .and .persisting .to .the .point .of .
satisfactory .resolution . .Nurses .must .be .comfortable .with .utilizing .the .medical .chain .of .command .
whenever .a .practitioner .does .not .respond .to .calls .for .assistance, .fails .to .appreciate .the .seriousness .
of .a .situation .or .neglects .to .initiate .an .appropriate .intervention . .The .following .strategies .can .help .
reduce .apprehension .regarding .chain .of .command .issues:
– Proactively .address .communication .issues .between .nursing .and .medical .staffs, .and .identify .
instances .of .intimidation, .bullying, .retaliation .or .other .deterrents .to .invoking .the .chain .of .command .
– Notify .leadership .of .individuals .or .areas .that .prevent .nursing .staff .from .invoking .the .chain .of .
command .or .impose .punitive .actions .for .doing .so .
– If .the .organization’s .current .culture .does .not .support .invoking .the .chain .of .command, .explain .
the .risks .posed .to .patients, .staff, .practitioners .and .the .organization, .and .initiate .discussions .
regarding .the .need .for .a .shift .in .organizational .culture .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 44
Scope of practice
Nurses .are .required .to .practice .within .their .states’ .scope-of-practice .act, .as .well .as .their .employers’ .
policies .and .procedures .and .their .own .job .descriptions . .Practicing .outside .these .applicable .regula- .
tions .or .policies .can .jeopardize .patient .safety .and .result .in .liability .either .from .a .lawsuit .or .a .board .
complaint . .The .following .strategies .can .help .reduce .the .likelihood .of .scope-of-practice .allegations:
– Annually .review .the .state .scope .of .practice/nurse .practice .act, .job .description .or .contract, .and .
organizational .policies .and .procedures .
– Know .the .organization’s .policies .and .procedures .related .to .clinical .practices, umentation, .and .
appropriate .responses .to .assignments .beyond .one’s .current .scope .of .practice .and .experience .
– If .a .job .description, .contract, .or .set .of .policies .and .procedures .appears .to .violate .one’s .legal .
scope .of .practice, .bring .this .discrepancy .to .the .organization’s .attention .
– Clearly .state .one’s .unwillingness .to .risk .license .revocation .and .potential .legal .action .by .failing .
to .comply .with .the .state .scope .of .practice/nurse .practice .act .
For .additional .nurse-oriented .risk .control .tools .and .information, .visit .www.cna.com .and .www.nso.com .
Conclusion
The .first .step .in .the .process .of .protecting .patients .and .reducing .liability .exposure .is .to .learn .about .
the .risks .that .confront .today’s .nurses . .The .claims .data, .analysis .and .risk .control .recommendations .
contained .in .this .resource .are .presented .in .an .effort .to .inspire .nurses .nationwide .to .examine .their .
practice, .dedicate .themselves .to .patient .safety, .and .direct .risk .control .efforts .toward .areas .of .statis- .
tically .demonstrated .error .and .loss .
http://www.cna.com
http://www.nso.com
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 45
Risk Control Self-assessment Checklist for Nurses
Scope of Practice Yes No Actions needed to reduce risks
I .read .my .nurse .practice .act .at .least .annually .to .ensure .that .I .understand . .
the .legal .scope .of .practice .in .my .state .
If .a .job .description, .contract, .or .set .of .policies .and .procedures .appears .to . .
violate .my .state’s .laws .and .regulations, .I .bring .this .discrepancy .to .the .organization’s . .
attention .and .refuse .to .practice .in .violation .of .these .laws .and .regulations .
I .decline .to .perform .a .requested .service .that .is .outside .my .legal .scope .of .practice .
and .immediately .notify .my .supervisor .or .the .director .of .nursing .
I .contact .the .risk .management .or .legal .department .regarding .patient .and . .
practice .issues, .if .necessary .
If .necessary, .I .contact .the .board .of .nursing .and .request .an .opinion .or .position .
statement .on .nursing .practice .issues .
If .necessary, .I .use .the .chain .of .command .or .the .legal .department .regarding . .
patient .care .or .practice .issues .
Patient Safety: Falls Yes No Actions needed to reduce risks
I .evaluate .every .patient .for .risk .of .falling, .utilizing .a .fall-assessment .tool .that . .
considers .the .following .factors, .among .others: .
– Previous .fall .history .and .associated .injuries .
– Gait .and .balance .disturbances .
– Foot .and .leg .problems .
– Reduced .vision .
– Medical .conditions .and .disabilities .
– Cognitive .impairment .
– Bowel .and .bladder .dysfunction .
– Special .toileting .requirements .
– Use .of .both .prescription .and .over-the-counter .medications .
– Need .for .mechanical .and/or .human .assistance .
– Environmental .hazards .
I .identify .higher-risk .patients, .including .those .who .experience .recurrent .falls . .
or .have .multiple .risk .factors .
For .home .health/hospice .patients, .I .conduct .a .home .safety .check .prior .to . .
commencement .of .services .
If .I .detect .safety .problems .in .the .home, .I .recommend .that .corrective .actions . .
be .taken .as .part .of .the .patient .service .agreement .
I .regularly .assess .patients .and .modify .the .health .record .in .response .to .changes . .
in .their .condition .
I .inform .patients .and .families .of .salient .risk .factors, .as .well .as .basic . .
safety .strategies .
I ument .all .assessment .findings .and .incorporate .them .into .the .patient . .
service .plan .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 46
Patient Safety: Falls (continued) Yes No Actions needed to reduce risks
I ument .the .patient’s .condition .at .each .visit, .and .also:
– Report .any .changes .to .the .supervisor .and .family .in .a .clear .and .timely .manner .
– Perform .frequent .home .safety .checks, .as .appropriate .
– Reinforce .fall-reduction .tactics .with .patients .and .family .
– Encourage .patients .to .ask .for .assistance .with .risky .tasks .
– Keep .accurate, .detailed .records .of .patient .encounters .
After .a .fall, .I .offer .emotional .support .to .the .patent .and .the .caregiver
I .review .patient .falls .for .quality .assurance .purposes, .including .analysis .of .root . .
causes .and .tracking .of .trend .
I .perform .post-fall .analysis, .describing .the .circumstances .of .the .fall .and .also:
– Identifying .major .causal .factors, .both .personal .and .environmental .
– Indicating .the .patient’s .functional .status .before .and .after .the .fall .
– Noting .medical .comorbidities .
– Listing .witnesses .to .the .fall .
– Intervening .to .prevent .or .mitigate .future .falls .
I .conduct .a .thorough .post-fall .analysis .and .incorporate .findings .into .quality . .
assurance .and/or .incident .reporting .programs .
Patient Safety: Medication Yes No Actions needed to reduce risks
I .complete .a .patient .drug .history, .including .current .prescription .medications; . .
over-the-counter .drugs .and .supplements; .alternative .therapies; .and .alcohol, . .
tobacco .and .illicit .drug .use .
I .utilize .electronic .or .hard-copy .medication .profiles .when .readily .available .at .the .
point .of .care . .
I .review .allergy .notations .on .medication .profiles .prior .to .administering . .
any .medications .
I .record .patient’s .weight .and .height .measurements .in .metric .units .to .avoid . .
possible .confusion .
I .review .laboratory .values .and .diagnostic .reports .prior .to .administering . .
medications, .and .make .practitioners .aware .of .any .abnormalities .
I .utilize .machine-readable .coding .to .check .patient .identity .and .drug .data .prior . .
to .administration .of .drugs .or, .if .this .is .not .possible, .I .verify .patient .identity . .
using .two .patient .identifiers .(such .as .patient .ID .number .and .birthdate) .from .the .
original .prescription .
I ument .simultaneously .with .medication .administration .to .prevent .critical .gaps .
or .oversights .
I .utilize .only .medication .containers .prepared .in .advance, .ensuring .that .intravenous .
and .oral .syringes, .vials, .bowls .and .basins .are .appropriately .labeled .with .the .name .
of .the .patient .and .the .drug’s .name, .strength .and .dosage .
I .store .unit .doses .of .medications .in .packaged .form .up .to .the .point .of . .
handoff/administration, .in .order .to .facilitate .a .final .check .of .the .medication . .
administration .record .
I .accept .verbal .drug .orders .from .practitioners .only .during .emergencies .or .sterile .
procedures, .and .before .transcribing .the .order, .I .read .it .back .to .the .prescriber .and .
document .the .read-back .for .verification .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 47
Patient Safety: Medication (continued) Yes No Actions needed to reduce risks
I .communicate .potential .drug .side .effects .at .points .of .transition .and ument .
them .on .accompanying .patient .care .plans .and/or .handoff .reports .
I .include .patients .in .the .handoff .dialogue, .when .possible, .in .order .to .prevent .
errors, .reinforce .their .awareness .of .the .medication .regimen .and .strengthen .post- .
discharge .compliance .
I .follow .procedures .to .prevent .wrong .dosages .or .concentrations .of .identified . .
high-alert .drugs .(e .g ., .anti-coagulants, .muscle .relaxants, .insulin, .potassium .chloride, .
opioids, .adrenergic .agents, .dextrose .solutions .and .chemotherapeutic .agents) .
I .ensure .that .high-alert .medications .are .always .accompanied .by .standardized .
orders .and/or .computerized .safe-dosing .guidelines, .and .are .verified .by .two . .
persons .before .administration .
I .ensure .that .pediatric .medications .are .accompanied .by .standardized .orders . .
and/or .computerized .dosing .guidelines . .
I .follow .my .employer’s .guidelines .for .both .adult .and .pediatric .patients’ . .
dosages, .formulations .and .concentrations .of .drugs . .
I .seek .out .education .about .minimizing .the .risks .associated .with .look-alike . .
and .sound-alike .products, .and .I ument .my .training .
I .follow .my .employer’s .policies .and .procedures .to .keep .drugs .with .look-alike . .
and .sound-alike .names .separate .
I .receive .notification .when .medication .stock .is .relocated .or .storage .areas . .
are .reorganized, .in .order .to .reduce .the .likelihood .of .confusion .or .error .
I .have .pharmacists .available .on-site .or .by .telephone .to .consult .regarding . .
prescribed .medications .
PART 1 CNA AND NSO Nurse 2015 Claim Report Update 48
Claim Tips
Below .are .some .proactive .concepts .and .behaviors .to .include .in .your .nursing .custom .and .practice, .
as .well .as .steps .to .take .if .you .believe .you .may .be .involved .in .a .legal .matter .related .to .your .practice .
of .nursing:
Everyday practice
– Practice .within .the .requirements .of .your .state .nurse .practice .act, .in .compliance .with .organiza-
tional .policies .and .procedures, .and .within .the .national .standard .of .care . .If .regulatory .requirements .
and .organizational .scope .of .practice .differ, .comply .with .the .most .stringent .of .the .applicable .
regulations .or .policy . .If .in .doubt, .contact .your .state .board .of .nursing .or .specialty .professional .
nursing .association .for .clarification .
– Document .your .patient .care .assessments, .observations, .communications .and .actions .in .an .
objective, .timely, .accurate, .complete, .appropriate .and .legible .manner . .Never .alter .a .record .for .
any .reason .or .add .anything .to .a .record .after .the .fact .unless .it .is .necessary .for .the .patient’s .care . .
If .it .is .essential .to .add .information .to .the .record, .properly .label .the .delayed .entry, .but .never .
add .any umentation .to .a .record .for .any .reason .after .a .claim .has .been .made . .If .additional .
information .related .to .the .patient’s .care .emerges .after .you .become .aware .that .legal .action .is .
pending, .discuss .the .need .for .additional umentation .with .your .manager, .the .organization’s .
risk .manager .and .legal .counsel .
Once you become aware of a claim or potential claim
– Immediately .contact .your .personal .insurance .carrier .if .you:
– Become .aware .of .a .filed .or .potential .professional .liability .claim .against .you .
– Receive .a .subpoena .to .testify .in .a .deposition .or .trial .
– Have .any .reason .to .believe .that .there .may .be .a .potential .threat .to .your .license . .
to .practice .nursing .
– If .you .carry .your .own .professional .liability .insurance, .report .claims .or .potential .claims .to .your .
insurance .carrier, .even .if .your .employer .advises .you .that .it .will .provide .you .with .an .attorney .
and/or .cover .you .for .a .professional .liability .settlement .or .verdict .amount .
– Refrain .from .discussing .the .matter .with .anyone .other .than .your .defense .attorney .or .the .claim .
professionals .managing .your .claim .
– Promptly .return .calls .from .your .defense .attorney .and .the .claim .professionals .assigned .by .your .
insurance .carrier . .Contact .your .attorney .or .claim .professional .before .responding .to .calls, .e-mail .
messages .or .requests .for uments .from .any .other .party .
– Provide .your .insurance .carrier .with .as .much .information .as .you .can .when .reporting .such .matters, .
including .contact .information .for .your .organization’s .risk .manager .and .employer-assigned .attorney .
– Never .testify .in .a .deposition .without .first .consulting .your .insurance .carrier .or, .if .you .do .not .carry .
individual .liability .insurance, .the .organization’s .risk .manager .or .legal .counsel .
– Copy .and .retain .all .legal uments .for .your .records, .including:
– The .summons .and .complaint
– The .subpoena
– Attorney .letter(s)
– Any .other .legal uments .pertaining .to .the .claim
PART 2 Nurses Service Organization’s
Analysis of License Protection Paid Claims
(January 1, 2010-December 31, 2014)
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 50
Introduction
An .action .taken .against .a .nurse’s .license .to .practice .differs .from .a .professional .liability .claim .in .that .it .
may .or .may .not .involve .allegations .related .to .patient .care .and .treatment . .In .addition, .license .pro-
tection .claims .involve .only .the .cost .of .providing .legal .representation .to .defend .the .nurse .before .a .
regulatory .or .licensing .board, .whereas .professional .liability .claims .also .may .include .an .indemnity .
payment .
License Defense Paid Claims
Between .January .1, .2010 .and .December .31, .2014, .there .were .1,301 .license .defense .paid .claims .in .
which .legal .counsel .defended .nurses .against .allegations .that .could .potentially .have .led .to .license .
revocation . .License .defense .paid .claims .involving .medical .or .non-medical .allegations .made .to .a .
regulatory .or .licensing .body .have .increased .15 .4 .percent .since .the .2011 .claim .report, .which .had .1,127 .
license .defense .paid .claims . .While .the .cost .of .defending .a .license .protection .claim .is .typically .less .
than .that .associated .with .resolving .a .professional .liability .claim, .the .consequences .for .the .nurse .can .
be .severe . .The .regulatory .or .licensing .body .has .the .authority .to .issue .letters .of .concern, .warnings .
or .reprimands, .or .to .suspend .or .revoke .the .nurse’s .license .to .practice .
Analysis of claims by licensure type
The .percentage .of .license .defense .paid .claims .correlates .to .the .proportion .of .RNs .and .LPNs/LVNs .
within .the .overall .CNA/NSO-insured .nurse .population . .Total .paid .increased .by .37 .3 .percent .since .the .
prior .report, .and .the .average .payment .for .a .license .protection .closed .claim .increased .by .18 .9 .percent .
1 LICENSE DEFENSE PAID CLAIMS BY LICENSURE TYPE
License type RN LPN/LVN Total
License .defense .paid .claims 1,127 174 1,301
Percentage .of .defense .actions .by .license .type 86 .6% 13 .4% 100 .0%
Total payments $4,554,539 $634,445 $5,188,984
Average payment $4,041 $3,646 $3,988
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 51
Analysis of claims by location
Registered .nurses .with .a .license .defense .paid .claim .most .often .work .in .a .hospital .setting .(60 .0 .percent) . .
LPNs/LVNs, .however, .are .most .likely .to .work .in .an .aging .services .setting .(57 .5 .percent) .
Other .practice .locations .include .schools, .correctional .facilities, .community .health .centers .and .
group .homes .
2 PRACTICE LOCATIONS BY NURSING LICENSE
Note: The percentages indicated for RNs are based upon the 1,127 paid claims for RNs. The percentages for LPNs/LVNs are based upon the 174 paid claims for LPNs/LVNs.
RN LPN/LVN
Hospital 60 .0% Aging .services .facility 57 .5%
Aging .services .facility 18 .2% Hospital 19 .0%
Practitioner .office . 6 .9% Home .health/hospice 10 .3%
Home .health/hospice 5 .9% Practitioner .office . 6 .3%
All .other .settings 9 .0% All .other .settings 6 .9%
Total 100.0% Total 100.0%
License defense paid claims involving medical or
non-medical allegations made to a regulatory
or licensing body have increased 15.4%
since the 2011 claim report.
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 52
Analysis of claims by allegation class
Additional review of allegation sub-categories follows in Figures 5-8.
– For .RNs, .professional .conduct .complaints .account .for .the .highest .percentage .of .license .defense .
claims, .at .24 .2 .percent .of .all .allegations . .Such .complaints .include .professional .misconduct .for .
a .nursing .professional .as .defined .by .state .statute, .criminal .acts/behaviors .and .substance .abuse, .
including .drug .diversion .while .on .duty .and .driving .under .the .influence .while .off .duty .
– For .LPNs/LVNs, .medication .administration .errors .and .improper .treatment .and .care .account .
for .the .highest .percentage .of .license .defense .paid .claims, .comprising .44 .8 .percent .of .paid .
LPN/LVN .claims .
3 PRIMARY ALLEGATION CLASSES BY NURSING LICENSURE
Note: The percentages indicated for RNs are based upon the 1,127 paid claims for RNs. The percentages for LPNs/LVNs are based upon the 174 paid claims for LPNs/LVNs.
RN LPN/LVN
Professional .conduct 24 .2% Medication .administration . 22 .4%
Medication .administration . 18 .6% Improper .treatment/care 22 .4%
Improper .treatment/care 18 .5% Patients’ .rights/patient .abuse 21 .3%
Patients’ .rights/patient .abuse 11 .0% Professional .conduct 12 .6%
Scope .of .practice 9 .4% Assessment 6 .3%
Documentation .error .or .omission 9 .1% Scope .of .practice 6 .3%
Assessment 5 .0% Documentation .error .or .omission 4 .6%
Monitoring 4 .0% Monitoring 4 .0%
Breach .of .confidentiality 0 .1% Total 100.0%
Total 100.0%
Average payment by allegation class
Professional .conduct, .abuse/violation .of .patients’ .rights .and umentation .error/omission .allegations .
have .an .average .payment .higher .than .the .overall .average .license .protection .payment .of .$3,988 .
4 DETAILED VIEW OF AVERAGE PAYMENT
BY SUB-CATEGORY
Allegation class
Average
payment
Professional .conduct $4,545 .69
Patients’ .rights/patient .abuse $4,137 .72
Documentation .error/omission $4,124 .29
Medication .administration .errors $3,933 .25
Improper .treatment/care $3,777 .65
Monitoring $3,758 .17
Scope .of .practice $3,332 .61
Assessment $3,128 .40
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 53
Claims by Allegation Class Sub-Categories
Exhibits .5 .through .8 .provide .additional .information .regarding .the .most .frequent .and .severe .allegation .
sub-categories . .Note .that .the .percentages .are .calculated .based .upon .the .total .paid .claims .by .
licensure .type, .with .1,127 .closed .claims .for .RNs .and .174 .closed .claims .for .LPNs/LVNs .
Allegations related to sub-category of professional conduct
– Drug .diversion .and/or .substance .abuse .remain .the .top .allegations .for .both .RNs .and .LPNs/LVNs . .
Examples .of .such .activities .include:
– Diverting .medications .for .oneself .or .others .
– Neglecting .to ument .proper .disposal .of .narcotics .
– Neglecting .to .perform .or .incorrectly .performing .accurate .medication .counts .
– Apparent .intoxication .from .alcohol .or .drugs .while .on .duty .
– Criminal .acts .involve .off-duty .misbehavior, .such .as .shoplifting, .driving .under .the .influence .and .
other .violations .
5 DETAILED VIEW OF ALLEGATION SUB-CATEGORY
RELATED TO PROFESSIONAL CONDUCT
Note: The percentages indicated for RNs are based upon the 1,127 paid claims for RNs. The percentages for LPNs/LVNs are based upon the 174 paid claims for LPNs/LVNs.
RN LPN/LVN
Drug .diversion .and/or . .
substance .abuse 15 .3% Drug .diversion .and/or . .
substance .abuse 8 .6%
Professional .misconduct . .
as .defined .by .the .state . 3 .8% Professional .misconduct . .
as .defined .by .the .state 2 .3%
Other .inappropriate .behavior 3 .2% Criminal .act .or .conduct 1 .1%
Criminal .act .or .conduct 1 .9% Other .inappropriate .conduct 0 .6%
Suspended .or .revoked .license 0 .1% Total 12.6%
Total 24.2%
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 54
Allegations related to sub-category of patients’ rights
and patient abuse
– Abuse/patients’ .rights .allegations .constitute .11 .0 .percent .of .all .RN .allegations .and .21 .3 .percent .
of .all .LPN/LVN .allegations . .These .proportions .are .similar .to .the .2011 .claim .report .
– Physical .abuse .is .the .most .common .allegation .for .both .RNs .and .LPNs/LVNs .
– Verbal .abuse .allegations .more .than .doubled .for .LPNs/LVNs .since .the .2011 .claim .report .
6 DETAILED VIEW OF ALLEGATION SUB-CATEGORY
RELATED TO PATIENTS’ RIGHTS AND PATIENT ABUSE
Note: The percentages indicated for RNs are based upon the 1,127 paid claims for RNs. The percentages for LPNs/LVNs are based upon the 174 paid claims for LPNs/LVNs.
RN LPN/LVN
Physical .abuse 5 .6% Physical .abuse 12 .1%
Sexual .abuse 1 .2% Verbal .abuse 7 .5%
Verbal .abuse 2 .9% Sexual .abuse 1 .1%
Failure .to .provide .a .safe .environment 0 .8% Failure .to .provide .a .safe .environment 0 .6%
Violation .of .patients’ .rights 0 .4% Total 21.3%
Emotional .abuse 0 .1%
Total 11.0%
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 55
Allegations related to sub-category of improper treatment and care
– RNs .and .LPNs/LVNs .have .many .of .the .same .allegations .relating .to .improper .treatment/care . .
These .include:
– Failure .to .implement .established .treatment .protocols .
– Abandonment .of .the .patient .
– Failure .to .follow .and .implement .practitioner .orders .regarding .care .and .treatment .
– Failure .to .the .notify .primary .care .practitioner .of .the .patient’s .condition .
– Nurses .can .minimize .the .likelihood .of .allegations .of .failure .to .implement .established .treatment .
protocols .by .regularly .reviewing .facility .policies .and .protocols .
Allegations .also .can .result .from .miscommunication .or .lack .of .communication .with .a .practitioner .or .
nurse .or .from .inadequate .handoff .of .a .patient .to .another .practitioner . .By .carefully umenting .
the .information .shared .with .the .patient .and/or .other .members .of .the .patient’s .care .team, .nurses .can .
significantly .reduce .communication-related .risks .
7 DETAILED VIEW OF ALLEGATION SUB-CATEGORY
RELATED TO IMPROPER TREATMENT AND CARE
Note: The percentages indicated for RNs are based upon the 1,127 paid claims for RNs. The percentages for LPNs/LVNs are based upon the 174 paid claims for LPNs/LVNs.
* “All other” includes allegations that individually represent less than 0.8 percent of the paid claims, such as failure to respond in a timely manner to patient concerns,
improper nursing management of patients in need of physical restraints, premature cessation of treatment and improper nursing management of a medical complication.
RN LPN/LVN
Failure .to .implement . .
established .treatment .protocol 8 .6%
Abandonment .of .patient 4 .0%
Failure .to .notify .practitioner . .
of .patient’s .condition 2 .9%
Failure .to .carry .out .practitioner . .
orders .for .care .and .treatment 2 .3%
Improper .or .untimely .nursing . .
management .of .patient .condition 1 .7%
Improper .nursing .technique/ .
negligently .performed . .
treatment .with .injury
1 .1%
Failure .to .timely .obtain .practitioner .
orders .to .perform . .
necessary .additional .treatment
1 .1%
Wrong/incorrect .information . .
provided .or .recorded 0 .6%
Total 22.4%
Failure .to .timely .implement . .
established .treatment .protocol 9 .9%
Abandonment .of .patient 2 .0%
Failure .to .carry .out .practitioner . .
orders .for .care .and .treatment 2 .0%
Failure .to .notify .practitioner . .
of .patient’s .condition 1 .8%
Failure .to .timely .obtain .practitioner .
orders .to .perform . .
necessary .additional .treatment
0 .7%
Wrong/incorrect .information . .
provided .or .recorded 0 .5%
Delay .in .implementing . .
practitioner .orders 0 .4%
Improper .nursing .technique . .
or .negligent .performance .of . .
treatment .resulting .in .injury
0 .4%
All .other* . 0 .8%
Total 18.5%
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 56
Allegations related to sub-category of medication administration
– Medication .administration .issues .accounted .for .18 .6 .percent .of .RN .paid .claims .and .22 .4 .percent .
of .LPN/LVN .paid .claims . .There .has .been .a .modest .reduction .in .frequency .since .the .2011 .report, .
in .which .19 .7 .percent .of .RN .paid .claims .and .25 .4 .percent .of .LPN/LVN .paid .claims .involved .
administration .of .medications .
– While .medication .administration-related .allegations .were .similar .for .all .nurses, .the .frequency .
of .specific .allegations .differed .slightly .for .the .two .licensure .types .
8 DETAILED VIEW OF ALLEGATION SUB-CATEGORY
RELATED TO MEDICATION ADMINISTRATION
Note: The percentages indicated for RNs are based upon the 1,127 paid claims for RNs. The percentages for LPNs/LVNs are based upon the 174 paid claims for LPNs/LVNs.
RN
Failure .to .notify . .
primary .care .practitioner 2 .8%
Wrong .dose 2 .5%
Wrong .information . .
provided .or .recorded 2 .3%
Missed .dose 2 .1%
Wrong .medication 1 .6%
Failure .to ument . .
medication .administration 1 .6%
Wrong .patient 1 .1%
Improper .technique 0 .5%
All .other 4 .1%
Total 18.6%
LPN/LVN
Missed .dose 5 .2%
Failure .to .notify . .
primary .care .practitioner 2 .9%
Wrong .information . .
provided .or .recorded 2 .3%
Wrong .dose 1 .7%
Wrong .medication 1 .1%
Improper .technique 0 .6%
Wrong .patient 0 .6%
Wrong .time 0 .6%
Failure .to .immediately .report/ .
record .improper . .
administration .of .medication
0 .6%
Failure .to ument . .
medication .administration 0 .6%
All .other 6 .3%
Total 22.4%
Medication administration issues account for 18.6% of
RN paid claims and 22.4% of LPN/LVN paid claims.
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 57
Licensing Board Actions
Comparison of 2011 and 2015 distribution of licensing board actions
9 COMPARISON OF 2011 AND 2015 DISTRIBUTION
OF NURSE LICENSING BOARD ACTIONS n .2011 n .2015
Case closed – no action
49.2%
50.0%
Probation
10.8%
13.9%
Reprimand
7.3%
8.0%
Letter
6.9%
4.5%
Continuing education
6.8%
3.4%
Suspension
4.6%
5.1%
Stipulation
3.2%
1.0%
Surrender
3.2%
3.5%
Consent order
2.3%
4.3%
Censure
1.7%
1.5%
Fine
1.7%
3.1%
Revocation
1.7%
1.3%
Criminal – deferred
0.5%
0.4%
Citation
0.2%
0.0%
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 58
Explanation of Terms
Case closed – no action .– .A .decision .by .the .board .of .nursing .or .other .regulatory .body .not .to .
impose .discipline, .reflecting .a .successful .defense .of .the .nursing .professional .
Censure .– .A .public .written .reprimand .regarding .a .violation .of .the .Nurse .Practice .Act, .which .does .
not .impose .any .conditions .on .the .nurse’s .professional .license .
Citation .– .A .disciplinary .notice .that .is .more .formal .than .a .letter .of .warning, .concern .or .guidance .
Consent order .– .A .stipulation .of .a .condition .or .conditions .that .must .be .fulfilled .before .the .nurse .
can .continue .to .practice .
Criminal – deferred .– .A .notice .of .a .pending .board .of .nursing .action, .while .the .board .awaits .the .
results .of .a .criminal .action .against .the .nurse .
Letter of concern (includes .warning, .admonition .and .guidance .letters) .– .A .communication .from .the .
Board .of .Nursing .expressing .concern .that .the .nurse .may .have .engaged .in .questionable .conduct .
Letter of reprimand .– .A .communication .stating .that .probable .cause .of .an .infraction .has .been .found, .
and .that .disciplinary .action .will .be .implemented .if .any .further .problems .arise . .A .letter .of .reprimand .
is .more .serious .than .a .letter .of .concern .
Revocation of license .– .A .decision .by .a .board .of .nursing .prohibiting .the .nurse .from .practicing .
Stipulation .– .A .condition .or .limitation .on .the .nurse’s .practice .
Surrender of license .– .A .decision .by .the .nurse .to .cease .professional .practice .
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 59
General Recommendations
– Nurses .must .educate .themselves .on .an .ongoing .basis .about .quality .of .care .issues .and .strategies, .
and .focus .on .mastering .and .reinforcing .key .competencies . .The .importance .of .maintaining .
documentation .skills .cannot .be .overemphasized .
– As .nursing .professionals .are .asked .to .deliver .care .to .diverse .patient .populations, .managing .
difficult .patient .situations .is .a .core .competency .for .all .nurses . .By .enhancing .their .communication .
skills .and .reviewing .established .policies .and .protocols, .nurses .can .minimize .the .risk .of .claims .
or .complaints .alleging .patient .abuse .or .violation .of .patients’ .rights .
– Nursing .professionals .must .be .aware .of .the .stress .factors .that .may .lead .to .unprofessional . .
conduct, .and .be .proactive .in .seeking .support .to .manage .the .situations .or .circumstances .that .
can .make .them .vulnerable .
Conclusion
A .board .complaint .can .be .filed .against .a .nurse .by .a .patient, .patient’s .family .member .or .employer . .
Once .filed, .a .license .complaint .takes .an .average .of .two .years .to .achieve .resolution, .and .can .have .
career-altering .consequences . .In .4 .9 .percent .of .the .cases .in .the .dataset, .the .nurse’s .license .was .either .
surrendered .or .revoked, .effectively .ending .the .individual’s .nursing .career .
By .becoming .aware .of .the .most .common .complaints, .nurses .can .identify .potential .vulnerabilities .
in .their .own .practice .and .take .measures .to .protect .their .patients .and .themselves . .Basic .risk .control .
strategies .for .every .nurse .include:
– Enhancing .communication .and .interpersonal .skills .to .prevent .potential .errors .
– Adhering .to .facility .policies .and .procedures .
– Maintaining .nursing .skills/competencies .through .continuing .education .
– Paying .careful .attention .to umentation .requirements .
PART 3 Highlights from Nurses Service Organization’s
2015 Qualitative Nurse Work Profile Survey
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 61
Introduction
CNA .and .NSO .are .committed .to .informing .nurses .of .the .risks .they .may .encounter .in .their .daily .
practice . .This .section .of .the .report .presents .selected .highlights .from .the .NSO .2015 .Qualitative .
Nurse .Work .Profile .Survey, .which .examines .nurses’ .professional .liability .closed .claims .in .relation .to .
various .demographic .factors .and .workplace .attributes .not .addressed .in .Parts .1 .and .2 .of .the .report .
The .survey .enables .us .to .compare .several .workplace .variables .which .may .influence .professional .
liability .exposure, .including:
– The .effect .of .using .information .technology .versus .not .using .such .technology .
– The .relationship .between .varying .levels .of .employment .training .programs .and .periodic .checks, .
and .average .paid .indemnity .amounts .
– The .liability .consequences .of .having .or .not .having .a .rapid .response .team .when .an .incident .
occurs .
– The .effect .of .having .access .to .evidence-based .information .versus .not .having .access .
Methodology
This .survey .was .undertaken .in .order .to .examine .the .relationship .between .professional .liability .
exposures .and .a .variety .of .demographic .factors .and .workplace .attributes . .The .survey .looks .specifically .
at .a .sample .of .CNA/NSO .program .nurses .who .had .a .closed .professional .liability .claim .between .
January .1, .2010 .and .December .31, .2014, .and .compares .their .responses .with .a .sample .of .insureds .
who .did .not .experience .a .claim .during .that .time .period .
Two .similar .survey .instruments .were .distributed .to .NSO-insured .nurses .with .and .without .claims . .The .
first .group .consisted .of .738 .nurses .who .were .identified .as .having .had .a .claim .close .between .January .1, .
2010 .and .December .31, .2014 . .The .second, .non-claims .group .of .NSO .nurses .consisted .of .a .random- .
ized .sample .of .5,000 .current .insureds, .which .approximately .matched .the .geographic .distribution .of .
the .closed .claims .group . .In .this .survey, .“respondent” .refers .to .those .NSO-insured .registered .nurses, .
licensed .practical .nurses .and .licensed .vocational .nurses .who .voluntarily .replied .to .the .NSO .survey .
A .hybrid .methodology .was .used, .comprised .of .a .printed .mail .survey, .including .an .email .invitation .
to .complete .an .online .version .of .the .survey . .Each .participant .was .sent .the .print .version .and, .if .an .
email .address .was .available, .the .online .invitation .as .well . .Those .receiving .the .print .version .were .
invited .to .take .the .online .survey .via .a .generic .link . .Each .survey .was .labeled .with .a .unique .identifier .
to .prevent .multiple .responses . .Sample .members .were .sent .reminder .notifications .to .encourage .
study .participation .
Survey .findings .are .based .on .self-reported .information .and .thus .may .be .skewed .due .to .memory .
lapses .and .personal .biases . .The .qualitative .NSO .survey .results .are .not .comparable .to .the .CNA .nurse .
closed .claims .data .in .Part .I .or .the .nurse .license .protection .closed .claims .data .in .Part .II, .and .are .not .
representative .of .all .NSO-insured .nurse .paid .claims .or .nurse .paid .claims .in .general . .
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 62
The .following .chart .summarizes .the .response .rates .for .the .survey .
SURVEY RESPONSE RATES
Claims Non-claims
Total Total
Initial .deployment 7/16/15 7/16/15
Reminder .#1 .sent 7/28/15 —
Field .closed 8/21/15
Initial .sample .size 738 5,000
Undeliverable/opt .out 17 283
Usable .sample 721 4,717
Number .of .respondents 134 593
Response rate 18.5% 12.5%
Within .the .report, .results .are .reported .on .overall .responses .for .both .the .claims .and .non-claims .
segments . .The .margin .of .error .at .the .95 .percent .confidence .level .for .the .claims .portion .of .the .study .
was .±7 .3 .percent . .In .addition, .the .corresponding .mark .for .the .non-claims .version .was .±3 .7 .percent . .
In .either .case, .a .95 .percent .confidence .level .has .enabled .us .to .conclude .that .percentages .in .the .
actual .population .would .not .vary .by .more .than .this .in .either .direction .
Some .figures .and .narrative .findings .include .a .reference .to .the .average .paid .indemnity .of .the .
respondents’ .closed .claims . .It .is .important .to .remember .that .this .refers .only .to .indemnity .payments .
made .on .behalf .of .NSO-insured .RNs .and .LPNs/LVNs .who .experienced .a .closed .claim .and .who .
responded .to .the .survey .
Offering development opportunities to staff
has a positive effect on liability claims
and payments. Under-trained nurses have a
higher likelihood of experiencing a claim.
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 63
Summary of Findings
– Nurses .trained .outside .of .the .United .States .are .more .likely .to .experience .a .claim .than .nurses .
trained .in .the .United .States . .However, .the .average .paid .indemnity .for .this .group .is .about .one .
half .the .average .indemnity .of .those .trained .domestically .
– The .majority .of .nurses .(85 .0 .percent) .who .experienced .a .claim .have .been .in .practice .for .at .least .
16 .years . .However, .the .largest .average .indemnity .payments .($70,171) .were .made .to .practitioners .
working .as .a .nurse .for .three .to .five .years .
– The .majority .of .nurses .reported .that .they .have .technology .in .their .place .of .employment .that .
allows .rapid .access .to .clinical .information . .Those .without .rapid .access .to .information .experienced .
a .higher .indemnity .payment .
– While .technology .is .intended .to .drive .efficiency, .69 .1 .percent .of .those .experiencing .a .claim .
noted .that .it .takes .more .time .to .manage .the .technology .system .
– Respondents .who .reported .that .patient .notes .were .unnoticed .or .underutilized .had .a .higher .
level .of .liability, .with .41 .5 .percent .of .this .group .having .experienced .a .claim . .Average .indemni-
ty .payments, .however, .were .similar .for .all .respondents . .
– Evidence-based .practice .is .becoming .the .standard .for .patient .care . .Those .who .lacked .access .to .
evidence-based .information .had .an .average .indemnity .payment .66 .percent .higher .than .those .
who .had .access .to .this .information .at .their .place .of .employment .
– Offering .development .opportunities .to .staff .has .a .positive .effect .on .liability .claims .and .payments . .
Under-trained .nurses .have .a .higher .likelihood .of .experiencing .a .claim .
– Nurses .at .organizations .without .a .rapid .response .team .were .more .likely .to .experience .a .claim . .
This .group .also .experienced .the .highest .average .payment .
The .complete .results .of .the .survey .may .be .accessed .on .the .NSO .website .at .www.nso.com/nurse
claimreport2015 .*
* Note that the numbering of the figures in this section of the report is not sequential because they have been excerpted from the full survey results posted on
the NSO website.
http://www.nso.com/nurseclaimreport2015
http://www.nso.com/nurseclaimreport2015
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 64
Topic 1: Respondent Demographics
Nursing licensure
The .majority .of .respondents .who .experienced .a .claim .were .licensed .registered .nurses . .The .overall .
distribution .of .nursing .licensure .for .respondents .with .claims .and .those .without .claims .was .similar . .
As .reported .in .Part .1, .the .overall .proportion .of .the .CNA/NSO-insured .nurses .within .the .CNA/NSO .
book .of .business .varies .somewhat .over .time, .but .the .distribution .here .basically .mirrors .the .in .force .
ratio .of .89 .percent .RNs .to .11 .percent .LPNs/LVNs .
1 NURSING LICENSURE
Q: .Please .indicate .your .current .nursing .licensure .
Non-claims Claims Average paid indemnity
Registered .nurse 85 .4% 86 .5% $35,702
$78,368
$68,125
Retired 6 .5% 7 .5%
Licensed .practical/vocational .nurse 8 .1% 6 .0%
Gender
The .overall .distribution .of .male .and .female .respondents .is .roughly .equal .in .both .the .non-claim .and .
claim .groups . .This .implies .that .the .likelihood .of .a .claim .is .roughly .the .same .for .male .and .female .
nurses, .although .women .constitute .a .much .larger .proportion .of .the .program . .Males .who .experience .
a .claim .have .a .higher .average .paid .indemnity .than .do .their .female .counterparts .
2 GENDER
Q: .What .is .your .gender?
Non-claims Claims Average paid indemnity
Female 93 .9% 91 .5% $38,570
$55,175Male 6 .1% 8 .5%
The likelihood of a claim is roughly the same for
male and female nurses, although women constitute
a much larger proportion of the program.
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 65
Pre-licensure nursing program
The .data .suggest .that .completing .a .pre-licensure .nursing .program .through .a .traditional .brick-and-
mortar .institution .results .in .a .lower .average .indemnity .payment . .Additionally, .the .data .suggest .that .
nurses .completing .pre-licensing .hospital-based .programs .are .more .likely .to .experience .a .claim .
5 PRE-LICENSURE PROGRAMS
Q: .Which .best .describes .the .type .of .pre-licensure .nursing .program .you .completed?
Non-claims Claims Average paid indemnity
University/college .- .on-site .program 42 .4% 39 .6% $29,991
$35,446
$60,931
$73,146
$8,035
Community .college 31 .8% 35 .1%
Hospital-based .program 17 .9% 20 .9%
Accelerated .degree .program 6 .9% 3 .0%
Online .program 1 .0% 1 .4%
Origin of education
Nurses .trained .outside .the .United .States .have .a .higher .likelihood .of .experiencing .a .closed .claim .
than .do .nurses .trained .in .the .United .States . .However, .the .average .paid .indemnity .for .this .group .is .
about .one-half .the .indemnity .of .those .trained .domestically .
6 ORIGIN OF EDUCATION
Q: .What .is .your .origin .of .education? .
Non-claims Claims Average paid indemnity
Trained .in .the .United .States 95 .3% 85 .0% $42,542
$21,188Trained .outside .of .the .United .States 4 .7% 15 .0%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 66
Additional certifications
On .average, .an .additional .certification .in .a .specialty .increases .the .likelihood .of .a .claim, .as .nurses .
with .additional .certifications .and .training .tend .to .care .for .patients .with .a .higher .acuity .level .
The .percentages .in .this .figure .add .up .to .more .than .100 .percent, .as .respondents .may .have .more .
than .one .additional .certification .
8 ADDITIONAL CERTIFICATIONS
Q: .In .what .areas(s) .have .you .achieved .additional .certification .to .practice .as .a .nurse? . .
(check .all .that .apply)
Non-claims Claims Average paid indemnity
Critical .care 18 .7% 24 .1% $30,524
$32,289
$42,368
$50,661
$53,533
$80,812
$39,579
$64,246
$47,387
$141,661
$60,813
$54,432
$112,433
$175,500
$64,117
$68,772
$33,111
$83,367
$83,367
$57,375
$100,000
$343
$4,166
$0
Medical/surgical 12 .9% 21 .5%
Gerontology 8 .6% 17 .7%
Emergency .department 8 .9% 16 .5%
Home .health/hospice 8 .6% 11 .4%
Operating .room 3 .9% 10 .1%
Psychiatric/behavioral .health 5 .0% 10 .1%
Ambulatory .care 2 .5% 8 .9%
Infusion 4 .3% 8 .9%
Obstetrics/perinatal 4 .7% 7 .6%
Oncology/hematology 9 .7% 7 .6%
Pediatrics 5 .7% 6 .3%
Community/public .health 9 .0% 5 .1%
Aesthetics/cosmetics 2 .1% 3 .8%
Education 8 .6% 3 .8%
Occupational .health 1 .4% 3 .8%
Correctional .health 1 .1% 3 .8%
Clinics 1 .8% 2 .5%
School .nursing 8 .6% 2 .5%
Surgical .day .care 1 .4% 2 .5%
Adolescent .care 0 .8% 1 .3%
Family .practice 1 .1% 1 .3%
Neonatal 3 .6% 1 .3%
Urology/renal 1 .1% 0 .0%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 67
Years in practice
Nurses .who .have .been .in .practice .for .at .least .16 .years .are .more .likely .to .have .a .claim .than .are .less .
experienced .nurses . .However, .the .largest .average .indemnity .payment .($70,171) .was .for .nurses .in .
practice .for .three .to .five .years .
9 YEARS IN PRACTICE
Q: .How .many .years .have .you .been .a .licensed .nurse?
Non-claims Claims Average paid indemnity
Less .than .1 .year 7 .8% 0 .0% $0
$0
$70,171
$22,394
$12,432
$57,860
$40,118
1 .to .2 .years 9 .3% 0 .0%
3 .to .5 .years 13 .4% 1 .5%
6 .to .10 .years 13 .4% 6 .0%
11 .to .15 .years 6 .7% 7 .5%
16 .to .20 .years 9 .1% 13 .5%
21 .years .or .more 40 .3% 71 .5%
Nurses who have been in practice for at least
16 years are more likely to have a claim
than are less experienced nurses.
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 68
Topic 2: Current Practice Profile
Technology and rapid access to information
The .majority .of .nurses .reported .having .technology .available .in .their .place .of .employment .that .
permits .rapid .access .to .clinical .information . .Those .without .rapid .access .to .information .have .a .higher .
average .indemnity .payment .
17 TECHNOLOGY AND RAPID ACCESS TO INFORMATION
Does .this .technology .provide .you .rapid .access .to .clinical .information?
Non-claims Claims Average paid indemnity
Yes 94 .3% 92 .0% $35,403
$44,150No 5 .7% 8 .0%
Technology and patient records access
The .majority .of .respondents .report .having .technology .available .permitting .immediate .access .to .
patient .records . .Those .who .report .not .having .such .technology .have .a .higher .average .indemnity .
payment, .although .claim .frequency .is .similar .for .both .groups .
18 TECHNOLOGY AND PATIENT RECORDS ACCESS
Q: .Does .your .technology .provide .you .immediate .access .to .patient .records .for umentation?
Non-claims Claims Average paid indemnity
Yes 87 .3% 85 .5% $35,153
$43,266No 12 .7% 14 .5%
Managing technology and time
While .technology .is .intended .to .drive .standardization .and .efficiency, .69 .1 .percent .of .those .experiencing .
a .claim .noted .it .takes .more .time .to .manage .the .technology .system . .
19 MANAGING TECHNOLOGY AND TIME
Q: .Does .managing .the .technology .require .additional .time .on .your .end?
Non-claims Claims Average paid indemnity
Yes 54 .8% 69 .1% $37,955
$30,972No 45 .2% 30 .9%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 69
Technology and information verification
The .majority .of .respondents .reported .that .they .are .required .to .verify .information .in .their .practice .
technology . .Nurses .who .are .required .to .verify .any .information .managed .through .the .mentioned .
technology .are .less .likely .to .experience .a .claim .than .are .nurses .who .are .not .required .to .verify .infor- .
mation . .Average .indemnity .payments .for .both .groups .are .fairly .consistent .
20 TECHNOLOGY AND INFORMATION VERIFICATION
Q: .Are .you .required .to .verify .any .information .managed .through .the .mentioned .technology?
Non-claims Claims Average paid indemnity
Yes 84 .8% 73 .6% $37,332
$33,543No 15 .2% 26 .4%
Usage of electronic patient notes
Respondents .reporting .that .patient .notes .were .unnoticed .or .underutilized .have .a .higher .likelihood .
of .a .claim .than .respondents .who .reported .otherwise .
21 USAGE OF PATIENT NOTES
Q: .Do .electronic .patient .notes .go .unnoticed .or .underutilized?
Non-claims Claims Average paid indemnity
Yes 36 .2% 41 .5% $28,373
$29,918No 63 .8% 58 .5%
Access to evidence-based data
Evidence-based .practice .is .becoming .the .standard .for .patient .care .and .most .nurses .are .benefiting .
from .its .availability . .Those .who .reported .having .access .to .evidence-based .information .have .a .lower .
average .paid .indemnity . .Those .who .did .not .have .access .to .evidence-based .practice .information .have .
average .indemnity .payments .67 .percent .higher .than .those .who .did .
22 ACCESS TO EVIDENCE-BASED DATA
Q: .Does .your .place .of .employment .provide .access . .
to .evidence-based .data .base/practice .information?
Non-claims Claims Average paid indemnity
Yes 71 .7% 69 .0% $31,479
$52,505No 28 .3% 31 .0%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 70
Staff development opportunities
Having .regular .staff .development .opportunities .appears .to .have .a .positive .effect .on .liability .claims .
and .payments .
23 STAFF DEVELOPMENT OPPORTUNITIES
Q: .Does .your .place .of .employment .provide .regular .staff .development .(1X .per .year) .on:
Non-claims Claims
Yes No Yes No
New .organizational .procedures 88 .4% 11 .6% 81 .9% 18 .1%
New .technology 87 .9% 12 .1% 81 .4% 18 .6%
New .nursing .processes 81 .9% 18 .1% 75 .9% 24 .1%
Emerging .nursing .issues 67 .4% 32 .6% 72 .2% 27 .8%
Understanding .changing . .
reimbursement .and .how .that . .
links .to .patient .outcomes
63 .7% 36 .3% 62 .5% 37 .5%
Average paid indemnity
New .organizational .procedures
$54,380
$31,883
$52,206
$33,092
$48,750
$33,588
$42,997
$35,374
$60,469
$23,951
New .technology
New .nursing .processes
Emerging .nursing .issues
Understanding .changing . .
reimbursement .and .how .that . .
links .to .patient .outcomes
n .Yes n .No
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 71
Employment practice periodic checks
Employers .who .have .periodic .checks .and .offer .programs .that .support .future .educational .opportu-
nities, .job .satisfaction .and .proficiency .seem .to .decrease .the .likelihood .of .a .workplace .incident . .
When .these .periodic .checks .and .programs .are .in .place, .respondents .experience .lower .average .
indemnity .payments .
24 EMPLOYMENT PRACTICE PERIODIC CHECKS
Q: .Does .your .place .of .employment .…
Non-claims Claims
Yes No Yes No
Have .periodic .checks .on . .
complicated .scenarios .like .codes . .
and .other .emergencies?
71 .4% 28 .6% 67 .5% 32 .5%
Provide .tuition .reimbursement . .
to .pursue .higher .education? 60 .3% 39 .7% 58 .3% 41 .7%
Have .a .strategy .to .minimize . .
workplace .stress .and .violence? 41 .8% 58 .2% 35 .0% 65 .0%
Have .its .own .simulation .lab? 24 .2% 75 .8% 28 .7% 71 .3%
Average paid indemnity
Have .periodic .checks .on . .
complicated .scenarios .like .codes . .
and .other .emergencies? $51,345
$32,815
$54,013
$28,237
$46,890
$25,291
$48,766
$17,518
Provide .tuition .reimbursement . .
to .pursue .higher .education?
Have .a .strategy .to .minimize . .
workplace .stress .and .lateral .violence?
Have .its .own .simulation .lab?
n .Yes n .No
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 72
Topic 3: About the Claim Submitted
Working situation at the time of the incident
Those .working .in .a .consistent .location/unit .are .more .likely .to .experience .a .claim . .These .nurses .also .
have .lower .average .indemnity .payments .
27 WORKING SITUATION AT THE TIME OF THE INCIDENT
Claims .Q: .At .the .time .of .the .incident, .were .you: .
Non-claims .Q: .Which .of .the .following .best .describes .your .current .work .assignment? .
Non-claims Claims Average paid indemnity
Working .in .your .regularly .assigned .unit? 86 .1% 81 .0% $34,599
$56,642
$46,070
$76,774
$790
Other 10 .0% 11 .2%
Temporarily .assigned/traveler? 1 .8% 3 .5%
Temporarily .assigned .to .another .unit? 1 .2% 2 .6%
Working .in .permanent .pool? 0 .9% 1 .7%
Employment status at the time of the incident
Full-time, .self-employed .or .contracted .nurses .have .higher .average .indemnity .payments .
28 EMPLOYMENT STATUS AT THE TIME OF THE INCIDENT
Claims .Q: .At .the .time .of .the .incident, .what .was .your .employment .status? .
Non-claims .Q: .What .is .your .employment .status?
Non-claims Claims Average paid indemnity
Employed, .full-time 58 .4% 64 .2% $32,560
$21,710
$83,200
$54,799
$58,185
$72,968
$0
$0
Employed, .part-time 15 .3% 15 .5%
Self-employed/contracted, .full-time 3 .5% 8 .1%
Working .for .a .temp .staffing .service 2 .0% 4 .9%
Other 10 .1% 4 .1%
Self-employed/contracted, .part-time 4 .1% 3 .2%
Retired/permanently .disabled 3 .3% —
Student 3 .3% —
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 73
Years in practice at the time of the incident
Nurses .who .have .been .in .practice .for .11 .years .or .longer .are .most .likely .to .experience .a .closed .claim . .
As .years .of .practice .increase, .so .does .the .average .indemnity .payment .
29 YEARS IN PRACTICE AT THE TIME OF THE INCIDENT
Q: .At .the .time .of .the .incident, .how .many .years .have/had .you .practiced .nursing?
Claims Average paid indemnity
Less .than .1 .year 1 .7% $3,921
$343
$12,220
$21,050
$48,627
$21,592
$53,752
1 .to .2 .years 0 .8%
3 .to .5 .years 6 .6%
6 .to .10 .years 11 .6%
11 .to .15 .years 11 .6%
16 .to .20 .years 21 .5%
21 .years .or .more 46 .3%
Magnet™ designation at the time of the incident
A .Magnet™ .designation .recognizes .healthcare .organizations .for .quality .patient .care, .nursing .excel- .
lence .and .innovations .in .professional .nursing .practice . .The .Magnet .designation .was .developed .by .
the .American .Nurses .Credentialing .Center .(ANCC) .to .be .a .leading .source .of .successful .nursing .
practices .and .strategies . .A .majority .of .respondents .reported .they .do .not .work .in .an .institution .that .
has .a .Magnet .designation . .While .only .a .small .percentage .reported .having .Magnet™ .designation, .this .
group .has .a .lower .average .indemnity .payment .compared .with .non-Magnet™ .institutions .
32 MAGNET™ DESIGNATION AT THE TIME OF THE INCIDENT
Claims .Q: .At .the .time .of .the .incident, .was .your .hospital .a .Magnet™ .Institution? .
Non-claims .Q: .Is .you .hospital .a .Magnet™ .Institution?
Non-claims Claims Average paid indemnity
Yes 13 .5% 9 .0% $7,361
$40,492
$44,120
No 44 .8% 56 .6%
N/A 41 .7% 34 .4%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 74
Substance abuse procedure in place at the time of the incident
The .majority .of .nurses .report .that .their .place .of .employment .has .a .procedure .in .place .for .assessing .
substance .abuse .
34 SUBSTANCE ABUSE PROCEDURE IN PLACE AT THE TIME OF THE INCIDENT
Claims .Q: .At .the .time .of .the .incident, .did .your .facility .have .a .procedure .in .place .for .assessing .substance .abuse? .
Non-claims .Q: .Does .your .facility .have .a .procedure .in .place .for .assessing .substance .abuse?
Non-claims Claims Average paid indemnity
Yes 71 .3% 61 .2% $43,564
$34,473No 28 .7% 38 .8%
Tenure in position at the time of the incident
At .the .time .of .the .incident, .43 .4 .percent .of .nurses .had .been .at .their .position .for .11 .years .or .more . .
Respondents .with .three .to .15 .years’ .tenure .have .the .lowest .average .paid .indemnity, .while .those .
nurses .who .have .been .at .their .position .16 .or .more .years .have .the .highest .average .paid .indemnity .
35 TENURE IN POSITION AT THE TIME OF THE INCIDENT
Q: .At .the .time .of .the .incident, .how .many .years .had .you .worked .in .this .particular .position?
Claims Average paid indemnity
Less .than .1 .year 9 .0% $36,616
$47,304
$21,670
$33,519
$30,928
$50,047
$64,637
1 .to .2 .years 8 .2%
3 .to .5 .years 19 .7%
6 .to .10 .years 19 .7%
11 .to .15 .years 14 .8%
16 .to .20 .years 16 .3%
21 .years .or .more 12 .3%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 75
Topic 4: About the Facility
Where the Incident Occurred
Technology in the workplace at the time of the incident
The .benefits .of .technology .in .the .workplace .are .apparent . .Nurses .who .either .did .not .have .access .
to .electronic .technologies .or .who .did .not .use .the .technologies .they .had .access .to .were .more .likely .
to .have .a .closed .claim .than .nurses .who .used .the .technologies .
40 TECHNOLOGY IN THE WORKPLACE AT THE TIME OF THE INCIDENT
Claims .Q: .At .the .time .of .the .incident, .what .types .of .technology .did .you .use .in .your .workplace? .
If .you .do .not .use .it, .please .select .“do .not .use .”
Non-claims .Q: .What .types .of .technology .do .you .use .in .your .workplace? .
Non-claims Claims
Yes No
Did not
use Yes No
Did not
use
Electronic .medical .records .(EMR) 79 .8% 1 .0% 19 .2% 35 .0% 20 .0% 45 .0%
Handwritten .medical .records 81 .3% 15 .5% 3 .2% 79 .8% 10 .9% 9 .2%
A .combination .of .electronic . .
and .handwritten .medical .records 36 .5% 48 .2% 15 .3% 37 .1% 28 .5% 34 .5%
Medication .administration . .
bar-coding .system 52 .6% 4 .9% 42 .5% 16 .7% 33 .3% 50 .0%
Mobile .phone .applications, . .
e .g ., .Epocrates® 42 .9% 8 .8% 48 .3% 6 .7% 35 .0% 58 .3%
Mobile .monitoring 58 .9% 2 .6% 38 .5% 5 .9% 39 .0% 55 .1%
Texting 19 .3% 7 .2% 73 .5% 7 .6% 35 .6% 56 .8%
Care .management .system 31 .0% 16 .8% 52 .2% 18 .5% 28 .6% 52 .9%
Patient .portal 39 .6% 8 .5% 51 .9% 10 .8% 30 .0% 59 .2%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 76
40 TECHNOLOGY IN THE WORKPLACE… (CONTINUED)
Average paid indemnity
Electronic .medical .records .(EMR) $45,397
$33,197
$38,551
$26,544
$39,270
$44,220
$49,469
$26,724
$44,083
$44,220
$44,807
$31,977
$43,851
$70,160
$31,408
$41,114
$74,515
$32,691
$38,836
$76,682
$31,240
$48,066
$49,759
$29,009
$47,199
$58,531
$29,538
Handwritten .medical .records
A .combination .of .electronic . .
and .handwritten .medical .records
Medication .administration . .
bar-coding .system
Mobile .phone .applications, . .
e .g ., .Epocrates®
Mobile .monitoring
Texting
Care .management .system
Patient .portal
n .Yes n .No n .Did not use
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 77
How long were you using technology at the time of the incident?
Electronic .technology .seems .to .have .a .low .adoption .rate .within .nurse .practices . .Nurses .who .use .the .
listed .technology .have .been .doing .so .for .a .year .or .less .
41 HOW LONG WERE YOU USING TECHNOLOGY AT THE TIME OF THE INCIDENT
Q: .If .you .answered .“Yes” .to .question .40, .please .check .the .answer .that .best .describes .the .length .of .time .using .
the .technology .mentioned .in .the .previous .question . .At .the .time .of .the .incident, .how .long .were .you .using:
Non-claims
0-3
months
3-6
months
6 months
-1 year
Over
1 year
Do not
know
Did not
use
Electronic .medical .records .(EMR)? 6 .4% 8 .3% 7 .3% 22 .9% 3 .5% 51 .6%
Handwritten .health .records? 4 .3% 3 .1% 4 .2% 74 .1% 2 .5% 11 .8%
A .combination .of .electronic .and . .
handwritten .medical .records? 3 .6% 6 .2% 9 .0% 28 .9% 6 .4% 45 .9%
Medication .administration . .
bar-coding .system? 0 .7% 8 .2% 4 .1% 4 .2% 5 .3% 77 .5%
Mobile .phone .applications, . .
e .g ., .Epocrates®? 0 .6% 0 .5% 4 .1% 5 .6% 3 .9% 85 .3%
Mobile .monitoring? 0 .6% 1 .3% 3 .1% 17 .5% 4 .1% 73 .4%
Texting? 1 .4% 3 .2% 6 .3% 9 .3% 10 .5% 69 .3%
Care .management .system? 1 .6% 2 .6% 5 .1% 13 .1% 8 .3% 69 .3%
Patient .portal? 0 .9% 4 .5% 2 .9% 8 .2% 6 .5% 77 .0%
Claims
0-3
months
3-6
months
6 months
-1 year
Over
1 year
Do not
know
Did not
use
Electronic .medical .records .(EMR)? 4 .4% 1 .8% 4 .4% 23 .0% 6 .2% 60 .2%
Handwritten .health .records? 2 .6% 0 .9% 3 .5% 70 .7% 5 .2% 17 .2%
A .combination .of .electronic .and . .
handwritten .medical .records? 3 .5% 0 .0% 2 .6% 30 .7% 8 .8% 54 .4%
Medication .administration . .
bar-coding .system? 0 .9% 0 .0% 0 .9% 11 .4% 6 .1% 80 .7%
Mobile .phone .applications, . .
e .g ., .Epocrates®? 0 .0% 0 .9% 0 .0% 7 .0% 4 .4% 87 .8%
Mobile .monitoring? 0 .0% 0 .0% 0 .0% 7 .0% 5 .3% 87 .7%
Texting? 0 .0% 0 .0% 1 .8% 7 .1% 3 .5% 87 .6%
Care .management .system? 0 .9% 0 .9% 0 .9% 13 .2% 9 .7% 74 .6%
Patient .portal? 0 .0% 0 .0% 0 .0% 11 .5% 7 .1% 81 .4%
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 78
41 HOW LONG WERE YOU USING TECHNOLOGY… (CONTINUED)
Average paid indemnity
Electronic .medical .records .(EMR)
$43,651
$27,933
$30,199
$40,346
$40,955
$27,346
$36,907
$31,030
$36,450
$62,642
$36,111
$69,575
$35,114
$80,014
$34,857
$58,612
$37,602
$59,644
Handwritten .health .records
A .combination .of .electronic .and . .
handwritten .medical .records
Medication .administration . .
bar-coding .system
Mobile .phone .applications, . .
e .g ., .Epocrates®
Mobile .monitoring
Texting
Care .management .system
Patient .portal
n .Used n .Did not use
The majority of nurses believe that streamlining their
practice with technology enhances patient safety.
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 79
Perceived patient benefit of technology
A .majority .of .nurses .believe .that .streamlining .their .practice .with .technology .enhances .patient .safety .
42 PERCEIVED PATIENT BENEFIT OF TECHNOLOGY
Claims .Q: .At .the .time .of .the .incident, .did .you .feel .the .technology .used .at .your .place . .
of .employment .enhanced .or .jeopardized .patient .safety?
Non-claims .Q: .Do .you .feel .the .technology .used .at .your .place .of .employment .enhances . .
or .jeopardizes .patient .safety?
Non-claims Claims Average paid indemnity
Enhanced 83 .4% 60 .1% $43,564
$34,473Jeopardized 16 .6% 30 .9%
Rapid response team
Nurses .not .having .a .rapid .response .team .were .more .likely .to .experience .a .claim .
44 RAPID RESPONSE TEAM
Claims .Q: .At .the .time .of .the .incident, .did .you .have/use .a .rapid .response .team? .
Non-claims .Q: .Do .you .have .a .rapid .response .team? .
Non-claims Claims Average paid indemnity
No, .my .facility .does .not .have .an .RRT 34 .3% 51 .4% $48,374
$15,372
$45,731
Yes, .my .facility .has .an .RRT, . .
but .I .did .not .use .it 23 .3% 30 .6%
Yes, .my .facility .has .an .RRT, . .
and .I .used .it 42 .4% 18 .0%
The purpose of this report is to provide information, rather than advice or opinion. It is accurate to the best of CNA’s knowledge as of the date of the publication.
Accordingly, this report should not be viewed as a substitute for the guidance and recommendations of a retained professional. In addition, CNA does not endorse
any coverages, systems, processes or protocols addressed herein unless they are produced or created by CNA.
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this report contains any examples, please note that they are for illustrative purposes only and any similarity to actual individuals, entities, places or situations is
unintentional and purely coincidental. In addition, any examples are not intended to establish any standards of care, to serve as legal advice appropriate for any
particular factual situations, or to provide an acknowledgement that any given factual situation is covered under any CNA insurance policy.
One or more of the CNA companies provide the products and/or services described. The information is intended to present a general overview for illustrative
purposes only. It is not intended to constitute a binding contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages,
amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. “CNA”
is a service mark registered by CNA Financial Corporation with the United States Patent and Trademark Office. Certain CNA Financial Corporation subsidiaries
use the “CNA” service mark in connection with insurance underwriting and claims activities. Copyright © 2015 CNA. All rights reserved. For additional healthcare
risk management information, please contact CNA Healthcare at 1-888-600-4776 or www.cna.com/healthcare.
Nurses Service Organization (NSO) is the nation’s largest administrator of professional liability insurance coverage to individual nursing professionals. Nurses
Service Organization is a registered trade name of Affinity Insurance Services, Inc., an affiliate of Aon Corporation. For more information about NSO, or to inquire
about professional liability insurance for nursing professionals, please contact NSO at 1-800-247-1500 or visit NSO online at www.nso.com.
Published 10/2015
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