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
IntroductionFor .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 .
PurposeIn .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 MethodologyThe .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 .
ScopeThe .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
TermsFor .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 .
LimitationsThe .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 .
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 typePercentage 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 nurse88.5%
91.9%
Licensed practical/vocational nurse11.5%
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 indemnityAverage 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
$1,000,0003.1%3.5%
$750,000 – $999,9992.7%2.1%
$500,000 – $749,9993.8%
2.1%
$250,000 – $499,99910.6%11.2%
$100,000 – $249,99920.9%
24.8%
$10,000 – $99,99958.8%
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
5ASEVERITY BY NURSE SPECIALTY (Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
Nurse specialtyPercentage 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
Obstetrics9.8%10.3%
Emergency/urgent care10.7%
9.7%
Home health/hospice12.4%
8.9%
Adult medical/surgical36.1%
40.1%
Gerontology – in aging services facility16.4%
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 .
LocationPercentage 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-related10.6%
9.3%
Patient’s home12.6%
8.9%
Hospital – inpatient medical services17.7%
20.2%
Hospital – inpatient surgical services11.3%
10.3%
Aging services16.9%
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 AllegationFigures .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 administration8.0%
14.7%
Monitoring13.8%
6.8%
Treatment/care45.9%
58.5%
Assessment15.7%
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-categoriesFigures .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 .document .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)
AllegationPercentage 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) .
AllegationPercentage 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 .practitioner21 .1% $1,903,375 . $118,961 .
Failure .to .monitor .results .of . .ordered .tests, .consultations .or .referrals, . .
or .report .them .to .practitioner2 .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)
AllegationPercentage 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 .document .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 .documented .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 administrationSignificant .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.
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)
AllegationPercentage 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 .site2 .3% $200,000 . $200,000 .
Failure .to .recognize .contraindication . .and/or .known .adverse .interaction . .
between/among .ordered .medications9 .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 .administration6 .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 .
12ASEVERITY OF ALLEGATIONS RELATED TO PATIENTS’ RIGHTS, PATIENT ABUSE AND PROFESSIONAL CONDUCT (Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
AllegationPercentage 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
12BSEVERITY AND FREQUENCY OF FALLS (Closed .Claims .with .Paid .Indemnity .≥ .$10,000)
FallsPercentage 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 .
InjuryPercentage 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 deathAs .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 deathPercentage 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 injuriesNot .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)
InjuryPercentage 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)
DisabilityPercentage 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 claimsThe .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 specialtyPercentage 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)
InjuryPercentage 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 typePercentage 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 claimsThe .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 MillionThe .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 RecommendationsThe .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 safetyFalls .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 .documentation .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/ .
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 .documentation
-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 monitoringAccurate .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 careThe .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 .document .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 commandNurses .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 practiceNurses .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, .documentation, .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 .
ConclusionThe .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 .
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 .document .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 .document .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 .document .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 .document .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 .document .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 TipsBelow .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 .documentation .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 .documentation .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 .documents .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 .documents .for .your .records, .including:
-The .summons .and .complaint
-The .subpoena
-Attorney .letter(s)
-Any .other .legal .documents .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
IntroductionAn .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 ClaimsBetween .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 typeThe .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 locationRegistered .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 LICENSENote: 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 classAdditional 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 classProfessional .conduct, .abuse/violation .of .patients’ .rights .and .documentation .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 classAverage 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-CategoriesExhibits .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 .document .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 .documenting .
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 .injury1 .1%
Failure .to .timely .obtain .practitioner .orders .to .perform . .
necessary .additional .treatment1 .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 .treatment0 .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 .document . .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 .medication0 .6%
Failure .to .document . .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 action49.2%50.0%
Probation10.8%
13.9%
Reprimand7.3%8.0%
Letter6.9%
4.5%
Continuing education6.8%
3.4%
Suspension4.6%5.1%
Stipulation3.2%
1.0%
Surrender3.2%3.5%
Consent order2.3%
4.3%
Censure1.7%1.5%
Fine1.7%
3.1%
Revocation1.7%1.3%
Criminal – deferred0.5%0.4%
Citation0.2%0.0%
PART 2 CNA AND NSO Nurse 2015 Claim Report Update 58
Explanation of TermsCase 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 .
ConclusionA .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 .documentation .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
IntroductionCNA .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 .
MethodologyThis .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.
PART 3 CNA AND NSO Nurse 2015 Claim Report Update 64
Topic 1: Respondent Demographics
Nursing licensureThe .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 LICENSUREQ: .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%
GenderThe .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 programThe .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 educationNurses .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 certificationsOn .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 practiceNurses .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 informationThe .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 accessThe .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 .documentation?
Non-claims Claims Average paid indemnity
Yes 87 .3% 85 .5% $35,153
$43,266No 12 .7% 14 .5%
Managing technology and timeWhile .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 verificationThe .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 notesRespondents .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 dataEvidence-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 opportunitiesHaving .regular .staff .development .opportunities .appears .to .have .a .positive .effect .on .liability .claims .
and .payments .
23 STAFF DEVELOPMENT OPPORTUNITIESQ: .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 .outcomes63 .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 checksEmployers .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 CHECKSQ: .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 incidentThose .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 incidentFull-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 incidentNurses .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 incidentA .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 incidentThe .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 incidentAt .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 incidentThe .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 INCIDENTClaims .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 NoDid not
use Yes NoDid 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 INCIDENTQ: .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 technologyA .majority .of .nurses .believe .that .streamlining .their .practice .with .technology .enhances .patient .safety .
42 PERCEIVED PATIENT BENEFIT OF TECHNOLOGYClaims .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 teamNurses .not .having .a .rapid .response .team .were .more .likely .to .experience .a .claim .
44 RAPID RESPONSE TEAMClaims .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%
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Published 10/2015
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