My husband ask me why do you need to pay for professional insurance?  My response to him was as follows:  there are many advantages to having one's own policy which include:

1.  The NP will have her/his own legal counsel with expenses covered.
2.  The NP may be covered for incidents that occur out of the employment setting (depending on the terms of the policy).
3.  The NP can purchase limits that may be higher than the employer's.
4.  If the NP purchases an occurrence policy, the NP will be covered if he/she leaves the employer's practice, and need not purchase a tail.

The disadvantages of having one's own policy may include:

1.  The plaintiff may draw the NP into the lawsuit, or attempt to keep the NP in a lawsuit longer than justified, in hopes of drawing on the NP's insurance.  However, this may happen whether or not an NP has his or her own policy, as a plaintiff will not know until the discovery part of the litigation process whether or not the NP has an individual policy.
2.  It is an significant expenditure.

A key complicating factor in obtaining malpractice coverage is that insurance companies are unfamiliar with the individual state rules and regulations for NPs.

Other problems include misunderstandings about scope-of-practice variations, prescribing issues and even nurse practitioner business entity.

Upon further explanation to my husband I told him that there are several ways to prevent malpractice suits and if one arises to make sure there is no merit to the lawsuit, here is a short list of preventative measures using the example of prescribing medications:

 In a medical malpractice lawsuit, the defendant provider’s actions and decisions will be judged by looking at the information available to the provider at the time the medical decision occurred. Staying current and up-to-date about medications is critical to avoiding and minimizing risk.

It is more challenging than ever to stay current about prescription drugs due to the amount of information being produced, the speed at which it develops, and because sometimes there is conflicting and/or incomplete information.

There are various resources that should be consulted to stay current, including, but not limited to:
• Professional literature, journals
• Published research
• Continuing education programs
• Information from professional organizations
• Information from government agencies
• Knowledgeable colleagues/professionals with expertise 

Resources for Providers
With the hectic schedules today of providers, may curtail the time available for reading, researching and continuing education about all the topics they wish to follow. It is important to find resources that are reputable and readily available when information is needed. Here are some accessible, online resources to consider:

• FDA Patient Information Sheets for more than 200 medications that provide basic facts about the medication, warnings, precautions and safety information. There are also healthcare professional information sheets and various other resources available on the website. http://www.fda.gov/cder/drug/DrugSafety/DrugIndex.htm

FDA MedWatch Program – You can sign up to receive e-mails from the FDA Safety Information and Adverse Reporting Program, MedWatch, for clinically important safety alerts. The e-mail also provides hyperlinks to obtain more detailed information. www.fda.gov/medwatch/index.html

• FDA Center for Drug Evaluation and Research has a variety of resources including, consumer information, drug safety podcasts, etc. http://www.fda.gov/cder/index.html

• National Institutes of Mental Health website has variety of resources and information available for physicians and patients. http://www.nimh.nih.gov/

• National Institute on Drug Abuse. http://www.nida.nih.gov/

• National Library of Medicine. http://www.nlm.nih.gov/

Medication monitoring guidelines
Another important part of collecting information about medications is to be knowledgeable about medication monitoring guidelines. 


Put a medication monitoring system in place to keep track of and evaluate the effectiveness of medications prescribed. Such a system is a powerful tool that helps provide ongoing information about the patient that is essential in adjusting the treatment plan.

There are two principle benefits of effective communication:

• Improved quality of care
• Decreased professional liability litigation

Effective communication leads to improved:

• Diagnostic accuracy
• Patient involvement in the decision-making process
• Information retention
• Patient compliance with the treatment plan
• Patient satisfaction
• Patient retention

Ideally, documentation should accomplish the following:

• It should substantiate clinical judgment and choices
• It should demonstrate the knowledge and skill exercised during treatment
• It should provide contemporaneous assessment of the patient’s needs and behaviors
• It should document explanations of the treatment decisions, significant events, and revisions to the treatment plan
• Provide the most important defense in a medical malpractice lawsuit or an administrative action against your license

Poor documentation can result in:

• Mistakes or delays in treatment due to missing or inaccurate information
• Loss in malpractice litigation
• Loss of licensure
• Loss of accreditation status
• Loss of eligibility for reimbursement by payers

It is helpful to think about documentation in terms of “why” instead of just “what”. Thinking about why certain information is documented will naturally lead to the relevant information being included.

Basically, providers should document so that another professional could review the record and understand what happened in treatment and why. Remember the primary purpose of the record is for clinical care; this documentation approach is consistent with the goal of providing and supporting appropriate patient care.

Consider including in the record:

• Information about what actions were taken and why, AND
• Information about what actions were considered but rejected and why

The Standard of Care

If documentation is questioned how is it evaluated? What factors determine whether a record meets an acceptable standard?

There are many factors that could be used as evidence of the applicable standard of care for a particular patient care issue. Factors that could be relied upon as evidence of the appropriate standard of care include, but are not limited to, the following:

• Statutes (federal and state) – such as prescribing laws addressing items to be documented
• Regulations (federal and state) – such as regulations from a state medical board, the FDA, and the DEA about patient records
• Other materials from federal and state regulatory agencies – such as
o Rules
o Guidelines
o Policy statements
• Authoritative clinical guidelines
• Policies and guidelines from professional organizations
• Learned treatises
• Journal articles
• Research reports
• Accreditation standards – such as JCAHO standards
• Facility’s own guidelines, protocols, policies and procedures
• Etc.