Many nurse legal experts believe it's good to have individual malpractice insurance, and carry it themselves. Nurses may want to speak to an attorney about the advisability of carrying it, especially if they have a fair number of assets.
"It's a lot of comfort for a small amount of money," Randolph says.

Nurses in large healthcare systems are generally covered by their employer and can be reasonably assured the facility will provide them with legal counsel for acts "carried out in the normal course of their employment," Mahlmeister says. Nurses who work for an agency or in an office should make sure they are covered, either by their employer's insurance or their own. No employer is expected to defend criminal acts, such as assault and battery of patients, she adds. Nor will any professional liability insurance, employer-purchased or individually purchased, provide coverage for criminal acts or intentional torts, such as defamation or false imprisonment.

Most of the time, a facility will protect a nurse involved in a legal action, Phillips says, but when the facility doesn't -- or if the nurse faces a hearing in front of a state licensing board -- individual insurance may allow the nurse to hire an attorney without worrying about legal fees. Individual insurance can also keep nurses from losing their assets in the unlikely but possible event of a huge judgment against them. During their orientation, nurses should ask the risk manager whether their employer's malpractice insurance policy covers them for all aspects of their work. For example, in one case, nurses discovered they were not covered for care rendered while transporting a patient from their facility to a higher level of care, Mahlmeister says.

After obtaining information from the employer about the coverage provided, the nurse should explore the possibility of purchasing his or her own policy. Such a decision is an individual one that each staff nurse should make.

Individual malpractice coverage varies, so the nurse should read the coverage and know what he or she is getting, Phillips says. For instance, the insurance may pay $150 an hour for attorney time, and if an attorney bills for $250 an hour, the nurse must cover the rest.

Nothing is foolproof, nurse legal experts say. Even the most cautious nurses sometimes make mistakes. Occasionally, even when nurses do everything right, patients still die or don't recover properly, and they or their families may sue.

Like most things in life, nursing carries a risk, Mahlmeister says. But nurses can counter that risk by assuming control of their practice, she adds.

Nurses who feel in control of their practice will call a physician repeatedly, even when they think the physician might get angry, or tell a supervisor they can't work a double-shift because they feel exhausted, or won't let anyone interrupt them while they are giving medications.

"That's a big issue in preventing lawsuits," she says.

Although she is probably more aware of the risks than most nurses are, Mahlmeister says she loves the job too much to give it up. Nurses should not be afraid to practice, she contends, adding, "The risk is absolutely manageable."

Cathryn Domrose is a senior staff writer for NurseWeek. To comment on this story, e-mail

DISCLAIMER: The opinions of the nurses in this article should not be considered legal advice. Nurses should speak with a risk manager or attorney for guidance about legal questions.

Among healthcare providers, physicians remain the main targets of medical malpractice lawsuits. Nurses account for about 2% of all medical malpractice payments, according to the National Practitioner Data Bank, operated by the U.S. Department of Health and Human Services.

But medical malpractice payments on behalf of nurses nearly doubled from 307 in 1997 to 586 in 2005. About two-thirds of these were against non-advanced practice RNs. Most of the others were against nurse anesthetists, nurse midwives, and nurse practitioners.

"More and more nurses are being sued individually," says Rita Kae Restrepo, RN, BS, CPAN, a legal nurse consultant and post-anesthesia care unit nurse at San Francisco General Hospital, who teaches nurses about legal issues. "It's becoming the new trend."

Tort reforms in some states have capped the amount of money patients can seek from physicians, nurses, or hospitals.

However, "The patient's attorney is going to examine the nurse's conduct for breaches in the standard of nursing care," says Laura Mahlmeister, RN, PhD, president of Mahlmeister and Associates, a risk management and continuing education company, and a staff nurse in the birth center at San Francisco General Hospital. "If the damages awarded to the patient exceed the limits of the doctor's malpractice policy, the additional damages may be paid by the nurse's insurer, if the nurse has been found negligent."

Nursing responsibilities have also expanded. Busy physicians who spend less time at the bedside rely more on nurses to be their eyes and ears, which increases pressure on the nurse to report and follow through on changes in the patient's condition, Mahlmeister says.

The biggest reasons for lawsuits against nurses include medication errors; communication errors; failure to monitor and assess; failure to properly advocate for the patient; working while impaired, whether by inadequate sleep or controlled substances; and negligent or inappropriate delegation and supervision, say nurse legal experts interviewed for this story.

They add that the best way for a nurse to avoid a lawsuit is to be aware of the standards of nursing practice and follow them to the letter.

"Ultimately, to prevent errors, you meet the standard of care," says Cheryl Randolph, RN, MSN, CRRN, CEN, FNP, a legal nurse consultant and owner of Paragon Education, a nursing education company in the San Francisco Bay Area. "That means being aware of your hospital's policies and procedures, your state nursing practice act, and the professional standards of your specialty."

Among healthcare providers, physicians remain the main targets of medical malpractice lawsuits. Nurses account for about 2% of all medical malpractice payments, according to the National Practitioner Data Bank, operated by the U.S. Department of Health and Human Services.

But medical malpractice payments on behalf of nurses nearly doubled from 307 in 1997 to 586 in 2005. About two-thirds of these were against non-advanced practice RNs. Most of the others were against nurse anesthetists, nurse midwives, and nurse practitioners.

"More and more nurses are being sued individually," says Rita Kae Restrepo, RN, BS, CPAN, a legal nurse consultant and post-anesthesia care unit nurse at San Francisco General Hospital, who teaches nurses about legal issues. "It's becoming the new trend."

Tort reforms in some states have capped the amount of money patients can seek from physicians, nurses, or hospitals.

However, "The patient's attorney is going to examine the nurse's conduct for breaches in the standard of nursing care," says Laura Mahlmeister, RN, PhD, president of Mahlmeister and Associates, a risk management and continuing education company, and a staff nurse in the birth center at San Francisco General Hospital. "If the damages awarded to the patient exceed the limits of the doctor's malpractice policy, the additional damages may be paid by the nurse's insurer, if the nurse has been found negligent."

Nursing responsibilities have also expanded. Busy physicians who spend less time at the bedside rely more on nurses to be their eyes and ears, which increases pressure on the nurse to report and follow through on changes in the patient's condition, Mahlmeister says.

The biggest reasons for lawsuits against nurses include medication errors; communication errors; failure to monitor and assess; failure to properly advocate for the patient; working while impaired, whether by inadequate sleep or controlled substances; and negligent or inappropriate delegation and supervision, say nurse legal experts interviewed for this story.

They add that the best way for a nurse to avoid a lawsuit is to be aware of the standards of nursing practice and follow them to the letter.

"Ultimately, to prevent errors, you meet the standard of care," says Cheryl Randolph, RN, MSN, CRRN, CEN, FNP, a legal nurse consultant and owner of Paragon Education, a nursing education company in the San Francisco Bay Area. "That means being aware of your hospital's policies and procedures, your state nursing practice act, and the professional standards of your specialty."