Transcript LPN-C - Faculty Sites

LPN-C
Unit One
Legal Aspects of IV Therapy
Scope of Practice R/T IV Therapy
LPN-C = An LPN who has had additional
education and has passed an
examination to obtain certification in an
advanced role permitting him/her to
provide limited services in intravenous
therapy.
 LPN-C is the licensed title
 An LPN can ONLY practice IV therapy
under the LPN-C scope in the state of
certification

Scope of Practice (cont’d)

Application requirements for a certificate
to practice as an LPN-C are as follows:
◦ Current license to practice as an LPN in the
state of Nebraska
◦ Successful completion of an approved
certification course within one year of
certification application
◦ Submission of proof of certification course
completion
◦ Satisfactory passing of board approved exam
for certification: 80% out of 100 multiple
choice questions (results within 30 days)
Licensed Practical Nurse-Certified
Act

Purpose:
◦ To provide a means by which licensed
practical nurses-certified (LPN-C) may
perform certain activities related to
intravenous therapy
◦ To provide for the approval of certification
courses to prepare licensed practical nursescertified (LPN-C)
◦ To ensure the health and safety of the
general public
Scope and Authority of the
Practice of LPN-C in the State of
Nebraska Title 172, Chapter 102
Perform limited IV therapy interventions under
the direction of an RN or licensed practitioner.
 Observe, initiate, monitor, discontinue,
maintain, regulate, adjust, document, assess,
plan, intervene, and evaluate with regard to IV
treatment.
 Provide IV interventions only when there is a
licensed practitioner or RN assessing the
patient at least once every 24 hours ( or more
frequently with significant change in therapy or
condition).

IV therapy is the responsibility of the RN as
ordered by the licensed practitioner:
The RN must perform a physical assessment
prior to initial IV insertion.
 The RN need not be on premises in order for
the LPN-C to perform directed activities
EXCEPT:

◦ Initial venipuncture for a peripheral line
◦ Central line activities
The RN must be present at least once in 24
hours.
 The RN must be present more than once in 24
hours in cases of a significant change in
therapy or client condition.

LPN-C IV Activities
(*Refer to LPN/LPN-C Comparison Chart)






Expanded scope of practice
LPN license AND certification as an LPN-C
required
Approved certification course
Examination
General and direct supervision
Assessment by RN or licensed practitioner
required every 24 hours (or more frequently
when change in client’s condition or IV therapy
occurs)
LPN-C Activities
Adult Patients
(*Direct Supervision)

Initial venipuncture to upper extremity (with
use of 3-inch device or less)
◦ NOTE: RN MUST PERFORM FACE-TO-FACE
ASSESSMENT OF PATIENT PRIOR TO IV INSERTION

Infuse IV fluids and administer medications
through a continuous flow central line
◦ NOTE: INFUSING FLUIDS AND ADMINISTERING
MEDICATIONS THROUGH AN INTERMITTENT
CENTRAL LINE IS NOT PERMITTED
Administer the initial dose of an approved
medication
 May add 500cc Dextrose 10% as a meal
replacement

LPN-C Activities
Adult Patients
(*Under Direction)







Venipuncture to upper extremity (with use of 3inch device or less)
Infuse IV fluids and administer medications
through an intermittent OR continuous flow
peripheral line
Calculate and regulate rate of flow
Administer approved medications via push OR
piggyback
Reinsert, convert and flush peripheral
intermittent devices
Flush peripheral lock with heparin or saline
solution
Add pain medication solutions to a PCA pump
LPN-C Activities
Patient-Controlled Analgesia (PCA)
Pain medication MUST be
◦ Prepared by a pharmacist or physician
◦ Prepared by the RN
◦ Commercially prepared
 All ordered settings and medications for PCA
MUST be
◦ Checked by the RN
◦ Signed on the PCA infusion sheet

LPN-C Activities
Pediatric Patients
(*Under Direction)
Pediatric Patient = one who is both younger
than 18 years of age AND under 35 KG
 Administer pain medications by PCA

◦ Only if medication is commercially prepared or
prepared by physician, pharmacist, or RN
◦ Always checked by RN after PCA pump has been set
per order and before infusion is started
◦ RN must sign the PCA infusion sheet
Flush intermittent peripheral device
 May NOT calculate the rate of IV fluid infusions
 May NOT perform venipuncture

Medications that are NOT approved for
LPN-C administration are as follows:
Blood
 Blood products
 Antineoplastic agents
 Oxytocics

◦
◦
◦
◦
Pitocin
Ergotrate
Methergine
Syntocinon
Anti-arrhythmics
 Hyperalimentation

IV administration by the LPN-C of approved
medications by approved methods shall be
those for which nursing interventions are
routine and predictable in nature related to
individual responses and adverse reactions.
The RN must consider:
 Adverse consequences
 How adverse consequences are
manifested
 How adverse consequences are
measured
 What intervention is required
 How intervention is applied
LPN-C Renewal
Certification as an LPN-C must be
renewed along with LPN license
 Must complete 5 hours of IV-related
continuing education; these hours can
be included in the 20 hours required for
LPN renewal
 Renewal of LPN license and
certification is due on or before October
31st during odd-numbered years

Clinical Competencies for
HLTH1210
The LPN must demonstrate the ability to:

Select administration site
◦
◦
◦
◦

Hands
Forearms
Antecubitus
Upper arm
Assemble equipment and set up flow control
administration devices
◦ Gravity
◦ Pump(s)
Clinical Competencies (cont’d)

Perform at least 3 venipunctures in the lab
and/or clinical area under the direct
supervision of faculty
◦
◦
◦
◦
◦
Selection of appropriate site
Preparation of site
Selection of appropriate type/size of catheter
Completing the venipuncture
Securing the device
Problem-solve non-functioning peripheral IV
lines
 Convert and flush a peripheral intermittent
infusion device

◦ Drawing up correct irrigant
Clinical Competencies (cont’d)






Add a fluid to a functioning central venous line
Change central line tubing and sterile
dressings at insertion site
Document the insertion of a peripheral IV
Document the administration of select fluids
Document the administration of acceptable
medications
Add a fluid and/or medication to an infusion
pump
◦ Change tubing
◦ Reset administration parameters
Pathway to achieving and demonstrating
competence in IV therapy
Study the professional and legal implications of
expanded practice and accountability
↓
Undertake study relating to IV therapy, obtaining
knowledge, skills, and evidence for practice
↓
Undergo a period of supervision from faculty
who is experienced in IV therapy
↓
Demonstrate competence
It is essential for the LPN to develop a
knowledge base in the following areas:
1.
2.
3.
4.
Accountability
Circulatory anatomy and physiology
Fluid and electrolyte balance
Techniques and equipment used for
IV therapy administration
5.
Pharmacology
6.
Administration of fluids
7.Risk management relating to IV therapy
8.
Possible effects of treatment on the
patient physically, socially, and
psychologically
Elements of Competence






Describes the rationale for administration of
medications via IV
Describes the risks associated with IV
medication administration
Demonstrates knowledge of medications
routinely administered by IV in the clinical area
Describes the signs and symptoms
exhibited if a medication reaction occurs
Describes and takes appropriate action in the
event of a medication reaction
Correctly calculates doses, volumes, and rates
of medications to be given by IV
Elements of Competence (cont’d)





Demonstrates appropriate techniques and
actions in preparation of medications for IV
administration
Demonstrates SAFE practice in the
administration of prescribed IV medications
Demonstrates appropriate techniques in the
administration of IV medications by bolus or
infusions-over-time
Demonstrates health promoting practices in
caring for IV access and medication
administration
Describes how to act appropriately in the event
of a drug error or adverse incident associated
with administration of IV medications
Elements of Competence (cont’d)
Demonstrates awareness of professional
accountability
 Demonstrates knowledge of available
resources related to medication information,
local policy, and current evidence for practice

The Five Rights of Medication
Administration

Right patient

Right medication

Right dose

Right route

Right time
The Three Checks of Medication
Administration
1.
Read the label of the medication as it is
removed from the shelf, unit dose cart,
refrigerator, or dispensing system
2.
Read the label of the medication when
comparing it with the MAR
3.
Read the medication label again before
administering the medication to the
patient
Medication Verification (cont’d)





LOOK at the label for verification of the
medication name, dosage, route, and
expiration date
CHECK the medication itself, NOT just the
pharmacy label
Be overly cautious with regards to dose, proper
dilution, and administration rate
Watch decimal points
Be aware of the unit
◦ Is the medication dispensed in mcg or mg?
◦ What is ordered in comparison?
Infusion Nurses Society (INS)
(781) 440-9408
www.ins1.org





Recognized globally as an authority in infusion
therapy
Places the highest priority on the care and
safety of patients receiving infusion therapy
Dedicated to exceeding the public’s
expectations of excellence by setting the
standard for infusion care
Developed standards of practice backed by
evidence-based research
Supports professional certification
The INS’s Infusion Nursing
Standards of Practice
The Standards of Practice have undergone an
extensive review process by INS nurses,
pharmacists, physician, legal advisors,
healthcare clinicians, and manufacturers of
infusion therapy products
 Defines the accountability of nursing in the
participation and delivery of specialized
nursing care
 Provides measurable components in
establishing nursing competencies,
performance improvement criteria, and
identification and evaluation of patient
outcomes

INS Standards of Practice (cont’d)
Used as a framework for the development of
organizational infusion-based policies and
procedures applicable for all practice settings
and all patient populations
 The Infusion Nurses Society’s Infusion Nursing
Standards of Practice include nursing practice,
patient care, documentation, infection control
and safety compliance, infusion equipment,
site selection and device placement, access
devices, site care and maintenance, infusionrelated complications, nursing interventions,
nonvascular access devices, and infusion
therapies

Legal Aspects of IV Therapy
Administration





Legal aspects of IV therapy administration are
important as your role as LPN is expanding
With the increase in responsibility comes
an increase in liability
You have a duty to care for the patient without
exceeding the scope of your LPN Certification
Knowledge of the standards of practice within
the bounds of the LPN Certification is critical
to malpractice prevention
Over 85% of hospitalized patients will receive
IV therapy
Legal Aspects (cont’d)
Of the 180 million IV’s inserted, 150 million are
peripheral IV’s
 Therefore, there are 150 million opportunities
for the nurses who insert peripheral lines to
become involved in litigation
 Most lawsuits involve cases of infiltration and
phlebitis that juries feel could have been
prevented

Liability Issues
Infiltration = the leakage of IV solution or
medication into surrounding tissue
 The nurse is responsible for selecting the
appropriate device, needle gauge, venipuncture
technique, and venipuncture site
 If an infiltration occurs, the priority concerns
include:

◦
◦
◦
◦
◦
◦
What was the solution that infiltrated?
Could the vesicant cause tissue necrosis?
How much of the solution infiltrated?
How soon was the infiltration discovered?
Was the patient injured by the infiltrate?
What injury occurred (i.e. nerve compression, tissue
loss, disfigurement, loss of function)?
Causes of Legal Action in
Nursing Practice

The two most common causes of legal action
in nursing practice are
◦ Unprofessional practice = failure to conform to
minimal standards
◦ Professional malpractice (civil action) = professional
misconduct or unreasonable lack of skill that results
in harm
Professional nursing practice is measured
based on what a reasonable and prudent nurse
would do
 Measuring tools include the Nurse Practice Act,
institutional policy and procedures, the Nurse’s
Code of Ethics, and HIPAA

Nurse Practice Act





Determines the scope of professional nursing
practice in a particular state
Establishes guidelines whereby the nurse can
perform skills or services
Describes rules and regulations that provide
guidance
Establishes educational, examination, and
behavioral standards for nurses that protect
the public
Enforces these requirements
Institutional Policy and
Procedures

KNOW the specific policy and procedures
related to LPN-C functions in your facility
Code of Ethics

Statement of values developed by the
American Nurses Association (ANA) to provide
guidance to the nurse and protection for the
client and family
Code of Ethics (cont’d)
Correlates with the Patient’s Bill of Rights
 Consists of ethical principles that dictate
nursing action:

◦
◦
◦
◦
◦
◦

Autonomy = the right to independence
Beneficence = doing good for patients
Nonmaleficence = doing no harm to patients
Veracity = truthfulness
Fidelity = an obligation to be faithful
Justice = an obligation to be fair to all people
In decision-making, the nurse’s choices and
actions should ideally reflect three criteria:
◦ They should be best-practice clinically
◦ They should be within the legal scope of policies,
procedures, and practice acts
◦ They should be the right things to do morally
Dilemmas of Autonomy

Involves freedom to take action for self and
make decisions that will impact own welfare
◦ Ability to determine personal goals
◦ Complete understanding of choice
◦ Freedom to implement plan or choice

Dilemmas of autonomy are often related to
beneficence issues
◦ Occurs when individuals other than the patient must
determine, or attempt to determine, what’s best for
the patient
Dilemmas of Beneficence

Involves acting in the best interest of others,
such as through patient advocacy
◦
◦
◦
◦

To contribute to the well-being of others
To promote good
To prevent harm
To remove harm
Dilemmas of beneficence occur when health
care providers, the patient, and/or family
members disagree about what course of action
is in the patient’s best interest
Dilemmas of Nonmaleficence






Involves the avoidance of intentional or
unintentional harm
Related to the principle of beneficence
Often involves the nurse’s responsibility to
“blow the whistle” if another is seen as
compromising the patient’s safety
The nurse is charged with protecting those that
cannot protect themselves, such as the
mentally challenged, the unconscious, the
weak, and the debilitated
Discourages experimental health research that
may have a negative outcome
Prohibits the performance of unnecessary
procedures used as learning experiences
Dilemmas of Veracity
Veracity = truthfulness
 Patients may not be given information about
health care treatment or outcomes if the
information would cause further harm to the
patient
 Not telling the patient the truth may show lack
of respect for others and untrustworthiness of
the person telling the lies or omitting the truth

Dilemmas of Fidelity
Embodies the nurse’s duty to be loyal, faithful,
and keep promises
 Dilemma occurs when the nurse is forced to be
loyal and accountable to two opposing interests
 One situation may be a conflict between duties
and loyalties to the patient and the economic
needs of the employer -
◦ Example: The nurse is forced to discharge a patient
from outpatient care because the patient can no
longer pay for services
Dilemmas of Justice
Encompasses the nurse’s duty to be fair and
equitable, and provide access and appropriate
care to all patients
 Begs the question, “Who is entitled to these
goods and services?”, when dividing limited
health care services
 One example may be an organ procurement
system

Moral Dilemmas
Moral dilemmas occur when one must make
choices that are complicated by uncertainty,
psychological pressures, and personal
emotions
 In health care, choices must often be made
quickly, further complicating the dilemma
 Ethics, the law, and best practice do not always
agree -
◦ Example: A patient verbalizes to the nurse that she
does not want to have surgery, but has given consent
because her husband insisted. Since this is not a
valid consent via informed consent protocol, the
nurse contacts the physician even though the surgery
is in the patient’s best interests.
The Health Insurance Portability
and Accountability Act (HIPPA)
Protects the patient’s privacy, confidentiality,
and security of medical information
 ONLY those who need to know patient
information for the care of the patient, and those
authorized by the patient to have access to his or
her medical information, can lawfully enter a
patient’s medical record
 Take care when faxing patient information
 Health care facilities must demonstrate that
their computer systems are trustworthy enough
to be used in court (i.e. software automatically
records entries with time, date, and author;
when an error is corrected, the software
preserves both original and corrected versions)

The Patient’s Bill of Rights
Guarantees certain rights and privileges to
every patient
 The nurse shall be an advocate for the
patient’s rights
 The Bill of Rights should be given to each
patient upon admission to a health care facility

Areas Most at Risk for Malpractice










A study of 747 malpractice claims in which
nursing negligence (i.e. failure to adhere to a
standard of care) led to a settlement was
conducted in 1997
Of the 747 cases, 219 resulted in death
76 of these deaths were related to inadequate
communication to the physician
46 were caused by inadequate assessment
Medication errors led to 42 deaths
17 resulted from inadequate nursing
intervention
21 deaths were caused by inadequate care
7 deaths were due to an unsafe environment
7 were related to inadequate infection control
3 deaths were caused by the improper use of
equipment and products
Most Common Causes of Lawsuits
*All involved failure to maintain a standard of practice
1.
2.
3.
4.
5.
6.
Medication and treatment errors
Lack of observation and timely reporting on
the patient
Defective technology or equipment
Infections caused or worsened by poor
nursing care
Poor communication of important
information
Failure to intervene to protect the patient
from poor medical care
Factors Impacting Practice
Standards
1.
2.
3.
4.
5.
6.
Certain knowledge and skills are essential to
nursing practice
In court, it is difficult to argue the 5 rights of
safe drug administration
The public is better informed than they used
to be
When accidents or injuries occur, the public
expects accountability
Patients are more acutely ill on admission to
the hospital and more invasive treatments
are required, which can lead to more
accidents
Nursing shortage and cost containment
increases nurse-to-patient ratios
Legal Terms
Tort = a wrong committed by an act or an
omission
 There are two types of torts –

◦ Intentional: Assault, battery, restraints as a form of
false imprisonment, slander, and breach of
confidentiality
◦ Unintentional: Negligence
Assault = the unjustifiable attempt or threat to
touch a person without consent that results in
fear of immediately harmful or threatening
contact (actual contact need not occur)
 Battery = the unlawful, harmful, or
unwarranted touching of another, or the
carrying out of threatened physical harm,
REGARDLESS of the intent or outcome

Legal Terms (cont’d)

Invasion of privacy is an intentional tort that
may involve
◦ Releasing private information about a patient to a
third party
◦ Allowing unauthorized persons to read a patient’s
medical records
◦ Allowing unauthorized persons to observe a
procedure
◦ Taking pictures of a patient without his or her
consent

Slander = making false statements about a
patient that cause damage to the patient’s
reputation
Legal Terms (cont’d)
Negligence = failure to do something that a
reasonable person would do, or doing
something that a reasonable and prudent
person would not do
 Malpractice = a type of negligence

◦ Committed by a professional person
◦ Any professional misconduct, unreasonable lack of
professional skill, or nonadherence to the acceptable
standard of care that causes injury to the patient
◦ The nurse may be held liable for not following the
organization’s policy and procedures
Malpractice

In a malpractice case, four components are
required to prove liability –
◦
◦
◦
◦
That there existed a duty to act
That there was a failure to carry out that duty
That harm or injury occurred
That the injury resulted from the breach of duty
Special legal doctrines apply to cases involving
subordinate-superior relationships
 Respondeat superior (Italian for “let the
master answer”) = if an employee is found
negligent, the employer must accept
responsibility if the employee was acting
within scope of practice

Liability
Each person is liable for his/her own
wrongdoings
 Nurses are liable in carrying out physician’s
orders
 Nurses have a legal and professional
responsibility to be knowledgeable regarding
IV fluids, medications that are administered,
and techniques for initiating and maintaining
infusion devices
 Risk factors for malpractice suits include
infiltration, nerve injury, extravasations,
fractured central venous catheters,
administration of the wrong medication, and
failure to document appropriately

Liability (cont’d)

Most lawsuits related to IV therapy involve
infiltration and phlebitis
◦ Infiltration = the leakage of IV solution or
medication into surrounding tissue. This is 100% a
nursing responsibility
◦ Phlebitis = inflammation of the vein wall; often a
precursor to sepsis
Informed Consent





If a surgeon performed surgery without the
patient’s consent, the patient could sue for
battery, which is legally defined as one person
touching another without consent.
A physician can be sued for negligent
nondisclosure if the patient did not obtain
enough information to enable an informed
decision.
Informed consent must be obtained before
central line IV insertions
Responsibility to obtain informed consent rests
on the physician
The nurse’s signature only acknowledges that
this is the right patient for the procedure
Risk Management for
Infusion Therapy







Know venous anatomy and physiology
Know appropriate vein selection
Use infusion equipment appropriately
Clarify unclear orders
Refuse to follow orders that you know are not
within the scope of safe nursing practice
Know the infusion indications, side effects,
and special considerations for IV medications
Administer medications and/or infusions at
the proper rate and within the ordered
intervals
Risk Management (cont’d)









Assess the patient and monitor the IV site for
complications
Use proper IV care and maintenance
Notify physician promptly of IV complications
Know and give appropriate treatments for
complications
Provide proper patient education
Document all aspects of IV therapy, including
patient education
Follow your institution’s policy/procedures
Abide by Nebraska’s Nurse Practice Act and
standards of IV practice
Keep current in research R/T IV therapy
IV Therapy Documentation
In an IV-related lawsuit, nursing skill would be
considered secondary to accurate, appropriate,
and concise documentation
 Document ONLY firsthand information

◦ What you observed
◦ What the patient said or did
◦ What you said or did
Use the word “observed” instead of “noted”, as
noted could describe an item that was written
in the medical record
 Write “No IV-related complications observed”
instead of “site is normal” to document your
assessment of a complication-free venous
access site

Documentation (cont’d)

Give details about complications
◦
◦
◦
◦
Nursing interventions
Physician orders
Patient’s comments regarding the complication
Patient’s response to treatment
Do NOT document opinions
 Do NOT chart “patient tolerated procedure
well”, as the court may view this statement as
an opinion and ask how you reached such a
conclusion; instead, chart the patient’s own
words in quotation marks (i.e. “That wasn’t so
bad…”)

What DO You Chart?
Date and time of insertion of venous
access device
 Specific vein chosen
 Gauge and length of infusion device
 Brand and style of infusion device
 The solution that is being infused
 The method of solution infusion

◦ Gravity
◦ Pump (include name and model of pump)

Any comments the patient has made
concerning how the infusion site feels
Legal Testimony
At the legal deposition and in court, you will be
asked difficult questions
 You may be asked vein anatomy and
physiology, reasons for choosing certain veins,
insertion techniques, etc.
 You need to make sure you portray yourself as
a professional
 Use scientific terms to name veins and identify
insertion sites

◦ Saying “I started the IV in the patient’s left hand”
may imply that you inserted the cannula into the
tissue of the hand instead of a vein.
◦ It is better to say “I inserted the IV catheter in the
dorsal metacarpal vein of the patient’s left hand.”
Legal Testimony (cont’d)
Do not say “I always use that catheter size”, as
this does not sound professional. It would be
better to say “I chose the smallest catheter
size available to promote hemodilution of the
infusate and blood flow around the catheter,
and to prevent trauma to the wall of the vein”
as this demonstrates scientific rationale
 Do not mention an incident report in the
patient record, as the plaintiff’s attorney may
attempt to have the document admitted as
evidence
 Never include opinions, accusations, excuses,
or suggestions in an incident report, as they
are subjective, and can be used against you

Legal Testimony (cont’d)

Other questions you may be asked in a legal
situation include:
◦ What was the anatomic location of the catheter tip?
◦ What standards did you follow to monitor the venous
access device for complications?
◦ How did you determine that the device was
functioning properly?
◦ When did you recognize the signs and symptoms of
the complication?
◦ What nursing actions did you take when you
recognized the problem?
Legal Case Studies
Staph infection at the IV site was blamed for a
premature delivery; the plaintiff was awarded
$8.6 million in a 1992 Florida case
 In Ohio, a nurse failed to clamp an IV pump
regulating the flow of an antibiotic through a
central line to a child; this resulted in the
delivery of nearly 7 times the prescribed
dosage of gentamycin, causing the child to
become totally deaf
 In Pennsylvania, an emergency department
nurse placed an IV line that infiltrated the
patient’s hand, resulting in reflex sympathetic
dystrophy; the patient could not return to work,
and was awarded $702,000 in damages

Legal Case Studies (cont’d)
Several recent lawsuits have involved
allegations that the nurse struck a patient’s
radial nerve during insertion of an IV line; this
can cause compartment syndrome and
requires emergency fasciotomy and skin grafts.
Uncorrected compartment syndrome can
progress to gangrene and amputation of the
fingers.
 A New York case involving finger amputation
related to radial nerve damage resulted in a
$40 million jury verdict (this was later reduced
to $5 million)

Legal Case Studies (cont’d)
When monitoring an IV line, listening to your
patient is just as important as monitoring the
infusion site, IV pump, and tubing
 In the case of Frank versus Hillsborough County
Hospital in Tampa, Florida, the patient’s
frequent complaints of pain were ignored; the
patient suffered permanent nerve damage and
later obtained an award of almost $60,000

Malpractice Insurance
Your employer may have liability coverage that
covers the individual nurse
 By obtaining your own malpractice insurance
policy, your best interest will be upheld rather
than that of your employer
 “Occurrence coverage” is the best type of
policy because it covers any negligent act
committed during the policy period regardless
of when it is reported

◦ Important for cases with minors, who have the right
to sue until the age of majority
Make sure your policy covers your nursing role
 Annual rates are higher for “high-risk” nursing

Malpractice Insurance (cont’d)

Ensure your policy covers the following options:
◦
◦
◦
◦
◦
Misuse of equipment
Error in reporting or recording care
Failure to properly teach patients
Errors in administering medications
Mistakes made while providing emergency care
outside the employment setting
◦ Coverage for a case in which your employer sues you
Know the exclusions to your policy
 Know that no insurance policy will cover you
for acts outside your scope of practice or
licensure

Malpractice Insurance (cont’d)
Make sure your policy allows you to chose your
own lawyer
 Some policies allow the nurse to consent to
settlement while others do not; this is
important for future professional employment
opportunities
 Court costs, legal fees, and reimbursement for
your lost earnings may all be covered in an
individual malpractice insurance policy
 Nebraska State Division of Insurance can
review the insurance company’s background,
history, and financial stability
