Medical malpractice coverage is necessary for healthcare professionals, especially certified registered nurse anesthetists (CRNAs), but what about supplemental liability coverage? Below, we’ll explain the basics of supplemental liability coverage and why CRNAs need it.
What Is Supplemental Liability Coverage?
Before we get into why CRNAs need it, what exactly is supplemental liability coverage? Supplemental liability coverage is when a CRNA holds individual malpractice coverage separate from the insurance provided by their employer.
Most CRNAs and medical professionals have group medical malpractice insurance where all the personnel who practice within the employer’s facility, like a hospital, are covered by one policy. But more and more medical personnel and CRNAs are getting supplemental liability coverage along with their employer insurance. Why?
Why CRNAs Need Supplemental Coverage:
Independence From Employer
One of the primary reasons for getting supplemental liability coverage is that it gives the individual a degree of independence and freedom from their employer. Instead of being attached to a group policy that keeps them at their job, CRNAs can take their supplemental policy with them should they decide to work elsewhere.
It also gives CRNAs more control over their reputation by being more involved in the claims process. Some may be surprised to hear that it’s not uncommon for a CRNA or other professional to not even know they had a malpractice claim against them until they attempt to work elsewhere. With supplemental CRNA medical malpractice insurance, professionals can earn more independence and greater control of their coverage and reputation.
As we discussed, when a CRNA is only covered by group insurance, they’re much less involved in the claims process. Another reason to attain supplemental liability coverage is that it guarantees direct representation of the CRNA in the proceedings.
Unless the claim goes to a jury trial—which rarely happens—malpractice claims can be addressed and settled with little to no input from the CRNA or defendant. A separate policy ensures that the CRNA will have someone present specifically looking out for their interests.
Often, individual employees like CRNAs and others part of a group policy aren’t even sure what coverage they have or what they’re covered for. Finding out the details of a group policy can be a hassle for an individual as they have to go through human resources instead of directly dealing with the insurance provider.
With supplemental liability coverage, CRNAs can better understand their coverage and fill any gaps they feel are necessary for their coverage. Supplemental coverage offers complete coverage and peace of mind for individuals.
Malpractice claims are severe for nurse practitioners and can cause them to lose their nursing licenses and face financial ruin. Negligence is a common cause of a malpractice claim, so we’ll explain the different elements a claim needs to prove negligence against a nurse practitioner.
Legal Negligence, Defined
Negligence, in a legal setting, is a term that generally describes conduct deviating from the standard of care expected from a professional such as a nurse practitioner (NP). While negligence and malpractice are similar and sometimes used interchangeably, they’re different legal terms.
Malpractice is the failure of a professional to act with the prevailing professional standards. For example, a physician may misdiagnose a patient, or a surgeon could make an operating mistake. On the other hand, professional medical negligence against an NP must contain certain elements: duty to the patient, breach of duty, damages, and causation.
Elements of Negligence for Nurse Practitioners:
Duty to the Patient
First, a litigant has to prove the NP owed a legal duty to the patient. For example, an NP has a duty to monitor the patient and sometimes administer medication and other small but crucial tasks in a patient’s treatment plan.
An NP may also be responsible for monitoring a patient and alerting physicians and doctors should they become unstable in a reasonable amount of time. Before a malpractice negligence case can proceed, the plaintiff must first establish that there is a duty owed to the patient.
Breach of Duty to the Patient
Once the duty of the NP to the patient is covered, the litigant must prove that the NP breached that duty. These elements of negligence for nurse practitioners may be different, but they often go together as a plaintiff typically establishes the duty owed to the patient and the breach of that duty at the same time.
For a negligence case, the breach of duty may be that the NP failed to administer the proper medication to the patient or didn’t adequately monitor the patient and alert doctors when they became unstable.
Damages & Causation
Lastly, a negligence case against an NP must also prove that there are damages of pain and suffering to the patient and that the breach of duty outlined prior caused these damages. A court may find a breach of duty, but the damages and causes of those damages could be separate.
It’s also possible for a court to find a breach of duty but not any damage caused by the breach, which would mean a victory for the defendant. A plaintiff must prove a direct line from the NP’s breach of duty to the patient’s pain and suffering.
In the healthcare community, there’s a debate about the scope of practice and independent practice for nurse practitioners (NP). In our guide, we’ll explain the basics of this discussion and break down the laws regarding the practice authority of NPs and the benefits of full practice authority to NPs and patients.
Scope of Practice for NPs
What does the scope of practice mean, and how does it apply to NPs? Scope of practice refers to the procedures, actions, and processes a healthcare professional, such as an NP, is legally permitted to do.
The scope of practice for an NP can vary from state to state, as each state has the legal authority to enact its scope of practice laws on healthcare professionals such as NPs. In all states, though, NPs have the scope of practice to assess, diagnose, treat, and manage illnesses by ordering, conducting, and interpreting tests or prescribing medication. The discrepancy from state to state involves the supervision of NPs.
Independent Practice for NPs
For NPs, independent practice allows them to provide care without the mandated supervision from a physician that some states require. An NP that works in a state with full practice authority can open their own practice and assess, diagnose, and treat patients in much the same way a physician might.
There are also degrees of independence that vary by state, and the debate of scope of practice vs. independent practice for NPs can be a contentious topic between NPs and physicians. There’s some friction among healthcare professionals because some states require NPs to compensate physicians for overseeing their work. Naturally, NPs prefer to be independent and not be on the hook for this expense.
Prescriptive Authority for NPs
Much of the discussion and debate on the independence of NPs revolves around the issue of prescriptive authority. Prescriptive authority is a health professional’s legal ability to prescribe prescriptive medication.
In all 50 states, NPs have prescriptive authority, but the degree to which they can exercise this authority without mandated physician supervision is where the debate between scope and independence hinges. NP advocates say the extra step of supervision and legal barriers is wasteful and only harms the patient through delays and expenses. In contrast, others claim that supervision is explicitly for the patient’s benefit.
State boards of nursing aim to earn the ability to regulate prescriptive authority instead of physician state boards, which is the situation in many states currently.
Practice Regulation for NPs
As we discussed, there are some discrepancies between states regarding the legal practice authority of NPs. The states are divided into three categories of varying independence—full practice, reduced practice, and restricted practice authority.
Full Practice Authority
In a full practice authority state, NPs can prescribe, diagnose, and treat patients without physician oversight. Full practice states allow NPs to establish and operate their independent practice as a physician may do in other states.
NPs can freely prescribe medication based on their education, training, and skills for a patient and also prescribe other health services like home care. As of this writing, around half the states (and Washington DC) have full practice authority laws for NPs, while the other half are basically evenly split between reduced and restricted laws.
Reduced Practice Authority
As its title suggests, reduced practice authority laws allow for some independence on behalf of NPs but limit their scope of practice in at least one area. The area that’s limited for NPs varies by state, but it’s most often in the area of prescriptive authority.
In most reduced practice states, NPs can still diagnose and treat patients, but physician oversight is required when prescribing medicine or health services.
Restricted Practice Authority
At the other end of the spectrum, the opposite of full practice authority is restricted practice authority states. Clearly, these states are the most restrictive and require that an onsite physician supervise NPs for the prescription, diagnosis, and treatment of patients.
While a handful of states still have restrictive laws, their number has diminished in recent years as most states are at least creating legislation to lax restrictive laws and move towards reduced practice authority instead of restrictive.
Benefits of Full Practice Authority for NPs and Patients
NPs are strong advocates for full practice authority and offer many arguments for why it would improve the healthcare system and provide better care for patients. We’ll explain some benefits of full practice authority that NPs cite below.
Greater Access to Care
Perhaps the primary benefit of affording full practice authority to NPs is that it allows for greater patient access to medical care. In many areas of the country, especially rural regions that are sparsely populated, physicians and doctors are scarce, and medical resources are stretched thin.
With full practice authority, NPs can open independent practices and treat patients as a physician would without legally requiring supervision from a physician. This independence for NPs means that patients will have more choices in the areas where they live in to provide more healthcare to areas that traditionally have few options.
Fill Personnel Shortages
Unfortunately, gaps in the American healthcare system regarding access to care in many places are due to personnel shortages. During the pandemic, healthcare personnel shortages became evident in many areas of the country as physicians and nurses were shorthanded in dealing with the influx of patients.
According to many experts, those personnel shortages are expected to only worsen as physician and nursing shortages are predicted throughout the decade. NPs can help fill the gap in personnel from these shortages, especially for physicians, by providing quality care and access to full practice authority.
Better Care to Patients
Many NPs also rave about the direct benefit to the patient when NPs are allowed full practice authority. As we discussed, full authority means patients have more options—which means less time waiting for appointments and quicker follow-ups.
Patients no longer have to drive hours in some parts of the country to see a physician or wait around for NPs to have their prescription orders confirmed by supervising physicians. Overall, full authority means a faster, more accessible, and better healthcare experience for many patients.
There are many other considerations when discussing practice authority for NPs, including nurse practitioner malpractice insurance, but overall, NPs would prefer the accountability and responsibility of independent practice rather than the restrictive supervision measures. If you have further questions about nurse practitioner practice authority or malpractice insurance, don’t hesitate to contact our expert staff at Baxter & Associates.
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