Do Nurses Need Malpractice Insurance?

If there is a professional practice (i.e. “legal”) question I get more than “Is it true that if it wasn’t charted, it wasn’t done?” it’s gotta be:

“Do I need malpractice insurance?”

Nurse malpractice insurance is an important—and surprisingly polarizing—subject in the nursing community. Some see it as a necessary evil for nurses, something that’s just part of being in the profession. Others avoid it:

“You’re more likely to be named in a lawsuit!!”

So, why do nurses ask me these questions?

I’m a nurse. I also serve as an expert witness in birth injury malpractice cases. How the legal system works and impacts nurses is something I think about a lot. And it’s something many nurses come to me for information on.

So here is the lowdown, based on my experience and the available resources.

This comes with a caveat: this is an extremely challenging thing to research.

Most, if not all, of the available information online on this topic is either written by companies selling malpractice insurance or folks with financial ties to insurance companies. The same goes for nurse influencers on social media.

Do I need nursing malpractice insurance?

While everyone is looking for a black-or-white answer, there are plenty of misconceptions about nursing malpractice insurance, particularly when it comes to whether nurses need coverage, what it will actually get you, and when it comes into play.

You have to decide for yourself: What is your risk level, and will this bring you peace of mind in your career?

I will not be responsible for this decision.

Stop listening to any nurses who say you absolutely should or shouldn’t. Let’s take a look at liability insurance and how to decide if it’s right for you. 

What is nurse malpractice and liability insurance?

Professional liability or malpractice insurance helps cover you against personal claims that you violated the standard of care as a nurse, whether in a civil lawsuit or with your state Board of Nursing.

How many nurses are personally sued each year?

It is VERY HARD to get a clear answer on this.

A wide range of numbers are reported, from one hundred to thousands of nurses per year, and that number is suspected to be rising.

One challenge is that while nurses may be named in a complaint, they aren’t necessarily identified as the financially responsible party. They are typically named as agents of their employer, who does carry liability insurance. It feels scary to see your name listed, but there is a difference and it does matter.

The other challenge is that folks with a vested interest, the insurance companies who sell insurance to nurses, consistently report these numbers as though the nurses are the financially responsible ones.

My best guess: it’s in the very low hundreds.

In the 400+ cases I’ve reviewed, involving well over a thousand nurses, I haven’t encountered a nurse who was being individually sued outside of their relationship with their employer. But the rules vary by state and by the type of hospital you work in. Your best bet? Ask your hospital whether you’re indemnified as an employee and what that coverage actually includes.

Is the number of nurses being sued going up?

It does seem like there is an upward trend, according to the available reports.

But why is that?

Primarily because nurses are working in increasingly independent and entrepreneurial endeavors, like aesthetics, IV infusions, and coaching. Outside of this, home health and hospice make up a large portion of the rest of the claims.

Inpatient hospital nurses, although they may be involved in lawsuits and have their care questioned, are among the least likely to be individually named and financially liable in a malpractice lawsuit.

But with reported payouts and the cost of defending a license before the state Board of Nursing, it’s not something to dismiss.

What can nurses get sued for?

This is the real question beneath the “Do I need malpractice insurance?” question.

It’s because many nurses have a fear, instilled since probably nursing school, that you can do something totally unintentionally, kill someone, and lose your license/job/house/everything.

Which does feel scary.

But as we’ll discuss below, you are almost always considered an agent of your employer.

In short: malpractice requires a failure to meet the standard of care that more likely than not led to a patient injury.

The standard of care is a legal term, found in state statutes or jury instructions, and reads something along the lines of:

“Level of skill, knowledge, and care in diagnosis and treatment that other reasonably careful nurses would use in the same or similar circumstances.”

Which means the standard of care is highly contextual.

Working conditions are rarely perfect, and forces outside of your control may affect how well you can do your job.

These may include:

• Hospital location and resources (i.e. critical access vs. a Level I trauma center)
• Staffing
• Patient ratios

Things that are typically considered the hospital’s duty to provide include safe staffing, proper equipment, adequate training, etc.

But during a given shift, deficits in these factors will affect your ability to provide the level of care expected of you.

You wish you could reliably show up to work each shift knowing these would be provided, but you would be naive to think that’s been the case…like pretty much ever.

But it’s not just things we wish for. The public expects we will have these as well.

How much does nurse malpractice insurance cost?

It’s so freaking cheap.

Which also annoys me, tbh.

A product you will almost certainly never need, but so inexpensive you just pay for it anyway.

And there are a lot of nurses, so let’s just say…the companies know how to make money.

If there were as many lawsuits against nurses as some marketing materials suggest, the policies would likely cost far more, like they do for providers and hospitals.

With that said, it’s not surprising how low-priced it is.

In many states, you can find $1 million policies for less than $100 per year. It depends upon a few factors, including location and type of work.

But this low price is why you’re hard-pressed to find anyone hardcore advocating against it.

If you have a policy or are getting a policy, read all of it. Fine print, everything. Know what you are paying for.

Ask questions and make sure you understand the answers.

If you are unsure what something will cover, ASK!

You don’t want to think you’re protected for something only to discover later that you aren’t.

Is malpractice insurance for nurses worth it, even if my employer covers me?

This is where my thoughts on this topic have changed in recent years for two main reasons:

1. Your employer’s policy does not cover you outside of work.

And we don’t just suddenly stop being nurses once we walk out those doors.

Personal liability insurance may protect you in circumstances outside your employment, depending on the policy. Individual liability policies can also include additional benefits beyond what the hospital policy covers.

Check with the particular company, but these policies may include coverage for things like volunteer work, HIPAA violations, and libel or slander.

(Hi, social media rants!)

And if you are doing any independent work—education, consulting, coaching, aesthetics, IV therapy, expert witness work, or anything else— your employer’s policy won’t have anything to do with it.

2. License protection is increasingly compelling to me.

I’m not one to fearmonger.

In fact, it is against my values and everything I teach nurses regarding lawsuits and professional-practice issues.

But the license-protection benefits—i.e., Board of Nursing/license defense—are probably the most compelling reason for me in our current nursing environment.

Primarily because we continue to see staffing shortages and higher-acuity assignments.

The normalization of heavy assignments with higher acuity creates patient-safety risk.

We all know patients can be preventably harmed when nurses are placed in situations where they cannot reasonably provide the care their patients need.

What is less clear is how those circumstances will be factored into decisions by individual state Boards of Nursing when something goes wrong.

And that's something I think nurses should at least consider when deciding whether the relatively small annual cost of an individual policy is worth it to them.

So…should you get your own malpractice insurance?

I know you want me to tell you yes or no.

I’m not going to.

Look at your actual risk.

Look at the work you do.

Find out what your employer covers.

Think about what you do outside of your employment.

Look carefully at the Board of Nursing/license-defense coverage.

Read the policy you’re considering—not just the sales page.

And then ask yourself:

Would having this coverage bring me additional peace of mind?

For some nurses, the answer will be yes.

For others, it may not be.

Either way, make the decision based on good information—not because somebody scared you into buying it or because Janet on day shift told you carrying insurance is basically an engraved invitation to get sued.

You’re a nurse.

You can look at the evidence, assess your own circumstances, and make a reasonable decision for yourself.