This content origi­nally appeared in the Spring/​Summer 2020 issue (PDF) of The Washington Nurse magazine. See the full set of stories on long-term care.

This risk manage­ment infor­ma­tion was provided by Nurses Service Organi­za­tion (NSO), the nation’s largest provider of nurses’ profes­sional liability insur­ance coverage for over 550,000 nurses since 1976. This individual profes­sional liability insur­ance policy is admin­is­tered through NSO and under­written by American Casualty Company of Reading, Pennsyl­vania, a CNA company. Repro­duc­tion without permis­sion of the publisher is prohib­ited. For questions, send an email to or call 1 – 800-247‑1500. www​.nso​.com

Wa nurse liability risk

Consider this scenario: A nurse working in a long-term care facility ignored the facility’s policies and proce­dures on medica­tion admin­is­tra­tion and gave a methadone injec­tion to the wrong patient, which caused fatal respi­ra­tory arrest.

This case not only had a devas­tating outcome for the patient but also resulted in litiga­tion against the nurse.

Nurses at legal risk #

According to the most recent CNA/NSO claim report, Nurse Profes­sional Liability Exposures,” nurses who worked in an aging services facility, inclu­sive of long-term care, accounted for 16.9% of all closed claims against regis­tered nurses and LPNs/​LVNs over the five years studied. The average paid indem­nity for closed claims at this type of location was $104,686.

Consider your patient population #

Older patients are at an increased risk for negative outcomes due to changes in cogni­tion, sensa­tion, and physical condi­tion. For example, loss of skin turgor makes older patients more suscep­tible to pressure injuries.

Older patients may often have to get up during the night to use the bathroom. Make sure pathways are clear of clutter, and a night­light is present as a guide. Instruct patients who need help to call before trying to get up, and document this instruc­tion in the medical record.

Sensory changes such as reduced vision and hearing means you must take special care with educa­tion. For example, provide educa­tion materials printed in a large font for a patient who has impaired vision.

Many older patients suffer cogni­tive changes such as memory impair­ment. You may need to create aids such as check­lists to ensure they engage in proper self-care.

Prevent falls #

Falls are a common yet largely avoid­able source of both patient harm and litiga­tion. While elimi­nating falls may not be a realistic goal, decreasing falls and mitigating the severity of fall-related injuries should remain a top priority for nurses in any health care setting. Over half of the falls in the NSO/CNA nurse claim report occurred in either the patient’s home or an aging services facility when an unattended patient failed to comply with caregiver instruc­tions, attempted to self-transfer or self-ambulate, rejected assis­tance from staff or maneu­vered into a wheel­chair without assistance.

Nurses can help minimize falls and fall-related liability by following sound opera­tional policies, environ­mental precau­tions and documen­ta­tion practices, especially with respect to describing the patient’s condi­tion and the specific circum­stances of the fall.

The following suggested actions can assist in reducing the liability associ­ated with patient falls:

  • Focus fall preven­tion programs and care plans on the locations of greatest risk, such as bedside, bathrooms and hallways.
  • Encourage teamwork in the care-planning process. Include certi­fied nursing assis­tants in order to benefit from their unique knowl­edge of patients and families.
  • Assess the environ­ment for poten­tial hazards, make patients and families aware of any dangers and encourage environ­mental modifi­ca­tions as necessary.
  • Educate patients and families about fall-related risks and preven­tive measures. Encourage patients and families to mitigate fall risks by addressing such issues as hydra­tion, medica­tion manage­ment and environ­mental safety.

No matter where you work, an impor­tant part of preventing falls is identi­fying patients at risk. Consider factors such as a history of falling, medica­tions, comor­bidi­ties and physical condi­tion. Many organi­za­tions have staff huddle” at the start of the shift to discuss patient needs; this is a good time to identify those at risk for falls.

Document completely #

Proper documen­ta­tion is a key force in whether you can success­fully defend yourself against a lawsuit. Document your patient care assess­ments, obser­va­tions, commu­ni­ca­tions and actions in an objec­tive, timely, accurate, complete and appro­priate manner.