According to the Centers for Disease Control and Prevention (CDC), suicide is one of the top ten causes of death for all ages, and is the second leading cause of death for those between 10 and 24 years of age. Unfortunately, suicidal individuals are often unwilling or unable to seek help because of the stigma attached to mental health and substance abuse disorders or barriers blocking access to needed care.
As healthcare delivery has continued to evolve, many Americans are using nurse practitioners for much of their healthcare needs, making NPs a critical component of the modern system. This growth in demand and responsibility has also increased and evolved the many risks NPs face in their work environments.
The new Nurse Practitioner Claim Report: 4th Edition from CNA and Nurses Service Organization (NSO) took a deeper look at the risks nurse practitioners face by analyzing 287 closed professional liability claims against nurse practitioners (claims that resulted in an indemnity payment of $10,000 or greater) over a 5-year period. This Nurse Practitioner Claim Report found when looking at claims by NP specialty, 15.3 percent of claims included behavioral health, compared with 6.5 percent in the 2012 report. Many of these cases involved an alleged failure to address a behavioral health condition, such as depression or suicidal ideation, in a timely manner. In fact, suicide occurred in 3.2 percent of claims, with an average paid indemnity of $108,889. This was the fourth leading cause of death in the dataset, in closed claims where death was the reported injury.
To help protect their patients and their practice, nurse practitioners must be on the alert for the following suicide risk factors, as noted by the CDC:
- Family history of suicide.
- Family history of child abuse or mistreatment.
- Previous suicide attempt(s).
- History of mental disorders, particularly clinical depression.
- History of alcohol/substance abuse.
- Feelings of hopelessness.
- Impulsive or aggressive tendencies.
- Predisposing cultural beliefs (e.g., the idea that suicide is a noble resolution of personal dilemmas).
- Local epidemics of suicide.
- Feelings of being cut off from other people.
- Loss (e.g., familial, occupational, financial).
- Chronic or terminal illness.
- Easy access to potentially lethal drugs or weapons.
This analysis reveals that, while there have certainly been advances in clinical practice and patient safety, nurse practitioners must continue to seek continuing education and be cognizant of patient behavioral health concerns such as depression and suicide risks. Armed with this insight, nurse practitioners can apply key risk control recommendations and resources such as:
- Obtain regular continuing education to retain and enhance clinical competencies. Contact the state nurses association, board of nursing, board of medicine or pharmacy, and nurse practitioner professional associations for information about reputable educational and training offerings.
- Revise physician collaborative or supervisory agreements and other documents accordingly. Ensure that collaborative or supervisory agreements provide appropriate support for the scope of services being provided.
- Seek alternative physician assistance or consultation if the collaborating/supervising or employing physician is not providing adequate nurse practitioner support. Determine whether the collaborative/supervising/employment agreement requires revision or whether alternate agreements are required.
- Ensure that collaborating and supervising professionals, practice partners, and employing or contracting facilities maintain appropriate professional liability insurance limits, as required by the practice setting, state law and/or regulations.
- If insurance is provided through the employer, review the policy and employment contract/agreement to determine if employment-based coverage is adequate, or whether it is advisable to obtain individual coverage. Finally, determine the steps needed to ensure continued coverage if employment status changes or the employer changes insurers.
- Ensure that one’s individual professional liability coverage limits are aligned with the other members of the practice, in order to protect one’s private assets.
About the Author
Jennifer Flynn, CPHRM, is Risk Manager for Nurses Service Organization in the Healthcare division of Affinity Insurance Services, Inc. specializing in risk management. With more than 16 years’ experience in the healthcare insurance business, Jennifer is dedicated to educating healthcare professionals on professional liability risks and offering strategies to mitigate those risks. For more information, please visit www.nso.com.
The Nurse Practitioner Claim Report: 4th Edition report analyzed professional liability claims affecting nurse practitioners, nurse practitioner practices, or nurse practitioner students that closed between January 1, 2012 and December 21, 2016 and resulted in an indemnity payment of $10,000 or greater. The database for this report was derived by applying this specific exclusion criteria to the 2,236 closed claims attributed to CNA-insured nurse practitioners through the NSO program during this time period. These exclusion criteria narrowed the database to 287 closed nurse practitioner claims, which were subsequently reviewed and analyzed. For the full report, visit www.cna.com and www.nso.com.
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. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to email@example.com or call 1-800-247-1500. www.nso.com.