Professional indemnity insurance arrangements for enrolled nurses, registered nurses and nurse practitioners

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1 Guideline August 2013 Prfessinal indemnity insurance arrangements fr enrlled nurses, registered nurses and nurse practitiners Intrductin This guideline has been develped by the Nursing and Midwifery Bard f Australia (Natinal Bard) under sectin 39 f the Health Practitiner Regulatin Natinal Law, as in frce in each state and territry (the Natinal Law). The guideline prvides directin t enrlled nurses, registered nurses, nurse practitiners, their emplyers and educatin prviders abut the requirements fr prfessinal indemnity insurance arrangements (PII) under the Natinal Law. Wh needs t use this guideline? This guideline is relevant t: enrlled nurses registered nurses nurse practitiners emplyers f registered nurses and nurse practitiners, and educatin prviders. Summary f the guideline Under sectin 129 f the Natinal Law, enrlled nurses, registered nurses and nurse practitiners (endrsed under sectin 94 f the Natinal Law) must nt practice their prfessin unless they are cvered in the cnduct f their practice by apprpriate prfessinal indemnity insurance (PII) arrangements. Prfessinal indemnity insurance The Natinal Registratin and Accreditatin Scheme (the Natinal Scheme) fr health prfessinals in Australia cmmenced n 1 July Enrlled nurses, registered nurses and nurse practitiners are three f the prfessinal grups regulated thrugh the Natinal Scheme under the authrity f the Natinal Bard. Enrlled nurses, registered nurses and nurse practitiners must have apprpriate prfessinal indemnity insurance (PII) fr practice t meet the requirements f sectin 129 (1) f the Natinal Law. This prvisin states: A registered health practitiner must nt practise the health prfessin in which the practitiner is registered unless apprpriate prfessinal indemnity insurance arrangements are in frce in relatin t the practitiner s practice f the prfessin. Sectin 5 f the Natinal Law defines apprpriate prfessinal indemnity insurance arrangements, in relatin t a registered health practitiner, as: Australian Health Practitiner Regulatin Agency G.P.O. Bx 9958 Melburne VIC 3001

2 ... prfessinal indemnity insurance arrangements that cmply with an apprved registratin standard fr the health prfessin in which the practitiner is registered. The Natinal Bard has develped a number f registratin standards under sectin 38 f the Natinal Law, including the Prfessinal indemnity insurance arrangements registratin standard which details the requirements relating t PII arrangements. This standard applies t all nurses and midwives registered by the Natinal Bard in Australia. This guideline utlines the requirements in mre detail. Figure 1 verleaf summarises the requirements fr enrlled nurses, registered nurses and nurse practitiners wh prvide nursing services in Australia. These requirements are discussed in detail in this dcument. Page 2 f 7

3 Figure 1: Requirements fr enrlled nurses, registered nurses and nurse practitiners wh prvide nursing services in Australia Enrlled nurse/registered nurse/nurse practitiner prviding r intending t prvide nursing services in Australia. Enrlled nurse/registered nurse/ nurse practitiner in Australia under the Health Practitiner Regulatin Natinal Law (the Natinal Law) as in frce in each state and territry. Enrlled nurse/registered nurse/ nurse practitiner must meet the requirements f the Natinal Bard prfessinal indemnity insurance (PII) registratin standard. Sectin 129 (1) A registered health practitiner must nt practise the health prfessin in which the health practitiner is registered unless apprpriate prfessinal indemnity insurance arrangements are in frce. Prviding nursing care as an emplyee f a health service r practice (private r public). Prviding nursing care as a privately practicing, registered nurse r nurse practitiner part-time r full time. Apprpriate PII must be purchased by the enrlled nurse/registered nurse/ nurse practitiner t be able t meet the Natinal Bard s PII registratin standard. Enrlled nurse/registered nurse/nurse practitiner must determine if they are cvered by their emplyers PII cverage fr emplyees. Enrlled nurse/registered nurse/ nurse practitiner des nt need t purchase insurance if apprpriate PII is prvided by emplyer. Registered nurse/ nurse practitiner has run ff cver after ceasing t prvide private nursing services. RUN OFF COVER Insurance that prtects an enrlled nurse/ registered nurse/nurse practitiner wh has ceased a particular practice against claims that arise ut f, r are a cnsequence f, activities that were undertaken when he r she was cnducting that practice r business. This type f cver may be included in a PII plicy r may need t be purchased separately. Page 3 f 7

4 PII fr enrlled nurses, registered nurses and nurse practitiners Prfessinal indemnity insurance prvides enrlled nurses, registered nurses and nurse practitiners with insurance frm civil liability 1. This insurance generally includes cver fr legal claims fr cmpensatin and assciated expenses arising frm the enrlled nurse, registered nurse r nurse practitiner s practice. The Natinal Bard ntes that PII arrangements, particularly thse prvided by emplyers, may nt prvide cver fr matters f a disciplinary character, which d nt usually lead t awards f cmpensatin t patients, clients r ther persns wh have suffered detriment as a result f a health practitiner s actin. Hwever, the matters may invlve csts fr the individual health practitiner. The Natinal Bard des nt require health practitiners t have insurance cver fr matters that d nt invlve ptential f cmpensatin against a health practitiner. Examples are unlawful r unauthrised, regulatry r disciplinary matters including breaches f prfessinal cdes r ethics. Hwever, the Natinal Bard recmmends that health practitiners cnsider whether they have this cver as part f their PII arrangements whether as an individual r prvided by an emplyer and, if nt, whether they wish t btain it. Each enrlled nurse, registered nurse and nurse practitiner shuld make an assessment t determine what PII they require. Prfessinal indemnity arrangements that enrlled nurses, registered nurses and nurse practitiners shuld cnsider include: civil liability cver unlimited retractive cver, and run-ff cver. Scpe f the insurance required The Natinal Bard has described the PII arrangements required in the PII registratin standard as: Arrangements that secure fr the practitiner s prfessinal practice insurance against civil liability incurred by, r lss arising frm, a claim that is made as a result f a negligent act, errr r missin in the cnduct f the practitiner. This type f insurance is available t practitiners and rganisatins acrss a range f industries and cvers the cst and expenses f defending a legal claim, as well as any damages payable. Sme gvernment rganisatins under plicies f the wning gvernment are self-insured fr the same range f matters. The Natinal Bard requires that enrlled nurses, registered nurses and nurse practitiners have PII t cver the full scpe f their practice, whether they are emplyed in: public r private health services private medical practices, r self-emplyed and wrking in private practice. The Natinal Bard als recgnises that enrlled nurses, registered nurses and nurse practitiners in different types f practice will require different levels f PII cver, accrding t their individual scpe and cntext f practice and the risks assciated with that practice. In rder t understand what cnstitutes apprpriate prfessinal indemnity insurance arrangements fr each enrlled nurse, registered nurse and nurse practitiner, the Natinal Bard prvides the fllwing infrmatin that enrlled nurses, registered nurses and nurse practitiners are required t cnsider: the practice setting and type f services and care delivered 1 Liability: A persn s present r prspective legal respnsibility, duty, r bligatin Frm: Peter Butt (General Editr) (2004) Butterwrths Cncise Australian Legal Dictinary, 3rd editin, LexisNexis Butterwrths, Chatswd (NSW). Page 4 f 7

5 the client grup the vlume f clients t whm treatment, advice, guidance r care is prvided by the enrlled nurse, registered nurse and nurse practitiner the health status f the enrlled nurse s, registered nurse s r nurse practitiner s client grup previus histry f insurance claims and the type f claim made against the enrlled nurse, registered nurse r nurse practitiner in the past, if any the prfessinal experience f the enrlled nurse, registered nurse r nurse practitiner advice frm prfessinal indemnity insurers, prfessinal assciatins and industrial rganisatins, including advice regarding the histry and vlume f prfessinal liability claims experience by ther members f the prfessin, prvided by a relevant prfessinal assciatin advice f an insurance brker the enrlled nurse, registered nurse r nurse practitiner current emplyment status: wrking exclusively as an emplyee in public r private health services, r in private medical practices wrking as a sle health practitiner (either n a full-time r part-time basis) in businesses wned slely by the enrlled nurse, registered nurse r nurse practitiner, r in a partnership r cllective emplyed (full-time r part-time) by a cmpany that is wned slely by the enrlled nurse, registered nurse r nurse practitiner, r that is wned slely by enrlled nurses, registered nurses r nurse practitiners where the nly directrs f that cmpany are enrlled nurses, registered nurses r nurse practitiners wrking as an emplyee fr part f their time and in private practice fr anther part f their time prviding nursing r nurse practitiner services in a vluntary, subsidised r therwise unpaid capacity. When applying fr registratin r renewal f registratin, enrlled nurses, registered nurses and nurse practitiners are required t declare that apprpriate PII arrangements are, r will be, in place while they practise. Run-ff cver Enrlled nurses registered nurses and nurse practitiners in private practice wh have ceased their practice are als required t have run-ff cver. Run-ff cver insures enrlled nurses, registered nurses and nurse practitiners fr claims made in the future that relate t incidents ccurring when they were practicing in the past. Enrlled nurses registered nurses and nurse practitiners are required by the Natinal Bard t maintain run-ff cver fr the whle time after they have ceased t practise privately t be prtected against claims that may arise in the future. There is n definitive recmmended time perid fr run-ff cver and each enrlled nurse, registered nurse and nurse practitiner shuld discuss this with their insurer. Emplyed enrlled nurses, registered nurses and nurse practitiners The majrity f enrlled nurses, registered nurses and nurse practitiners in Australia wrk as emplyees. In mst cases, this is in public r private health services, r in private medical practices. Enrlled nurses, registered nurses and nurse practitiners wh are emplyees may be cvered by their emplyer s insurance. Hwever, as there is n bligatin fr emplyers t prvide PII fr their Page 5 f 7

6 emplyees, enrlled nurses, registered nurses and nurse practitiners shuld carefully check their PII arrangements with their emplying rganisatin. There are situatins where a civil claim may be made against an enrlled nurse, registered nurse r nurse practitiner as an individual. This includes situatins where emplyer-based liability cver may nt apply. Fr example, the enrlled nurse, registered nurse r nurse practitiner may have acted in a way that a curt wuld find was nt within the curse and scpe f their emplyment. One example wuld be an enrlled nurse, registered nurse r nurse practitiner perfrming an unlawful r unauthrised act, such as in the curse f their emplyment supplying medicines fr a client that is utside the enrlled nurse s, registered nurse s r nurse practitiner s scpe f practice. In such a case, the emplyer s insurance may nt accept liability fr the enrlled nurse, registered nurse r nurse practitiner act, shuld any frmal investigatin r legal actin ensue. Emplyed enrlled nurses, registered nurses nurse practitiners and als wrking in private practice Sme enrlled nurses, registered nurses and nurse practitiners may prvide services t clients while emplyed in public r private health services, r in private medical practices, and may als cnduct part f their practice in private practice where their emplyer s indemnity insurance wuld cver their practice. This may arise in a frmal business arrangement where an enrlled nurse, registered nurse r nurse practitiner (generally with the knwledge and agreement f their emplyers) has established a private practice, but als wrks as an emplyee in public r private health services, r in private medical practices. Enrlled nurses, registered nurses and nurse practitiners wrking in private practice and wrking as emplyees must have their wn PII in place t cver the services they prvide fr their private clients. Situatins als arise where enrlled nurses, registered nurses and nurse practitiners, as well as being emplyed in public r private health services, r in private medical practices, als prvide vlunteer nursing services r subsidised services fr charitable, aid r welfare rganisatins in Australia In each f these situatins enrlled nurses, registered nurses and nurse practitiners will be wrking in a prfessinal capacity using their skills, knwledge, judgment and experience as an enrlled nurse, a registered nurse r a nurse practitiner and will require PII. In sme cases, the charitable r welfare rganisatins may have purchased PII fr prfessinals wrking with them but this is nt always the case; enrlled nurses, registered nurses r nurse practitiners may have t purchase their wn insurance. Whatever the situatin, the respnsibility is n the enrlled nurse, registered r nurse practitiner t make the necessary enquiries and ensure the apprpriate prfessinal indemnity arrangements are in frce. Enrlled nurses, registered nurses and nurse practitiners wrking in private practice Private nursing r nurse practitiner practice is where a registered nurse r nurse practitiner is wrking as a sle health practitiner (either n a full-time r part-time basis) in a business r in a partnership r cllective. The NMBA Natinal cmpetency standards fr the enrlled nurse require the enrlled nurse t wrk under the directin and supervisin f the registered nurse and therefre the enrlled nurse is unable t wrk as a sle health practitiner. Enrlled nurses, registered nurses and nurse practitiners may als be deemed t be wrking in a private capacity when they prvide nursing services in a vluntary capacity as an individual r as part f a prgram run by a welfare, aid r charitable rganisatin, where the rganisatin is nt frmally an emplyer and des nt have PII fr persns wrking with them as vlunteers. In all the abve situatins, enrlled nurses, registered nurses and nurse practitiners are respnsible fr purchasing the apprpriate PII t cver the scpe f their nursing practice. The PII registratin standard requires enrlled nurses, registered nurses and nurse practitiners wh hld insurance cver in their wn name t retain dcumentary evidence f their insurance and t prvide it t the Natinal Bard n request. Page 6 f 7

7 As nted previusly, enrlled nurses, registered nurses and nurse practitiners wrking in private practice are als required t have run-ff cver. This applies t enrlled nurses, registered nurses and nurse practitiners wh wrk exclusively in private practice and thse wh may wrk in private practice fr part f their wrking time and in an emplyed capacity at ther times. Definitins Civil liability - a ptential respnsibility fr the payment f damages fr lss r injury, fr example arising ut f a breach f a duty f care. Prfessinal indemnity insurance arrangements means arrangements that secure fr the health practitiner s prfessinal practice insurance frm civil liability incurred by, r lss arising frm, a claim that is made as a result f a negligent act, errr r missin in the cnduct f the health practitiner. This type f insurance is available t health practitiners and rganisatins acrss a range f industries and cvers the csts and expenses f defending a legal claim, as well as any damages payable. Sme gvernment rganisatins under plicies f the wning gvernment are self-insured fr the same range f matters. Retractive cver - PII arrangements which cver the insured against claims arising ut f, r in cnsequence f, activities that were undertaken in the curse f the health practitiner s prfessinal practice, prir t the date f the cmmencement f the insurance. Run-ff cver means insurance that prtects a health practitiner wh has ceased a particular practice against claims that arise ut f, r are a cnsequence f, activities that were undertaken when he r she was cnducting that practice r business. This type f cver may be included in a PII plicy r may need t be purchased separately. The Natinal Bard means the Nursing and Midwifery Bard f Australia. Page 7 f 7

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