APRNs: 'What Level of Malpractice Insurance Do I Need?'

Carolyn Buppert, MSN, JD


February 24, 2017

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An advanced practice registered nurse (APRN) submitted a question about malpractice insurance to our legal expert:

I am educated as an APRN but not currently employed in an advanced practice role. I do not plan renew my state advanced practice license or my national certification as an APRN. Am I covered by malpractice insurance when working or volunteering as a registered nurse (RN)? Or, because of my previous APRN education and certification, am I held accountable to a higher standard of practice? In other words, do I need to carry malpractice insurance to cover me as an APRN, even if I'm not practicing as an RN?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

This is a tricky question. APRNs often ask whether they need to purchase coverage for APRN-level practice, even though they are working as a RN, without advanced practice responsibilities. (See also "Can an APRN Take a Job as an RN?"). To that question, I always answer that the nurse should check with his or her insurer. Recently I asked one of the insurers of RNs and APRNs, "Must an APRN working as an RN have APRN-level insurance coverage?" The company responded:

According to our underwriting guidelines, we are required to insure all of our applicants with their highest credentials as a healthcare professional. Also, once their application is approved, we will add all other licenses or certifications at no additional premium. If a claim was to arise, we would defend all licenses or certifications one may hold in the healthcare field.

However, the nurse who submitted this question is no longer licensed as an APRN, although she has the education and was certified as such in the past. The safest answer is to recommend that she pose this question to the malpractice insurer of her choice.

If I try to apply the insurer's response to the question of what coverage is required for an APRN working as an RN, I would say that the nurse's highest credential is now RN. However, it really doesn't matter what I think, if the insurer thinks otherwise. What must be avoided is a situation like this: The nurse makes a choice when purchasing a policy, the insurer thinks the nurse should have purchased a more expensive policy with broader coverage, the nurse is sued, and the insurer refuses to pay because the insurer has a requirement that wasn't followed.

The best advice I can give a nurse who is in the market for insurance is to tell the insurer exactly what your situation is, in detail. Let the company representative tell you what policy to purchase. Write down the insurer's instructions about what policy is appropriate (including the representative's name and the date), and follow the representative's instructions. It doesn't matter whether the insurer's requirement makes sense to the nurse, or to me. All insurer requirements must be followed. You don't want to give an insurer any opportunity to get out of covering you when the time comes that you need coverage.

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