Nurses Under Fire: The Stress of Medical Malpractice

Gail Fiore


May 13, 2022

Gail Fiore

Just because nurses are sued less often than doctors doesn't mean that their actions aren't a focus of a large number of medical malpractice lawsuits. Whether they are defendants or not, nurses are often crucial to the defense and subject to the same stress as the physicians they work with. A condition known as medical malpractice stress syndrome (MMSS) is increasingly being recognized as affecting medical professionals who are subjected to litigation.

According to a 2019 report by CRICO, the risk management arm of Harvard's medical facilities, nursing was a "primary service" in 34% of cases with a high-severity injury and in 44% of cases that were closed with a payment. And even though nurses were named as defendants only 14% of the time, likely because many nurses don't have their own personal malpractice coverage, their hospitals or facilities were sued in most of these cases — making the nurses important witnesses for the defense.

We have every reason to believe that things have gotten worse since the CRICO study was published. Chronic nursing shortages were exacerbated during the COVID pandemic, and we have seen a large number of nurses leave the workforce altogether. In a recent survey of nurses by Hospital IQ, 90% of respondents said they were considering leaving the nursing profession in the next year, with 71% of nurses who have more than 15 years of nursing experience thinking about leaving within the next few months.

Those remaining are faced with increased workloads and extra shifts — often mandated — and working with too little sleep. Their commitment to their mission is heroic, but they are only human; it's hard to imagine the number of errors, the number of bad outcomes, and the number of lawsuits going anywhere but up.

And of course, the entire profession has been fixated on the recent case of the Tennessee nurse who was prosecuted criminally and convicted in connection with a fatal medication error.

These are all reasons to expect that an increasing number of nurses are going to be trying to cope with symptoms of MMSS. Too many of them will initially be viewed by lawyers or claims professionals as simply defensive, arrogant, or difficult to work with. In fact, it's impossible to know how many cases are settled just to avoid the risk of such a "difficult client" being deposed.

These caring, hard-working, and committed individuals have had their lives shaken in ways that they never expected. Nurses with MMSS need support, but traditional psychotherapy, with a diffuse focus and long-time horizon, is not the most effective option. What's necessary is practical support that is short-term, goal oriented, and tailored to the specifics of the pending litigation process.

Most important, they need to know that they are not experiencing this alone, that MMSS is a common phenomenon, and that a productive coaching relationship can be highly effective.

When approached and supported effectively, nurses — and indeed all medical professionals — can regain their confidence and focus, continue having productive professional and personal lives, and reduce the likelihood of a downhill spiral. And it makes it more likely that they'll remain in the profession rather than becoming just another statistic in the ever-worsening shortage of nurses in the United States.


Mixed with their feelings of anxiety and depression, nurses with MMSS often have thoughts such as:

  1. Am I going to lose my license?

  2. Am I going to lose my job?

  3. Will my reputation be destroyed? Will I ever be able to work as a nurse again?

  4. What am I going to do for a living?

  5. If I lose everything, will my spouse divorce me? Will I lose my kids?

  6. I don't think I did anything wrong, but what if I'm still found to be at fault?

  7. Did I miss something? Did I make a mistake? Was there something more that I should have done?

  8. What's going to happen next? What else could go wrong?

  9. Are there more people out there who are going to sue me?

  10. Everything feels overwhelming and out of control.

  11. My entire identity is now in question.

  12. How do I get this case out of my head? I can't focus on anything else.

  13. I'm developing medical problems of my own.

  14. I'm having difficulty focusing at work and relating to patients; how do I know who's going to sue me next?

  15. I wish that I could escape it all; I feel like killing myself.

Gail Fiore is president of The Winning Focus, LLC, which works with physicians and other professionals involved in litigation who are having difficulty coping with stress, anxiety, and other emotional issues.

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