Disclaimer: The following is not legal advice or intended to provide any legal guidance to nurses. Always consult with a legal professional. 

Being a nurse can mean opening yourself up to potential lawsuits or criminal cases. While hospital insurance may protect in some situations, the American Nurses Association (ANA) recommends that all nurses carry their medical malpractice insurance to safeguard themselves further.

This article highlights critical legal cases every nurse should be aware of and steps you can take to protect your career and practice safely. Always consult with a licensed legal professional in your area for specific guidance.

Medical Malpractice And Negligence Cases

The terms "malpractice" and "negligence" are often used interchangeably, but according to Nursing Management and Professional Concepts, negligence is "the failure to exercise the ordinary care a reasonable person would use in similar circumstances." However, the term malpractice applies when the person in question is a licensed professional, like a doctor or nurse.

So, technically, for a nurse, negligence and malpractice would be any failure to act or lack of standard care that causes patient harm. Negligence as a nurse could be failing to assess a patient when you were supposed to or ignoring a patient's requests for help when they are having symptoms. Malpractice could also be administering the wrong dose of medication, especially if you failed to follow your hospital's protocol for double-checking medication dosage.

According to Nursing Fundamentals, to prove negligence or malpractice took place legally, the following elements must be established:

• A duty owed the patient
• Breach of duty owed the patient
• Foreseeability
• Causation
• Injury
• Damages

In Downes v. Carpenter, a Chester County, Pennsylvania jury awarded Kerri Downes $18 million after a Nurse Practitioner's failure to order imaging led to a delayed breast cancer diagnosis. Initially misdiagnosed as benign in March 2018, her aggressive cancer was discovered nine months later, requiring a bilateral mastectomy and chemotherapy instead of a potentially less invasive lumpectomy. The Nurse Practitioner was found negligent, with the delay significantly worsening Downes' prognosis.

There are some situations when a nurse can be accused of negligence when negligence has not actually occurred. For instance, a 2023 case involved a patient who was brought into a hospital and was belligerent and physically assaulted a nurse. The nurse called the police after being hit, following hospital protocol. However, when the patient died two days later, her estate sued the nurse personally for negligence. The case against the nurse was eventually dismissed because the nurse followed hospital protocol.

The best way to prevent being accused of patient negligence is to follow all hospital protocols for patient assessment and monitoring and thorough and accurate documentation. Remember, if you didn't chart it, it didn't happen.

Criminal Cases Involving Nurses

Other than criminal charges involving patients, nurses could be accused of stealing controlled substances, falsifying patient records, or patient mistreatment.

Criminal accusations against nurses have received more of a focus since the case of RaDonda Vaught, a nurse who was charged criminally for making a fatal medication error. The case eventually ended in Vaught receiving probation and no jail time, despite facing up to 8 years in prison. The case brought nursing errors to the forefront and highlighted the risks that lay in the nursing profession, with some saying a medication error should not be charged criminally.

Former nurse Maricela Leija was arrested and jailed in Bexar County for allegedly aiding a smuggling plot in 2018. Authorities say Leija, while working as a jail nurse, helped a detention officer smuggle a cell phone to inmate Gabriel Moreno, who is already serving a 20-year sentence. Leija, the officer, and the inmate face charges that could result in 2 to 20 years in prison and fines up to $10,000 if convicted.

To prevent a criminal charge, nurses can maintain professional integrity, follow all ethical guidelines, and understand their legal obligations. Medication errors can be an especially fraught area for nurses, so if you have any concerns about your facility's medication dispensing system, be sure to talk with your supervisors and document your concerns. Additionally, if you are a nurse with a substance abuse disorder, there is treatment and help available to you.

Discrimination and Harassment Lawsuits

When you hear about discrimination in nursing, it's often referring to discrimination accusations against nurses. However, nurses can also be accused of discriminating against patients, based on race, gender, and age.

A nurse fails to provide adequate care based on their own feelings or biases of someone's sex, age, or gender. A nurse can also be accused of sexual harassment towards a patient or coworker in the workplace.

For instance, a Michigan nurse was recently accused of racial discrimination after a patient and singer claimed the nurse and other hospital staff didn't believe who he was and called him derogatory names based on the fact that he was a Black man.

To prevent these situations, actively participate in all your facility's training on discrimination and bias awareness and workplace conduct, understand employment rights, and foster a respectful work environment. If you have concerns about a fellow nurse's behaviors, speak to a supervisor and document all interactions and steps you have taken.

Employment and Labor Disputes

Employment and labor dispute-related lawsuits tend to involve nurses filing cases against hospitals or employers, rather than the other way around. These types of situations could be related to employment contracts, wage disputes, and wrongful termination.

A nurse could sue an employer for a breach of contract, failing to adequately compensate for overtime pay or unfair dismissal. Cases of labor disputes tend to involve nursing unions or groups of unions rather than one single nurse.

For instance, 8 Massachusetts nurses recently sued their hospital for claiming that they were fired after speaking out against unsafe patient care conditions.

However, a single nurse can absolutely file against an employer or facility. For instance, Oregon nurse Linda Boly received a $3 million settlement in 2017 after successfully filing a wrongful termination suit. The nurse argued that she was fired for not rushing through patient care.

A former charge nurse at Kaiser Permanente Woodland Hills Medical Center in Los Angeles won a $41 million jury verdict in a lawsuit alleging age and disability discrimination, wrongful termination, and whistleblower retaliation. Kaiser plans to appeal, maintaining that the termination was justified.

To prevent these types of cases, fully understand your employment contract, seek legal counsel when needed, and know the labor rights in your area. It's also helpful to become involved with your nursing union to educate yourself more and have a place to turn if you encounter a situation you think maybe a breach of contract.

HIPAA Violations and Privacy Breaches

The Health Insurance Portability and Accountability Act (HIPAA) is an important law that nurses are usually very familiar with, but how it plays out in day-to-day life as a nurse can look different. In today's world of social media, it can be even more challenging to ensure HIPAA compliance, which is why all nurses should understand the rules of HIPAA and know how to prevent violating the act.

Direct HIPAA violations could include things like using your hospital login to look at patient records or sharing patient information without consent. By law, HIPAA protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. Not only does HIPAA protect information that directly identifies the individual, but it also protects information about "which there is a reasonable basis to believe it can be used to identify the individual." That means that any detail that could link a patient to a story you're telling could be a HIPAA violation.

This includes all information about:

• the individual's past, present, or future physical or mental health or condition,
• the provision of health care to the individual, or
• the past, present, or future payment for the provision of health care to the individual

In 2017, a nurse lost her job and was accused of violating HIPAA after telling a doctor and technician to use gloves during an echocardiogram because the patient had hepatitis C. The patient then sued, accusing the nurse of talking so loudly that other patients and employees not involved in their care heard their private medication information. The nurse fought against the lawsuit but lost her case.

An article on defamation in The National Library of Medicine also cautions that nurses should refrain from commenting even if someone accuses them publicly of something online, like in a forum or on a Facebook page. For instance, if someone goes to your local town discussion Facebook group and names you as a nurse who cared for them and complains about the care you provided, if you reply to that comment to defend yourself, you could be in violation of HIPAA for confirming private patient details.

HIPAA violations by nurses are often underreported because they typically impact fewer than 500 individuals, which means they do not appear on the breach report published by the HHS Office for Civil Rights. Instead, these incidents are more commonly reported to the healthcare facility where they occurred and handled internally.

To prevent HIPAA violations, participate in your facility's training on patient privacy, also use secure communication methods when discussing patient care, and maintain strict adherence to HIPAA guidelines. If you're a nurse active on social media, you may want to seek specific counsel on HIPAA training, but when in doubt, leave it out. The ANA also has helpful social media guidance for nurses.

Defamation Lawsuits

There isn't a specific definition of defamation as it applies to nursing, but an article on defamation in The National Library of Medicine explains that defamation in healthcare can look different than in the general public because defamation could be something that discredits someone's abilities as a nurse or affects how their colleagues or patients view them.

Defamation in nursing could look like a nurse spreading false information about colleagues, patients, or employers. It could also look like someone spreading false information about a nurse in a way that affects their ability to perform their job.

One interesting case about nurse defamation saw a nurse successfully go against a hospital that fired her—the nurse won her case that not only had the hospital fired her because of her union activity, but was also able to argue the hospital defamed her in the ensuing legal proceedings.

Another case concerning defamation involves a physician, fired from a facility due to not following procedures, and filing a suit against a CNO. These allegations were later disapproved in court.

To prevent being accused of defamation, maintain professionalism in all communications. It's especially important not to reveal private information about employees of your facility to patients or the community.

Licensure and Disciplinary Actions

Legal proceedings related to nursing licensure, including suspensions, revocations, and disciplinary actions, are handled by state nursing boards. That means that if there's a situation at your hospital or you are involved in a patient lawsuit, the state nursing board could review your license and decide to suspend or revoke it entirely.

There is no "one" scenario that can lead to evaluating a nurse's license, but some situations that could trigger a state nursing board to review a nurse's professional standing could include accusations of misconduct, incompetence, or criminal convictions. Additionally, nurses should know that anyone can file a legal complaint against a nurse at any time, for any reason.

According to the National Council of State Boards of Nursing, "a nurse's practice and behavior is expected to be safe, competent, ethical and in compliance with applicable laws and rules. Any person who has knowledge of conduct by a licensed nurse that may violate a nursing law or rule or related state or federal law may report the alleged violation to the board of nursing where the conduct occurred."

To prevent review of your nurse's license, follow all nursing professional standards, complete your ongoing education, and adhere to licensure requirements based on your state and facility.

Final Thoughts

Of course, this is not an exhaustive list of all the legal situations that could involve nurses. As the profession evolves with new patient care technologies, the legal encounters a nurse could have will most likely change as well. Nursing is a challenging but rewarding profession. By staying informed, documenting diligently, and adhering to ethical and professional standards, you can protect yourself and your license while continuing to provide excellent care.

If you have any concerns about a legal situation involving your work as a nurse, it may be helpful to look into purchasing your own professional liability insurance, such as the malpractice insurance offered by the Nurses Service Organization. Joining professional organizations like the American Nurses Association, taking advantage of resources from www.nurse.org, or obtaining malpractice insurance through groups like NSO can provide valuable resources and peace of mind. Don't wait until you're facing a legal situation to protect yourself. Get educated, get insured, and stay vigilant