Risk management is a concern for all nurse practitioners (NPs), but it poses a different set of challenges for NPs who are also business owners. As a business owner, you will need several different types of insurance to protect you:
1. A business owner's policy protects your office contents-the physical parts of your practice.
2. Disability insurance provides you with income when you cannot work. You can purchase it as a short-term or long-term policy.
3. Malpractice insurance protects you from professional medical liability.
Malpractice
Malpractice risks pose the most complex insurance issues to NP business owners. Liability frequently results from inadequate follow-up, insufficient documentation, failure to refer or collaborate with a physician, or inadequate supervision of an employee.
First, evaluate your current malpractice insurance and continue evaluating it on a regular basis. Do you have enough coverage for your practice and for the type of employees you have? Do you have any contracted employees? Do you understand the difference between a claims made and an occurrence policy and is your policy appropriate for your practice? Do some research first and meet with an insurance agent who is familiar with professional liability insurance. Compare premiums, but do not let that be your sole determinant in choosing a policy.
Hiring Practices
If you hire any employees, evaluate your human resource policies. Set up a written policy manual, which needs to include your hiring procedures, job descriptions with clear scope of responsibilities, employee training and orientation, performance evaluation tools, supervision, and dismissal policies. Handbooks are available to help you do this and allow you to individualize policies for your practice. Maintain files on all employees that include periodic evaluation and any disciplinary actions.
When you hire an employee, be sure to perform a credentialing check. Verify your employee's education, licensure, certifications, and competencies, and consider a criminal background check. Set up a mechanism to be sure your employees keep their licenses current. Be familiar with all your state laws regarding legal scope of practice for any licensed employees and follow them precisely.
If your state laws require you to have a "collaborative" or "supervising" physician to practice, carefully review the laws and make sure you are in compliance. It may be a good investment to consult with an attorney. If you need a collaborative or supervising physician, choose one with the same medical specialty that you have. Your state laws may not specify that you need to do this but it may be hard for an internist to defend adequacy of "supervision" for a family NP who treats pediatric and adolescent patients. Be sure to update mutually agreed upon policies or protocols at least annually.
Prescriptive Laws
Review the laws pertaining to prescriptive practice in your state. Do you need any physician involvement in order to prescribe? Do you need any practice agreements for prescriptive practice in writing? Do you have policies to cover situations in which a patient needs a prescription that you cannot write? I practice in New Hampshire, and our state laws do not require physician involvement in my practice. Sometimes patients mail a prescription I have written to a pharmacy in a state that requires a supervising physician or cosignature for NP prescriptions. The pharmacy must abide by its state laws even if they conflict with my state laws. We have a policy on how to handle this situation.
Risk management is easy to neglect, but it is vital for your protection. Review your current areas of vulnerability. Make a plan to address each of these areas now.