During a busy Friday morning clinic, Mrs S, 26 years old, came to see Nurse M with her son for his six month vaccinations. After the injections had been given, Mrs S mentioned to the nurse that she had been having vague tummy pains and thought she may have a urinary tract infection (UTI), as she had suffered from them in the past.
Nurse M asked her if she wanted to see the GP, but Mrs S declined. Nurse M said that it was perhaps a UTI and agreed to do a urinalysis and send a sample to the laboratory.
The urinalysis showed a trace of protein and +1 of blood. Nurse M agreed she would send the sample to the lab for culture and sensitivity. Nurse M advised Mrs S to take plenty of fluids and pain relief and to return to see the GP if she was no better.
Nurse M made the following entry in the clinical notes:
Later that night, Mrs S developed severe abdominal pain and collapsed; she was seen by a GP from the OOH service and was admitted by ambulance to the Emergency Department. Mrs S died shortly after arriving in hospital. A postmortem examination confirmed the cause of death as a haemorrhage from a ruptured right tubal pregnancy.
Her death was reported to the coroner by the Emergency Department staff and the coroner instigated an investigation into the circumstances surrounding the death. Nurse M was called to give evidence at the coroner’s inquest. The coroner returned a verdict of natural causes. The family pursued a claim of clinical negligence against the nurse.
Medical indemnity for practice nurses
The Nursing and Midwifery Board of Ireland (NMBI) Scope of Nursing and Midwifery Practice framework outlines the professional responsibilities of nurses and midwives working in Ireland.1
It states: “Nurses and midwives are accountable both legally and professionally for their practice, that is, for the decisions they make and the consequences of those decisions.” It also states that: “You are responsible for ensuring you have, or need to get, professional indemnity insurance”.
For this reason, all practice nurses should ensure that they have their own appropriate indemnity.
Does my GP indemnity extend to the vicarious liability of my practice nurse?
No. If you, as a GP, employ a practice nurse you must ensure the nurse has appropriate and adequate professional protection for their own acts and omissions.
The benefits of GP membership with Medical Protection do not include vicarious liability protection for the nurse.
Find out more about Medical Protection indemnity for Practice Nurses
Practice nurses and nurse practitioners employed by a member of Medical Protection (or their practice) can apply for membership in their own right. The annual subscription is €399 for practice nurses or €689 for nurse practitioners. These rates are correct as of 1 May 2019.2
The benefits of Medical Protection membership are provided on an occurrence basis. This means that members can apply for assistance with complaints and claims arising from incidents that occur during their membership – even if it is brought years after they have left Medical Protection or ceased to practise for any reason. In this example, if Nurse M had been a member of Medical Protection at the time of her consultation with Mrs S, she would have been able to request assistance with the inquest, where we would have provided legal representation or assisted with her report. Similarly she would have been indemnified for the subsequent claim.
Out of hours
Nurses working in urgent or out of hours care should contact Member Services on 1800 509 441 to join Medical Protection.
Medical Protection does not provide membership for the provision of midwifery services. However, membership does extend to practice nurses participating in basic antenatal care, including weight measuring, blood pressure and urinalysis.
Membership does not extend to practice nurses undertaking the assessment of foetal growth, presentation, viability or scanning.
As the role of the practice nurse expands, so too does the risk of an adverse event occurring. Many nurses work in isolation, managing their own clinical workload – this in itself may present additional risks to safe and effective practice. Medical Protection has seen a steady rise in the number of claims relating to general practice, some of which involve nurses. It is therefore essential that nurses have appropriate clinical indemnity arrangements in place.
1 Nmbi.ie. (2019). NMBI - NMBI Scope of Practice. [online] Available at: https://www.nmbi.ie/Standards-Guidance/Scope-of-Practice
2 Medicalprotection.org. (2019). MPS membership for practice nurses in Ireland. [online] Available at: https://www.medicalprotection.org/ireland/join/practice-nurse-membership