What Malpractice Insurance Does an NP Need if Working as an RN?

Carolyn Buppert, MSN, JD

Nurse practitioners (NPs) are sometimes offered jobs that could be filled by a registered nurse (RN). In those positions, NPs are not expected to diagnose, order tests or treatments, or prescribe medication.

An NP might be interested in such a position as a side job while working full time in their current role, as a bridge between the ending of one NP position and the start of another, or to make ends meet if advanced practice jobs are scarce.

NPs considering an RN-level job often ask what insurance they should purchase. Is it sufficient to be insured as an RN? Or must the NP be insured at the highest level of license? The cost differential between insurance for RNs and NPs is significant.

The answer: Ask the insurance company what level of coverage they require for your situation and purchase that type of policy. Insurance companies get to make their own rules. Clinicians who purchase malpractice insurance need to follow the company's rules or face the possibility that the insurer will deny coverage at the very time it is needed most.

I recently queried a company that insures NPs and nurses about this scenario and was told, "As per our underwriting guidelines, we must insure the insured to their highest licensure. If they hold an active license as a nurse practitioner, we would need to insure them as such even if they are only working as a registered nurse." 

This insurer's response doesn't mean all insurers would require that nurses be insured to the highest level of their license, no matter what their level of performance is, but I suspect that the insurer I asked is not an outlier.

An NP who is considering a job as an RN should contact several insurers and pose this question: "I am an NP considering working in an RN role — no diagnosing or prescribing. Will you cover me if I purchase insurance for RNs and I am sued or need license defense? Or must I purchase a policy specifically for NPs?"

If a reputable insurer says a policy for RNs will suffice, get that statement in writing before purchasing the policy. If all of the insurers require NPs to be insured at the advanced practice level, then weigh the cost of insurance against the compensation being offered. Taking a several-hour job as an RN giving vaccinations probably isn't going to justify the expense of a malpractice policy at the advanced-practice level. 

Keep in mind that nurses and NPs don't necessarily need to purchase their own malpractice insurance policies. Most employers provide their employed clinicians with professional liability coverage. For example, if an NP takes a job as an RN at a hospital, the hospital is probably going to insure that NP or otherwise provide a defense if the individual is sued because of a work-related incident. It may or may not matter to a hospital if an NP is filling a position slated for an RN; it instead depends on how the hospital has structured its professional liability coverage.

Before accepting a position, ask the employer how they would cover you for malpractice insurance. Most employers provide their employees with some form of professional liability insurance, so specifically ask whether that insurance will be applicable to an NP working in an RN role. 

If the entity doesn't provide professional liability coverage and the NP must purchase their own policy, ask whether the total compensation for the year sufficiently covers the cost of insurance, as well as the customary NP salary or hourly rate.

Carolyn Buppert (www.buppert.com) is an attorney and former nurse practitioner who focuses on legal issues affecting NPs.

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Cite this: What Malpractice Insurance Does an NP Need if Working as an RN? - Medscape - Nov 11, 2021.