If you’ve ever had that post-shift spiral of, “Did I chart enough? Did I miss something? What if that situation comes back on me?” …you’re not alone.
The newest NSO nurse liability report highlights some shifts in nurse liability claims that honestly surprised me: especially where claims are showing up more (and why). So I sat down with Jennifer Flynn, Vice President of Risk Management for the Nurse Service Organization (NSO), to break down the trends and pull out what actually matters for nurses who are just trying to take good care of patients without practicing scared.
Table of Contents
What’s New in Nurse Liability Claims
NSO has been tracking claims for years, so they’re not looking at one-off stories. They’re watching for trends: what’s happening more often (frequency) and what’s getting more expensive or severe when it does happen (severity).
In this latest report, Jennifer shared that some “newer” practice areas are showing up more in both frequency and severity, including:
- Correctional nursing
- Home health
- Aesthetics/cosmetic nursing
And yes, traditional areas like adult med-surg and surgical care still matter, too. But the big takeaway is this: the highest risk isn’t always where you assume it is.
Correctional Nursing and “Deliberate Indifference”
One of the most striking parts of our conversation was correctional nursing. Not because nurses in corrections are careless (they’re often working in extremely challenging conditions), but because the legal framework around incarcerated patients can be different.
Jennifer explained a concept that shows up in these cases: deliberate indifference.
In plain language, it means a patient had a known condition or obvious need, and the care team (including nursing) consciously disregarded it, sometimes because the patient is viewed as “manipulative,” “attention-seeking,” or “unreliable.”
That’s not just a documentation issue. That’s a bias + systems + safety issue.
The reminder here is uncomfortable but important: incarcerated patients still deserve standard-of-care assessment and follow-through. If you work in corrections, protecting yourself often just looks like doing the basics very consistently: assessment, escalation, and clear documentation when something isn’t adding up.
Why Home Health Drives So Many Nurse Liability Claims
Home health continues to be a huge slice of nurse liability claims, and this part shocks a lot of nurses.
Jennifer shared that only about 10-11% of nurses work in home health, but home health represents around 20-22% of NSO’s claims. That mismatch matters.
Why? A few reasons show up over and over:
- You’re often working more independently
- Resources/equipment may be limited
- Patient/family dynamics blur boundaries fast
- Scope can quietly drift when you’re trying to “just help”
The home health boundary problem (and how it spirals)
Jennifer shared a case where a home health nurse was caring for a patient with diabetes and CHF. She was ordered to visit for 30 days, 3x/week… but she became very close with the family. The calls increased. She started coming over outside of ordered visits. (⚠️ Boundaries!) Then she started doing extra care: like insulin injections and wound care, all without orders, without documentation, and without telling the broader team.
The family didn’t complain. The hospital did…. after a catheter reinsertion attempt went wrong, the patient required surgery, and the ED reported the nurse’s actions. What followed was a board investigation, findings of practice outside scope/orders, mandatory education and supervision, and job loss.
This is one of those situations that starts with compassion and ends with consequences.
If you work home health (or you’re considering it), this is your reminder: **boundaries aren’t cold. They’re protective.**
“No Pump Available” and the Danger of Improvising Care
Another trend that came up: improper technique, and Jennifer pointed out that some of this data overlaps the COVID-era training disruptions. Less in-person clinical exposure, more simulation, faster onboarding… we’re still seeing the downstream effects.
One story that stuck with me involved a new nurse performing a home infusion, but there was no infusion pump available. She asked her supervisor what to do and was told to calculate a drip rate. She didn’t feel confident, didn’t want to look incompetent, and tried to fill the gap with a YouTube video. A pressure bag was used. Air ended up in the line. The patient suffered an embolism.
This is one of those painful reminders that “figuring it out” can be dangerous in healthcare.
If you take anything from this section, let it be this: do not improvise procedures you haven’t been trained and validated on. Raise your hand. Escalate. Delay if needed. Advocate for equipment. Looking competent is never worth patient harm (or losing your license).
Aesthetics Nursing Isn’t “Low Risk”
Aesthetic/cosmetic nursing is growing fast. And it’s showing up more in nurse liability claims than many nurses expect.
The claims Jennifer described are often tied to things like:
- burns from laser treatments (often on the face)
- disfigurement
- technique and training gaps
- inadequate supervision
- weak informed consent processes
Cosmetic settings can feel “less intense” than hospital nursing, but the risks are still VERY real, especially because the procedures are elective and expectations are high. A poor outcome can quickly become a legal problem.
Nurse Leaders Can Be Named in Claims (Even Without Touching the Patient)
This part is for charge nurses, managers, directors, and business owners: being “indirect care” does not mean you’re insulated.
Jennifer explained that nurse leaders can be implicated through things like:
- policy/procedure failures
- training gaps
- hiring/credentialing problems
- staffing decisions
- failure to intervene/escalate when a bedside nurse brings concerns
Even charge nurses (who may not have physically touched the patient) can be named when they were notified of deterioration and no action followed. This is where leadership documentation and communication matter just as much as bedside charting.
The Documentation Problem: “Feast or Famine”
Jennifer said something that describes modern charting perfectly: “feast or famine.”
We have a feast of time stamps and audit trails:
- when you opened an alert
- when an order was placed
- when meds were pulled
- when administration happened
But a famine of clinical context:
- why the delay occurred
- what barriers existed
- what you escalated and to whom
- what you saw and how the patient responded
And in a legal defense, context is everything.
A sepsis alert example came up where an antibiotic was ordered… but not pulled for hours. Without a short nursing note explaining what happened (competing emergencies, access issues, pharmacy delay, provider response, escalation steps), defense teams are left with a timeline that looks bad, even if the reality was more complicated.
You don’t need to write a novel. But you do need to leave breadcrumbs.
The AI Liability Questions Nobody Can Fully Answer Yet
AI is showing up everywhere: predictive deterioration tools, sepsis alerts, ambient documentation, decision support. And legally, we’re still in the “wild west” phase.
Jennifer outlined the big questions risk teams are wrestling with:
- If AI contributes to harm, who’s responsible?
- Should patients be told AI is being used, and what exactly should be disclosed?
- Is AI legally a tool, or is it a product? (Courts haven’t fully decided this yet.)
One key point that matters for nurses right now: if AI writes documentation (like ambient listening), you’re still responsible for what you sign. AI can save time, but it can’t replace your judgment, or your accountability.
How to Reduce Risk Without Practicing Scared
If you’re reading this and thinking, “Cool, new fear unlocked 😰,” breathe. The point isn’t to make you anxious. It’s to give you control of the controllables.
A few practical themes Jennifer emphasized:
- Know your risk environment. Transitions are risky: new job, new specialty, new policy, new tech, new role.
- Raise your hand early. If you need training, ask. If policy is unclear, ask. If you’re being pressured to “figure it out,” escalate.
- Stay in scope and within orders. Compassion doesn’t require you to practice outside your lane.
- Document for credit. Your charting should reflect the care you actually provided, and the decisions you made.
- Build rapport and communicate well. There’s evidence that strong patient rapport can lower likelihood of complaints and claims.
Final Thoughts on Nurse Liability Claims
The simplest truth Jennifer and I kept circling back to is this: Good care + good documentation = protection.
That doesn’t mean you can prevent every bad outcome. It means you can practice with intention, communicate clearly, and make sure your record reflects reality, not just time stamps. And if you’re in a setting like home health, corrections, aesthetics, or leadership, this report is a reminder that the risks are different, but they’re not unmanageable. Awareness changes everything. 😌
More Resources
- Learn more about NSO nurse liability resources and coverage info: https://www.nso.com/
- NSO Nurse Case Study: Alleged failure to appropriately resuscitate a PACU patient after a complex cosmetic surgery
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