Nurse Leader Case Study: Failure to perform appropriate hiring practices

Medical malpractice claims may be asserted against any healthcare practitioner, including nurses. This case involves a registered nurse working as a director of nursing in a rehabilitation/skilled nursing facility setting.

Complaints are subsequently investigated by the SBON, with results ranging from no action against the nurse to revocation of the license to practice nursing. This case study involves a registered nurse, employed as the Director of Nursing (DON) at a rehabilitation/skilled nursing facility.


A 42-year-old woman was a resident in an aging services facility due to injuries sustained during an automobile accident. A male licensed practical nurse (LPN) was assigned to the patient on six occasions over a period of three months. A few weeks following the completion of the assignment, the resident left the facility and filed a complaint with the local police, asserting sexual battery and inappropriate touching by the LPN. The LPN continued to work at the facility until his license was suspended by the state, at which time his employment was terminated.

One year after filing the complaint, the patient sued the aging service facility, the director of nursing (DON) and the administrator, asserting both negligent hiring and improper supervision. Discovery revealed that although the DON knew of similar accusations made against the LPN while employed by another facility, she was personally convinced of the nurse’s innocence and had failed to perform adequate background checks prior to hiring him.

The administrator and other staff members testified that they had never witnessed any inappropriate behavior by the employee, but observed that he routinely closed treatment room doors when treating female patients, despite being told that facility policy required him to leave the doors open.


A settlement was eventually reached prior to trial on behalf of the insured DON, with the total amount incurred to settle and defend the case on behalf of the insured DON totaling over $160,000.*

Risk Control Recommendations

The following strategies can help nurse leaders, supervisors, DONs and managers enhance quality of care and resident/patient satisfaction, while reducing the likelihood of medical malpractice claims and state board of nursing actions:

  • Serve as the residents’/patients’ advocate in ensuring resident/patient safety and the quality of care delivered.
  • Know and comply with your facility’s policies, procedures and protocols. If policies and procedures are obsolete, unclear, or absent, request that the appropriate person or committee update, clarify, or initiate the policy.
  • Ensure that nursing policies and procedures are patient-centered and in written format.
  • Review nursing licensures, qualifications and competencies for nursing staff on an annual basis.
  • Create and cultivate an open and direct line of communication culture between leaders and staff.
  • Monitor the needs of staff and anticipate resident/patient care problems before they arise.
  • Ensure that nursing practice is safe, effective, efficient, equitable, timely, and patient-centered and reflect current professional nursing standards of practice.
  • Review and update nursing policies and procedures on an annual basis, or more often, if necessary.
  • If the organization’s current culture does not support the chain of command, explain the risks posed to patients, staff, practitioners and the organization, and initiate discussions regarding the need for a shift in organizational culture
  • Respond promptly to all allegations, whether instituted by residents/patients or staff, of incompetent or questionable nursing care. Thoroughly investigate allegations, recommend options for correction, and follow up on recommended actions. Include follow-up evaluations in nurses’ records, documenting that the nurses are competent to care for residents/patients within clinical settings.
  • Alert hospital/facility administrators and upper level managers of staffing concerns after taking all necessary actions within the nurse leader’s/manager’s control to alleviate the circumstances, such as approving overtime or reassigning personnel. Notify the chief operating officer when understaffing endangers patient welfare, either directly or through formal communication channels.
  • Contact the risk management department or legal department regarding patient or practice safety issues, if necessary.

* Expenses represent the payments made solely on behalf of our registered nurse and do not include any payments that may have been made by the registered nurse’s employer on her behalf or payments from any co-defendants. Amounts paid on behalf of the multiple co-defendants named in the case are not available

The information, examples and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. Please note that Internet hyperlinks cited herein are active as of the date of publication, but may be subject to change or discontinuation. This material is for illustrative purposes and is not intended to constitute a contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. Use of the term “partnership” and/or “partner” should not be construed to represent a legally binding partnership. All products and services may not be available in all states and may be subject to change without notice. CNA is a registered trademark of CNA Financial Corporation. Copyright © 2021 CNA. All rights reserved.
This publication is intended to inform Affinity Insurance Services, Inc., customers of potential liability in their practice. It reflects general principles only. It is not intended to offer legal advice or to establish appropriate or acceptable standards of professional conduct. Readers should consult with a lawyer if they have specific concerns. Neither Affinity Insurance Services, Inc., NSO, nor CNA assumes any liability for how this information is applied in practice or for the accuracy of this information. This publication is published by Affinity Insurance Services, Inc., with headquarters at 1100 Virginia Drive, Suite 250, Fort Washington, PA 19034-3278. Phone: (215) 773-4600. All world rights reserved. Reproduction without permission is prohibited.
Nurses Service Organization is a registered trade name of Affinity Insurance Services, Inc. (TX 13695); (AR 100106022); in CA, MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services, Inc.; in CA, Aon Affinity Insurance Services, Inc. (CA 0G94493); Aon Direct Insurance Administrators and Berkely Insurance Agency; and in NY, AIS Affinity Insurance Agency.
© 2021 Affinity Insurance Services, Inc.

More learning right here

Check out these related articles.

Nurse Leader Case Study: Failure to perform Director of Nursing duties in a competent manner

A State Board of Nursing (SBON) complaint can be filed against a nurse by a patient, resident, colleague, employer, and/or regulatory agency.

Nurse Case Study: Alleged failure to assess and monitor teen patient’s pulmonary status

A male patient in his mid-teens arrived at his pediatrician at 5:11 p.m. with complaints of difficulty breathing.

Nurse Case Study: ICU Charge Nurse allegedly failed to monitor a critical patient and escalate treatment

Medical malpractice claims may be asserted against any healthcare practitioner, including nurses. This case involves a registered nurse working in the Intensive Care Unit (ICU) as a Charge Nurse.

Nurse Practitioner Case Study: Failure to counsel patient on risks of noncompliance

This case involves a family nurse practitioner (NP), her business (a women’s health clinic), and employees that specialized in gynecology and hormone therapy.