Good communications with patients and their families, staying up to date on practices and procedures, and adequate documentation are among the risk management steps nurses must take to avoid claims and defend themselves should they be sued.

“Be nice,” said Edie Ann Brous, a New York-based attorney and registered nurse. “It's very hard to sue someone whom you like.” If a patient's interaction with a nurse makes them believe she has acted in their best interest “you're not likely to be sued.” Those who are unkind, insensitive, abrasive and have no interpersonal skills run the greater risk of being sued, “even if you haven't made a bad mistake,” said Ms. Brous.

Maintaining patient confidentiality also is critical, said Scott Kelley, senior vp and health care business leader for Marsh U.S. Consumer, a unit of Marsh Inc., in New York. In today's world, which is driven by the Health Insurance Portability and Accountability Act, “you've got to be very concerned and protect anything that's not public information that deals with (patients') privacy,” Mr. Kelley said.

Observers say nurses should be sure to stay within the guidelines of their particular state's nurse practices act, which sets out the scope of their practice and responsibilities. “It's very hard to defend a nurse if they're working outside the scope of their practice and do something wrong,” said Judy Simmons, president and owner of Richardson, Texas-based Bill Beatty Insurance Agency Inc., which specializes in medical professional liability insurance.

Familiarize yourself with the policies and procedure manuals of the particular institution that employs you, experts say. Many nurses work in multiple settings, each of which have different requirements, said Michael Auerbach, vp of allied health and miscellaneous programs for Liberty International Underwriters in New York.

Nurses must be “fully oriented to their position,” whether they are working in a hospital setting, ambulatory setting or a physician's office, said Emily Rhinehart, vp and division manager of global loss prevention health care for Chartis Inc. in New York, who also is a registered nurse.”

Nurses must stay up to speed on developments in their field, say observers. A recent study found nurses 51 or older accounted for 66.9% of the claims filed.

Documentation is also critical. It “can be your best friend or your worst enemy,” said David Griffiths, Philadelphia-based senior vp of the Nurses Services Organization, a division of Aon Affinity Insurance Services Inc. He said NSO has heard from nurses “who have sat there in the courtroom and had their documentation put on a projector and a screen,” while they are asked questions by an attorney.

“You have to document the actions as soon as you can after they're taken,” as well as the exact time those actions were performed, said Ms. Simmons. “It's just amazing how many times we've had to provide a defense for a nurse and those notes are missing, or not accurate or they're not timely,” she said. “Basically, you're tying your defense attorney's hands if you didn't make those notes.”