Post a total of 3 substantive responses over 2 separate days for full participation. This includes your initial post and 2 replies to classmates or your faculty member.?Substantive responses

Nurse Professional Liability Exposures: 2015 Claim Report Update

A COMPARATIVE ANALYSIS FROM CNA AND NURSES SERVICE ORGANIZATION

PART 1 Nurse Professional Liability Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Database .and .Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Data .Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Analysis .of .claims .by .licensure .type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Analysis .of .severity .by .year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Nurse .closed .claims .with .expense .payments .only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Analysis .of .severity .by .nurse .specialty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Analysis .of .severity .by .location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Analysis .of .Severity .by .Allegation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Allegation .by .category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Analysis .of .Allegation .Sub-categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Allegations .related .to .assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Allegations .related .to .monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

Allegations .related .to .treatment .and .care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Claim Scenario: Delay in Implementing Provider Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Allegations .related .to .medication .administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Claim Scenario: Medication Error Resulting in Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Allegations .related .to .patients’ .rights, .patient .abuse .and .professional .conduct . . . . . . . . . . . . . .28

Analysis .of .Severity .by .Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

Analysis .of .fatal .injuries .by .underlying .cause .of .death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Analysis .of .severity .by .cause .of .death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Analysis .of .obstetrics-related .injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Analysis .of .severity .by .disability .outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Analysis .of .director .of .nursing .(DON) .closed .claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Claims .related .to .agency .nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

Claim Scenario: Successful Defense of a Nurse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Licensed .practical/licensed .vocational .nurse .closed .claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Summary .of .Closed .Claims .with .a .Minimum .Indemnity .Payment .of .$1 .Million . . . . . . . . . . . . . . . . . . . .39

Risk .Control .Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Patient .safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Assessment .and .monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

Treatment .and .care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

Chain .of .command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43

Scope .of .practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44

Risk .Control .Self-assessment .Checklist .for .Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Claim .Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Everyday .practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

Once .you .become .aware .of .a .claim .or .potential .claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

PART 2 Nurses Service Organization’s Analysis of License Protection Paid Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

License .Defense .Paid .Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Analysis .of .claims .by .licensure .type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Analysis .of .claims .by .location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

Analysis .of .claims .by .allegation .class . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Average .payment .by .allegation .class . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

Claims .by .Allegation .Class .Sub-Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

Allegations .related .to .sub-category .of .professional .conduct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

Allegations .related .to .sub-category .of .patients’ .rights .and .patient .abuse . . . . . . . . . . . . . . . . . . . .54

Allegations .related .to .sub-category .of .improper .treatment .and .care . . . . . . . . . . . . . . . . . . . . . . . .55

Allegations .related .to .sub-category .of .medication .administration . . . . . . . . . . . . . . . . . . . . . . . . . . .56

Licensing .Board .Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57

Comparison .of .2011 .and .2015 .distribution .of .licensing .board .actions . . . . . . . . . . . . . . . . . . . . . . . .57

Explanation .of .Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

General .Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

PART 3 Highlights from Nurses Service Organization’s 2015 Qualitative Nurse Work Profile Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61

Summary .of .Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63

Topic .1: .Respondent .Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Nursing .licensure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

Pre-licensure .nursing .program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

Origin .of .education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

Additional .certifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66

Years .in .practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

Topic .2: .Current .Practice .Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Technology .and .rapid .access .to .information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Technology .and .patient .records .access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Managing .technology .and .time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Technology .and .information .verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Usage .of .electronic .patient .notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Access .to .evidence-based .data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Staff .development .opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70

Employment .practice .periodic .checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71

Topic .3: .About .the .Claim .Submitted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

Working .situation .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

Employment .status .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72

Years .in .practice .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Magnet™ .designation .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73

Substance .abuse .procedure .in .place .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Tenure .in .position .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Topic .4: .About .the .Facility .Where .the .Incident .Occurred . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Technology .in .the .workplace .at .the .time .of .the .incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

How .long .were .you .using .technology .at .the .time .of .the .incident? . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Perceived .patient .benefit .of .technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

Rapid .response .team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79

PART 1 Nurse Professional Liability Exposures

CNA Five-year Closed Claims Analysis (January 1, 2010-December 31, 2014) and Risk Control Self-assessment for Nurses

PART 1 CNA AND NSO Nurse 2015 Claim Report Update 6

Introduction For .over .30 .years, .CNA .and .our .business .partners .at .Nurses .Service .Organization .(NSO) .have .been .

committed .to .helping .nurses .insure .themselves .against .loss .by .providing .specialized .insurance .

coverage .and .working .to .enhance .their .risk .awareness . .Our .joint .professional .program .is .the .nation’s .

largest .underwriter .of .professional .liability .insurance .for .individual .nursing .professionals, .with .more .

than .550,000 .policies .in .force . .CNA/NSO-insured .nurses .provide .healthcare .in .an .increasingly .

broad .array .of .locations .and .specialties, .including .hospitals, .aging .services .facilities, .outpatient .and .

ambulatory .centers, .practitioner .offices, .schools, .community .and .retail .health .settings, .spas .and .

aesthetic/cosmetic .centers .

Purpose In .collaboration .with .NSO, .we .are .pleased .to .present .our .third .report .on .nurses’ .risk .exposures, .

which .examines .CNA .nurse .claims .that .closed .between .January .1, .2010 .and .December .31, .2014 . .

Our .goal .is .to .identify .liability .patterns .and .trends .in .order .to .help .nurses .understand .their .areas .of .

greatest .vulnerability, .in .order .to .take .appropriate .action .to .protect .patients .from .harm .and .reduce .

the .risk .of .potential .litigation .

When .possible, .this .report .compares .CNA/NSO .nurse .professional .liability .closed .claims .that .occurred .

between .January .1, .2006 .and .December .31, .2010 .with .the .corresponding .set .of .closed .claims .dating .

from .January .1, .2010 .through .December .31, .2014 . .The .two .groups .of .closed .claims .are .referred .to .

as .the .2011 .and .2015 .closed .claim .reports, .respectively . .This .comparison .provides .a .broader .historical .

perspective .on .claim .characteristics, .including .trends .in .exposures .and .severity .

The .report .also .summarizes .individual .claims .with .settlements .or .judgment .awards .equal .to .or .

greater .than .$1 .million . .Detailed .case .studies .illustrate .failure .to .comply .with .professional .standards .

of .care, .resulting .in .patient .injury .and .consequent .claims .of .negligence . .Finally, .risk .control .recom-

mendations .and .a .self-assessment .checklist .are .included .to .assist .nurses .in .reviewing .their .custom .

and .practice .in .relation .to .the .risks .identified .in .the .report .

PART 1 CNA AND NSO Nurse 2015 Claim Report Update 7

Database and Methodology The .report .includes .only .those .CNA .professional .liability .closed .claims .that:

– Involved .a .registered .nurse .(RN), .licensed .practical .nurse .(LPN) . .

or .licensed .vocational .nurse .(LVN) .

– Closed .between .January .1, .2010 .and .December .31, .2014 . .

(although .they .may .have .been .reported .earlier) .

– Resulted .in .an .indemnity .payment .of .$10,000 .or .greater .

These .inclusion .criteria .were .applied .to .10,639 .reported .adverse .incidents .and .claims .that .closed .

during .the .designated .time .period . .The .final .primary .database .comprises .549 .nurse .closed .claims, .

which .were .subsequently .reviewed .and .analyzed .

In .addition .to .the .primary .dataset .of .claims .that .closed .from .January .1, .2010 .to .December .31, .2014 .(the .

2015 .dataset), .a .dataset .consisting .of .claims .that .closed .between .January .1, .2006 .and .December .31, .

2010 .(the .2011 .dataset) .was .utilized .in .this .report .to .draw .comparisons .and .identify .trends . .Since .

both .of .these .datasets .include .closed .claims .from .2010, .it .is .important .to .note .that .the .two .datasets .

are .not .fully .independent . .Nevertheless, .by .comparing .the .two .datasets .we .can .see .how .the .average .

paid .indemnity .amounts .associated .with .various .claim .characteristics .are .changing .over .time .and .

better .identify .patterns .in .nurse .claim .activity .and .litigation . .The .2011 .dataset .includes .516 .professional .

liability .claims, .while .the .2015 .dataset .includes .549 .professional .liability .claims .

As .this .report .has .unique .data .inclusion .criteria, .readers .should .exercise .caution .about .comparing .

the .findings .with .similar .publications .from .other .sources .

Scope The .focus .of .the .analysis .is .on .the .severity .of .nurse .closed .claims .that .satisfied .the .inclusion .criteria .

described .above . .Claim .characteristics .examined .within .the .report .include .location .of .the .event, .

nurse .specialty, .type .of .allegation, .and .harm .or .injury .

Unless .specifically .noted, .the .tables .and .charts .in .Part .I .of .this .report .include .both .RN .and .LPN .nurses .

closed .claims . .See .Figure .20 .on .page 38 .for .a .comparative .analysis .of .RN .and .LPN/LVN .closed .claims .

PART 1 CNA AND NSO Nurse 2015 Claim Report Update 8

Terms For .purposes .of .this report only, .please .refer .to .the .terms .and .explanations .below:

2011 claim report .– .A .reference .to .the .prior .CNA .study, .titled .“Understanding .Nurse .Liability, .

2006-2010: .A .Three-part .Approach,” .www.cna.com/healthcare .

Agency nurse .– .Any .RN .or .LPN/LVN .who .provides .nursing .services .as .an .independent .contractor .

or .as .an .employee .of .a .staffing .or .placement .service .

Aging services .– .Specialized .facilities .or .organizations .that .provide .healthcare .to .a .senior .population . .

Aging .services .facilities, .which .also .may .be .referred .to .as .long .term .care, .include .but .are .not .limited .

to .nursing .homes, .assisted .living .centers .and .independent .living .facilities .

Average total incurred .– .Indemnity .plus .expense .costs .paid .by .CNA, .divided .by .the .number .of .

closed .claims .

Expense payment .– .Monies .paid .in .the .investigation, .management .and/or .defense .of .a .claim .

Incurred payment .– .The .costs .or .financial .obligations, .including .indemnity .and .expenses, .resulting .

from .the .resolution .of .a .claim .

Indemnity payment .– .Monies .paid .on .behalf .of .an .insured .nurse .in .the .settlement .or .judgment . .

of .a .claim .

Practitioner .– .A .licensed .independent .healthcare .provider .such .as .a .physician, .dentist, .advanced .

practice .nurse .or .physician .assistant .

Severity .– .The .average .indemnity .amount .of .CNA .nurse .closed .claims .included .within .the .dataset .

Limitations The .data .analysis .within .this .report .is .subject .to .the .following .limitations .and .conditions:

– The .database .includes .only .closed .claims .against .nurses .insured .by .CNA .through .the .NSO .

program, .which .does .not .necessarily .represent .the .entire .spectrum .of .nurse .activities .and .nurse .

closed .claims .

– Noted .indemnity .payments .are .only .those .paid .by .CNA .on .behalf .of .its .insured .nurses .through .

the .NSO .program .and .do .not .reflect .additional .amounts .paid .by .employers, .other .insurers .or .

other .parties .in .the .form .of .direct .or .insurance .payments .

– The .process .of .resolving .a .professional .liability .claim .may .take .many .years . .Therefore, .claims .

included .in .this .report .may .have .arisen .from .an .event .that .occurred .prior .to .2010, .yet .closed .

during .the .period .of .the .report .

PART 1 CNA AND NSO Nurse 2015 Claim Report Update 9

Data Analysis

Analysis of claims by licensure type – Of .the .549 .nurse .closed .claims, .88 .5 .percent .involve .RNs .and .11 .5 .percent .involve .LPNs/LVNs . .

These .percentages .reflect .the .overall .proportion .of .CNA/NSO-insured .nurses . .While .the .distri- .

bution .of .licensure .types .within .the .CNA/NSO .book .of .business .varies .somewhat .over .time, .the .

current .ratio .of .our .in .force .business .represents .89 .percent .RNs .to .11 .percent .LPNs/LVNs .

– Claims .asserted .against .LPNs/LVNs .resulted .in .a .58 .percent .increase .in .average .total .incurred,

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