Unexpected Considerations for Nurse Practitioners Volunteering Abroad
Whether you are a seasoned nurse practitioner or a new grad looking for an adventure, volunteering abroad is a great experience that is not only beneficial to you, but greatly to the people you’ll help. Underserved communities throughout the developing world are in need of nearly every type of healthcare service, from vaccines to basic health care exams. But lack of access to advanced healthcare as well as extreme poverty make it difficult for people in many countries to get the healthcare services they need.
While you may feel the call to serve in impoverished countries, stepping outside of your comfort zone and taking your medical skills outside the US can be daunting, especially when considering what protections you’ll have as a foreign medical provider. Here are five considerations you should make before volunteering internationally.
1. Understand the risks of medical error associated with volunteering abroad
Simply put, volunteering abroad as a nurse practitioner has the potential to cause accidental harm to those in need. No matter how well meaning your efforts are, unfamiliarity with the patient population and their medical histories, the language barrier, and limited resources all increase your risk for medical error.
In addition, the country where you’re volunteering may be largely unregulated, and as such you may be tempted to practice skills and techniques that are beyond your level of training. Practicing within the scope of your practice, however, is an ethical responsibility that will benefit both you and the patient, thus reducing your risk of being held liable in the event that something goes amiss.
2. Educate yourself on the legal framework in the country you’re volunteering in
While there is not standard international law that protects volunteers and medical malpractice laws in the developing world are overall weak, the country in which you’re volunteering in may have specific legislation in place that would provide you with protection in certain circumstances such as disaster relief. Though most developing countries have a very non-uniform approach to the legal protection of volunteers, many jurisdictions have general exemptions from liability for acts carried out in good faith.
3. Discuss malpractice coverage options and recommendations with the sponsoring organization
Talking with your sponsoring organization about how they’ll protect you or what they recommend will give you a better idea of whether or not you need to purchase additional malpractice coverage. They may also inform you of the laws in place in the country where you’ll be volunteering and how they apply to you as their agent.
Bear in mind that most organizations do not provide medical malpractice coverage for volunteers under the pretense that coverage is not necessary because the likelihood of a lawsuit is insignificant. And many organizations will eliminate the need for litigation by proactively offering settlements to families. However a few organizations, such as Doctors Without Borders, will provide professional liability coverage for field staff in addition to other benefits like health insurance, accident insurance, private liability, repatriation and flight insurance. Coverage from sponsoring organizations is really hit or miss.
4. Determine if additional malpractice insurance is beneficial to you
While some case law studies have found that there have been no active or past cases of medical malpractice against providers who have volunteered internationally, others have found evidence of a few cases and settlements; the highest being a $500,000 settlement in Kenya. Overall, evidence of malpractice suits against US volunteers is virtually nonexistent as patients in developing countries often do not have the resources to pursue justice, and as such many prefer to settle their disputes informally, with settlements generally being in the thousands of dollars.
In general, malpractice claims are uncommon against American providers volunteering their services overseas for free or at minimal charge and typically, volunteers are protected if they can show that they acted in good faith, within their scope of practice, and without any indirect or improper motive. It’s because of these factors that many providers choose to travel without liability coverage. However the decision to travel with or without liability insurance is really an individual decision that should be made by evaluating whether the risks outweigh the benefits and costs of obtaining additional coverage.
5. Understand malpractice coverage options available to medical volunteers
Self-insured entities such as academic and large private hospitals may provide coverage on an individual basis for an international medical mission, whereas only about half of commercial insurance carriers in the US market offer coverage to providers volunteering internationally. Of the commercial companies that do offer coverage, most do not offer stand-alone policies for humanitarian missions and such coverage is only available in the form of specialized policies, which have limitations to coverage and high premiums. If you are able to purchase separate coverage for your trip, be sure to carefully review and understand the conditions, exclusions and terms in order for coverage to be effective.
If your insurance carrier does not provide such coverage, and you do determine that the costs and benefits to carrying an additional policy outweigh the risks of not doing so, there are a handful of companies that provide policies that are specifically for short-term medical outreaches.
Before practicing in foreign territory, it's important that nurse practitioners consider the legal implications of doing so and prepare for them ahead of their trip.
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