Long term care is a highly litigated area of health care. As a legal nurse consultant (LNC) without a clinical background in long term care, I had to educate myself on this specialty. The nursing tasks were familiar but the chart was not. As I worked on more of these cases, I came to rely upon a uniform set of documents that provided a good starting point for LTC case analysis: Minimum Data Set (MDS), Resident Assessment Protocols (RAPs) and the Care Plan. Starting my analysis with these documents gave me information on baseline function, skin condition, cognition and more. From there, I could wade through the piles of nurses’ notes, nursing assistant checklists and medication administration records looking for the details I needed to provide my clients with the meaningful tool they required to litigate the case.

History

In 1987, Congress passed the Omnibus Budget Reconciliation Act (OBRA). This legislation set specific standards for all Medicare certified skilled nursing facilities including a detailed assessment of the patient that was linked to their plan of care. What came out of this legislation was the Resident Assessment Instrument (RAI). Don’t let all the acronyms confuse you. The RAI standardizes communication regarding the person’s medical problems and conditions both within the LTC facility and to outside healthcare providers. The RAI enables the nursing home to track changes in a patient’s status and evaluate their individualized plan of care. So, you can see how the RAI is a great place to start a medicolegal analysis.

Specific Documents of the RAI

•     Minimum Data Set (MDS) provides a detailed assessment of the patient that is linked to that person’s individualized plan of care. The MDS includes information on people’s cognitive and functional abilities along with their physical condition. The MDS is a goldmine for a LNC. One of the best things about the MDS is consistency throughout all facilities in the United States. Of course, there is a twist to this. A revision of MDS – MDS 3.0 – was rolled out in late 2010 with an expanded section on skin conditions. It is critical to analyze cases according to the standard of care in place at the time of the alleged negligence. If the events took place in 2010, the new MDS 3.0 would not be applicable. Please refer to Angie Duke Haynes’ article devoted specifically to this new version of MDS.

•     Resident Assessment Protocols (RAP) is the next step in the RAI. Based on the MDS, certain protocols are triggered. Think of these as “problems”. Included in these protocols are risk factors that prompt care planning. A RAP summary is part of the MDS. It is a checklist and includes which RAPs are triggered, date of assessment documentation and where that document is located in the record, i.e. speech therapy note. Again, this form is consistent among all facilities in the U.S.

•     Care Plan – There is nothing new or different about a LTC care plan. Nurses in all specialty areas assess, plan, implement and evaluate based on the individual patient’s needs. The key in long term care is to review the care plan to ensure it is consistent with the MDS and RAP. As with all case analysis, the care plan is reviewed to ensure the nursing staff identified issues and appropriately provided interventions and evaluated those interventions.

Practice Pearls

•     Educate yourself if this is a new area of nursing for you. Utilize resources such as National Pressure Ulcer Advisory Panel (NPUAP), Agency for Healthcare Research and Quality (AHRQ) Clinical Practice Guidelines, RAI User’s Manual and The Long Term Care Survey. Be careful to use resources during the time for which the alleged negligence took place.

•     Compare the MDS to the RAPs and the care plan. Is the information consistent? Then compare the clinician progress notes including therapy notes. Note relevant inconsistencies in your analysis.

•     Were changes in function or cognitive status identified appropriately? Was the plan of care adjusted based on the change in status? Where is the evidence to support or refute the standard of care being met?

Written by Dana Jolly, BSN, RN, LNCC, is Principal of Jolly Consulting, LLC.

To learn more about these specialty documents and to create your own long term care case analysis, please join Angie Duke Haynes, Pat Iyer and Dana for a multimedia course on writing skills and long term care case analysis on February 1 and 8, 2012.

Check out details for the Polish Your Writing Skills Multimedia Course and other helpful resources here.

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Legal Nurse Consultants bring value through their work product. Will an attorney judge you by your ability to write? You better believe it! You will not be able to get your foot in the door unless you can present yourself in a professional manner. You won’t get chosen over your competitors if you don’t shine in the one chance to show your value to your clients. Making a lasting impression can turn a one time client into a customer for the lifetime of your business.

One of my pet peeves is hiring subcontractors who can’t write professionally. I hire nurses to help me with the work load, but then I end up rewriting their reports because they are so poorly composed that I refuse to allow it to go out from this office. If I am constantly rewriting the reports, what help was the nurse contractor?

Check out this interactive multimedia course, Polish Your Writing Skills,scheduled for Feb. 1 and 8, 2012. There will be three sessions between 11 AM and 5 PM on Feb. 1 with a follow up session from 8 to 9 PM on Feb. 8. Experienced LNCs Dana Jolly, Angie Duke Haynes and Pat Iyer will present the course.  The attendee will review records of a medical malpractice case and be guided by experts through the process of case analysis to develop your own detailed comprehensive report. You will learn how to avoid common mistakes and hone your analytical skills to produce a report that your client will depend on throughout the litigation process. Never leave your home or office. All you need is a computer.

All course participants receive access to the multimedia course, digital downloads of medical records and course recordings, transcripts of each session, and 10 bonus articles.
The early bird price for the course is just $127.   In addition to the course itself, an optional critique can be added plus bonuses to make any legal nurse consultant more confident when writing reports. Visit this website for all the details. The early bird registration expires on Monday, January 16 so hurry and register s

Image via Wikipedia

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I previously mentioned a new life care planning course by FIG Services. I personally have not participated in this particular course though I have attended other educational offerings from Shelene Giles.  That being said, the course is apparently a big hit.  Here are some recent testimonials from those who have attended.

“Two weeks ago I had the opportunity to participate in FIG Services Nurse Life Care Plan Course.  This was the onsite legal section of the 120 hour course.  The group was intimate and small with lots of one on one interaction.  There was role playing performed, case studies presented, and templates were provided as tools for one to use in their practice.  Difficult topics were presented in (qualifying as expert witness and testifying) a non-intimidating manner.  All agreed it was an excellent program in which they learned invaluable education to use in their own practices.  The next legal section of the 120 hour course is scheduled for July in Asheville, NC.  Check out the website for further information. http://figservices.com”

Kim Wages, BBA, BSN, RN, CNLCP, MSCC

“I attended the same conference and have high praise for this course.  It exceeded my expectations in every way.  I felt prepared with the tools presented to develop a life care plan from beginning to end.  FIG services has developed a 120 hour course that addresses all of the elements necessary for a detailed and thoughtful life care plan.  Shelene Giles’ teaching style was extraordinarily conducive to the adult learner’s needs.  The break-out sessions with instructors were relaxed and supportive of all questions and learning needs.  Prior to this course, I had never had the privilege of attending a course so dedicated to each attendee’s individual knowledge level.

I completely agree with Kim’s assessment of the complex topics that were addressed in a safe environment.   The small group allowed for valuable interactions.  I learned a great deal on how the legal system views qualifying as an expert witness and the anxieties related to depositions and trials.

If you attend no other course in 2011, I suggest you invest in this one.  You won’t be disappointed.”

Penny G. Cates RN, BSN, CLNC, MSCC

Cates Consulting Group

Image by Getty Images via @daylife

Dana Jolly, BSN, RN, LNCC, Principal, Jolly Consulting, LLC & Legal Nurse Consulting Institute, LLC and co-presenter of an all new webinar on polishing your writing skills. For more info visit the information link here.

The first report a LNC produces for a new client is equivalent to a first impression. We all know how important first impressions are. For LNCs, they can have even more significance. A good report highlights the value of a LNC. It can launch a LNC career, revive a struggling LNC practice or expand a growing LNC practice. Busy litigators are only going to give LNCs one chance to make a good impression through their work product.

LNC clients need to be able to “hit the ground running” with the medical facts. They need a tool to quickly identify the medical facts and understand the implications of those facts on their case strategy. Analytical and writing skills are critical in developing such a tool. A poorly written analysis does not help the client. The client won’t see the value the LNC brings to the litigation team and in all likelihood, that LNC won’t be given another chance. So, how does a LNC write a report that will WOW their client turning a one-time client into a customer for life?

Here are a few tips on performing spot-on case analysis to get started.

1.    Remember the purpose of the report.

I think of this as the bottom line of the report. What is it the client needs to know? Identifying the issues of the case with the client ensures the LNC will deliver the information the client seeks.

2.    What format does the client prefer?

Some LNC clients won’t have a preference. If they do, of course follow it (at least for the first report). If the report is a narrative account of the facts, it should read like a story. Other formats include tables, bulleted lists, and timelines. Regardless of how the information is presented, objectivity and brevity are paramount.

3.    Be clear on deadlines.

When does the client expect the report? It is always good when a LNC can exceed the client’s expectations. One way to do this is to produce a report ahead of the deadline.

4.    Develop a system to review medical records

Identify relevant providers from whom records should be requested/subpoenaed. Organize those records chronologically and provide the client with an easily navigated set of all provider records.

5.    Draft the report.

The first task is identifying relevant medical facts found in the medical records. Focus on critical documents/facts identified by the issues in the case. For example, if the case involves an organ injury during surgery, chances are EMS and ED records are not critical. The next task is the analysis portion of the report.  Analysis uses the LNC’s informed opinions. Begin analysis by focusing on the purpose of the report. For example, medical malpractice analysis focuses on the delivery of health care and its outcomes. Personal injury analysis focuses on related injuries. Analysis also includes the impact of injuries, significance of preexisting conditions, and discrepancies/inconsistencies. Address central issues in simple terms. Do the medical facts support the plaintiff’s allegations? Remember, the report is a communication tool. Be sure it is easy to understand. Always keep the end in mind – how will this report be used by your client?

Learn how to WOW your clients and check out this information about an all new webinar on how to polish your writing skills.

See http://www.patiyer.com/vp for details.

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Image by churl via Flickr

As a college student we have all spent many hours laboring over term.  Hours of research were followed by many more hours of writing, and rewriting, and rewriting again.  Then more hours might be spent stretching the material into the minimum number of pages required.  Then to finish up the paper by citing the references appropriately would cause a sick feeling in the pit of my stomach and a panic as time was running out.

A legal nurse consultant one will be required to write regularly for their attorney clients.  That writing could be a report, a chronology, a timeline, letters, or even emails.  The writing style for the college professor is quite different that writing for an attorney.  The table below gives a quick summary of some of the differences between the two.

Both your professor and your attorney client are interested in clear writing that conveys information in a meaningful way.

Learn more about how to WOW your client by checking out this information about an all new webinar on how to polish your writing skills.

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When I am looking for a nurse expert or even a subcontractor, I am often amazed at how many nurses do not know the difference in a C.V. and a resume.  When it comes to locating a professional nurse, a curriculum vitae is expected.  My friend, Pat will go over the details of the CV as part of a new writing skills workshop along with many other tips, hints, tricks of the trade and things that make the attorneys say “Wow!”  Here is a few tips to whet your appetite.

1.      Choose between a resume and a curriculum vitae (C.V.). A resume is a brief (no more than 1-2 pages) summary of your educational and employment history. A C.V. is a longer and more detailed description of education, employment, awards, honors, publications, membership in professional associations, and offices held. To properly demonstrate expertise, legal nurse consultants and expert witnesses are more likely going to prepare a C.V.

2.      In your C.V., include the important and basic information. Don’t overlook adding your phone number and email, as well as an address.  Avoid adding extraneous details such as religious affiliation, names and ages of children, hobbies and interests.

3.      List each of your jobs in reverse order, starting with the most current job. Include the starting and ending years, the name of the employer, your title, and a brief description of your job responsibilities and accomplishments.

4.      Look at your background through the eyes of the attorney who is reviewing your credentials. Stress your clinical experience if you are seeking work as an expert witness. Avoid stating you serve as an expert, as this makes you look like a hired gun.  Avoid including education you completed to become a legal nurse consultant if you are seeking expert witness work, as this may make you look like a “legal nurse” rather than a “clinical nurse”.

5.      Design your C.V. to make good use of white space, bold, and serif fonts. For example, don’t crowd your C.V. by using a small font. Allow one inch margins all around. Place bold on the names of the places where you worked, and then unbold your job description and accomplishments. Use a serif font (with little feet) rather than a sans serif font. Serif fonts are perceived as friendlier. Avoid difficult to read fonts.

6.      Thoroughly proofread your C.V. and ask another person to check it as well. Typos on a C.V. can be enough to take you out of consideration for being hired. Check dates carefully. If you worked in more than one place during the same time frame, place (part time) after your position to help someone who is reviewing your C.V. understand the overlap. Otherwise, your overlapping dates may be seen as typos.

7.      Keep your C.V. current on an ongoing basis. It is far easier to produce an updated C.V. in a hurry than it is to have to make changes under pressure.

The one thing I would add is to always date your CV. This way if an attorney asks you something under oath about an item on your CV that is no longer relevant you can ask what date that CV has on it and compare with the current version. This is a tip also recommended by SEAK.

For more tips on writing resumes and C.V.s, and to learn how to WOW attorneys, check out this information about an all new webinar on how to polish your writing skills.  See this link for more details.

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Alice Adams is a legal nurse consultant who has found consulting work and met new clients using LinkedIn, the world’s premier business marketing network.  If you find yourself terrified at the thought of cold calling or having a difficult time trying to find a non-intrusive manner in which to market, Ms. Adams might just have the answer.

Ms. Adams is one of the experts presenting in the upcoming marketing course specifically for attorneys and legal nurse consultants. In the section, Reaching Out with LinkedIn,you will learn how to create and maintain a profile that is essentially an online c.v., resume and marketing tool.  Edit your profile as often as you like, at no charge. Join groups that are likely to have members who can utilize your services and add them to your personal connections.  You can link to your personal website, blog or any Internet-based enterprise that you want to promote.

Do you want to be seen as an authority in your area of expertise? Set up your profile so that new discussions and questions from your group come into your email as they arise. Too much email? Change your preferences to group this data on a daily or weekly basis.

Facebook and Twitter are wonderful social media tools, but too often the communication is of a personal nature that is not well suited to making serious business connections. However…LinkedIn is designed to work with all major social media markets. Tweet a news article and benefit from both markets.

With LinkedIn, you can update all your connections effortlessly about your professional achievements. If you have a blog elsewhere on the web, there’s an application for that – use BlogLink so that new entries automatically appear on your profile page.  Are you teaching or attending a seminar? Post this as a discussion so that all will know instantly what you are up to. Do you have a networking event for your association that would interest your contacts? Announce that event and your contact information under Discussions. Have you read an interesting article on a medical condition, a relevant jury decision or a change in the law? Post it.

Use LinkedIn to find expert witnesses in any area – medical, dental, nursing, environmental, engineering – there is one (and usually more) specialty group for any expertise.

Instead of emailing your resume and achievements to new prospects, send them a link to your profile.

Have you done exceptionally good work for an attorney or other referral source? Ask them for a recommendation that will be publicly posted on your profile. Accordingly, make a recommendation for that person – this benefits both of your practices.

Would you like to know when your contacts change jobs or move to a different firm? LinkedIn will tell you automatically.  Have they announced a favorable decision in court, written a compelling blog or article, voiced opinions on topics that you can relate to – think of the opportunities you are missing without even knowing it.

Marketing is so much more than telling people about you. Frankly, they would rather hear you talk about them.  Instead of asking bland and blind questions, read someone’s profile and background. Communicate to them that you have invested time in them as individuals, and make the contact count by jumpstarting conversations with personal knowledge.

Joining LinkedIn, creating a profile, and growing your network is free. A nominal monthly fee will give you invaluable access to connections, groups, in-mail messages and introductions.  As new nurses to the business world, we often ask ourselves, “How can I afford to (have business cards, get another phone line, buy copiers, printers, scanners, fax machines, send out brochures) start this new business of mine? With LinkedIn, the only question is, “How can you afford not to?”

Join Alice Adams and others like myself as we explore different marketing options for the business owner.  It isn’t all about the handshake and the telephone call anymore!

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Nurses often ask how they can get started in legal nurse consulting.  In fact, I am scheduled to hold an informational call with an interested nurse this week.  If you are one of those who is interested in this field and want to know more, I have just the thing for you.  Best of all it’s FREE!

Thursday, February 17 from 2-3pm CST
Speakers: AALNC Board of Directors
Topic/Title: So You Want to be a Legal Nurse Consultant? The Real World: Fact or Fiction
Price: FREE!
Are you currently a practicing nurse, or looking for ways to turn your nursing knowledge into a new career? Then you may want to explore becoming a Legal Nurse Consultant (LNC). The American Association of Legal Nurse Consultants (AALNC) wants to help jumpstart your LNC career with a FREE Webinar on February 17, 2011 at 2 pm CST.

Members of the AALNC board of directors will serve as expert panelists for this Webinar. They will discuss opportunities for LNCs, provide insight on how to become an LNC, and share their own personal success stories.
Learn how your experience is applicable to this Nursing Sub-specialty.

Learn how your experience is applicable to this Nursing Sub-specialty.

The following members of the AALNC Board of Directors will serve as the speaker panel for this presentation:

Karen Huff, BSN RN LNCC
Practice Setting:
*In-house LNC for large defense firm

Practice Areas:
*Medical Malpractice Defense
*Long Term Care / Nursing Home Litigation Defense
*Personal Injury Defense
*Deliberate Intent / Workplace Injury
*Civil Rights / Police Defense

Sharon McQuown, MSN RN LNCC
Practice Setting:
*In-house LNC for plaintiff firm in Dallas, Texas

Practice Areas:
*Personal Injury
*Medical Malpractice
*Drug Liability

Barb Boschert, RN BSN
Practice Setting:
*Currently works in-house in an LNC firm that provides a wide array of consulting services.
*Previous experience includes independent as well as in-house, (both plaintiff and defense)

Practice Areas:
*Med Malpractice
*Personal Injury
*Workers Compensation
*Long Term Care

Elizabeth Zorn BSN RN LNCC
Practice Setting:
*Currently in house LNC for a Plaintiff firm in Rochester, NY
*Prior experience as in house LNC for a defense firm in NY

Practice Areas:
*Medical Malpractice
*Products Liability
*Toxic Tort
*Personal Injury

If you are interested and want to register, you can find the registration form on the AALNC website.

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So many nurses struggle to get their consulting business off the ground.  Everyone starts out with high hopes, big dreams and lots of energy, but somewhere along the line it all peters out.  Some of you may need a push to get back into the game.  This training is not just limited to legal nurse consulting either!  If your desire is to consult with the legal industry, here is just what you need…

Learn from the experts. How do you get your foot in the door with new clients? You will learn how to use the power of social networking to get business, to build relationships with attorneys, to effectively use a website and blog for reaching clients (which I am teaching), to exhibit in a cost-effective way at attorney conferences, to present an educational session to attorneys, and to get past the gatekeeper when you call an attorney’s office.

This course was put together by Pat Iyer, a legal nurse consultant since 1987 and past president of the American Association of Legal Nurse Consulting. Her 6 week online marketing course is designed to help legal nurse consultants reach their audience. She has assembled a panel of experts to provide weekly one hour long webinars specifically on marketing strategies. The presenters come from the world of legal nurse consulting and business. All you need is a computer, phone line or headset to join in. See this link for details. www.patiyer/lncvp

Everyone who purchases this course will receive directions to participate in the live call, a transcript, and a replay link. That way you can re-watch a session or view the recording of one that you might have to miss. www.patiyer/lncvp

Purchasers will receive a 25% discount on the book, Marketing for the Legal Nurse Consultant, a classic by Betty and John Joos.

Join those who have already enrolled for this invaluable course. Enroll today! The first session starts January 19. Get details at www.patiyer/lncvp

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