Growing up watching the courtroom dramas of Raymond Burr’s Perry Mason, a successful television series spanning 1957-1966 helped instill in me a lifelong interest in the legal system. Set to iconic 1960’s-era the show featured a fictional LA criminal attorney and his stylish secretary, Della Street. Together, with Private Investigator Paul Drake, countless murder mysteries were solved – all within the span of 60 minutes!

Today the legal process may include the skills of the legal nurse consultant. According to the American Association of Legal Nurse Consultants (AALNC), these registered nurses “bring specialized healthcare education and clinical experience to the medically related issues of the litigation process.” Building on the basic nursing education and substantial clinical experience, this specialty has a range of professional activities, such as:

• Educating attorneys about medical facts related to a case
• Preparing a synopsis of medical literature
• Evaluating medical care based on accepted standards of practice
• Reviewing medical records, creating chronological accounts of events

Becoming a Legal Nurse Consultant (LNC)

If you are curious in a career in the legal profession, perhaps you need to do a little more investigation. One introductory resource is the

AALNC’s Getting Started in Legal Nurse Consulting. Packed with 34 pages of information, this free download introduces nurses to the field. The booklet covers the role, responsibilities, nursing educational requirements, licensing, and certification. When the specialty was emerging, nurses just received informal, on-the-job training. The process has now matured, with many formal educational offerings and certification opportunities. If you choose to proceed, determine where you choose to practice – investigating your state’s Nurse Practice Act for specifics. LNC programs abound; listed are some of the many available options. Evaluate each for reputation, costs, profit/nonprofit status and pros/cons. Certification is not required to practice as a LNC.

American Association of Legal Nurse Consultants Founded in 1989, the AALNC furnishes information, guidance, and its Legal Nurse Consulting Online Course. Providing an interactive experience, students may purchase the modules in a package or individually. The organization’s Certification Board offers the “only legal nurse consultant exam accredited by the American Board or Nursing Specialties;” a practice exam is also available for purchase.

Established Universities In the Southeast alone, certificate options range from the traditional classroom format certificate program offered by Duke University to the online format from the University of Central Florida. The latter program offers 71 CE credits, but completion of the program does not confer the certification status. The American Association of Legal Nurse Consultants (AALNC) first requires at least 2000 hours experience working in the capacity of a Legal Nurse Consultant and a RN license before qualifying to take their 4-hour certification exam.

Center for Legal Studies offers the same content in 2 separate formats. Although the same textbook is used for each, the Center presents the content via a 5 module online course or a traditional classroom course. Founded in 1980, the Center is a legal education company based in Colorado, focused on “providing students with the most affordable and effective legal education possible.”

Vickie Milazzo Institute Combining the knowledge of her nursing and legal backgrounds, Vickie Milazzo founded the Institute in 1982, as she “pioneered the field of legal nurse consulting.” Offering a free Intro course, the Institute sells the ‘Success System’ in three levels (VIP, Executive, Basic), with optional features of either online or seminar format classes, sample business contracts and case reports, mentoring, and the trademarked CLNC® certification exam, and NACLNC® Association membership.

The American College of Legal Nurse Consulting For those who desire certification status in legal nurse consulting as conferred by the American College of Legal Nurse Consulting, online continuing education (CE) courses are offered. Students have up to two years to complete the required 4 courses, totaling 165 hours of instruction. An approved CE by the State Boards of Nursing in Florida and the District of Columbia, additional states will accept these CE credits via reciprocity; clarify details with your state’s Board of Nursing.

Moving Forward

With the complexities of healthcare, this specialty will likely expand. As with any life decision, ask for assistance. Seek out the counsel of others established in the field- doing ‘due diligence.’  Be your own Private Investigator…as you consider a career as a legal nurse consultant.

As nurse consultants working in the legal field, we often have to generate reports for our clients.  My friend, Pat Iyer, is working to educate legal nurse consultants on how to sharpen their writing skills.  She held a contest recently in which contestants were to submit their best writing tip.  The top tip was from Barbara Boschert of St. Louis Missouri.  She states,  “Whenever possible, I keep specific turning points in a box because it is a way to pull them out, set them apart, and make them a quick point of reference. ”

Questions were posed to Barbara to explain what exactly what are turning points and how she uses them in her work.  She explained that the use of this “turning point box” format only works when you are providing a narrative summary. If the legal nurse consultant is working on a chronology in table format, everything is already in boxes.  Most LNC’s have a column for comments, and one could highlight these turning points in bold italicized text and/or with a color highlight as well.

The use of “turning points”  depends on the type of case.  In a personal injury or workers compensation case, the mechanism of injury may not fit the clinical picture, so Barbara reports she might put a citation or reference in a box that demonstrates that point. Or she might find a pre-existing condition that had been missed, but has a bearing on mitigating medical specials.

In a medical malpractice case, Barbara relates a time when she found that proverbial needle in the haystack that turned the case in a favorable direction for her client.  She wanted to be sure to highlight it so she made it a stand-alone entry. Barbara also suggests that LNC’s provide a key with the report or perhaps even a separate appendix that is a fast reference tool for the attorney that helps hi,/her better understand the import of emphasized content.

I’m sure many of you have many little techniques as well that work for bringing facts to the forefront. We are paid for our time and expertise in order to save the attorney firm from having to decipher, organize, and pull out the sometimes elusive issues.  We all have ideas to get the important information up front and center.  If you have a special tip or trick that you have used with success, leave a comment and perhaps your specialty will be featured in an upcoming post.

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Are you interested in legal nurse consulting?  Are you confused about what course to take?  Have you taken a course, but yet you still feel lost?  Would you like some hands on training?

My friends, Dana and Angela, have the solution.  Their company, the Legal Nurse Consulting Institute, or LNCI, is holding a case analysis workshop next month.  They will teach you to work up a case from start to finish.  You will spend the day drafting your own analysis of a medical malpractice case.

The workshop includes examining the records and legal documents, learning to avoid beginner mistakes and gain valuable feedback all in a relaxed atmosphere.  Not only will you get a chance to practice your skills, but you will also be developing a sample work product to use in your next marketing effort.

To learn more about this workshop check out their website.  They have events coming up in June and July that you don’t want to miss.  If that isn’t enough, come join me in September as I provide the entertainment (um, I mean marketing tips) at the annual marketing luncheon at Willow Oaks Country Club in Richmond, Virginia.

What part of learning legal nurse consulting are you struggling with?  What would you like to see for an educational event?  What questions do you have about marketing your services?

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Mark your calendar. The NNBA is celebrating its 25th anniversary on Saturday night, November 6, 2010, and you are invited to the Annual NNBA Educational Conference in Orlando, Florida. The party will begin at 5:30 p.m. at the Sheraton Suites Airport Hotel.  The hotel was chosen for ease in and out of the area and you can learn more about it on their website.

This NNBA conference will present business best practices that are applicable to all nurses in business. A best practice is one that has proven to work best in this economy. The speakers will also host roundtable discussions for participants who want more details regarding the practice.  The roundtable events are some of the most popular.  You get face to face time with nurses working in the field in businesses of their own.  Best of all they are willing to freely share time tested information with  you about how you can can be a success in a nurse owned business of your own.

Topics include new social marketing tactics, including Facebook, Twitter, websites, and blogs, as well as, better practices for collecting invoices, organizing routine work, and the use of smart technology to save time and money. An expert panel will also be available to answer questions from participants.

Visit the association website at http://www.nnba.net.  I hope to see you there!

My friends, Dana Jolly and Angie Duke-Haynes, have an excellent legal nurse consulting education business.  These girls are both experiences legal nurse consultants and set out to develop affordable training through their company; Legal Nurse Consulting Institute or LNCI.  They have live, interactive classes and provide hands on practice.

Each year they host a free information session to learn more about what legal nurse consultants do and how one gets involved in the specialty.  The next free session will be held on March 18, 2010.  You can learn more about this by checking out the event page of their website.

You should RSVP by emailing Info@LearnLegalNursing.com at which time you will be given a call in number and access code.  You can also check them out on Twitter @LegalNurseEduc or become a fan of LNCI on Facebook .  Tell ‘em Victoria sent ya!

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Every time Pat Iyer offers a teleseminar, someone asks whether 60 minutes is really enough time. I can attest to you that it is not!  Pat has accumulated knowledge and practical advice from excelling as a legal nurse consultant for the last 23 years. Here is what two of my colleagues had to say about her:

“I highly respect you and your knowledge as the author of the ‘LNC Bible’.  You are very well respected.  Your legal nurse consultant basics book is just awesome for all.”
Patricia A. Coonan RN, CEN, LNC, The Beasley Firm, LLC, Philadelphia, PA

“You are definitely the one and only leading expert in the field.”
Dolores Austin JD RN, Phoenix, AZ

Pat Iyer is ready to share her secrets with you in a no charge teleseminar. The topic is: How to Stand Out in a Crowded Field. There are still a few lines left for this teleseminar. It is happening tomorrow, Thursday, February 25 at 8 PM Eastern, 7 PM Central, 6 PM Mountain and 5 PM Pacific. You can get all of the details and register right now by going to this page.

Remember, there is no charge for this teleseminar.

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The lines for this call filled up the day after it was announced, so Pat Iyer has doubled the capacity. If you still want to join and haven’t registered yet, there are about 25 slots left. Pat is ready to share her secrets with you in a teleseminar on Thursday, February 25 at 8 PM Eastern, 7 PM Central, 6 PM Mountain and 5 PM Pacific. The topic is: How to Stand Out in a Crowded Field. The time for you to take action is now!

Here are 12 reasons why you should reserve your spot today…

You will learn about:

• the most important skill you need to get and keep your foot in the door of your clients
• the essential things you can do to make more money
• how this skill will gain you more work, more income, reduce frustration and gain more referrals
• why spending money on marketing is a huge waste of your valuable time and money unless you improve this skill.
• why attorneys put great emphasis on this skill
• how to avoid frustrating your client and harming your reputation
• if you can’t do this, you could be unknowingly making mistakes that cost you money and clients
• how to fix a flaw that will cause you to be instantly lose clients
• how to increase personal success through the ability to motivate, persuade, communicate with or assure others
• how to gain respect and job security by making sure your skills are valued by clients, an employer or insurance company
• how to succeed in a knowledge-driven industry
• how to save time and prevent misunderstanding

This call could change your practice forever.

Want to be part of this no-charge teleseminar? Go here:

Pat is the real deal.  I have had the pleasure of working with her and I recommend you get on this call.

Here are the details.

Date: February 25, 2010
Time: 8:00 PM – 9:00 PM Eastern, 7:00-8:00 Central, 6:00-7:00 PM Mountain, 5:00-6:00 PM Pacific

Cost: FREE

Free teleseminar: How to Stand Out in a Crowded Field
To sign up for this fantabulous free event, just click here.

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A former military surgeon accused of falsifying medical research received more than $780,000 from Medtronic between 2001 and 2009, according to information released on Wednesday by the company. Medtronic said the payments to Dr. Timothy R. Kuklo were reimbursement for travel expenses, speaking engagements, training other doctors or other consulting services. The Justice Department is currently investigating whether Medtronic paid doctors like Dr. Kuklo to help market medical devices for unapproved uses.
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Settlements that Travelers Companies Inc agreed to in 2003 and 2004 to resolve asbestos-related claims were wrongfully overturned by an appeals court, the U.S. Supreme Court has ruled. When the $500 million settlement was reached, it included a provision barring all future lawsuits relating to Johns Manville Corp, an asbestos mining company that Travelers insured for more than 30 years. In the earlier decision by the appeals court, the settlement was overturned because the court ruled the bankruptcy judge wasn’t authorized to prevent new suits.  James Vicini, Reuters 06/18/2009

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A state ban on allowing registered nurses to provide expert testimony has been overturned by the Pennsylvania Supreme Court. The impact of the decision may be limited because of 2002 legislation known as the MCARE Act which requires expert witnesses in medical professional liability cases to be a registered physician or a recent retiree. However Justice Debra Todd noted that MCARE does not apply to other cases, such as other professional liability cases or criminal cases.

Read in Law.com

And from Sullivan v. Edwards…

AANA persuasively reasons:

“A physician, who is not a nurse, is no more qualified to offer expert, opinion testimony as to the standard of care for nurses than a nurse would be to offer an opinion as to the physician standard of care. *** Certainly, nurses are not permitted to offer expert testimony against a physician based on their observances of physicians or their familiarity with the procedures involved. An operating room nurse, who stands shoulder to shoulder with surgeons every day, would not be permitted to testify as to the standard of care of a surgeon. An endoscopy nurse would not be permitted to testify as to the standard of care of a gastroenterologist performing a Colonoscopy. A labor and delivery nurse would not be permitted to offer expert, opinion testimony as to the standard of care for an obstetrician or even a midwife. Nor would a nurse be permitted to testify that, in her experience, when she calls a physician, he/she usually responds in a certain manner. Such testimony would be, essentially, expert testimony as to the standard of medical care.”

Scholars share this reasoning:

“Physicians often have no first-hand knowledge of nursing practice except for observations made in patient care settings. The physician rarely, if ever, teaches in a nursing program nor is a physician responsible for content in nursing texts. In many situations, a physician would not be familiar with the standard of care or with nursing policies and procedures which govern the standard of care. Therefore, a physician’s opinions would not be admissible in jurisdictions which hold the expert must be familiar with the standard of care in order to testify as an expert. An example of a common situation which gives rise to allegations of nursing negligence occurs when a nurse fails to follow the institutional ‘chain of command’ in reporting a patient condition to a physician who subsequently refuses to attend to the patient condition. It is unlikely that a physician would be familiar with the policy and procedure involved in handling such a situation. It is as illogical for physicians to testify on nursing standard of care as it would be for nurses to testify about medical malpractice.” E. Beyer & P. Popp, Nursing Standard of Care in Medical Malpractice Litigation: The Role of the Nurse Expert Witness, 23 J. Health & Hosp. L. 363, 365 (1990).

This scholarly insight has spread to litigators:

“Testimony from a physician about the standard of care may be subject to objection because the physician is not a nurse and does not have direct knowledge of nursing standards of care. A physician’s statement that he or she often observes nurses and therefore knows what they do may be inadequate.” P. Sweeney, Proving Nursing Negligence, 27 Trial 34, 36 (May 1991).

Beyond scholars and litigators, courts have begun to accept this reasoning.

In some jurisdictions, “the physician is no longer permitted to testify about the nursing standard of care since the physician is not a nurse and does not possess direct knowledge of nursing standards.” F. Cavico & N. Cavico, The Nursing Profession in the 1990′s: Negligence and Malpractice Liability, 43 Clev. St. L. Rev. 557, 578 (1995); see Dolan v. Jaeger, 285 A.D.2d 844, 846, 727 N.Y.S.2d 784, 786-87 (2001) (upholding trial court’s dismissal of nursing malpractice action where physician anesthesiologist was only expert to testify as to nurse’s standard of care); Vassey v. Burch, 45 N.C. App. 222, 226, 262 S.E.2d 865, 867 (“Although the affidavit of [the physician] may be sufficient to establish the accepted standard of medical care for a doctor in his office, it does not establish the standard of care for a nurse in a hospital”), rev’d on other grounds, 301 N.C. 68, 269 S.E.2d 137 (1980). According to one scholar:

“These cases represent a growing recognition on the part of courts that nursing, as a profession, has moved beyond its former dependence on the physician, and into a realm where it must and can legally account for its own professional practices. In doing so, the experts who provide the testimony, and the literature from which their opinions are derived, come from the nursing profession.” C. Kehoe, Contemporary Nursing Roles and Legal Accountability: The Challenge of Nursing Malpractice for the Law Librarian, 79 Law Libr. J. 419, 428-29 (1987).

Based on this reasoning, AANA argues that Dr. Barnhart should not be permitted to offer expert testimony against nurse Lewis based on his observation of nurses.

We agree. By enacting the Nursing and Advanced Practice Nursing Act (225 ILCS 65/5-1 et seq. (West 2000)), the legislature has set forth a unique licensing and regulatory scheme for the nursing profession. As AANA observes, under the nursing act, a person with a medical degree, who is licensed to practice medicine, would not meet the qualification for licensure as a registered nurse, nor would that person be competent to sit for the nursing license examination, unless that person completed an accredited program in nursing. See 225 ILCS 65/5-1 et seq. (West 2000). The appellate court in this case correctly reasoned:

“Dr. Barnhart is not a licensed member of the nursing profession. To allow the doctor to testify as to the standard of care applicable to the nursing profession implicates the risks raised by Dolan, namely, the imposition of a higher standard of care and the muddling and mixing of various tenets and practices unique to each profession.” 335 Ill. App. 3d at 272.

‘Nuff said!

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