Nurses Charting a New (Legal) Course
Monday April 1, 2002
Print This- Select Text Size:
Comments
advertisement
Recognized as a nursing specialty, the field of legal nurse consulting is rapidly growing in popularity as a career choice. In fact, while hospitals and other healthcare providers are finding it hard to find nurses to fill vacant positions, the American Association of Legal Nurse Consultants (AALNC), reports an astounding growth in recent membership - with most of its 4,000 members joining since 1998.1
Initially, nurses were primarily involved in medical-legal cases as expert witnesses. But, since that early beginning, their role has expanded. "The field is definitely growing as attorneys are realizing the skills nurses can bring," Fitch says, "plus they find our services to be cost-effective, especially in determining whether a case has merit." Litigation, Fitch explains, is always done on a contingency basis, so attorneys can avoid incurring costs that could not be recovered if they proceeded with cases that lack merit.
As a legal nurse consultant (LNC), Fitch uses her healthcare knowledge and expertise to consult on medical-related cases. Although LNCs are best known for their expertise in reviewing medical records, there are many more ways that they are involved in medical-legal cases, including conducting research and summarizing medical literature; interviewing clients; identifying and retaining expert witnesses; educating attorneys regarding medical facts and issues pertinent to the case; assisting with depositions and trials; and serving as a liaison between clients, attorneys, and physicians.
Are You and the Law a Good Fit?
Fitch recommends that nurses who may be interested in this specialty have at least five years of nursing experience. Although a varied nursing background can be helpful, experience in any field of nursing is relevant. "Our nursing education and experience gives us the ability to understand the medical record," she says, "and while we do not address medical standards of care, we can point out discrepancies to the attorney."
To be successful, Fitch says you must be able to work independently, be a self-starter, and feel comfortable making decisions. "One of the main points is analyzing and being able to identify weaknesses or strengths," Fitch explains, "depending on whether you are working for the plaintiff or defendant." Excellent reading and writing skills and the confidence to talk with experts are also key to a successful practice.
"You must also move from an advocacy role to one of education," says Vickie L. Milazzo, RN, MSN, JD, founder and president of Medical-Legal Consulting Institute Inc., in Houston. "In reviewing a case, you will need to critically think and be very analytical. To be effective, Milazzo adds, an LNC must look at both sides of a case. "You must be able to argue from any angle," she says, "then you must be able to communicate these views to the attorney."
Part of the analytical process that is often difficult is removing your own preconceptions. Milazzo offers an example: "You may look at a case where staffing is an issue, and your personal belief is that the staffing pattern was not sufficient. However, to be effective as an LNC, you must remove your personal attitude and look at the standard without any personal bias."
LNC vs. Paralegal
When Milazzo began teaching RNs how to become legal nurse consultants in 1985, she says the role of a nurse within the framework of working with attorneys was clear. But in 1998, the American Bar Association (ABA) decided that "...legal nurses and legal nurse consultants fall squarely within the ABA definition of paralegal/legal assistant..."2 This, Milazzo says, has blurred the role of LNCs and threatened the integrity of this relatively new practice. "If the option is given to the attorney," Milazzo says, "of course, the attorney will choose to place LNCs in the lower paying role of a paralegal.
"We have the right to define who we are, and remember that the reason an RN interfaces so well with the legal profession is because the LNC focuses on core competencies," Milazzo says. Although there is a clear need for paralegals within a law practice - to conduct legal research, do assistant work, and arrange scheduling - this role does not apply to nurses. "We need to be remunerated commensurately with the professional skills that we bring to this work," Milazzo explains. Although paralegal-based nurse consultant courses are available, Milazzo says these courses promulgate the view of a paralegal rather than that of an LNC.
Is Independent Practice Right for You?
The work may sound fascinating and the salary excellent. However, it is important to know that although an LNC with an independent practice can draw $75 to $150 an hour, an in-house LNC will receive a salary similar to that of an RN working in a hospital. Part of the equation in choosing which is best for you is whether you can financially afford to open your own practice. "Realistically, you will need several thousand dollars to start," Milazzo says, "but remember that in setting up your office space you do not need state-of-the-art equipment. The important thing is getting out there, marketing yourself, and getting business."
For Kathy McDiarmid, RN, LNC, in Manchester, MA, starting part-time seemed the best way to stay afloat while she built her consulting business. "I estimate that it will take between five to seven years to build a full-time practice," McDiarmid says, "so, for now, I work for MassPro, the state peer review board." She conducts medical record reviews for Medicaid, so it blends well with her legal nurse consultant background. "This work allows me an opportunity to review records from many hospitals," McDiarmid says. This, she believes, will continue to hone her skills while she builds an independent practice.
Having completed the LNC course, McDiarmid then came up with her company name, Baseline Consulting Services Inc. She gathered resources, researched mailing lists, and developed a packet that outlines the services she could provide as an LNC. "After I mailed out the information, I followed up with phone calls," she says. This brought consulting work that she does during evenings and weekends for now. Her next goal is to become certified through the AALNC.
For those who may consider independent practice, McDiarmid recommends finding a position that involves chart review, and "to realize that if you want your own practice, you must be prepared to do whatever it takes."
Starting your own business takes patience and persistence, but those who choose independent practice say it is well worth the effort. "The pluses of this work are that you have autonomy, flexibility, and control over your own career," Milazzo says. "You also have the ability to make a difference and see the impact of that difference."
Whether an LNC chooses private practice or a position with an attorney or company is a personal choice, but whatever the decision, the reality is that this nursing specialty offers many new and interesting career options.
Reader Comments
Login