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Original Articles

Always a Nurse

The Legal Nurse Consultant

Howland, Wendie MN, RN-BC, CRRN, CCM, CNLCP, LNCC

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Nursing Administration Quarterly: January/March 2020 - Volume 44 - Issue 1 - p 71-73
doi: 10.1097/NAQ.0000000000000402
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If a profession is defined by mere motor skills, we would be calling surgical robots professional. No, a profession is much more than the practice of motor skills. It is a host of characteristics like extensive education, a code of ethics, autonomous setting of standards for practice. Nursing is usually counted among the “learned professions” like law and medicine.

—Leslie Durr, PhD, RN, PMHCNS-BC-Retired

I'M A LEGAL nurse consultant. No, not the kind you see in those breathless advertisements, though I do work with attorneys and others to help them understand medical issues they encounter in their work. Let me tell you a little bit about how I got here, and about the many, many ways a good nursing education and background can open doors for you in unexpected ways.

I went to a university nursing program right after high school, decades before the BSN boom, graduating exactly a century after the first school of nursing (Bellevue Hospital in New York City) in the United States opened, and when associate degree programs were just making an appearance as an alternative to the hospital schools of nursing that defined nursing education since then. I got hooked on critical care and nursing autonomy as an undergraduate in a public health rotation where we worked with nurse practitioners (a totally new role) and got to play with a little hemodynamic research in intensive care unit. I worked in critical care areas for 7 years before realizing I had to go to graduate school if I wanted to teach (I did). Again, I was way ahead of the curve on MNs in the United States. I kept on working at the bedside and teaching undergraduates in laboratory, clinical, and lecture (didactic). I became a critical care clinical specialist before that designation had formal criteria, too, and did that for 6 years, then got rif'ed (reduction in force) one sunny June day when a mid-90s crash doomed many mid-management jobs in smaller hospitals, mine included.

I found myself desperate for paying work, accepting what I thought would be a temporary job as a work comp case manager, about which I knew exactly nothing, but figuring I could do anything for 3 months and get another teaching job by fall. To my vast astonishment I found that I liked learning an entirely new specialty where my critical care background and a bent for autonomy could actually be helpful. I never went back to hospital work, though case management sometimes had me in hospitals and working with people across the continuum from acute to rehab to home care to independence. That led me to let all my critical care certifications expire, to be replaced by certifications in case management and rehabilitation nursing. Then, I found myself working with a company that advised the reinsurance industry on their high-cost work comp cases, and several years later decided to put it all together to do life care planning for catastrophic cases on my own. Life care planning is part of legal nurse consulting (LNC), but as a beginner I didn't know that. I obtained the CNLCP credential in nurse life care planning, hung out my shingle, and started networking like crazy. About half my practice now is still as a testifying expert in life care planning for catastrophic injury, reviewing and interpreting records and identifying potential testifying experts for both plaintiff and defense attorneys, mostly on liability/injury cases of various kinds. (See the American Association of Nurse Life Care Planners for more information.)1

One day, one of my attorney clients said, “This isn't a life care planning case, but could you just look this over and tell me what's going on?” It was a pretty simple case of understanding terminology and who was responsible for what in the continuum of care, so I wrote him up a brief opinion. That was the beginning of my LNC practice. I learned about legal nurse consulting, discovering that many entities want nurses to interpret and advise on health-related matters. I obtained certification as a legal nurse consultant, LNCC. Now, roughly half of my practice is LNC work, not life care planning. Some of my LNC cases have involved nurse employment with wage age discrimination, nursing standards of care, divorce, elder care, or child custody involving an affected child.

Legal nurse consulting can encompass so much more than working behind the scenes for attorneys on medical malpractice cases. Some of these are listed in the Journal of Legal Nurse Consulting from March 2017, Niche roles in LNC2; December 2016, Forensics3; and September 2015, Expert witnessing.4 (Free access at www.aalnc.org > publications > Journal > Archives)

SOME LNC ROLES

Testifying expert in a clinical area (requires current nursing licensure)

Attorneys are always looking for experienced nurses who are working clinically to give opinions on standards of practice, standards of care, and policies and procedures. Med-surg, OR, PACU, L&D, high-risk OB, NICU, transport, interventional radiology, IV therapy, public health, oncology, psych, rehabilitation, amputations, burns ... if there's a nursing specialty, and especially if you're certified in it, there's a need for you to share what you know. Many attorneys do not want people with legal education, either—they want working experts. And you're an expert, right? Hasn't 8 or 10 years taught you anything about what you do? Of course, it has!

Medical fact witness

LNCs can summarize medical facts for the court without developing any opinions on liability to clarify the effects of care (eg, pain and suffering). They use a nursing framework to explain the details of care, treatment, patient responses, and complications when the patient is unable to speak about his experience due to cognitive issues, lack of memory for a long and difficult hospitalization, or death. LNCs can also help a jury understand the facts of anatomy, surgery, procedures, and the like, using graphics or models to set the stage before the testifying expert opines on liability or standards of care.

Medical reviewer for industry

This could mean reviewing injury files with the occupational health nurse for potential liability issues, helping the company attorney gathering information for litigation, or helping design a tracking system for health-related problems in the workforce.

Corrections nursing

Besides working as an RN in the health department in a jail or prison, you could be involved with inspecting such facilities; seeing that inmates' civil rights regarding health care are honored; providing training; first responding to emergencies, and more.

Forensic nurse consultant

Sexual assault nurse examiners (SANE) and SANE-P (for pediatrics) are LNCs. Forensic LNCs also work criminal cases, reviewing causes of homicide or injury from accidents, abuse, driving under the influence, or gunshots. LNCs serve as death examiners or coroners in some places, looking at crime scenes or accidents and relating them to injuries or deaths. There are also forensic psychiatric nurse experts. All of these LNCs can work for plaintiff or defense.

ADA or other regulatory compliance

LNCs can do drug testing, organize mass health events, investigate Occupational Safety and Health Administration or other work health compliance issues, evaluate Americans with Disabilities Act (ADA) accommodations, inspect facilities for compliance with health-related regulations, work on legislation for government entities, advise regulatory boards (such as a Board of Nursing or Board of Health), and do outreach and training.

Licensure investigations

LNCs assist in a malpractice insurer's defense of a professional's licensure by compiling and reviewing records, strategizing with the defense attorney, preparing exhibits, and helping to prepare witnesses for testimony before a regulatory board. Boards of Nursing may also use legal nurse consultants in investigations.

Risk management

LNCs evaluate variance reports, help develop policies and procedures, and advise in litigation if needed by hospitals, health facilities, camps, and other organizations.

Informatics

LNCs with specialized computer skills can work with facilities, organizations, and law firms on health information security, HIPAA-related issues, safe computing skills, developing and maintaining useful electronic health records, training, and equipment recommendations.

I wasn't planning on doing any of these when I went to college for nursing. Indeed, most of these jobs didn't exist, and to some extent, many are still evolving. Attorneys and other entities want people with nursing education and backgrounds because we know more of the ins and outs of health and health care than anybody, have a built-in drive to teach, and love to learn. It's been a long trip getting here, but everything I ever learned in nursing has come together to make it possible for me to do what I do as a nurse. I wouldn't change a thing.

REFERENCES

1. American Association of Nurse Life Care Planners home page. www.aanlcp.org.
2. Green Wan S. Round table: LNCs talk about their niche roles. J Legal Nurse Consult. 2017;28(1):11–16.
3. Regan Boersma R. Forensic psychiatric nursing and the LNC. J Legal Nurse Consult. 2016;27(4):25–30.
4. Kaminski S. My expert is better than your expert: tips for LNC expert witness location. J Legal Nurse Consult. 2015;26(3):26–30.
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