Q: How did you get started as a legal nurse consultant?
A: In the early 1980s, I attended a lecture on medical malpractice given by a nurse attorney who had written a book on medical malpractice issues. This piqued my interest in medical-legal issues. In 1985, when I was the nurse manager on a high-risk OB floor, I learned that the primary defense firm in town was hiring their first nurse to assist attorneys doing medical malpractice and other insurance defense work. I applied for the job and was hired.
Q: What professional titles do you hold?
A: RN, BSN, LNCC.
Q: Do you testify as an expert in your clinical field of nursing specialty?
A: No. I have worked full-time in-house at two different law firms since 1985.
Q: Are you presently working clinically?
A: No. I haven’t worked clinically since 1985.
Q: How many years have you been in LNC practice?
A: Full-time for 23 years.
Q: What are your LNC specialty areas?
A: Medical malpractice and other personal injury cases such as auto accidents, labor law, auto cases, slip and fall, products liability and toxic tort.
Q: How did you become aware of legal nurse consulting as a specialty practice?
A: When I went to work for a large defense firm in 1985, legal nurse consulting was not recognized as a specialty practice. My title was “nurse legal assistant.” I was hired because one the medical malpractice attorneys thought it might be helpful to hire someone with a medical background to assist the attorneys working on medical malpractice cases. I had always been interested in the law and so when I learned about the position, I decided to apply for it. I think that over time, LNC work was recognized as a specialty practice within nursing primarily due to AALNC’s initiatives.
Q: Why did you go into LNC practice?
A: I was interested in the law and intrigued with the concept of developing the role of a nurse within the litigation department of a large law firm.
Q: Describe your transition from clinical practice to LNC practice.
A: I put my clinical license on inactive status, went to work full-time in a defense law firm and never looked back. There was a transition period for both me and the attorneys because I was the first nurse they had ever hired. However, over time we worked together to develop my role and a year later we hired a second nurse. At the height of its medical malpractice defense practice, the firm had five in-house LNCs.
Q: How hard was it for you to get started in LNC practice?
A: I never worked independently, so never faced the challenges associated with growing and sustaining an LNC business. My challenge was to learn about the legal standards, develop valuable work products and continually think of new ways to assist the attorneys to provide high quality legal services.
Q: What barriers did you face?
A: The primary barrier I faced initially was being categorized as a “nurse legal assistant” because there was no other firm “category” to put me in at that time. I recall the partners’ concern that there might be some sensitivity among the paralegals that I was higher in the pecking order. However, as my role developed, it became clear to the partners that due to my medical background, I offered a unique set of professional services. Once the term “legal nurse consultant” became known, I requested a change in my title. This was initially denied because I was told that “consultants” are independent contractors, not employees. However, several years later we were allowed to begin using the title “legal nurse consultant” as this became more common within the legal community.
Q: Did you obtain any formal training? If so, where?
A: No, there really weren’t many LNC courses in 1985. I never took or needed an LNC course because I had (and continue to have) the best training there is — on the job, every day at a law firm.
Q: Describe your first attorney interview.
A: It was at a large defense firm for their first LNC job. The interview lasted more than an hour. My strategy was to control the interview by coming to the interview armed with many questions for the attorney. Prior to the interview, I read a book written by a nurse attorney (whose lecture I had attended a couple years previously) about medical malpractice so that I could ask informed questions. I was hired after interviewing with the attorney who spear-headed the effort to hire their first nurse, the chairman of the litigation department and the senior medical malpractice attorney.
Q: Describe your first case.
A: Given that I went to work full-time in a law firm, I was given a number of medical malpractice cases to work on when I got to the firm, including a birth injury case and a case involving a severe skin reaction to Penicillamine.
Q: What is your most memorable case?
A: A recent dental case in a bench trial (non-jury) in which our client (a nurse) sustained a severe nerve injury resulting from an anesthetic injection. Why is it memorable? The defense agreed to a bench trial because the carrier did not believe we could meet our burden of proof on the liability issue. At a mediation procedure prior to trial they offered only $15,000. Just prior to trial, they offered $75,000, which our client declined. Six months after the bench trial, the judge rendered a decision in our favor and awarded $685,000. The case subsequently settled (after defense counsel filed a notice of appeal after the judge rendered the verdict).
Q: What was your most difficult case? Why?
A: In general, the most difficult cases are the medical malpractice cases involving complex medical issues. These cases require an in-depth understanding of the relevant medical literature, including diagnosis, treatment and prognosis in order to objectively evaluate the liability and causation issues.
Q: Do you use or are you interested in subcontracting?
A: No, I don’t do any independent work at all. However, I think that LNCs who subcontract work out should be experienced and very careful to make sure that the work product of their subs meets high standards. I don’t believe that new independent LNCs should sub out work because they do not have sufficient experience to evaluate the adequacy of the sub’s work. I also think that attorneys should be informed when work is subbed out. Ultimately, the attorneys have responsibility for evaluating the credentials and experience of any nurse consultant who reviews a case for them.
Q: What are the top three things you like most about being an LNC?
A: The intellectual stimulation, the variety of my work — each case is different, and the personal satisfaction of making a substantive contribution to my attorneys’ cases.
Q: How often do you market?
A: I don’t do any marketing because I work in-house. However, the LNCs at my firm are involved in our firm’s practice development, are profiled on our firm’s website and appear on the firm letterhead. I also do a fair amount of networking with attorneys who refer cases to our firm.
Q: What is your biggest marketing challenge?
A: I have never worked independently, but I think that the biggest marketing challenge for new independent LNCs is to get the audience of an attorney and get that first case or two. The ease with which this can be accomplished varies with the extent to which a particular legal community uses and values LNCs and also depends on the number of LNCs within a particular area who are competing for the same business
Q: Have you written any articles? Any chapters or books? How many and on what topics?
A: I wrote a textbook chapter on the role of the in-house LNC for AALNC’s core textbook on legal nurse consulting. I also wrote two modules for AALNC’s online courses titled: “Legal Fundamentals — Basics of Law and Liability” and “Discovery and Disclosure.” I wrote an article for the Journal of Legal Nurse Consulting on LNCExchange, the legal nurse consulting listserv I started on Yahoo Groups two years ago with two other experienced LNCs. Finally, I have just started a “Case Law Corner” for Network News, AALNC’s quarterly newsletter in which I present legal cases of interest to LNCs, particularly any cases relevant to the potential legal liability of LNCs.
Q: Have you given any presentations?
A: My specialty area is screening, investigating and prosecuting medical malpractice cases. I have given presentations on this topic to LNC students at our local university-based LNC course, as well as at a New York State Bar Association seminar with my managing partner. In 2006, I started LNCExchange, an LNC listserve on Yahoo Groups, with two co-moderators. It has evolved into a unique networking and educational resource with over a thousand members nationwide. I spend about 20 hours per week moderating and tending to this group, including frequent feedback to listserve members about a diverse array of issues impacting our practice.
Q: Give three areas of interest other than legal nursing.
A: Reading, especially historical fiction and novels, cycling and traveling.
Q: Where do you see yourself as an LNC in five years?
A: At my current plaintiff firm. I have made career changes in 10-year blocks, but plan to remain at my current plaintiff firm until I retire.
Q: Where do you see the specialty of legal nurse consulting going in the next five years?
A: I believe that the use of nurses within the legal community, to handle medical-legal cases, will continue to grow. Also, I believe those nurses with the right skill set and experience will find themselves more integrally involved in higher level skills such as case analysis and case strategy. Attorneys who work with skilled LNCs will never want to practice without one again. On the other hand, attorneys who do not have a good first time experience with an LNC may sour on the idea.
Q: What recommendations would you make to a new LNC about the challenges of our specialty?
A: The biggest challenge of our profession is to educate new LNCs about the importance of producing high quality work products and advice and skills that are only acquired over time after working on many actual medical-legal cases. This is imperative to the success and evolution of our profession.
Another challenge is to educate clinical nurses who want to get into this field about the realities of our work before they spend thousands of dollars on an LNC course with the faulty promise that independent LNC work is an easy, lucrative alternative to the stress of clinical nursing. In fact, building up a profitable independent LNC practice is very hard work and takes on average at least five years — and that’s for those nurses with the right skill set and the ability to network and foster relationships within the legal community. Nurses whose first LNC job is in-house at a law firm do not need to take any course. Nurses who want to start out independently should take a reasonably priced entry level LNC course and then build their business one case at a time, taking care not to take on cases that are beyond their ability. LNC work is not for everyone. It requires that the nurse have excellent analytical, reading, writing and organizational skills. Many LNCs have significant difficulty finding work, especially in areas of the country that are economically depressed or where the medical-legal community has not embraced LNCs.
Finally, another very important challenge facing our profession is course-based certification, a “credential” that is bestowed on nurses who take a course when they may have never even worked on a medical-legal case. Course-based “certification” is utilized primarily as a marketing ploy to get nurses to take a particular course — unfortunately, it dilutes the meaning of certification within our profession which now has at least a dozen course-based “certifications.” It has no meaning as a credential, per se. It does signify that a nurse has successfully completed a course, but it is not synonymous with “experience and special expertise” like other nursing certifications. Clinical nurses and lawyers need to be educated that to the extent they believe certification is important, it should be experienced-based and “earned” after passing an independent exam with rigorous quality controls. Our profession has only one such certification — the LNCC. •