Long Term Care, Quality Improvement & Risk Management – Interview

Interview/LNC: Nancy L. Dion

Legal Nurse Consultant Nancy Dion on Long Term Care Practice & Clinical Services.

© 2009 The Medical-Legal News

Nancy L. Dion is a healthcare professional with more than 40 years in the healthcare and business arenas. She has expertise in varied areas of healthcare that include clinical services in acute and long-term care settings, organizational redesign, quality improvement, risk management, facility and agency executive team building and management. In addition, Nancy has served as a consultant to international, state and local facilities and agencies in the areas of healthcare, business, and education. Currently, Nancy owns and operates C.D. Consulting, through which she provides consultation to healthcare organizations and law firms in Florida, Kentucky, New Jersey, Michigan, Ohio, Texas and Washington.
Nancy, a registered nurse, began her educational process by completing her basic nursing education with a diploma from Bayonne Hospital in Bayonne, N.J. She received her undergraduate and graduate degrees in healthcare and business administration from Florida International University in Miami, and is currently completing her dissertation for a doctorate in business administration from Columbia State University. Additionally, Nancy is a Certified Legal Nurse Consultant, a Florida Licensed Nursing Home Administrator, a Certified Professional in Healthcare Quality and a Certified Health Care Risk Manager.
Nancy has served as a part-time faculty member at Florida International University in Miami and at Nova University in Fort Lauderdale. She has presented at both the Florida and National Associations for Healthcare Quality.
Her accomplishments have led to recognition in such publications as Who’s Who in American Women, Who’s Who in American Nursing, recognition as American Biographical Institute’s “Woman of the Year” and recognition in Florida as the “Outstanding Healthcare Quality Professional.”

Q: How did you start as a legal nurse consultant?
A: I got started as legal nurse consultant after attending an introductory program given by Vickie Milazzo in Ft. Myers, Fla. I had a very strong background in quality assurance and improvement and was looking for an alternative path in which to use my skills.

Q: What degrees and professional titles do you hold?
A: I am a registered nurse with a BS in health science and a masters degree in business administration from Florida International University. I am a licensed nursing home administrator, certified assisted living facility manager, a certified professional in healthcare quality and a certified healthcare risk manager.

Q: Are you clinically active?
A: Currently I continue to provide home health nursing services to ensure that I stay active in the long-term care segment of the healthcare industry.

Q: How many years have you been in LNC practice?
A: I have been practicing as an LNC since 1996.

Q: What are your LNC specialty areas?
A: My areas of specialty include all aspects of long-term care.

Q: Do you testify?
A: I am a testifying expert in long-term care litigation.

Q: How did you become aware of legal nurse consulting as a specialty practice?
A: I first became aware of the legal nurse consultant as a specialty practice through a flier I received about attending the introductory program I mentioned above. I further became aware through an associate in the Naples area who was providing this service for attorneys.

Q: Why did you go into LNC practice?
A: I had a strong background in the quality movement and, even though I had thoughts of becoming an attorney, I felt this was a more effective means to utilize my skills.

Q: Describe your transition from clinical practice to LNC practice.
A: Transition into the legal nurse consulting arena was fairly easy for me since I was already providing administrative and facility consulting services in the areas of quality and survey preparation.

Q: How hard was it for you to get started in LNC practice?
A: Getting started for me proved to be fairly easy. I found I had a professional associate who was performing these services and, as it turned out, she had a need to divest herself of her case load due to family issues. She set up an interview for me with a firm on the east coast of Florida and recommended that I take over her cases. I went to the interview, apparently did well, and left with two cases under my arm.

Q: What barriers did you face?
A: Barriers, if any, I created for myself, since I held off on doing review of the cases I had been given until after I took the certification program. That created about a six-week delay, but the firm which gave me my first cases was willing to wait.

Q: Did you obtain any formal training? If so, where?
A: Formal training was done through the Medical-Legal Consulting Institute which is now known as the Vickie Milazzo Institute. There was a lot of information crammed into a short period of time, but it worked for me, since I did the program on-site at a live seminar.

Q: Describe your first attorney interview.
A: Having been recommended by a nurse associate to the firm which gave me my first cases, my first interview was live and in person on the east coast. I drove more than two hours to meet at a law firm’s offices in Miami. I was an hour early, scared to death and worked at projecting an image of confidence and assurance. I must have done OK since, as I said earlier, I left with cases in tow and an agreement to accept more cases for review whenever it was appropriate.

Q: Describe your first case.
A: My first case was a long-term care case and I was working for the defense. Since I had served a number of years as an SNF nurse and administrator, I was comfortable with reviewing the case and was able to construct a theme that the defense used in its negotiations with the plaintiff firm. The case settled for much less than initially filed for by opposing counsel so the firm was very pleased with their outcome and my service.

Q: What is your most memorable case? Why?
A: That was probably my most memorable case, also. I felt so good about what I had done!

Q: What was your most difficult case? Why?
A: My most difficult cases are those that I read and cannot support. Very often, attorneys with whom I work will have cases read by other nurse consultants and feel they have a strong case with which to move forward. I know they are disappointed when I inform them that the case is not so strong and that I cannot support the premise of the case. I am always prepared to quote statutory chapter and verse, from Joint Commission standards to support my findings, but I feel bad when I need to tell them that I cannot provide any further assistance in the matter. I have, though, had a number of attorneys thank me for my forthrightness and for looking out for the dollars they would have expended in pursuit of a “bad” case.

Q: Do you use or are you interested in subcontracting?
A: Since I serve as a testifying expert, I do not use subcontractors. It is my responsibility to read each case and come to my own conclusions. I must also know the case in and out so that I can testify to the information in the records as related to practice and standards.

Q: What are the top three things you like most about being an LNC?
A: Being an LNC allows me the freedom to have a life outside of work, it gives me the joy of sharing my skills with others who are more new to the field and allows me to sit back and watch them grow, and it makes me feel great when I can say to an attorney, “The staff did everything they could to provide the best possible care to this patient,” since that’s what nursing is all about to me.

Q: How often do you market?
A: Marketing is not my strength. I hate cold calls and snail mail, so I don’t do it. Marketing is done for me by the attorneys and LNCs for whom I have provided services or who know my work. Word of mouth is the only tool I use.

Q: What do you think is the biggest reason you continue to receive cases?
A: I think the biggest reason I continue to receive cases is because I am honest in my opinions about cases, in general, and am usually well prepared for deposition or trial, so the attorneys know they don’t have to worry about how I will present or what I will say.

Q: Have you written any articles? Any chapters or books? How many and on what topics?
A: I’ve written articles on a number of topics including those in quality and long-term care patient management. I’ve also co-authored a chapter in a text on healthcare administration.

Q: Have you given any presentations?
A: I have made presentations locally to agencies, facilities and groups on the issues of healthcare funding, documentation and standards. I have also presented on topics for the National Association for Healthcare Quality and for the Vickie Milazzo Institute.

Q: Give three areas of interest other than legal nursing.
A: For diversity, I stay involved with the healthcare quality movement, I am an avid reader, and I look forward to spending time every july at an educational and networking retreat for community services executives held in North Carolina or Tennessee.

Q: Where do you see yourself as an LNC in five years?
A: In five years I look forward to being retired but active in my community and travel endeavors.

Q: Where do you see the specialty of the LNC going in the next five years?
A: I think the specialty of LNC practice will continue to grow in the short run, but I also see nurses returning to the bedside, since the demand is so great and the numbers are still dwindling.

Q: What recommendations would you make to a new LNC about the challenges of our specialty?
A: I believe that LNCs should continue to seek quality education in the clinical perspective to ensure that they are aware and on top of changes in care delivery, environmental adaptation, technologic advancements and the ways these impact standards and law. I feel the biggest challenge for all LNCs is to stay unbiased and focused at providing the most honest services they can.

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