An Emerging Role

Nurses have been working alongside attorneys for almost 25 years, if not more. These nurses went by titles such as "nurse paralegal," "medical litigation consultant," and other monikers. In some instances, they combined the duties of both the paralegal and nursing professions; there was no uniform role definition.

However, from the formation of a national organization in 1989 to the opportunity for national certification beginning in 1998, the field has come into its own. It provides an opportunity for nurses to serve as patient advocates in a unique way.

What Is the Role of an LNC?

The LNC’s primary role, according to the American Association of Legal Nurse Consultants (AALNC), is "to evaluate, analyze, and render informed opinions on the delivery of healthcare and the resulting outcomes." The organization recognizes that LNCs are first and foremost, NURSES.

LNCs work towards goals familiar to all nurses: better patient care, protection of the patient and family, and reversal of poor healthcare practices.

How Do LNCs and Attorneys Work Together?

Susan Burbank, RNC, an LNC who, for the past 10 years, has been providing legal nurse consulting services for attorneys and a research service for other legal nurse consultants summarizes the partnership between LNCs and attorneys:

"The nurse's expertise is in assisting the attorney in understanding the medical information, which is reflected in the medical records. The attorney performs the legal analysis to decide whether or not to pursue any case. It is a legal function to state whether or not a case has merit or does not have merit. Your role in providing an accurate and easy to understand summary and analysis of the contents of the medical records, is crucial in enabling the attorney to do this. If you provide your attorney with an accurate and comprehensive summary/analysis of the medical records, he or she will be able to determine whether or not there is negligence, and if the case is meritorious or not."

Nurses who use their health professional experience and nursing knowledge to clarify health questions for an attorney do not practice law, nor do they fill any other legal role than that of health consultant for the case.

An attorney may use a nurse for expert testimony in court, attendance at depositions and trials, or merely analyzing and researching health issues in the medical records. The function is decided by the LNC upon establishing his or her role.

Many times, an attorney simply wants to understand what happened, as does the family of the patient involved, in the hospital. The anger and grief that we nurses are trained to deal with in the clinical setting continues once the patient returns home. Communication from the hospital staff, physicians, or others during the events in question may not have been satisfactory, so the family, feeling someone must have been at fault, turns to the lawyer.

Before accepting a case for medical malpractice, negligence, personal injury, or other instances where health is involved, an attorney may ask a nurse to review the medical records and provide an opinion as to possible issues, and standard or substandard quality of care.

Nurses can save the attorney time and money by screening the medical records for pertinent information, assessing the issues, providing a well researched opinion, and even arranging the facts in a way that the physician would find most readable, should a medical expert need to be used. The nurse serves as a knowledgeable liaison between the attorney and other medical experts. Many times, the nurse suggests the appropriate medical expert needed in a case review. This gives the attorney a better understanding of events and a more learned argument for him should he accept a case.

Where Does an LNC Work?

The practice settings for LNCs vary, but all have the same principles in common: consultation and education, and performing liaison services between healthcare professionals, legal professionals, and any others involved where healthcare is at issue.

Practice has expanded from medical malpractice, personal injury, and product liability to worker’s compensation, risk management, and criminal law, just to name a few.

A LNC may also single out a particular service not only for attorneys, but also for insurance companies, healthcare systems, or other independent consultants. Many have made a successful business by specializing in a single service, such as medical research or locating expert witnesses. Other LNCs practice as life care planners, expert witnesses, crime scene investigators, licensing agency investigators, and government nurses.

In today’s age of electronic research, overnight mail and telephone, a LNC need not be local to the client for whom she does business. For example, Burbank lives in the Northeast, but works regular with an attorney in Columbia, SC. Geography is no longer a major concern in this field of practice.

How Can I Become a LNC?

Nurses have a sound base from which to launch a career in legal nurse consulting. They are uniquely and historically trained to be a patient advocate, to educate, and to provide to their patients the same services the LNC offers to clients: gather information, review, evaluate, educate/advise, and refer. Nurses are superbly qualified to explain the workings of the medical system, the hospital "innards," if you will, than any other healthcare professional. Nurses must also deal with multiple ancillary services, as well as community health and social services every day of their careers. Government and insurance restrictions are always guiding referrals, and legalities guide their practice. Performing these same services as a career choice is one step further along that path, towards advocating for others.

Many LNCs and other legal professionals are members of LNCNURSE, the Legal Nurse Consultants Listserv at http://www.legalnurseconsultants.com.

Another excellent resource is the AALC at www.aalnc.org. Most states have a chapter of AALNC, which offer educational seminars, networking, resources, and mentoring to its members.

Many LNCs continue to practice in nursing, while others keep up with current practices by reading journals and keeping close contact with peers in clinical settings.

A Continuing Opportunity

The legal nurse consulting field continues to expand and evolve. It provides opportunities for nurses to develop the profession through an exiting specialty.