Monthly Archives: January 2013

BYOB – Part III of III – Making it all Work

You can minimize your expenses as a legal nurse consultant if you are willing to learn and work. But if you buy “stuff” first, I promise you will purchase things you do not need. It is akin to stocking your first nursery without ever being around babies; what looks good doesn’t always work well.

Sad is the nurse who finishes a program and immediately begins to hemorrhage money – either to pay for that program, or for an accountant to track their future billing and give them tax advice, an attorney to set up their corporation, a separate phone line for the calls that might come in, stationery coordinated with business cards, postcards, and brochures that cost way more than they are worth. Computers, fax machines, copiers…gifts to leave at the offices of cold-call attorneys…everyone and everything is more than happy to take your hard-earned money.

With Microsoft Word, you can easily create your own stationery, business cards and envelopes. They will not look homemade, and if you are anything like me, you will change your design a number of times before you settle into your own “look.” There have been many times when I change the wording on my business cards just prior to an attorney meeting or conference. So, you do need a printer, but get one that prints in color, can be fed hunks of paper for copying and faxes on your home line.

If you don’t want to use your home line, there are HIPAA compliant internet fax services. I use one. All my faxes go out through my computer and come in through my email. My LLC cost and business license cost…maybe 125.00; QuickBooks keeps track of my income better than an accountant, and I file my taxes as an addendum to my personal 1040. I have never paid a mentor but I have had many generous nurses in my life that served that role.

For many people, it is easier to spend money on things than it is to spend time on learning. But your letterhead, presentation folder and business cards will not create an exemplary work product – they will just make it look good.

A successful business gives the customers what they want. Your customers are the attorneys. You cannot produce a work product for them until you know in advance their needs and expectations. What you need is to know is the attorney’s expectations in terms of billed hours. You may not know what to tell him (1000 pages looks like a heck of a lot of work and didn’t you read somewhere that you should charge by the ½ inch?).

At first, it may feel safer and more productive to obsess about how to structure the report, rather than figuring out what to tell the attorney about billing. Bullets? Indentations? Outline or chart chronology? Should those references be footnotes or endnotes and do I need a reference list at the end?

These thoughts can be distractions from concentrating on meeting the attorney’s needs and expectations.
Over time, you will develop a report format that works for you and a style of reviewing medical records that decreases the chances of missing important data. Until then, your business will grow faster if you concentrate on satisfying the customers’ needs.

Everyone travels a different path even if the end goal is the same. All successful LNCs were new, afraid, skeptical, and unsure of everything except believing that an attorney would pull back the curtain and find the Wizard of Oz.

Insecurities never go away completely.

Times of doubt and fear will come regardless of how successful your business may be. There will be stretches when your phone doesn’t ring and you question your own work product. Your work universe may be much like the phases of the moon: sometimes the tide brings work in faster than you can keep up, and sometimes it all goes out to sea at the same time.

But if you are meant to surf and ride that wave – just get started.

BYOB Part II of III: Putting your nose to the grindstone

This post will delve more deeply into what to expect in legal nurse consulting.

First, expect to do a LOT of research.

Unlike testifying experts who specialize in a nursing niche, legal nurse consultants are asked to assist in many types of healthcare claims. No two are alike and I have never worked on a case that did not require a great deal of research on injuries or conditions. For me, learning is one of the perks of this field, and you really have to enjoy the process of discovery (not in the legal sense).

Your responsibility does not change with the side of the claim you are on, because your job is to find facts without preconceived notions of causation. You need solid research on this disease, its incubation and likely sources of exposure, the preferred treatment, the long term effects and cure rate, and the medical history of the patient before and after exposure. You need to open those records and find out what’s missing so you can inform your attorney immediately what he needs to request from other sources.

This brings up the second point:

Expect to look at medical issues from completely different angles.

You have a case. You have the stationery to write the report. You have all the equipment to produce it.

Suddenly, you don’t know where to start. This is puzzling because, after all, you are a nurse, and you do know about the standard of care, how to spot a deteriorating patient, when to challenge a questionable order, and what the inside of a hospital chart looks like.

The problem is that the case may not concern the delivery of care. For example, the claimant is a heating and cooling maintenance man who has worked in his field for 15 years without a hitch. Now he says that one blast of air from an older home has resulted in aspergillum lung infection with encapsulating scar tissue and he can never work again. That may be true, but as a legal nurse consultant you never accept a claim at face value. This man is not a patient, he is a claimant. You need to learn everything you can about this disease even though you are not the testifying expert.

Third, give aspirations time…and feed them with hard work.

I get many emails from aspiring LNCs who want advice on getting started. Some just want a nudge in the right direction so they can find things out for themselves. Some have not pursued any training programs. Some have completed a program but complain that “I read the books, took the test at the end, started emailing attorneys and it’s been three whole weeks without a nibble. What am I doing wrong? Just tell me what to do.” Or, “Let me work for you”. Or, “Do you know anyone who needs my help…I’m so discouraged.”

Do you know what these situations remind me of? Weddings. Two people love each other and plan a formal wedding. The sheer amount of work and money that goes into this event is staggering. They (she) get caught up in reservations, gift registries, invitations, flowers, catering, the dress, the dress rehearsal, and oh my God—the bride’s maids’ dresses. You can lose sight of what this wedding is for – the beginning of a new life with challenges and rewards, neither of which depends upon the wedding itself.

But eventually you do get married or you do get that first case and it is so exciting! You can tell your family you haven’t been wasting money, neglecting the house and starving the cat in vain. There’s nothing like the thrill of a new referral…and “putting your nose to the grindstone” to turn out an excellent report.

It’s time to work.