Monthly Archives: January 2014

LNCC and CLNC – what do these initials mean, really?

Attorneys are practical professionals. They seek a legal nurse who consistently delivers an excellent work product and sound opinions. They also recognize that certification should be an indicator of experience and expertise in a nurse. Although LNCC and CLNC are often thought of as interchangeable, even by some nurses, they are not synonymous.

Brace yourself for an onslaught of initials.

The LNCC (Legal Nurse Consultant Certified) is the only credential recognized by the Accreditation Board for Specialty Nursing Certification (ABSNC), formerly known as the ABNS Accreditation Council, which is the only accrediting body specifically for nursing certification.

The LNCC is obtained through the ALNCCB (American Legal Nurse Consultant Certification Board); see http://www.AALNC.org:

The LNCC® program is accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC), formerly the American Board of Nursing Specialties (ABNS). ABSNC accreditation means that certification programs have met high standards for testing.

To be eligible to take the examination, candidates must have the following at the time of application:
• current licensure as a registered nurse in the United States or its territories, with a full and unrestricted license
• a minimum of five years of experience practicing as a registered nurse
• Evidence of 2000 hours of legal nurse consulting experience within the past five years.

Those who meet the eligibility criteria and successfully complete the examination will earn the Legal Nurse Consultant Certified (LNCC®) credential” (and must re-qualify by exam every five years).”

Note there is no mention of a specific “course” even though the AALNC does offer continuing education webinars throughout the year, various online courses, and other educational resources. However, their courses are not a prerequisite for taking the LNCC exam.

The LNCC credential is evidence of knowledge-based practice as well as broader knowledge of legal concepts in a wide range of settings from all medical-legal arenas. LNCC designation measures overall competency.

The CLNC designation is acquired through the Vickie Milazzo Institute; see http://www.legalnurse.com:

“2 Simple Prerequisites for Becoming a Certified Legal Nurse Consultant

1. Complete the Basic CLNC® Certification which is included in all 3 CLNC® Success Systems: VIP, Executive and Basic.
2. Maintain an active RN license in the U.S. or Canada. A BSN degree is NOT required.
Exemptions from meeting any of these criteria will not be granted.

Whichever CLNC® Success System you choose, you’ll receive everything you need to know to get started as a highly paid professional consultant – 100% guaranteed. Our Certified Legal Nurse Consultants are 25 to 75 years old and live all over the U.S. in both rural and urban areas. There’s no limit on succeeding as a Certified Legal Nurse Consultant.”

The CLNC program is six days, either in person or online, and offers supportive mentoring as new LNCs start their business. It provides a wealth of information, teaches new nurses how to initiate and self-promote their new business, obtain sample work products from a highly successful businesswoman/LNC/attorney, and many nurses credit the system with “jump starting” their business.

The CLNC credential is achieved after passing an exam of the materials presented during the six-day course. No experience as an LNC is required, and while the course is accredited for continuing education (as are many others); it is not an accredited certification through ABSNC.

Many CLNC graduates later achieve accreditation as an LNCC after proof of 2000 hours of legal nurse consulting.

There are a number of LNC courses accredited for continuing education, both online and through traditional colleges and universities.

But there is no substitute for experience.

Writing Your First Report

There is no “correct” way to write a consultative report, and so much depends upon what your attorney wants.  What do you think the attorney needs to see?

This is just my personal style. The first thing I write is an introductory paragraph that cites the patient’s name, claimed injury, and brief description of that injury and residual damages. I end it with my opinion, right up front. This may be the last sentence I actually write, but it should be prominent, with any disclaimers.

I might then have a section that lists the supportive evidence. Bullets are great for this. I follow with mitigating information that may work against the claim, probably in paragraph form, to allow your positive bullet points to take center stage.

I also have a bullet list of pre-existing or concomitant conditions that influenced the outcome of the injury. If these conditions are likely to be unfamiliar to the attorney, I will footnote rather than clutter up this section with parenthetical references. If there is a complicated concept I may use a graphic (who wants to describe a foot orthotic or a fundoplication or ICP screw when a simple image says everything). I only use one or at the most two maximize the impact without my report resembling a comic book.

What comes after depends upon the type of report. If I have done a chronology, I do not include all that data into the report – that is why I wrote a chronology. If it is a stand-alone report, I will want more information about the timeline of events and injury, but a chronology is always preferred.

This is where I would address standards of care, if applicable, contributory negligence, and how the case might have resolved but for those issues, whatever they may be.

If I can clearly see the opposing position, I will point that out and offer any counter points.

I end with a list of considerations for the attorney to pursue. This includes the experts that he will need to support his case; specific records to request (always get the ones that predate the event and the most recent since you will rarely have all of either). No matter how strong the evidence, I know that an expert “will be needed to confirm the…” because the attorney cannot base his case upon my opinion. Attorneys will often go forward with a mediation without an expert, and with great success. The decision is theirs.

Elements I like:

• Bullets, as mentioned – using phrases instead of complete sentence structuring allows me to express things succinctly and with more impact

• The use of only one font unless I do something different in a section header • Bolded headers in a larger font, usually in dark gray so that it stands out but isn’t too heavy

• Sentences that are no longer than the ones in this blog • A header beginning on page two that lists “Confidential Attorney Work Product”, with case name under that and the page number under that.

• A complete absence of the use of first person – my opinion is based upon objective evidence, not my feelings

• Absence of emotional input – state the facts clearly and strongly and they will speak for themselves – “this poor dear lady” is just not my style and does nothing to support the case. The attorney will often use that language in his pleading.

• I end with appreciation for the consult, state my availability for further communication, and offer to review further medical records as they arise or fulfill other needs such as expert location

• I sign with “Respectfully Submitted” even if it is an attorney I work with all the time, because it is respectfully submitted

• If I used reference materials for the report, I will cite them.

• I use folders that are hard on the outside (they come in different colors), and have 2 or 3 separators inside, with 2-hole punch on the top. This allows me to organize my work in a logical fashion. I staple my business card to the cover. I include my invoice in a white envelope paper-clipped inside so they do not miss it but it is not the first thing they see.

It is a “process”, and you will find a way that works best for you.

What Your Attorney Needs from You

You should ask this question at the start of each new attorney-client relationship. I am not referring to the attorney’s area of specialization or their orientation towards defense or plaintiff work. I am speaking about their business and personal preferences, their personality, their desires. Despite having your own (no doubt strong) personality, you must adapt yourself to the communication and business style of the attorney.

I have a good rapport with some attorneys who like to share personal information and do not bother to begin and end emails with salutations. They encourage independent thought, brainstorming of theories; we have a mutually respectful and somewhat casual relationship.

There are also very formal attorneys, recognized immediately by their communication style. Respond to them in the same manner they address you. Begin your emails formally, pay close attention to your grammar and do not try to woo them with your witty asides. These attorneys may have a sense of humor but they do not know you well enough to share it.

Most attorneys have a very specific idea of what they need. They may want a detailed chronology and your personal opinion, but they will keep your opinion in-house. They may ask for a second chronology that does not have your name on the report, or your opinion in that optional column. You are their private resource and they need the opinions of experts to be based on clinical facts, not your intuition or experience. Your value is in your invisibility even though/because they are relying heavily upon you.

Some attorneys simply do not know what they want. They may have a case that falls outside their comfort zone. They may ask you how to proceed with experts, and dependently seek input. While this may be flattering, it is the trickiest case to manage because you cannot cross the line between nursing and the law. You are never responsible for their legal decision-making and you certainly don’t want to be responsible for the wrong opinion.

Be comfortable with yourself. Never accept demeaning or verbally abusive behavior even when putting your ego on the back shelf. This is a challenge for most nurses. We are an opinionated bunch and our opinion is what gives us value. Nonetheless, remember that no matter how close your affiliation with an attorney may become, it is first and foremost a business relationship. Their chief goal is to advise and satisfy their client. You will be most helpful if you ask them what kind of report, what kind of information, and what type of presentation they need from you. Then deliver a product that is unequivocal and fact-based, because the one thing all attorneys need is the truth.