Category Archives: LNC Practice Building

You thought this case had merit

Every law firm has a unique philosophy that guides them in their decision to represent a plaintiff or plaintiff’s estate. With that in mind, if a case is turned down, it is always for a good reason that applies to that particular firm. Most attorneys want to clearly explain reasons for denial in layman’s terms with the potential client.  No firm wants to be sued for professional negligence, so part of the explanation will emphasize that the plaintiff or family are free to seek a second legal opinion.

If you are asked to review medical records so that the attorney can determine the merits of a potential case, keep these points in mind:

  • The medical facts were not compelling during the initial review, or perhaps were not “facts”.
  • The firm does not handle this type of case – be certain you have a good understanding of the firm’s preferred specialty area
  • The case has merit but will require more money and resources than the firm can apportion
  • The firm handles high value cases referred to them by smaller firms who find merit, but cannot afford the cost of experts, records, depositions, etc.
  • The medical injury is a high-risk surgery or other event with known complications that are difficult to define as negligent
  • The permanent damages are minimal – the patient feels that past expenses support the severity of damages but in truth, future loss and costs determine the ultimate value

Know the firm’s philosophy, preferred type of work, tolerance for financial risk, and most importantly, the attorney’s first-brush legal opinion of the case. That opinion, more often than not, is accurate.

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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.

BYOB: Building Your Own Business: Part I of III

Career complacency is something that sneaks up on you. The years pass quickly and you are comfortable in your secure job, attending the requisite training seminars and extremely competent in your niche.

But maybe you peeked out from under your rock and found that legal nurse consulting was a blossoming field of interest. Thanks to the internet, this once flying-under-the-radar career is now prominent. Even though you may be excellent in your office/clinic/hospital/job, you may be ready for change. Does a sense of urgency well up within you because everyone seems to know something you do not, and you cannot get started fast enough?

Just because you can do a thing does not mean you should do that thing.

It’s hard to be patient, but easy to get caught up in what others are doing because of the fascination (and desperation to escape less-than-desirable working conditions?).

Before jumping into starting your own business as an LNC, let me help you pick my brain for advice. These next few weeks, I’ll be covering a few things that you should consider before or during your transition into having your own business as a legal nurse consultant.

In planning this new career move, ask yourself if this is what you really want to do. Why do you want to be an LNC, and are you willing to put in the hours of learning that will truly never stop? Because even though this is a career you can step into without extra licensing or certification, becoming an LNC is not a lateral move from nursing. Success in your current job does not guarantee success in becoming a legal nurse consultant.

These are two different worlds.

Wrong preconceptions and bad reasons for pursuing a career in legal nurse consulting:

• You are tired of your current job and just want something new
• You know the hourly rate is triple what you make in a hospital and zowie, that sounds great
• You always wanted to practice law
• You assume it can’t be that difficult or no one would be doing it
• You have been documenting care for years, so writing a consult letter can’t be all that different
• There is just enough credit left on your card to stock a home office

While this post may have emphasized more negative points about becoming an LNC, next week’s post will bring to light some positive points about the world of legal nurse consulting.

Maximizing Your Presence on LinkedIn

It’s very easy to join LinkedIn, but not everyone does it well. Here are a few tips from personal experience.

To me, groups are the heart and soul of LinkedIn. Joining a group says you are interested in the topic area and gives you a valid reason to connect with anyone in the group.

When I receive a connection invitation, I appreciate a personal comment that says I am not part of a general numbers game. When I invite someone into my network, I try to find something about them that I can reference in the invitation that shows I am interested in them personally.

I run several groups on LinkedIn and I appreciate members who post Discussions that stimulate dialogue. I do not appreciate the member who posts repeatedly (there is only so much room on a page before others’ posts get pushed out of sight) or is blatantly marketing a service or product (that one goes to Promotions).

Posting an interesting and relevant article is a safe way to market yourself if you are reluctant to respond to others’ posts.

Congratulating someone in your network when they post an update about themselves is something that not very many people do, so you will stand out in the mind of that person.

When someone writes a recommendation for you and you allow it to appear on your site, return the favor. Ideally, you have asked someone who really knows you or your work; a safe rule of thumb is to only ask for recommendations from people you would be comfortable recommending. An even better rule is to recommend them first. Then send them a personal email telling them you have done so, in case they do not have their account set up for daily alerts.

Lastly, avoid politics or articles that clearly take a controversial social tone. Someone will be offended and there is nothing more uncomfortable than being attacked publicly.

Wait, sorry, one more thing. Critique your profile for grammar and punctuation errors. When you are presenting yourself to the public, it is ridiculously easy to ruin credibility with simple mistakes. Review your profile on a regular basis for errors, or just to make sure that you still feel the same way you did on the day you created it.

There is a group for everyone’s interests on LinkedIn, but these are a few ways to stand out in the crowd.

Alice

Here’s (Who’s) Looking at You, Kid

Legal nurses, like expert witnesses, attorneys and politicians, are only as credible as their public image. While we have faith in the integrity of our friends and fellow professionals, we are not immune to the intentional harm inflicted by others.

Most of us unwittingly sow the seeds of our own demise. We engage in light-hearted email bantering back and forth with friends and colleagues. We know to screen our Facebook friendships and confine our LinkedIn connections to business, but still…

We do love voicing an opinion when asked, and even when not asked.

Our professional listservs allow many opportunities to hone our critical thinking skills and play beat-the-buzzer at guessing elusive diagnoses, arcane abbreviations and other mind-teasers thrown out by our colleagues.

We might even voice a public opinion on an expert’s skill level. Woops.

What we say today will be here tomorrow, and the next day, and the year after that, forever circulating and percolating in cyberspace, molded into sound bites that hardly represent the original intent.

In fact, this recently happened to me, or rather, I did it to myself. I wrote a short article called “It’s not life… it’s social media” (http://www.caseconsultant.com/Social%20Media.pdf). I still support most of what I wrote about not wanting a Facebook account, but I now have 160 Facebook friends, attend Martindale Hubbell online conferences, and recently presented a webinar on the use of LinkedIn. My disdainful article on social media lingers on.

Recently, a fellow LNC posted several sites that construct an image of you based upon your shopping habits, public profiles, emails, etc. The images were not accurate portrayals, but there are people who use their free time to make mischief for the rest of us.

As the NYPD day sergeant would say, “Let’s be careful out there” as we fall in love with the sound of our voices and the sight of our words.