Category Archives: Personal Thoughts and Experiences

As the daughter of an Army Drill Sergeant, I grew up around Fort Jackson, SC. We shopped at the PX, attended the Roman Catholic church on base, bought 29 cent gasoline and went to the movies for a quarter. But the place I seemed to spend most of my time was in the outpatient infirmary. I remember the wooden structures that were meant to be temporary when first constructed, the highly polished wooden flooring and ramps, the “shot” room where I received more than my share of Pen V for recurrent pneumonia and tonsillitis…many decades later it still feels like yesterday.

My most vivid memory though, is the nurses. All wore Army issue 100% cotton uniforms, starched and white, with sharp caps and polished shoes. From my vantage point, I could see little beyond large bosoms in sharp Playtex bras that preceded them into the room like the prow of a ship.  They terrified me. I remember hiding behind the medicine refrigerator when I knew a shot was imminent.

These nurses were tough, and a pediatric department was nonexistent. No lollipops for good behavior (and I would not have earned one in any event). I was expected to behave like a small soldier.

Many of these women had served overseas and their pride was evident in their bearing as they marched down the polished hallways, shoulders back and snapping salutes from the brow of their stern faces. They were subordinate only to God and outranking physicians. The distinction between the two was not always clear but my inferior position was never in doubt. My mom was also a nurse, and I secretly thought she identified with them more than me, her youngest national treasure. Of one thing I was certain; I would never become a nurse.

So much for that resolution. I too grew up to wear polished shoes and cap for graduation, but the hospital I worked for had a wonderful pediatric floor. Body language had changed.  I wore child-friendly smocks, tossed the cap after I kept losing it in the nebulizer tents, and there was a rocker in every room. No scary nurses allowed. Gently approaching children instead of pinning them down like feral cats was a solution the military had never conceived. Sheltering in mom’s embrace for injections took away some of the sting, and parents were calmed by having their own hands held after a particularly hard night.

When I transferred to ICU, body language was equally if not more central to the care of adults. They scrutinized our faces for indication of bad news as did their families. Amidst their lines, wires and tubing, they were vulnerable. Their spirits were buoyed by unhurried baths and clean bedding. Their families were less apprehensive when their loved ones looked well-cared for, and sometimes they needed a hug. They wanted to know we cared and that we would be there when the call light was not on, and that our shift ended when the work was done and not before.

In the latter 70s and early 80s, you did not wear gloves to start IVs, give baths, take vital signs or draw blood. Gloves were only required for trach and wound care, suctioning, Foley insertions, continent care and when isolation demanded it. Although today’s MRSA-resistant hospital environment demands protection for staff and patients, those gloves also communicate “unclean” to patients who crave human contact. Now more than ever, smiles and reassuring body language are indispensable to good patient care.

And honestly, who needs frown lines?

I don’t know – do you have mine?

I was strolling through Costco a few days ago (if I miss a week the staff become anxious) when I overheard a young man speaking at a moderate volume into his earphone. He was speaking, but he was not listening. He was providing IT support to a client who either could not follow his instructions or was utilizing a wholly different program than the one under discussion.

I am not an eavesdropper, usually, but it was clear that he was shopping for groceries and envisioning a computer screen concurrently, and not doing either effectively. He repeatedly misinterpreted the problem and provided incorrect troubleshooting. He resembled many IT technicians who have stolen hours of my life without resolving my problem.

How do you know if you have someone’s attention, and are you also guilty of not listening effectively?

Here a few telltale and annoying signs of inattention on the other end of the phone:
• Papers rustling in the background – either the person is going through their mail, lost an important document or has vermin on their desk
• The conversation is one-sided but for the occasional “mm hmm” that passes for “I hear you”
• The same information is requested more than once
• You clearly hear the clatter of a keyboard that is not in sync with the conversation

Most of us can multitask to some extent, but none of us can anticipate the critical points in a conversation that require our full attention. If you miss that key sentence and find yourself fumbling to catch up, you have dropped the ball. Concentrate on the caller, or ask if you can call them back (the attorney, the expert, your mother). No one likes to repeat themselves.

I am blessed, and if you are reading this now, you are also blessed. We both have electricity, internet access, computers, an education, and by default, the ability, or at least the opportunity, to “make something of ourselves”.

I forget about that sometimes, but all it takes is a little change to remind me. The electricity just returned after being off for four hours. Four hours, not four days. Suddenly I was excommunicated (the Catholic in me) from hundreds of people I may never meet, but are my friends by every definition of the word.

Gone was the air-conditioned comfort, reading lights, Netflix and worst of all, Dogs of War or whatever that Xbox game is that makes my teenage son scream like a little girl with his online gaming friends.

Might as well go to bed, which I did, but I have never noticed how quiet the house is without the sound of the air conditioner, fan, or my woosher (the civilized world calls it a sound machine, but it will always be my woosher, tuned to the ocean setting that reminds me of Sanibel).  What was left? The persistent sounds my dog makes in his undisturbed sleep – little snores, dry swallows, and an assortment of unidentified noises that jolt me into awareness at the precise moment I am falling asleep.

“Count your blessings”, “things could be worse”, “be glad you are not that one”, “at least you have your health”…things people say to comfort each other. In times of disaster, people must reach very deeply to find their gratitude but most will succeed. “At least we have each other”, as they mourn the loss of their home. These expressions are not platitudes; they are truths that guide our lives.

I know that I am spoiled when my biggest complaint is bemoaning the passage of time and youth, and I will spend more time being grateful, I promise. Although…I can still hear my dog swallowing above the sound of the woosher. I should wake him up and remind him that he too is blessed to have electricity, and that porcelain thing he is so fond of using as a water bowl.

Increasingly, nurses contact me for information on legal nurse consulting. This field is too rich and diverse for a simple explanation, and all I can share is my own journey. As Led Zeppelin said, “yes, there are two paths you can go by, but in the long run, there’s still time to change the road you’re on”.

I did not hear the term “legal nurse consultant” until 2005. Until then I had been a nurse – ICU, ortho, pediatrics, psych…from that moment forward, Google was my new best friend.

I looked into various programs that purported to turn me into a legal nurse consultant, indeed a wildly successful one. These programs were legion. Some were taught by universities, either in the classroom or online; others were agencies that offered “specialization” in numerous fields of study, and still others were more concerned with the business and marketing of legal nurse consulting. All offered certificates, but not certification. (The only certification recognized by the American Association of Legal Nurse Consultants is theirs, and you cannot become certified without 2000 hours of LNC work and passing the AALNC course of study. I have the hours, but not the time for studying…perhaps next year.)

I selected a course, learned a great deal, and acquired an impressive string of initials to add to my RN. I stopped using those when I realized they meant nothing. I read Pat Iyer’s Legal Nurse Consulting Principles and Practice, Nursing Malpractice, and Business Principles for Legal Nurse Consultants. I read Betty Joos’s Marketing for the Legal Nurse Consultant, bought a comprehensive handbook of legal terminology, and reviewed changes in nursing standards of care. I did the coursework for SANE certification, bought malpractice insurance, and joined too many organizations. The most useful group I joined was the JERKS, because you can never know too many LNC’s, or have too much advice and support.

I bought a color printer, created and printed a brochure; wrote, and constantly re-wrote, a cover letter to send to attorneys along with my c.v. I designed and printed my own business cards, and developed a website (now on my fourth). I switched from Word Perfect to Word and bought chronology software. I mailed ten packets a week for many weeks before someone called me and it was for the one thing I would not do – provide expert testimony.

Eventually, an attorney called me with three controverted workers compensation cases – cardiac, and he wanted me to help him overturn them. This, I could do, and he still uses my services. I found, however, (being a healthy skeptic), that I really love defense work. First nursing home litigation, then numerous premises liability cases, product liability, slip and falls, mold exposures, wrongful deaths, medical malpractice, World Trade Center merit assessments – each case was, and will always be, unique. The learning curve never flattens out.

I developed a profile on LinkedIn, started several groups, carefully built my network, and joined my local AALNC chapter. I presented a webinar on using LinkedIn and overcame some of my loathing of public speaking. I am president of my AALNC chapter, and our Board produced a very successful regional LNC conference in July. I love this path I have chosen, and I hope the journey never ends.

TweetIt is true. These are legal nurse consultants, working at the limits of their physical capacity, and never complaining about aches, pains or the horrible nausea from chemotherapy. I have known some LNC ‘s for years before they told me they had cancer or Crohn’s or a debilitating orthopedic condition.

I am fortunate to be in good health. A major cold is enough to stop me in my tracks, each minute feels like an hour, and fleeting stomach upset makes me look twice at staying in bed.

But these nurses. One in particular is a dynamo; she projects positive energy, shares her contacts, knowledge and resources with others, and never complains. She has so much information in her head she should have her own search engine. She is on chemo, and just yesterday, she said to me, “Alice, this chemo thing is not that bad. My sister cut my long hair short so it wouldn’t be a shock to lose it; this Zofran handles the nausea, and those mouth sores respond pretty well to the medicated mouthwash. Anemia and thrombocytopenia will be a problem, but listen; I have a case I’m working on. Let me tell you about it…”

And, off she goes. Within the forums that I frequent, a good percentage of the LNC’s either currently have or have had cancer or other disabling diseases. Undoubtedly, the illness rate is higher than in the general nursing population. They work because they love it, they need the mental stimulation, they have families who depend upon their income, and because they are tough. No one is judging their consult report by how they dressed that day and no one will know if they were too sick to get out of bed when they wrote that excellent report.

They are nurses, and they are tough. If a legal nurse consultant tells you to get over yourself and get on with it, there is a good chance that she is speaking from personal experience. Listen to her.

I have always heard that clichés were the conversational crutches of concrete people; that the truly bright and abstract among us do not think with the thoughts of others. But I have come to believe that behind every cliché is a solid foundation of truth, and the clichés surrounding independent employment are no exception.

It’s “feast or famine out there”. This is true, and truer still is the fact that independent work often results in famine and forgets to feast. For the newly independent legal nurse consultant, know this: never count on work that is promised to you, and never ever turn down work because you think you will be too busy to manage it. The attorney that calls you to check on your availability for a case may sound very sincere, and he may know that he needs your expertise. What he may not know is whether the adjustor that ultimately pays the bill will allow him to hire you. S/he may have miscalculated the tolling of a case, or the client may get cold feet, or simply go elsewhere for legal advice. I have congratulated many new LNC’s who are ecstatic that someone called them after seeing their brochure, email or marketing packet and said “I’ve got a case…”. The LNC will then turn down a job that paid half as much as their independent hourly fee because they want to remain available for this higher paying consult. Do not do this. Do not “count your chickens before they are hatched” for a very good reason; you cannot predict the hatch rate.

Attorneys know this lesson well. The very successful medmal attorney will only take a “case that has legs” (another cliché, although sometimes the legs take cases in the opposite direction). This is an attorney with “deep pockets”; it took me a while to learn all the nuances of that cliché. The majority of attorneys will take all but the most openly hopeless case in the knowledge that you “never know where your next meal is coming from”. They can juggle hundreds of cases if they have good support staff and strong organizational skills, but some will juggle those cases even without the requisite staff and skills, which is one of the reasons the retainer check, records or agreement never arrive as promised.

The other trap for a new LNC is the Friday afternoon call for an expert that is needed immediately. If I could recall the nurse who said it I would give her credit for the following: “Failure to plan on your part does not constitute an emergency on my part.” I really love that sentiment even though it is not a cliché. Fellow nurses, know that with rare exception, last minute requests are the result of poor planning. Poor planning goes hand-in-hand with failure to notify you that “Oh that case settled”. Do not be discouraged. The Declaration of Independence was the beginning of hard work, not the end of it. “Pick your battles wisely”, “Don’t get too big for your britches”, and “Don’t give up your day job” when you choose the route of independent LNC work. It really is a wonderful life.

As I write this, there are four projects that have been promised, three open cases I am working and two more that are in the pipeline. You will notice though, that I have time to write this blog. I have learned not to “put all my eggs in one basket” (clearly, poultry farmers have much wisdom to share). The projects were to be spaced so that one began as another ended, but I have no doubt they will hit in overlapping waves – less of a feast and more like Cloudy with a Chance of Meatballs. Oh well. I could eat.