Tag Archives: legal nurse

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.

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Can Anyone Create a Chronology?

[Encarta Dictionary: English (North America) chro-nol-o-gy (noun) 1. Order of events: the order in which events occur, or their arrangement according to this order.]

This simple definition is what many professionals conceptualize when they think “chronology”. If it were that simple, I could present a high school student with 1000 pages of medical records from physicians, facilities, hospitals, etc., and instruct them as follow:

• Create a basic four column table with headers across the top for the Date, Page Reference, Facility, and Event
• Enter every doctor’s order, every medication given, and the results of all x-rays and lab work.
• Include all vital signs, and every diagnosis that is made along with the physician and date.
• Use a separate row for each type of event and be certain not to miss any of the above.
• Write down the abbreviations and terms as you find them, but do not look them up
• After entering all information, sort by date, spell check your work and review the formatting
• Email the chronology to me within the next ten days

The result would be a 100 page chronology filled with errors and minutiae, faithfully recorded without knowledge of its bearing on the case, deviations from standard of care, definitions of medical terminology, or ability to connect the many dots.

A legal nurse doing the same chronology would be seeing the case unfold in her imagination, having walked those hospital halls, cared for the injured patient with comorbidities, understanding policy and procedure while juggling physicians, ancillary staff and family.

A nurse doing the same chronology would likely produce only 20 pages of data after sifting through the information that is not relevant to the case. There would be a fifth column with observations, definitions, research data and identification of unrelated conditions.

This chronology would be not an endpoint, but merely the first stage of organizing the course of events to allow a pattern to emerge. Only when the pattern of care is established will the inconsistencies become apparent to the medical eye.

Can anyone create a chronology? Yes. Does that make it meaningful? No.

Length does not equal quality, and recitation without filtering is a waste of time, resources, and a client’s money.

Sleep is good. Work is good. Working without sleep…not so good

Sleep and work. We spend more time doing these two activities than anything else in life.

The need for a good night’s sleep is evident in the number of medications, therapies and sleep aids that promulgate the market. But we do not need advertising to tell us what we already know – a bad night’s sleep makes us miserable the next day, less efficient, moody and irritable. No sleep at all makes us dangerous at the wheel and to our patients.

For years I saw medical and surgical residents come through my ICU, sleep deprived, complete with bed-head and stumbling gait, reaching for a cup of coffee to jolt their nervous system. I never understood how being on call for 24-36 hours was a good thing for anyone but the attendings who were getting a good night’s sleep. It certainly wasn’t necessary to prepare students for being in private practice, and it occasionally put patients’ welfare in danger.

I could relate. I alternated between (3) shifts every two weeks. The coveted morning shift was bustling with activity, diagnostic studies, lab draws, ventilator weaning, PT, OT, breakfast and lunch. No way was I falling asleep on that shift. The afternoon shift was quieter, family more present, bedside and surgical procedures occurring when they could not wait until the next day, but never scheduled for 8pm. It was a time, with any luck, of relative respite for patients and staff.

But those night shifts. I well remember charting at 5am, standing up because I was trying to stay alert and literally sleeping on my feet. The circadian rhythm of my brain was not attuned to working at night. I could not sleep during the day for more than two hours, and felt like a zombie the rest of the time. Oh yes – I fell asleep at the morning wheel on more than one occasion. Thank goodness for that part of the brain that never truly sleeps.

“The stream of information (to the brain during sleep) is considerably reduced, but the brain is not fully disconnected from the environment. An inspection of the environment takes place to optimize safety during sleep. Stimuli…signaling danger are recognized, and may enter awareness, leading to a wake-up call, which allows the individual to react. This subconscious stimulus evaluation is regarded as having a guardian function for sleep.”

It’s no wonder that we spend so much time thinking about our work and worrying about our sleep. When either or both are out of balance, we are miserable and unable to enjoy everything that happens between these two activities – like family and friends, recreation and exercise.

Bones grow during sleep, brains recharge, and unless we have nightmares, a good night’s sleep cures many ills. Let sleeping dogs lie. Sleeping like a baby. Shhh! the baby (nurse, patient, doctor) is sleeping.

Words Matter

Recently, a nurse was sharing her angst that attorneys to whom she marketed via email were not responding to her. I have been giving this some thought because it is a situation that many new LNCs experience.

Everyone finds their comfort level in marketing, and chances are, if you are too comfortable, it might be time to change things up a little. This is particularly true if you are comfortable, but your efforts are not producing results.  Although LNCs can market to a variety of settings, let’s focus on marketing to attorneys, and begin by looking at ourselves.

What makes you buy a product that has no entertainment value? Need. You might watch a Bare Minerals commercial and be amazed that makeup can completely cover scarring, but if your skin is perfect, you don’t need to buy the product (and it is costly).  If you suffer from acne scarring or other blemishes, the cost may be irrelevant to the benefit you will gain from having the appearance of smooth skin.

Attorneys are the same way. If you call or visit and they do not see a need for you right then and there, they are going to say things like “I’ll keep your information on file”, or they may be “busy” when you call to schedule an appointment. This is not personal; they are concentrating their time and attention where they perceive a need, and right now, you are not it.

What do you do at this point? Do you simply move on to the next target and never look back? Or do you send them a partial work sample and CV, thank them for taking the time to look at or save your materials, and promise to keep in touch? Do you send them a relevant article a few weeks later and then maybe monthly? Because sooner or later, your name will come across their desk when they need your service, and if they like what they have seen of you, you might land a case.

During all this “down” time that no one needs you, what if they are curious enough to look you up online? What will they find?

If you are on LinkedIn, they should find a complete profile, with picture, your education and work history, hopefully a recommendation or two, and a respectable number of connections. They will look for a link to your website and a clear description of your services. They can only see what you have written.

Here is the crux of my rambling (which is another no-no). How many nurses have your medical knowledge and experience? Thousands.

What sets you apart and makes you special; what will convince the attorney that he needs you and not the others? Presentation, and the ability to communicate are critical to being a successful LNC. If your profile is not complete, if your description of yourself is not well-written, if your writing has errors in grammar or punctuation, or flips between first and third person, or past, present and future tense, you may not find work. To an attorney, words are everything.

Words reflect knowledge and experience, and how you put those words together in a sentence indicates the work product you can provide to an attorney. This is such an important issue that attorneys are constantly learning about the best way to write a brief, develop a line of questioning for depositions, or structure interrogatories to opposing counsel.  They will attack each other’s writing style and word choice, and are chastised by judges for using unnecessarily complex terminology.

Words matter. Attorneys work for their client, whether plaintiff or defense; they can be removed from a case if their work is subpar. This is always foremost in their minds. If your writing is poor, how can they trust you to analyze their case, present data in a clear and logical fashion, and not miss relevant data? How can they be comfortable that you will not represent them poorly to their client?

You cannot make a new client call you, but while you are waiting for the phone to ring, use that time to review your marketing materials – brochures, business cards, CV, sample work product and online profiles. Make sure these items have a common theme, represent your expertise, and do not misrepresent your ability to communicate. Look for webinars or courses that teach you how to write for attorneys.  (There’s probably one right now at www.patiyer.com/mcc, or www.lnctips.com).

There are many ways to write a report or chronology, but none of them include nursing shorthand, medical abbreviations, incomplete sentences and grammatical errors. Find a peer to critique your work and return the favor. If verbal communication is quicksand for you, focus on email and snail mail. Attend law seminars or sit in court and listen to trials, read about affidavits and other legal documents that you may never write but need to understand.  You will feel more confident, be more competent, and have no trouble letting that attorney know that s/he does indeed need you.