The jurors file into the courtroom, avoiding eye contact with the attorneys and spectators. I hold my breath. The plaintiff’s attorney straightens his tie; the defense attorney flexes his shoulders—both bracing for the jury’s decision. I scrutinize the jurors’ faces, but can’t tell what they’re thinking—or how they’ve voted.Next to me sits the mother of the defendant—a physician on trial for medical malpractice. She fumbles with her purse, trying to find a tissue to dry her tears. For the past 3 weeks, she has struggled to contain her emotions, but today the tears well up and spill over. I take her hand. We’ve been through much together in the last few months. As the legal nurse consultant (LNC) to her son’s attorney, I’ve helped prepare his defense while offering her emotional support. I feel a connection with her, and await the verdict with apprehension…
LNC roles and responsibilitiesLike all LNCs, I use my healthcare knowledge and registered nurse (RN) experience to advise attorneys on the medical and healthcare elements of legal cases and claims. The LNC’s roles and responsibilities include:
• demystifying medical terminology for legal staff
• reviewing and interpreting medical documents and records
• researching medical and healthcare literature
• evaluating claims of damages and causation related to health care
• developing chronologies and summaries to clarify the events in a case or claim
• locating expert healthcare witnesses
• serving as an expert healthcare witness
• interviewing clients, witnesses, and other parties
• attending independent medical examinations
• assisting in developing the case strategy
• offering support during legal proceedings.
What skills are requiredBesides a diverse background in clinical nursing, LNCs must have:
• excellent medical research skills, with the ability to quickly find and evaluate relevant nursing and medical literature
• good computer and Internet search skills
• excellent written and oral communication skills
• highly developed critical thinking skills
• knowledge of the legal issues involved in nursing and health care.
Although some LNCs work for law firms, insurance companies, LNC corporations, and other organizations, more than 60% are self-employed independent consultants who need solid business skills—specifically in starting, maintaining, and managing a business. To sustain an income and advance in the LNC community, an LNC must be knowledgeable in marketing, billing, collections, and business development.
A case unfolds—and unravelsOne of my first cases as an LNC illustrates our value. I’d been hired by an attorney whose client had fallen and fractured her hip while walking in her hospital room in the middle of the night. She needed rehabilitation, and wanted to sue the hospital for medical malpractice.
While reviewing the case, I examined the four elements that a plaintiff in a malpractice claim must prove—duty, breach of duty, causation, and damages.
First, the plaintiff must prove that the hospital and nursing staff had a duty to the patient to provide care that met the standards expected of similar hospitals and nursing staffs. I concluded that because this patient was in the care of the hospital and its staff, this point was met.
To determine if breach of duty had occurred, I researched relevant standards of care and developed a chronology of the case to align the facts in the medical record with the standards of care. From my chronology and medical record analysis, I found that this 58-year-old patient had been able to get out of bed for the previous 3 days and had walked independently more than 200 feet three times daily. She was stable on her feet, totally oriented, and able to communicate with staff; she hadn’t received sedating drugs and was scheduled for discharge the next morning.
Now I had a more complete picture of the case—and serious questions about whether the client’s injury resulted from negligence. I told the attorney she had a normal mental status, was capable of independent ambulation, and hadn’t been sedated or otherwise compromised. I asked him how she’d described her fall. He said she’d gotten out of bed during the night to use the bathroom. The nightlight was off; on her way to the bathroom, she tripped over a blanket that had fallen onto the floor.
Then I asked how she’d unplugged her I.V. pump from the wall and why she hadn’t turned on the room light. He said she’d been able to get out of bed herself, unplug the pump, and walk across the room without needing the light.
After hearing this, I told him that in my opinion, the hospital and nursing staff couldn’t have foreseen that the incident would unfold as it did and could have done nothing to prevent the client from falling. We both concluded she’d made bad decisions and the hospital staff wasn’t negligent. My consultation had given the attorney a clearer understanding of the case, and he advised his client not to file suit.
Getting started as an LNC
Diverse nursing experience is critical for anyone hoping to become an LNC, as our main asset to attorneys is our medical and healthcare expertise. It takes several years for a nurse to accumulate enough expertise to be valuable as a legal consultant. This expertise must be coupled with familiarity with the legal process. LNCs need a foundation of knowledge that evokes confidence in their ability to perform vastly different types of work at a level of acceptance that provides for word-of-mouth marketing and repeat customer loyalty.
Although formal training isn’t required to become an LNC, many RNs find such training invaluable.
Autonomy and empowerment
Working as an LNC provides a sense of autonomy and the ability to use critical thinking skills and medical knowledge in new and exciting ways. We contribute meaningfully to setting standards of nursing care while participating in case law, and we gain a sense of self-worth and empowerment by doing so.
As a bedside nurse, I took great pride in helping patients master the skills they needed to self-manage health problems. As an LNC, I take equal pride in helping to influence the standards of nursing care by educating attorneys, judges, and laypersons.
The verdict is in…
…The jurors take their seats. “Madame Foreperson,” says the judge, “will you please read the verdict?”
I hold my breath, squeeze the hand of the defendant’s mother, and prepare to accept the outcome.
“Not guilty,” the forewoman states firmly. I exhale with relief, then hug the defendant’s mother. In that moment, I realize that no matter what the verdict had been, my role in educating the attorney, supporting litigation, and interacting with plaintiffs and defendants is a privilege and a responsibility—one for which my experience as an RN has prepared me well.
Lynda Kopishke, MSN, RN, LNCC, is an independent nurse consultant with Forensic Matters in Delaware. She uses her clinical expertise to assist attorneys, insurers, families, and government entities in the critical analysis of issues at the crossroads of health care and the legal system. She can be reached at firstname.lastname@example.org.