You know you are a Legal Nurse Consultant when:

Quitting your day job no longer seems impossible.
When asked what you do at a party, you no longer fall over your words.
You actually believe, deep in your heart, that you are as valuable as your brochure claims.
Your attorneys take one look at a case and call you instead of trying to do everything themselves and messing it all up.Your attorney-client emails and says, “The senior partner wants you to look at a set of medical records for deviations in care because as usual, we don’t have any idea.” 
Your family and friends ask you if you have heard of their doctor and are relieved when you say no.
You learn that the correct answer to almost any question can be “It depends…”
You believe there are actually three sides: the plaintiff side, the defense side, and the truth.
Opposing counsel approaches you after a trial and tries to make small talk then asks for your business card, your experience and if you have an interest in working for the opposing counsel.
You ask someone you know well a question, don’t get a direct answer, and then say, “Would the witness please answer the question?”
Your mailman gives you that look, as he delivers the second file box of records up the two flights of stairs to your front door.
You used to meet malpractice and personal injury attorneys and hope you would never need their help. Now you meet malpractice and personal injury attorneys and are pretty sure they could use your help. 
You feel as though butterflies (or worse) will surely fly out of your mouth or behind once you have finally mustered up the gumption to make that first cold call!
You find yourself screaming at the computer screen “No, she didn’t just document that!”
Your attorney says the medical records will be ready in a few days and you go ahead and plan a short vacation, maybe even a long vacation. 
Your answer to your kids or husband asking repetitive questions is, “Asked and answered”.
You create a PowerPoint to get ideas across to family and friends.
Your attorney client tells you he couldn’t have won his case without your help and expertise.

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

If you are a professional seeking a career change or advancement, it is advantageous to enlist the professional contacts and marketing skills of a recruiter.  A recruiter acts as a personal “talent” agent who markets you to employers who are seeking your particular skill sets.

It is a recruiter’s job to learn about your work history, your career objectives, and your personal preferences, such as salary and benefits requirements, area of town/your commute, and your desired employment status (full-time or part-time or contract) and the hours you are available to work.  In order for the recruiter to learn this information, it is critical for the recruiter to conduct a personal interview.  The information that is gained about you in the interview becomes the marketing material that is presented to the potential employer.  And, that information is far more than what is written on your resume.

Once a recruiter has met you, gotten answers to important questions, and understands your work history and career objectives, a marketing presentation is created to distribute to potential employers.  So, what exactly makes a good presentation that is marketable to a potential employer?

First and foremost, be on time for an interview.  There is no excuse for tardiness and it lets the recruiter know you don’t respect or value their time.  Never arrive more than ten minutes early. Turn cell phone ringers off.

Look in the mirror before leaving for an interview.  Would you hire the person that is looking back at you?  Are you dressed in clean, professional attire?  How about your shoes?  Your nails?  Your hair?  Never wear perfume or cologne to an interview.  Make-up should be applied conservatively.

Be prepared.  Bring multiple copies of your resume.  When asked to complete an application, do not write “see resume”.  Applications are often seen by several individuals throughout the hiring process and may or may not have your resume attached, making the review of your application not possible.  Do not bring reference letters.  Bring a list of references in the event you are asked for it.  Do not attach the list to your resume.

Know the name of your recruiter and greet with a firm handshake.  Look them in the eye throughout the interview.  Looking away makes you look disinterested, or worse, dishonest.  And, never play with your face or hair and do not chew gum or suck on candy.

Answer questions truthfully and specifically.  Remember that less is typically more and no one wants to hear you babble.  Keep your personal life to yourself.  Too much personal information can be harmful to your employability.  Be prepared for tough questions.  Know beforehand your strengths and weaknesses, know your short- and long-term career goals, and be prepared to discuss your “hot buttons” – those things that reveal your likes and dislikes.  Be prepared to explain what you and your skills can do for an employer and why you are the best person for the job. 

Pay particular attention to the format of your resume.  In this employers’ market, employers receive hundreds of resumes for each job opening.  If your resume is not in chronological order, take the time to put it in order starting with your most recent employment first.  List the beginning and ending months and years, along with the company name, and the city and state, and your job title.  Either in paragraph or bulleted format, list your responsibilities and accomplishments.  Be precise without exaggeration.  References are checked for verification.  Remember, you want your resume to stand out from the rest and if your resume is difficult to read, contains spelling, punctuation or grammatical errors, or is not chronologically-formatted, your resume will be disregarded.

If you make yourself marketable, your recruiter can present you to the best jobs on the market, allowing you the opportunity to advance in your career and earnings.  Let them know that you shine.  Show them that you are the professional that your resume claims to be and doors may open.

If you would like to be considered for a position available through Sterling Legal Search, please submit your resume to Maureen Fitzgerald.  For additional information about Sterling Legal Search, please visit Sterling Legal Recruiters or call 404.250.9766.

In December 2011, a panel of experts rocked the pressure ulcer world by attacking some of the underpinnings of the current pressure ulcer classification systems (Staging, Grading, Categories). They said that some of the language creates problems from clinical, regulatory, legal and economic perspectives.  The advisory panel is proposing the new Superficial Changes & Deep Pressure Ulcer Theory©. Here is one piece of what they asserted:

Current numerical pressure ulcer classification systems (staging, grading, or categories) are problematic and misleading because they imply that pressure ulcers progress through defined stages (from I to IV).

The current numerical pressure ulcer classification systems are intended to describe the anatomic depth of tissue damage.  Stage 1 is characterized by non-blanchable erythema of intact skin that may be coupled with alterations in skin temperature and tissue consistency.  Stage 2 is a superficial lesion involving the erosion of epidermis with epidermal base or an ulcer with loss of epidermis and a dermal base.  Full thickness tissue damage may extend to subcutaneous tissue as in stage 3 pressure ulcers and to deeper supporting structures such as muscle, fascia, joint capsule and bone that are classified as stage 4 pressure ulcers.  Evolution of pressure ulcers does not necessarily follow a predictable linear pattern from superficial to deep; from Stage 1 ulcers to Stage 2, then to Stage 3 and finally Stage 4 ulcers.

Accumulating evidence suggests that a number of pressure ulcers (most Stage 3 and 4 ulcers) may initially originate in the deep tissue compartment and progress outward to the dermis and epidermis (inside out theory).   Deep tissue injury may not be visible to naked eyes but may take hours to days before any clinical signs are evident.  Once observed, deep tissue injury can deteriorate rapidly into deep craters despite stringent and optimal treatment that meets the standard of care.  Deep tissue injury has the appearance of a purple or maroon bruise under intact skin that resembles and is often mistaken for a stage 1 pressure ulcer.  Donnelly documented that 10% of pressure ulcers were initially diagnosed as stage 1 by visual inspection and evolved to stage 3/4 within days.  It is possible that a proportion of the stage 1 ulcers in this study were misclassified and that they were really deep tissue injuries given how quickly these ulcers evolved over time.  Other skin lesions with color change may reflect different dermatological diagnoses including; moisture associated dermatitis, fungal or yeast intertrigo or other dermatological conditions.

By eliminating the current numerical classification system and documenting the partial thickness and full thickness depth along with the appropriate physical findings (location, size, base, exudate, and margins), healthcare providers may prevent misleading communication.

Modified with permission from Dr. Diane Krasner, one of the authors of the Shifting the Original Paradigm article published in Advances in Skin and Wound Care December 2011.

This is only one of the controversial areas covered by this article. Get in on the shifting thinking about pressure sores by learning from one of the authors of this landmark statement. Dr. Krasner explores these and other controversies in an all new multimedia course that will take place on February 27 and March 5. Set aside the day of February 27 to join us for an interactive course, and complete the course the evening of March 5. Reserve your spot today. Can’t join us on either date? Get the on demand recordings at Pat Iyer. When you register for the course, you will receive 10 articles loaded with essential information about pressure ulcers, the opportunity to participate in the course and receive the transcripts, plus a substantial discount off two programs: Take the Terror of out Testifying and Negative Pressure Wound Therapy. Receive an individualized optional critique of your report. Sign up at Pat Iyer.

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.

Rhonda Haney, RN, BSN, LNCC, October 2011

She provided an eleventh hour consultation in a high profile bus accident with thirty-four injured and seven killed, and found the time to do this important work and do it well.

I also involved Alice in a series of environmental injury cases, which are always difficult to evaluate inasmuch as the symptoms claimed are so vague and ubiquitous. She did an excellent job making sense from the nonsensical and finding a clear path to an answer.

These and other cases have involved being part of a “team” which includes not only lawyers but also medical doctors, psychologists, engineers, economists, vocational, and environmental and health professionals. Her written work product, while necessarily technical, is suitably augmented with pictograms, references and the like, to permit better understanding.

The only consultations I have with Alice are challenging problematic matters, not the routine repeating fact patterns. She is not only a very competent professional, but one knowledgeable of how to successfully interface with other professionals in the field.

Stephen C., Esq., September 14, 2011

The first thing I write is an introductory paragraph that cites the patient’s name, claimed injury, and brief description of that injury. End it with your opinion, right up front. This may be the last sentence you actually write, but it should be one of the first he sees (I refuse to be gender PC; it is too much effort.)

If you are working for a plaintiff attorney and feel there is merit, you might then have a section that lists the supportive evidence. Bullets are great for this. Follow with mitigating information that may work against the patient – if you do it in a paragraph form, you still provide the information but allow your positive bullet points to take center stage.

If it is a defense report, which mine usually are, I often begin with 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. If there is factor that begs for a graphic I will add it (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 to maximize the impact without my report resembling a comic book.

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

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 where the other side is going to attack, I will point that out but offer the medical rebuttals for the attack.

I like to 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 strongly I feel about what happened, I always include something to the effect of “An orthopedic surgeon will be needed to confirm the…” because I do not want the attorney to base his case solely upon my opinion. Many times, however, they have done just that, and with great success. As long as I have that sentence in there, the onus is upon them to determine how they wish to manage their own case.

Things 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
•  When I bold a header, I do it in a dark gray so that it stands out but isn’t too heavy. Like this:______________________________________
                             Pre-Existing Conditions 
• 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 – it is obviously my opinion, but attorneys do not use first person and neither do we.
• 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 has already used an abundance of that language in his pleading.
• I end with appreciation for the consult, state my availability for further communication and review of the requested medical records as they arise
• 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 you to organize your presentation in a visually appealing way. I put the report on the inside left, the chrono on the right; turn that divider over and use the remainder for supportive research articles. 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. 

You will find a way that works best for you.

This nurse has a reliable income stream, because it takes a while to get a business up and running. “Don’t quit your day job” is our mantra, unless you are a salaried employee in a law firm. The panic of economic stress can abort an LNC’s career before it has a chance to succeed.

Here are some of the features that characterize the legal nurse consultants that I know:

• You take your work home with you – your home will probably be your office
• You develop marketing skills and become familiar with business sites like Linked In, polish up your resume and think about business cards, marketing brochures, etc.
• You are comfortable with basic software like the suite of Word programs and Adobe Acrobat, and pay strict attention to your email inbox
• You develop a style of analysis and critical thinking that allows you to communicate with your attorney, insurer, or whomever is your client
• You find a niche in which you are comfortable, and make it known that this is where you shine – neonatal, pediatrics, cardiac, wherever
• You offer informed opinions on LinkedIn or Yahoo LNC Exchange groups so that your name becomes familiar
• You distinguish yourself from a paralegal; you do not need to know the letter of the law – your value is in your nursing experience and medical knowledge
• You learn to look beneath the surface of everything
• You do not stop caring about patients, but you are now an advocate for the truth, a fact-finder, a researcher, a communicator of your findings
• You learn to anticipate what the “other” side will use to support their position and identify the weaknesses in your case– you do not allow your attorney to be surprised in a deposition or courtroom
• When you come up against an obstacle, your first inclination is to solve it before asking for help

Being a legal nurse consultant is not the same thing as being a patient advocate. It is finding the medical evidence that supports the truth.

It is about seeing what others miss, and believing in your work product and yourself. Most importantly, it is about learning, because every case is different, research evolves, even standards of care change. No one can assure you of success, but you can be successful if you believe in yourself and are willing to invest the time in preparation. Take advantage of all the free information that is out there, the inexpensive webinars, the textbooks and the conferences. You will never stop learning, and that is the greatest gift of any career.