What a difference 18 years makes. Back in 1997, I was a rarity as a legal nurse consultant (LNC). Today, you can hardly swing a stethoscope without hitting one. Attorneys now realize the value of using a skilled medical reviewer to evaluate complex records.
As my company has grown, I’ve attended dozens of conferences and read even more books and essays about LNCs. Nothing has helped me understand what it takes to excel better than hiring and managing my own staff.
Some of the LNCs I’ve hired over the past 20 years were new to the LNC world. Others were more experienced. A few came with an LNC certification. All of them have been RNs for at least a decade.
Experience is critical for LNCs, but it’s not enough to guarantee excellence. Poor writing skills and a lack of advanced critical thinking are the top reasons LNCs flounder. If a nurse does not understand a claim’s legal nuances and can’t explain the relevant medical issues clearly in writing, then that LNC won’t be an asset to the client.
Before hiring an LNC, always ask for multiple sample reports and references. To avoid other tough issues and wasted time, here are seven more tips when hiring an legal nurse consultant:
1. Be clear about your needs.
Don’t send the nurse on a fishing expedition. Have specific goals in mind. then, closely review the report to make sure those goals were met. Always ask if there is another set of eyes that will review the final product before it is sent to you.
2. Explain the case’s allegations.
The medical facts and issues are just part of the picture. How those facts play out through the prism of a lawsuit varies greatly. Make sure the LNC understands who is at fault, the standard of care and other relevant legal issues. If you are unsure what is going on or if there is a question of merit, discuss the details with the nurse reviewer. A little information can go a long way in helping the LNC fine-tune the final report.
3. Request more than a regurgitation of the medical record.
If the reader has to use Google or a medical dictionary to get through the report, then the LNC has missed the mark. the nurse needs to summarize the medical information and write about it in a way that an attorney can fully understand. the nurse reviewer should clearly explain the importance or lack of importance of an issue in her own words.
4. Insist on the details.
Misspelled words, wrong dates and other errors ruin a report’s credibility. We all make mistakes, but if the LNC repeatedly makes mistakes, then you need to seriously question whether she has what it takes to be a consultant.
5. Ensure medical information is properly reported.
Attorneys rely on the legal nurse consultant to find, detail and explain a case’s medical information. However, often because of inexperience, nurses don’t include all of the necessary information or forget to document a critical fact. Sometimes, it’s because the LNC didn’t fully understand the issues at hand. the LNC’s analysis should demonstrate knowledge of the disputed facts versus the undisputed facts, along with any expert opinions. Any information that speaks to your specific issue or questions should be included.
6. Look for a basic understanding of biomechanics.
While nurses are not biomechanical engineers, they need to have an understanding of how an accident affects the body. An experienced LNC should discuss in the review whether the injury caused a new problem or exacerbated a pre-existing condition. Always share police reports, incident reports, witness statements, photos and more with the nurse reviewer. they are essential for LNCs to know if an injury was caused by product misuse; human or product failure; or external or internal forces.
7. Meet in person or by telephone.
A legal nurse consultant must be able to think like the opposing counsel and determine why a provider did what they did. This kind of critical thinking can be difficult for a new LNC. Lack of it, however, will quickly sink a nurse reviewer because the work product will not hold up when it’s tested. A lot of information about the nurse’s skills and expertise can be gleaned from talking through issues in person or by telephone.
Even after vetting and preparing an LNC for work, we sometimes encounter problems. there is a difference between inexperience and a lack of capacity, so unfortunately, many of an LNC’s problems do not become apparent until multiple reports have been generated.
It is demanding and rewarding work, but as you consider your next medical reviewer, it is important to remember it is not an avenue for every RN. Kari Williamson
