ABOUT LNCing
Following are helpful articles originally submitted by our chapter members for our newsletter, but which we found so helpful that we have retained them for our web site to serve as ongoing resources for LNCs:
- LNCC-Celebrate
Certification!
by
Patricia Costantini, RN, MEd, CRC, CCM, CLCP, LNCC
- Considering
a Career as a Legal Nurse Consultant?
by Joanne Boyd, RN, MSN; Sophia Gardner, RN, MSN and Nursine Jackson, RN, MSN
LNCC-Celebrate
Certification!
by
Patricia Costantini, RN, MEd, CRC, CCM, CLCP, LNCC
About
the author: Patty
is a Past President of the Pittsburgh Chapter, and in addition, is a Past
President of our National organization, but has ongoing roles and commitments on
both levels. She is and independent
LNC and owner of Costantini Rehab, Inc., through which she provides
rehabilitation services and life care planning for both plaintiff’s and
defense firms. Patty entered
nursing, as a second and complementary career, after having worked as vocational
rehabilitation professional for many years.
This combined education and her wealth of experiences enables her to
provide unique perspectives in patient care issues.
There are currently 346 RNs who have earned the opportunity
to use the credential Legal Nurse Consultant Certified (LNCC).
Considering there are approximately 400,000 Registered Nurses who are
certified in their specialties, LNCCs are unique!
Joan
Magnussun, AALNC Past President and immediate Past Chair
of the American Legal Nurse Consultant Certification Board (ALNCCB), recently
commented during a session at the AALNC Annual Conference that the LNCC is the
“culmination of ten years of effort by your professional association.”
The Association made an early commitment to instituting a professional
certification in Legal Nurse Consulting, in order to establish a clear identity
for LNC practice. The
certification program was developed with American Board of Nursing Specialties (ABNS)
standards in mind, because AALNC was committed to eventually being accredited
through that entity.
ABNS is a membership organization that maintains a
national peer review program for nursing specialty certifications.
It is the “certifier of certifiers” for nursing.
An organization that wants to demonstrate the value of its credential
will seek to have its certification examination and process recognized as
complying with the stringent standards of ABNS.
Beginning in 1990, AALNC began working on defining Standards
for Legal Nurse Consultants. A Role
Delineation Study was done to determine, “What do LNCs do?”
That study became the foundation for the AALNC Legal Nurse Consultant’s
Scope of Practice. In 1995, the AALNC Board of Directors officially adopted the
Standards of Practice. In 1996, Legal
Nurse Consulting, Principles and Practice was published.
This is the core curriculum to consult for LNC’s general scope of
knowledge. The text is currently
being reviewed for revisions and updates, with a planned publication date in
late 2002.
In 1997, the AALNC Board of Directors appointed a
Certification Task Force to explore the next steps in establishing a
certification program. Following
extensive research, a testing company selected. This
company, C-NET, (Center for Nursing Education and Testing), deals only with
nursing certifications. The first
certification board, ALNCCB, was appointed in October 1997.
ALNCCB is an autonomous certification board.
Its first job was to set up eligibility requirements and a valid
examination.
A certification test must accurately reflect the
practice in question. By 1997, the
Role Delineation Study was outdated. A
Practice Analysis Survey was done in 1998.
Questions were asked about activities/tasks performed and how important
those tasks were. Knowledge areas
and abilities statements were evaluated on a scale, from “Irrelevant” to
“Essential.” One hundred thirty
nine specific LNC activities were identified as areas to be tested. Using the information gained, the LNCC test was developed by
experienced LNCs, under the guidance and direction of C-NET.
Each question was developed to be “legally defensible.”
The LNCC test was carefully designed to be a direct reflection of the
practice of Legal Nurse Consulting.
In 1999 the LNCC was accredited by
ABNS.
Achieving
the status of LNCC is a goal to which every LNC should strive.
A study by the Nursing Credentialing Research Coalition (NCRC) indicates
certified nurses report a variety of outcomes resulting from becoming certified.
These include increased confidence, increased feelings of competence,
personal growth, increased job satisfaction, and financial benefits.
In a field as “new” as legal nurse consulting, the LNCC at this time
may be even more significant to the field than to the individual.
Becoming an LNCC demonstrates a commitment to the LNC specialty. It validates the LNC’s commitment to professional standards
of practice. It becomes a
“talking point” to allow the LNC to educate others and promote the
specialty. On a personal level, the
LNCC publicly demonstrates an LNC’s experience and knowledge. It also provides incentive for the LNCC to consistently
pursue continuing education.
The credential, LNCC, represents that the individual has
experience (minimum is 2000 hours over three years prior to sitting for the
examination), knowledge demonstrated through passing psychometric testing that
is a valid and reliable measure of the knowledge base required to be an
experienced legal nurse consultant, ABNS recognition, and commitment to
continuing education.
Securing
or striving toward earning the LNCC proves the LNC’s commitment to the
specialty practice, and to her own identity.
As Diane Miller, MAOL, BSN, RN, the keynote speaker at the April 2001
conference, said, “Act as if what you do makes a difference!”
References and
Recommended Reading
American
Legal Nurse Consultant Certification BoardÒ, (2001) Certification Information Handbook and
Application, Glenview, IL.
Bernreuter,
M., The American Board of Nursing Specialties, Nursing’s Gold Standard,
JONA’s Healthcare, Law, Ethics, and Regulation, Vol. 3, N. 1, March 2001
Bogart,
J., The President’s Message, Journal of Legal Nurse Consulting, Vol. 9,
N. 2, April 1998
Burbach, V.,
et.al., Continued Competency in Nebraska:
Process and Progress. Issues, A Newsletter of the National Council,
Vol. 20, N. 2, 1999. National Council of State Boards of Nursing, Inc.
Cary, A.,
Certified Registered Nurses, Results of the Study of the Certified Workforce. American
Journal of Nursing, January 2001
Faherty,
B., Certification: Why Bother?, Journal of Legal Nurse Consulting, April
1991
Magnusson,
J., Legal Nurse Consultant Practice Analysis Summary Report. Journal of Legal
Nurse Consulting, January 1999
Webster,
S., If You’ve Got It – Flaunt It, Marketing Your LNCC, AALNC Chicago
Chapter Newsletter
Considering
a Career as a Legal Nurse Consultant?
Here
are some Helpful Tips to get you Started
The
editorial board extends their gratitude to Pamela Rice who generously shared the
wealth of her experience gleaned in developing her own LNC practice.
This article was developed through the combined efforts, and also
reflects the experiences of LNCs from our own chapter: Nursine Jackson,
an LNC in a plaintiff’s firm; Joanne Boyd, an LNC in a defense firm;
and Sophia Gardner, an independent LNC.
Faced with the realities of a constantly changing healthcare
industry, nurses often explore new career opportunities focused on integrating
their clinical expertise with other professional disciplines.
One such career venture is the growing profession of Legal Nurse
Consulting. This article is
intended to provide practical tips for nurses interested in pursing a career as
a Legal Nurse Consultant (LNC). In
addition, because of the insight often gained by learning from another
individual’s experience, featured in this article is an interview with an LNC
with a successful, full-time, independent practice.
[Please note: The views expressed by this LNC do not
necessarily represent the views of this chapter or editorial board.]
Helpful Tips:
As with any life-changing career decisions, it is important
to verify that you understand the essence of the anticipated profession to
ensure that it offers a career that fits your needs and abilities.
These helpful tips may help you focus your investigation into legal
nursing.
·
Visit the web sites for local and national information pertaining
to the bylaws, the guiding principles, and other related information.
·
Attend the local chapter meetings to network and inquire about the
profession.
·
Avoid developing tunnel vision.
All work is not related to medical malpractice cases, nor is it generated
from law firms. Investigate the
many different options for practice as an the LNC, including personal injury,
worker’s compensation, toxic tort, criminal law, risk management, insurance
company reviews, etc.
·
Experience/Expertise
in nursing is essential; therefore, examine where you are now, in terms of your
experience/expertise, and then determine what additional education, and/or job
experiences, you will require to be successful in the LNC profession.
·
Examine your own
strengths and abilities. Your
experience may be the most valuable factor to your success, but a professional
LNC also needs to be able to analyze medical records, research the medical
literature, and write.
·
There is no one
“Magic” product/course that will make you into an overnight success at
anything. Most often a common sense
practical approach will be your best guiding factor.
·
Purchase and
subscribe to related literature (e.g., reference books, peer-reviewed scientific
periodicals, authoritative treatises), or identify a mechanism through which you
will have ready access to the medical and nursing literature.
·
Attend
conferences, take courses, and review the literature to keep abreast of the
current trends in patient care, and legal nursing.
·
Should you choose to become
certified in the profession, carefully evaluate the source for the
certification. Not all
certification programs are the same. When
considering which certification to obtain, keep in mind credibility issues
associated with the certification course. National
associations are most often viewed as the governing bodies of
organizations/professional disciplines, thus, obtaining your certification from
the organization’s national association may be another avenue by which you can
add to your credibility as a LNC. However,
as with all certifications, you should first consider the pros and cons of
becoming certified relative to your area of practice (e.g., in-house
hospital/legal environment versus independent/expert witness).
There
are many options available to begin preparation for a career as a LNC, and we
recommend that you carefully evaluate all of your options and choose a path with
a realistic approach to accomplishing your goals. To give you additional
food-for thought, the following interview with Pam Rice of Rice Medical-Legal
Association provides some practical insights into developing and maintaining an
independent LNC practice.
In
1995 Pamela Rice, BSN, RN, CGRN entered
into the profession of legal nursing, following a long clinical career,
including many years of staff nursing and then managing a sizable
gastroenterology practice, which required that she develop many diverse roles.
She brought a wealth of academic, clinical, and business skills to her
LNC practice. She, like many LNCs,
started her business after taking a course designed to train nurses to become
legal nurse consultants. She attended the LNC seminars, purchased audiotapes and read
extensively to prepare for this “line of work.” Now six years later and working full time in her own
“exclusively plaintiff” LNC business, she
offered her views on facets of the business that she believes beginning
LNCs should consider.
Nurses
looking for a job that they can do from home and make significant hourly wages,
must recognize the importance of having a certain foundation in order to achieve
success in the business. According
to Ms. Rice, too often advertisements imply that, “Any nurse can take a LNC
preparation course and be ready to do the work, however,” she states, “that
just is not the case. I [Ms. Rice]
believe it should be emphasized to nurses entering this field that they must
come with extensive clinical experience, and at least some business management
knowledge.”
“Marketing
is only one aspect of the business side of this adventure, and from my
experience [Ms. Rice], it seems to be the only aspect of the business that is
mentioned in preparation courses. In
reality, often times marketing tends to be only a minor issue, as LNC’s become
invested in this work.” As stated
by Ms. Rice: “I can’t emphasize enough how important it is for nurses who
consider working in an independent practice to have a prerequisite sense of
running a business. Although a MBA
may not be necessary, some knowledge of accounting principles, business-writing
skills, and marketing principles is essential.
For example, mechanisms for invoicing, tracking accounts receivable and
payables, collection procedures, etc., are some of the basic financial
activities in any business. A good
accounting program will take care of a good deal of this.
But you have to know how to organize it, and at least, understand a
‘chart of accounts’.”
Additionally
she states, “Many nurses have no idea how to successfully write a business
letter, or a ‘consult’ letter. Nurses
do not naturally acquire even basic secretarial skills in their daily work.”
A nurse entering the business of legal consulting will need to know how
to format a letter, and turn out a polished work product.
Computer skills and research skills are also a necessity.
As stated by Ms. Rice: “I’ve received calls from nurses ready to jump
into this who barely know how to use a word processing program and are not even
on the Internet”. Most often,
nurses would be able to learn this in a relatively short amount of time, however
it is important to be aware of these necessary skills upfront.
In
Ms. Rice’s experience, she has found that often, nurses are not aware of the
importance of clinical experience as an essential element for the LNC
profession. She shared that “I’ve been approached by nurses who hated
clinical nursing, or the hours required after a year or less and want to do this
work”. She also shared one such example as follows: “During a conversation
with one of the Red Cross nurses, I was asked what I do for a living.
When I responded with the nature of my business as a LNC, her eyes lit up
and she said, ‘That sounds perfect for me!
I could work at home!’ When
I asked what her experience was she told me she had worked for 3 months at one
of the local hospitals and just hated it, and that she had figured out real fast
that she did not want to be pushed around on different shifts.
She went to work for the Red Cross and had been doing that for 1-1/2
years. With less than 2 years
experience in nursing at all, and only 3 months with any real clinical, I told
her she just didn’t have enough experience.
She was totally deflated, and I’m sure she didn’t believe me.
However from my point of view I say, ‘better deflated and dejected than
broke and depressed.’”
Glossy
ads suggesting that you can earn $60 - 120 per hour, working from your home can
be misleading. As stated by Ms.
Rice: “Consultants like me make more in the range of $65 - 85/hr., depending
upon venue and experience. I know
one area where LNCs can’t get $50 per hour.”
Ms. Rice shared that a nurse could be misled, and think that for roughly
a $2,000 investment and then charging a kind of middle of the road fee of $100
per hour, she could recoup her investment in twenty hours.
The reality: A
beginning LNC might be fortunate to bill twenty hours of work in six months,
just starting out, from which startup expenses must be deducted.
The new LNC may “talk one local attorney into giving her a case that
amounts to three hours of billable time; and that could be her only work, for
her first six months to a year. Now
what?”
Additionally,
advertisements suggest that in just one week you can become certified as a Legal
Nurse Consultant and “ready to practice”, but many nurses have found that
this proves to be an unrealistic expectation without prior related experience
and a solid clinical knowledge base.
Start-up
Costs: To
build a home office, a LNC will need a good computer, Internet access and at
least one good online research related service, for which there will be a
monthly fee. The LNC also needs to have access to a good medical library.
In addition, stationary, business cards, marketing tools such as
brochures, etc., as well as a different malpractice policy for
“self-employed”, and business insurance are all additional costs.
She recommends that the LNC considers consulting a business attorney and
a CPA, and joining, at the very least, the national AALNC.
In reality, the startup cost is going to be in the ballpark of $3 – 5K,
depending upon how well it is done and what deals are available.
Additional tools that could be added to the basic LNC office could
include a cell phone, beeper, a scanner, and a laptop.
These other pieces of equipment that make the LNC’s life easier could
easily raise the start up costs to a $7K investment.
In
summary, although Ms. Rice’s home base is in a small community in Bloomington,
Illinois, her practice involves working for attorneys all over America.
We hope her insights provide additional insights for nurses venturing
into this career.
