Legal Nurse Consultant 
by Sara Courson, BSN

Legal Nurse Job Search

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What is a Legal Nurse Consultant

Educational Requirements

Specialty Certification

Salary Ranges

Entry Advice

Associations

Publications

Schools

References

About the Author

What is a Legal Nurse Consultant

A Legal Nurse Consultant, or LNC, is a nurse who uses her nursing and medical experience, in addition to knowledge of legal issues, to assist lawyers in preparing their legal cases relating to healthcare issues. According to the American Association of Legal Nurse Consultants (AALNC), "The primary role of the Legal Nurse Consultant is to evaluate, analyze, and render informed opinions on the delivery of health care and the resulting outcomes." If you refer to the AALNC "Position Statement on the role of the Legal Nurse consultant as distinct from the role of the paralegal and legal assistant", you will find that the LNC role is expansive.

The following list of activities helps to distinguish the practice of legal nurse consulting:
Facilitating communication and thus strategizing with the legal professional for successful resolutions between parties involved in healthcare-related litigation or other medical-legal or healthcare-legal matters.
Educating attorneys and/or others involved in the legal process regarding the healthcare facts and issues of a case or a claim.
  Researching and integrating healthcare and nursing literature, guidelines, standards, and regulations as related to the healthcare facts and issues of a case or claim.
  Reviewing, summarizing, and analyzing medical records and other pertinent healthcare and legal documents and comparing and correlating them to the allegations.
Assessing issues of damages and causation relative to liability with the legal process.
Identifying, locating, evaluating and conferring with expert witnesses.
Interviewing witnesses and parties pertinent to the healthcare issues in collaboration with legal professionals.
Drafting legal documents in medically related cases under the supervision of an attorney.
Developing collaborative case strategies with those practicing within the legal system.
Providing support during recovery, depositions, trial, and other legal proceedings.
Testifying at depositions, hearings, arbitration, or trials as expert healthcare witnesses.
Supporting the process of adjudication of legal claims.
Contacting and conferring with vendors to develop demonstrative evidence or to collect costs of healthcare services, supplies, or equipment.
Supervising and educating other nurses in the practice of legal nurse consulting.

According to the nurse consultants I spoke with, it is imperative that individuals understand the distinction between the paralegal and the legal nurse consultant. Legal Nurse Consultants have a unique position in the legal field by virtue of their nursing experience. LNCs use their nursing/medical knowledge to clarify health-related issues for attorneys. These skills, that nurses offer to legal experts, can not be taught in any paraprofessional program but must be gained through years of practice in the healthcare industry. Paralegals work with lawyers in a totally different capacity that is not related to nursing.

Educational Requirements

Other than a nursing degree, which includes Diploma through Doctorate level nurses, there are no educational requirements to become a legal nurse consultant. If a nurse feels that further education would help their practice as a consultant, then there are courses available for LNCs through various sources.

In my research, I was not able to find any colleges in Pennsylvania that offered a certificate for Legal Nurse Consulting. There is a college program in Ohio, as well as distance programs through Medical-Legal Consulting Institute, Inc., and the AALNC. The LNC programs can help nurses to understand the dynamics of legal issues related to healthcare and how the nurse can use her/his nursing knowledge to assist the attorney in medical/legal issues.

The nationally known program through Medical-Legal Consulting Institute, Inc. is owned and operated by Vickie Milazzo, RN, MSN, and JD. This program offers a 6-day "live" course or a 92.7 contact hour home study course which makes you eligible for the certification exam to become an CLNC, an exclusive designation only available to participants of the Medical-Legal Consulting Institute's programs. The AALNC also offers a home study program for Legal Nurse Consulting.

It would be unrealistic to say that you could be a successful, independent nurse consultant without developing essential business know-how. Basic skills are taught in some of the legal nurse consultant programs, but experience, networking with seasoned nurse consultants and participating in business classes, are important aspects of having a lucrative LNC practice. Check with your local small business administration for classes on business and entrepreneurship.

If individuals decide to take classes geared toward legal nurse consulting, they must assess their learning needs and lifestyles to determine which program is best for them. This article is in no way recommending one program over another, each has merit and can advance an individual's career in the medical-legal consulting field. As with any other career choice, personal assessment, financial factors, time/travel restrictions, prior experience, learning style and program validity have to be considered wholly in order to make an intelligent choice. Research these programs thoroughly on your own and see which would be the best for you. It is essential to look for programs that are nursing based and taught by nurses/nurse-attorneys to assure pertinent and accurate information.

Specialty Certification

The American Legal Nurse Consulting Board offers certification in legal nurse consulting. The title LNCC, or Legal Nurse Consultant Certified, is dependent on the following requirements: "Must possess a full and unrestricted license as an RN and a bachelor's degree or the equivalent of 5 years' experience as a legal nurse consultant. Must have practiced 2 years as an RN and have evidence of 2000 hours (cumulative) of legal nurse consulting experience in a staff, administrative, teaching, or private practice setting within 3 years prior to the application."

There is also specialty certification offered through Medical-Legal Consulting, Inc. programs. This certification is different from that of LNCC. Medical-Legal Consulting, Inc., offers an exclusive title to the participants of their LNC programs. Once a nurse has completed the educational programs, either in the classroom or through home-study, and successfully passed the exam that is taken at the end of those studies, the nurse is then given the credential of CLNC(cm), Certified Legal Nurse Consultant.

Salary Ranges

LNC's who have successful, independent consulting businesses, usually charge between $60-150.00 per hour depending on their experience and the part of the country they are working in. Time requirement varies widely with the specifics of the work involved. If a basic chart review is requested, that can involve one or two hours-to several days, depending on the complexity of the case. If the LNC is called upon to do extensive research, interview plaintiffs, prepare for deposition, write summaries, etc., the process can be quite lengthy and time consuming.

Usually, a retainer is required of the attorney. The retainer is a flat fee, paid up front by the attorney, and used for working expenses by the LNC as they work on the case until completion at which time the fee is paid in full. Which brings us to a business issue of being able to collect on financial obligations from customers. This is a skill that is definitely needed by the LNC in this business. An LNC must be assertive and be able to work with parties who are slow to pay in order to keep the business running smoothly and keep financial records up to date and accurate.

Annual income is dependent on the size of the consultant's practice. This could be done on a part time, infrequent review basis, or a consultant could have a very busy practice with several clients running at the same time. Some consultants claim to be making salaries in the six-figure range, but more realistic are those practices in which consultants are making a comfortable profit, usually higher than their annual income as a staff nurse if the practice is active. Those nurses who choose to work with a law firm, can earn salaries ranging from $25-60,000, again depending on the consultant's experience and the size of the practice.

Entry Advice

Nurses who are interested in the field of legal nurse consulting, need to have the following traits:

Five or more years of experience - The legal cases you work on depend on your nursing background. If you have specialty experience, you will be valuable on cases pertaining to that specialty as well as general standards of care. For example, if you have an OB/GYN background, you would be kept very busy with OB cases (OB is the most litigious area at this time), but you would also be able to give advice on safety precautions indicated after anesthesia, intravenous or blood draw standards if that is within your field of practice, medication administration, etc. To quote a practicing LNC, "You need to know what you don't know!" You need to know your limits so that you do not get involved with cases outside of your clinical experience. If a case was presented to you that would involve standards you were unfamiliar with, you could take the case and contract out to another nurse to assist with the aspects of the case that you needed assistance with. Subcontracting is another way that nurses can get started in this business, reviewing cases with the assistance of other seasoned consultants until they developed confidence and familiarity with the legal/litigation process.

Excellent Communication Skills - Nurses need to have the ability to communicate, both in verbal and written forms, with attorneys, plaintiffs, families, and medical experts.

Confidence - LNC's must posses the knowledge and skills to be able to respond to the attorney's needs for the cases involved, and feel confident in giving the requested advice. When a LNC is involved in testifying in court, she/he must be prepared for cross-examination by the opposing legal team, which can be quite intimidating.

Business Skills - LNCs may choose to work in a law office as part of the in-house staff. Just to be aware, some offices need/want paralegal assistance, with the accompanying job description and salary range. LNCs must be conscious of the distinction of these roles as mentioned earlier in this article. Nurse consultants are not paralegals and must be sure that the attorney or firm that they are working for understands this and hires the appropriate person for the job. If a consultant wants to work independently however, then the necessary business skills must be obtained. For example: how to establish a consultant business (business structure, income tax laws, etc.); marketing and obtaining clients (a great deal of marketing is related to educating potential clients on the abilities of LNC's); setting and collecting fees; and so on.

Continued Clinical Experience - In many instances, attorneys will expect LNC's to have an active nursing license and work clinically in their specialty or a general nursing position to maintain competence and keep up with clinical standards and procedures.

Membership in Professional Organizations - Belonging to a nursing specialty organization, national and state nursing associations, and the AALNC or related groups is important for demonstrating continued involvement in the nursing profession. Also, participating in on-line discussion groups can expose the nurse to valuable information and positive collegial relationships with other practicing consultants.

Getting started as a LNC is a combination of the above mentioned traits and knowing where to turn for assistance. Some nurses start with occasional chart reviews, either by being referred by a colleague or directly contacting an attorney for such work. If work is done with the same attorney or law firm over a period of time, then the accompanying legal skills can be gained along the way by asking questions and being involved with the process from the sidelines. This goes a long way towards making a name for yourself in chart review and then you may be offered other projects as your skills grow or your name is spread to other attorneys in the area.

If a nurse is thinking about going into consulting without any previous experience with the legal/litigation process, then they would want to research structured programs to help acquire the necessary abilities. Interested individuals might consider the option to volunteer within a law clinic or law school, thereby becoming involved with the legal process while gaining experience. Begin by calling and asking if the organization needs help to do case summaries, chart review, or interpretation of medical language and procedures.

Before launching into a program or starting a business, you must do research on the viability of a consultant practice in your area. The LNCs I interviewed for this article stated that one of the biggest hurdles in obtaining clients in Pennsylvania and surrounding areas, was education of attorneys on the role and abilities of the professional legal nurse consultant. Starting with one client, if a consultant does an impeccable job with the requested projects, chances are that the attorney will refer to that consultant again in the future with similar cases or those that apply to her/his background. Word of mouth is also an extremely important marketing tool for the LNC. However, depending on the size of the law practice or town that the LNC is practicing in, the cases may be few and far between. Even in association with a busy law practice or in an urban area, it takes a while to establish a lucrative business. That is part of the risk of being in business for yourself, you must be prepared to spend time (and money) building a reputation in the specialty before having enough clients to be comfortable financially. This amount of time varies greatly from practice to practice.

Use of the Internet and state of the art electronics, enables a consultant to work on cases on the other side of the state or on the other end of the country. If the attorney is willing to work through the phone, fax and Internet, and there is no requirement to personally interview the plaintiff, give depositions or work face to face with the attorney, then a long distance business relationship can be successful.

Associations

American Association of Legal Nurse Consultants (AALNC)
PO Box 5054
Des Plaines, IL 60017-5054
(877) 402-2562
Fax 847-375-4777
E-mail info@aalnc.org
http://www.aalnc.org/member.htm

Philadelphia Chapter-AALNC
Kay Fox, President
24 Marcel Avenue
Spring City, PA 19475
(610) 948-3695

Pittsburgh Chapter-AALNC
Dianne Alessio, President
PO Box 97104
Pittsburgh, PA 15229-0104
(412) 355-2994

LNCNURSE - E-mail discussion list.
To subscribe, send an e-mail to: join-LNCNURSE@legalnurseconsultants.com

LEGALNURSE - E-mail discussion list.
To subscribe, send a blank email message to: legalnurse-newbies-subscribe@makelist.com

MEDICAL-LEGAL Network - E-mail discussion list.
To subscribe, send a message to: egroups.com-subscribe@medical-legal-network with the message: subscribe.

National Alliance of Certified Legal Nurse Consultants
Associated with Medical-Legal Consulting Institute, Inc.
(800) 880-0944
http://www.legalnurse.com

National Nurses in Business Association
56 McArthur Avenue
Staten Island, New York 10312
(800) 331-6534
http://www.greatnurses.com

U.S. Small Business Administration
200 North College Street, Suite A2015
Charlotte, North Carolina 28202-2173
http://www.sba.gov

Publications

American Association of Legal Nurse Consultants. (1991) "Getting Started in Legal Nurse Consulting."
    Glenview, IL: American Association of Legal Nurse Consultants.

Bogart, J.B. (1997). "Legal Nurse Consulting: Principles and Practice." Glenview, IL: American Association
    of Legal Nurse Consultants.

"Journal of Legal Nurse Consulting"
Published by the American Association of Legal Nurse Consultants
Publication Orders
4700 West Lake Avenue
Glenview, Illinois 60025-1485
(877) 402-2562
Fax 847-375-6313
E-mail info@aalnc.org
http://www.aalnc.org/journsub.htm

Paulson, E. & Layton, M. (1998). "The Complete Idiot's Guide to Starting Your Own Business." (2nd ed.)
    New York. Simon & Schuster Macmillan Company.

Schools

Distance Programs

American Association of Legal Nurse Consultants          Self Learning Course
Professional Legal Nurse Consulting Course Audio and Video Tapes
(See reference under "Associations" for contact information)

Medical-Legal Consulting Institute, Inc.                              Certificate Program
2476 Bolsover, Suite 632
Houston, Texas 77005
(800) 880-0944
Fax 713-942-8075
E-mail mail@legalnurse.com
http://www.legalnurse.com

Traditional Courses

Ohio State University at Lima                                              Certificate Program
Office of Continuing Education
315 North Elizabeth Street
Lima, Ohio 45801
(888) OSU-OHIO
Fax 419-224-2219
E-mail ced@lima.ohio-state.edu
http://www.lima.ohio-state.edu/admissions/ced/nurse.htm

Contacts…

The following individuals have graciously consented to serve as resources for those of you interested in starting in the field of medical-legal nurse consulting.

Nicole Marie Spring, RN (Phone Consultation fee = $75.00 per hour)                                      
President, Legal Nurse Consultants
Listowner, LNCNURSE
8621 Pine Hollow Drive
Russell, Ohio 44072
(440) 338-5203
Fax 440-338-4174
E-mail spring@legalnurseconsultants.com
http://www.legalnurseconsultants.com

Valerie Parisi, RN, CRRN, LNC
President, ValPar Consultants, Inc.
109 Windsong Drive
Doylestown, PA 18901
(215) 230-0141
Fax 215-230-9913
E-mail vparisi@voicenet.com
http://www.valpar.com

References

American Association of Legal Nurse Consultants. Webpage can be accessed through
http://www.aalnc.org/position.htm

Lippincott's Nursing Center, Certification Information. Webpage

Additional Sources of Information…

I would like to extend my sincere appreciation to the following individuals for their contribution to this article.

Ms. Dianne Alessio, President of the Pittsburgh Chapter of the AALNC

Ms. Angel Shannon, RN
Capital Legal Nurse Associates
PO Box 14
Owings Mills, Maryland 21117
E-mail LGLNRSE@ibm.net
http://mypage.ihost.com/LegalNurseAssociates

About the Author

Sara, a member of the PA State Nurses Association, is a nurse living and working in Western PA, who has 15 years experience in Obstetrical nursing and has written PA Nurses' career articles intended to inform and inspire nurses to learn more about the various employment opportunities within the nursing profession in addition to the traditional roles nurses have been involved in over the years. 

© 1999 This page was last edited: November 08, 2004