By Todd Stein
November 4, 1999
Photo: Photodisc

Sherri Reed, RN, remembers the old days, when a lawyer needing help on a medical case would treat a nurse friend to dinner in exchange for advice. The bargain, says Reed, was all on the lawyer's side: "He got information that helped him feel he could handle the case, and he didn't have to pay for it."

Today it takes more than a filet mignon to win a medical malpractice lawsuit. Increasingly, it takes a legal nurse consultant. And Reed is one of the reasons why.

Then and now

In 1984, when Reed left her nursing job at an Indianapolis hospital to work for a local law firm, it was a fairly radical step. Attorneys had long hired physicians as consultants to educate them about medical issues. The practice was especially common in firms handling personal injury and malpractice cases, where the ability to read a patient's chart meant the difference between losing and reaping millions in damages. But in 1985, few law firms had considered adding nurses to their staffs as a way of assuring consistent expert support while saving money. At the time, Reed knew only a few nurses who had made similar moves, and none of them really knew what to call themselves. Rather than invent a new title, they just continued to call themselves nurses.

Fifteen years later, Reed is president of the American Association of Legal Nurse Consultants (AALNC). Along the way to coining a new name for the job, the 10-year-old nonprofit organization picked up 3,500 members-1,000 in the last six months alone-and founded 39 chapters across the country. Among other coups, in October the Glenview, Ill., association persuaded the American Board of Nursing Specialties to recognize legal nurse consulting as a new specialty. Buoyed by that victory, the group now is taking on one of the most powerful professional associations in the country-the American Bar Association-in an effort to define its members as distinct from paralegals, which is what the ABA prefers to call them. If they're successful, they will raise their status and recognition-and probably their pay rates-to new heights.

While legal nurse consulting remains, essentially, a tiny market in the vast healthcare universe, it has proved to be a magnet for thousands of nurses looking to branch out into new careers. When instructors at the University of Cincinnati decided to test the waters for the nation's first baccalaureate program in legal nurse consulting last year by placing an ad in the local paper, they expected "maybe a hundred people to respond," said Donna Schoebel, RN, a paralegal and University of Cincinnati instructor who designed the degree program. "Much to our surprise, in the next eight to 10 days we got over 700 phone calls."

The University of Cincinnati program started Sept. 22 with 25 students, and Schoebel expects that number to increase to 75 within a couple of years. For nurses who already have a degree, certificate programs in legal nurse consulting are offered by dozens of public and private schools and organizations in the United States, which award titles like the AALNC's new legal nurse consultant certified (LNCC).

Exactly how useful the certificates are is unclear. "Many lawyers would say as long as you can help them win a case, it doesn't matter if you have a certificate," Reed said. "I think it will take some time, just as it has in the other nursing practice areas, to increase the significance of certification."

Working conditions

What is clear, however, is that breaking into legal nurse consulting can be tough. Dorothy Pollock, RN, president of the AALNC Los Angeles chapter, says most nurses who attend the group's introductory classes never come back. "They're overwhelmed by what it takes," said Pollock, a full-time surgical nurse who moonlights as a legal nurse consultant. "Nurses are not usually business savvy, and they shy away from the home office and the self-marketing you need to succeed."

For the roughly 50 percent of legal nurse consultants who choose to be independent over working for a law firm or insurance company, the perks can add up. Nancy Blevins, RN, a San Diego legal nurse consultant who left her hospital job after her first child was born, likes not having to work weekends and holidays. "I love it," Blevins said. "There's no staff shortage, no health risks from exposure to blood products or infectious disease, you work regular hours, and your beeper doesn't go off at 2 in the morning telling you to come in for a trauma."

The key to making a good living as an independent consultant is networking. Pollock got her first job after passing her card to her neighbor's son's girlfriend, an attorney. Others find employers through the conventions held by groups like the AALNC and the Medical-Legal Consulting Institute Inc., a for-profit organization in Houston.

But once they land that first client, work can start rolling in, Pollock said. Independent consultants earn $75 to $100 per hour doing research or writing summaries of medical records for clients; they earn up to $250 an hour for being an expert witness in a trial. By contrast, legal nurse consultants who work in-house for firms typically earn salaries comparable to nurse administrators who work in hospitals, though raises may accrue quickly "as the attorneys see how valuable you are to them," Reed said.

Background check

A background in critical care, with ICU and ER experience, is preferable for legal nurse consultants since the majority of medically related lawsuits concern serious injuries or death. Because many lawsuits stem from infant deaths, experience in labor and delivery also can be valuable. As a rule, a consultant should have at least five years' experience in a hospital setting because "attorneys need someone who has seen a variety of cases and who knows where to look for breakdowns in the standard of care," said Jeannie Autry, RN, LNCC, a Dallas, Texas-based legal nurse consultant.

Nearly all the nurses who have jumped from traditional nursing to legal consulting feel they haven't left nursing behind.

"I still feel I'm a nurse, except that now the medical record is my patient," says Autry, who worked for years in hospital risk management. "The whole thing is helping a client get better. So you look at the record and see what happened day to day and where the standard of care wasn't met. Or, on the other side, you help healthcare professionals who are being sued even though they did nothing wrong. Either way, it's helping people. And that's what nurses do best."

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