Nurses laugh when Georgana Taggart tells the story about a nurse paralegal who went to work for a lawyer helping him prepare cases. For years, this personal injury lawyer thought the letters "HA" on a medical chart stood for "heart attack."

"You can imagine how useless a lawyer being that ill-informed would be," said Taggart, a lawyer and director of paralegal studies at the College of Mount St. Joseph in Cincinnati.

Specialized knowledge, such as knowing that "HA" on a medical chart stands for headache, a litigious society and laws regulating the medical community have contributed to a growing need in the legal community for advice from trained medical professionals.

Nurses increasingly are using their medical knowledge to assist the legal community in criminal and civil matters as nurse lawyers, nurse paralegals, legal nurse consultants and forensic nurses.

True counselors

"There certainly has been a growth in the number of nurses who have dual degrees as a nurse and an attorney," said Virginia Fleming, MS, JD, a lawyer and president of The American Association of Nurse Attorneys.

She said it's hard to say how many nurse lawyers there are working in the United States. Membership in The American Association of Nurse Attorneys stands at around 400. Nurses who enter law school take the same courses non-nurses take, Fleming said, and to her knowledge, no one offers a degree in nursing law.

Broader education

Kathleen Lambert, JD, RN, a Tucson, Ariz., nurse lawyer, became a lawyer 20 years after earning her nursing degree. She said she did it to broaden her education.

"I wanted something that took me out of medicine, but kept me with a toehold in it," she said.

Lambert uses her combined skills to educate nurses on avoiding lawsuits and to lecture Arizona's elderly on advanced directives, wills, trusts and other medical/legal issues.

She works as a solo practitioner from her Tucson home and takes only those cases that appeal to her.

She said that as both a nurse and lawyer she can address a client's legal, physical, emotional and spiritual needs.

"I'm a nurturing attorney, which is not what people generally think of when they think of an attorney," she said. "I feel a true lawyer is a counselor in the true sense of the word."

Those for whom law school is not an option might want to consider becoming a nurse paralegal or a legal nurse consultant. Nurse paralegals have worked on an informal basis for two decades, Taggart said.

But not until recent years have educators felt the need to develop formal training programs for them, she said. The College of Mount St. Joseph has offered a nurse paralegal program for 25 years, she said, but it wasn't until 1999 that the college began to offer training for nurse paralegals.

"A nurse paralegal is more interested in law in general," said Taggart, who said nurse paralegals generally earn the same as nurses. "They're looking to make a career change and to still use their medical knowledge."

Nurse paralegal

A nurse paralegal can assist a lawyer in interpreting and understanding medical issues and may draft pleadings, conduct legal research and handle other legal issues that someone not trained as a paralegal would not be able to handle.

Taggart recommends a nurse paralegal training program that is approved by the American Bar Association or, at least, is a member of the American Association for Paralegal Education.

In contrast to a nurse paralegal, a legal nurse consultant is more interested in expanding nursing skills into the legal horizon, said Vickie Milazzo, MSN, JD, RN, a Houston lawyer who founded the Medical-Legal Consulting Institute Inc., a private company that trains and certifies legal nurse consultants.

"Any nurse can go into an attorney's office and promote herself as an LNC; you don't have to go through any particular course of study," Milazzo said. "What our program does is what any program should be doing-it is to teach them to take their existing skills and translate them into what attorneys and insurance companies need."

Legal nurse consultants may work for a law firm or an insurance company or start their own consulting business and work as an independent, she said. Legal nurse consultants generally help lawyers prepare cases and occasionally serve as expert witnesses in court.

In-house LNCs earn salaries comparable to nurses, while independent LNCs can earn considerably more, charging $75 to $100 an hour developing cases and around $150 an hour as an expert witness, Milazzo said.

"I've known independent consultants who have earned $60,000 to $80,000 per year," Milazzo said, "and met quite a few LNCs who have earned in the six figures and one or two in the seven-figure range."

Those in the seven-figure range, she said, are LNCs who start their own businesses and hire other LNCs to work for them.

Milazzo added that LNCs enjoy the independence and autonomy that comes from working as a consultant and owning a business.

"I think that probably one of the challenges is making that transition into that legal world," she said. "Attorneys think differently from nurses. In a way, even though they're using their nursing skills, they're learning a different language to communicate."

Contact Scott Williams at scottwilliams21@msn.com