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The Power of Focus – Who Are We? by Vickie L. Milazzo, RN, MSN, JD, Texas Recently, I had the opportunity to hear former President George Bush speak, and one of his themes was that leaders have a firm understanding of who they are. Certainly we as legal nurse consultants want to be leaders for our profession. Leaders Know How to Focus Leaders know how to focus on who they are and on who they want to be as professionals. Perhaps more importantly, leaders also know how to ask the right questions to find their focus. As legal nurse consultants, are we asking the right questions? Here are six questions I think we should be raising right now:
Question # 1 – Who Are We? Are we nurse consultants or are we nurse paralegals? Are we practicing consulting or are we practicing "legal assisting"? When I started my legal nurse consulting practice in 1982, our profession was very clear about who we were. Don't let the fledging paralegal-based legal nurse consulting programs blur your vision. These programs are being called "legal nurse consulting programs," but in reality they are nothing more than paralegal programs. Such programs offer us nothing NEW, nothing different, nothing exciting. In fact, what they do is relegate RNs to roles as legal assistants. This is not only a denigration of nursing, it's a complete obliteration of legal nurse consulting as we know it today. Our future depends on each of us being clear about who we really are. If you want to be a consultant, your vision must be 20:20, not 20:25. Question # 2 – Who Do We Want to Be? Do we want to be consultants or do we want to be paralegals/legal assistants? What are the implications of being a legal assistant? Any RN who buys into the role of being an attorney's legal assistant is denigrating the legal nurse consulting profession. We do not want to allow ourselves to be held back in yet another low-paid position, in a nonprofessional role along with other nonprofessionals. As a nurse paralegal, you would be on the same career level as people with a high school diploma and a paralegal certificate. Now I'm not a snob. Paralegals are fine people. Three of my closest friends don't have college degrees. But the reality of being a nurse paralegal is that this forces you to sit side-by-side professionally with other paralegals. Personally, I want to sit side-by-side with RNs who have gone through formal education in nursing, who have 5-30 years of experience, RNs I have cherished and loved since 1976. What are the implications of accepting the role of paralegal? I know this is painful to hear, but I think nurse paralegals become yet again bottom-feeders, accepting any little crumb that falls their way and being grateful for it. That is not what I teach nor what I believe legal nurse consultants should accept. It is certainly not what any other professional accepts ? not MDs, not architects, not accountants, CPAs nor any other professional who interfaces with the legal industry today. If you embrace the vision of being a professional consultant, rather than a bottom-feeder, then you have to decide what you intend to do to realize that vision. Top Question # 3 – Who's Deciding Who We Are? Who's creating our future? Are we as RNs deciding for ourselves who we are and who we want to be? These programs are by and large taught by attorneys. Do you recall being in nursing school? Did you want to be taught by doctors? Yet nurse paralegals are being taught by lawyers and even non-nurse paralegals. Is that what we want? Are we second-class citizens who are not good enough to teach our own? Of course not. We will continue to decide for ourselves who we are. Since 1982 I've worked side-by-side with attorneys, thinking of myself as their peer, not as some legal assistant. A legal nurse consultant is a separate and distinct category of professional interfacing with the legal system. As provided by the professional nursing license, we are governed by our Nurse Practice Acts. We are not governed by any outside entity, such as the ABA. Our RN license qualifies us to interface with the legal industry, and we do not need the permission of the ABA to do so. Like medical doctors, architects, engineers and scientists, legal nurse consultants are consultants to the legal industry. We offer the industry a unique professional expertise that clearly distinguishes us from paralegals/legal assistants. Legal nurse consultants use different skills than paralegals and nurse paralegals, skills we already possess from our nursing education and experience. We participate in cases where health, illness or injury is at issue. We do not delve into real estate, probate, marital property, real property or other fields of law unrelated to a specific health issue. Nor do we do le gal research and writing. A nurse who enters the legal field as a legal nurse consultant is still practicing nursing. We have not changed careers; we've only changed our practice area. We are not legal experts, nor do we "perform specifically delegated substantive legal work," which, according to the ABA, is what a paralegal/legal assistant does. To use an RN for legal work is gross under-utilization of the RN's core strengths and a waste of much needed resources. Becoming a nurse paralegal is a step backward for the RN. Our earning capacity and possibilities for career advancement are much higher than those of legal assistants. The legal industry knows it's your RN license that gives you power. Don't let the legal industry take that power away from you. We have to stay true to who we are. We have to stay true to our vision. And we have to act quickly if our profession is to continue and thrive. Top Question # 4 – Can We Be Both Consultants and Legal Assistants? Can the two roles really co-exist? I believe the concept of RNs trying to fill two completely different roles is basically flawed. History tells us that an unfocused company is doomed to fail. Similarly, when we lose our focus as professionals, we lose our power. According to the ABA, a legal assistant/paralegal is "a person, qualified by education, training or work experience who is employed or retained by a lawyer, law office, corporation, governmental agency or other entity and who performs specifically delegated substantive legal work for which a lawyer is responsible." Is that who we are? Do you really think you can wear two hats, as Certified Legal Nurse Consultant and as paralegal? Do you want to try to be an expert on legal matters and on nursing? I can't even stay up with nursing, much less stay up with the legal field, too. As RNs we (and any association representing us) are only fooling ourselves if we think we can be both legal nurse consultants and paralegals. It's a matter of economics. Why would the legal and insurance industries pay legal nurse consultants $100 to $150 per hour when they can hire an RN-legal assistant for $16 to $18 per hour? Managed care is pushing RNs away from the bedside and replacing us with lower-paid technicians. Don't allow the legal industry to push the legal nurse consultants out in favor of the less-skilled, lower-paid nurse paralegal. We have total control over making sure this doesn't happen. Why would an RN even want to be both? We must proactively prevent this NOW, while we still have time. Clearly, one of these conflicting "hats" has to go. Personally, I'm putting my money on the RN as the professional legal nurse consultant. I believe in nurses, and I know we will put the exploitation of RNs as legal assistants to an end. Top Question # 5 – What Does the Legal Industry Really Need? Does the legal industry need consultants or more paralegals? The answer seems obvious: they need professional consultants. To use an RN as a paralegal/legal assistant is to pull her away from her CORE strengths. You wouldn't go to a CPA for medical services. You would consider it a waste of resources to put a neurosurgeon in a family practice clinic two days a week. If we did put the neurosurgeon in the family practice clinic, the neurosurgeon would not get compensated as a neurosurgeon, but as a family practitioner. I love lawyers – I've been working with them for a long time. But if they can avoid it, they don't share the BIG BUCKS with anybody. Not with their clerks, not with their young associates, not with their paralegals, not with their legal secretaries. And if they can avoid it, they are not going to share it with you either. The way they avoid sharing the wealth with you is to strip you of your power. A manipulative attorney will tell you that you have to be both a legal expert and a nursing expert to work for them. "Since we have to teach you a new career and since you're unskilled at what you do," they say, "we'll pay you low wages to do it." That's how they manipulate you into accepting $20 per hour. The bottom-line: This "new" career as a nurse paralegal is masterful manipulation by the legal industry. Unfortunately, many nurse paralegal programs see you as a source of revenue and are also participating in the manipulation, as are some misguided legal nurse consultants who teach in these programs. Question # 6 – What Must We Do to Proactively Create Our Professional Future? Here are six specific steps you can take now to assure that attorneys recognize RNs as Professional Consultants.
The nurse paralegal role is a DEAD END for nurses. Through the Institute, I've taken many RNs on the same adventurous ride that I've been on. Let's continue in this same adventurous direction. The Choice Is Yours – If You Grab It! The U.S. is a tremendous country! I love America – a country where we can be exactly whatever we choose to be. We get to choose who we become. Remember, who we are tomorrow is directly linked to the actions we take today. What's Your Choice? Take out your business card. Cross out whatever title you've got there. Choose one of the following:
If you wrote down consultant, write CEO next to it. Congratulations! You are now the CEO of your own consulting business. I love being an RN. I love being a CEO. I love RNs and the privilege of sharing my professional career with so many of you. I am passionate about this issue and I will not apologize for my passion. I invite you to tap into your own passion and live that passion in your legal nurse consultant career. Remember, in America you can be whoever you choose to be. That's not true in every part of the wo rld. I just got back from Nepal. Not even a decade ago, women there were bathing their husband's feet and, as a sign of submission, drinking the bath water afterwards. That reminds me of how I felt working in the hospital – drinking somebody's bath water. As a legal nurse consultant I've never had to drink somebody's bath water. You won't either. In Building Your Field of Dreams, Mary Mannin Morrissey shares a story about elephants, one of the strongest animals on earth. "Trainers capture the elephant and tether one of its legs to a giant tree. The elephant struggles to get away from the tree, and it pulls and pulls and pulls, feeling the tug of that chain. Finally, after a month of struggling, that elephant gives up. Then the trainers tie the elephant with a rope and repeat the process. Later the trainers can tie the beast with something even lighter, until finally they can take the elephant into the jungle, where it labors uncomplainingly, tethered with the reed of the lotus flower. The elephant will not even think of making a break for freedom, because it feels a little tug on its leg. The elephant is trained to believe that with that tug, it is captured." Let's remember that any limitation we accept is our own doing. Like the elephant, we are bound by our beliefs and convictions. Like the elephant, we can break free of the bonds any time we choose. Let's join to gether and choose NOW to break free of the nurse-paralegal/ legal assistant bonds. Top Join the Revolution! My position on this issue comes from my vantage point of more than 21 years in this profession. I know how and where I started, and how many of my peers got started, too. Let's continue to embrace the glorious vision with which we began our profession. If you support what I believe in, all I ask you to do is help keep the momentum going – the momentum of the revolution I started in 1982. We must participate in the creation of who we are. None of us fully knows our future, but if we believe in our vision, it shouldn't matter to us that someone else fails to see it. If one dog sees a rabbit, it will give chase. Soon other dogs will follow the first. Eventually, though, they will cease running from fatigue and disinterest, while the first dog will persist. Why? Because the first dog could see the rabbit, while the others could not. If you can't quite see the vision for the future of our profession yet, trust those who can. As the Bible says, "Blessed are those who have not seen, yet believe." Remember, there are many things we would never see if some visionary hadn't seen it first. Trust the person who is open to infinite impossibilities, and soon your own vision will become clearer. Ultimately, you can not create your next greater good if you can't see yourself do it, if you can't hold it as a vision. Don't amplify the obstacles. Don't let the obstacles loom too large. As you realize your own personal vision, you will begin to appreciate how essential an empowered legal nurse consulting profession is to that vision. This may be the first time in history that we have the opportunity to significantly alter the face of nursing. Let's seize this chance to create something greater for ourselves as professionals. Let's shape a future that all RNs in any industry can model. Let's avoid a future where we're all wailing and whining about how things might have been. I believe in RNs and I know that, like me, you SEE. Let's join together to create our future as professional legal nurse consultants. HOLD the image! Martin Luther King, Jr. said, "Our lives begin to end the day we become silent about the things that matter." Dare to care and dare to act on that which you care about! May the power be with all of you. This article is adapted from Vickie's keynote speech at the annual conference of the National Alliance of Certified Legal Nurse Consultants. © 1999 Medical-Legal Consulting Institute, Inc. Reprinted from National Medical-Legal Journal, Vol. 10, No. 3, 1999  |
 The dangers of submitting yourself to the limiting label of nurse-paralegal
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