October 2009

My experience in hospital nursing was filled with mixed emotions. The frustration level was one that I have never experienced anywhere else. But I kept being a nurse, and I kept going to work. Nursing jobs paid the bills but did not contribute to my soul.

When I saw Vickie Milazzo’s ad for the CLNC^® Certification Program, I wondered if this was a nursing career that I could be passionate about. I saw the ad several more times after that. Each time I felt a tremendous pull. The woman in the ad looked like no nurse in my facility. Vickie personified a victorious nurse dedicated to her profession, unlike other ads where the model-like woman leaps through the air with her hair blowing in the wind.

Little did I know I was implementing a business plan by showing the ad to my husband and proclaiming, “What an investment this would be for our future. We need to choose the VIP CLNC^® Business System and take advantage of all the available resources.”

My fear of flying could not hold me back. Several months later, I looked out of the airplane window after take-off. Dark thunderheads hung over the mountain tops. Lightning flashed sending streaks of light all around the plane. Down below, hundreds of colorful hot air balloons lit up Balloon Fiesta Park waiting for their early morning launch. My overwhelmed senses were full of expectations yet to come and I was calmed by the knowledge that I was so lucky to be the lead character in this new adventure.

That was the calm before the storm. WOW, is how I describe the CLNC^® 6-day Certification Seminar. I was amazed by Vickie and the course content. Then the 2-Day NACLNC^® Apprenticeship followed. I was brain-dead by the time it was over. I assumed the hardest and most challenging part was behind me. I went home and began implementing everything I had learned right away.

I went on my first marketing campaign in my hometown. I had seven promotional packets. Each one contained a personalized introduction letter to the attorney, a brochure, a business card and a professional profile. I marketed to all seven offices, but it took every ounce of courage I had. My husband went with me to the first office. I’m sure “amateur” was written all over me. I decided taking my husband wasn’t a good idea. The next office I went to was torturous. I stood there knowing I had to go in, but wishing I didn’t have to. My palms were wet and my mouth was dry. My husband reassured me from the sidewalk and I took a deep breath and went in. I met four attorneys that day. Each time I felt out of my element and left the office thinking, “There has to be another way.” I felt as wanted as a telemarketer.

I did the “busy thing” for awhile after that. We built an office and I set that up. I reviewed the advanced resources in my VIP CLNC^® Business System. Then I went to the NACLNC^® Conference in March. I talked with Certified Legal Nurse Consultants about their strategies for overcoming fears. Nothing clicked for me. I did discover other strategies to beef up my promotional packet and implemented them as soon as I got home. I went on several more marketing campaigns, but I could not overcome the fear of meeting attorneys. I went to their offices hoping I wouldn’t see any. I could relate to the office staff and break ice with them, but not the attorney. How was I going to get business with this mindset? The fear of meeting attorneys was bordering on a phobia.

The turning point came when a legal secretary called my office after receiving my promotional package and left a message for me to call. As usual, I contacted Vickie Milazzo Institute for mentoring. I listened carefully to the CLNC^® Mentor and followed up with the appropriate phone calls and sent a follow-up letter. Three weeks later, the legal secretary called to set up my first appointment with the attorney. I was thrilled, but it was short-lived as fear began to well up inside of me, again. I contacted Vickie Milazzo Institute for mentoring yet again. I was probably over-prepared for this meeting, but it was important to get it right. I would have to do this in spite of the fear.

I had no idea what to expect, but I was well prepared in every way right down to the power suit. I arrived at the office early to find out the attorney would be late. “That’s okay,” I thought, “I can wait.” There were a couple of gentlemen also waiting. We made small talk until the attorney arrived. After she arrived, she took one of the gentlemen in her office for about twenty minutes. He left and then the legal secretary ushered me and the other gentleman into a small conference room.

“What is this?” I thought. I was led to believe it would be the attorney and I, only. Everyone was introduced. It was very formal.

The attorney said, “This is Mrs. Schmitt. She is an expert and she is going to tell us how to proceed. Go ahead, Mr. Jones (not his real name), tell her your story.”

I felt my eyes bug out. My inner voice said, “Wait! I didn’t practice this! No time for a mentor request.”

The man started talking, but I could not understand him. His lips were moving and I could hear his voice, but I was so paralyzed with fear that I wondered what I looked like to him or, horror of horrors, what did I look like to the attorney?! I thought, “I better snap out of it because the attorney is going to expect something intelligent from me!”

Thank God this drama was only going on inside my head and not in the room. In a split second, I realized that sitting in front of me was a patient, Mr. Jones. My nursing instincts kicked in. I forgot about the power suit I was wearing and immediately began to assess his physical condition and his words became crystal clear. “The other guy dropped the air conditioner causing me to fall and hurt my back and knee,” he continued.

The 30 services that Certified Legal Nurse Consultants offer with a risk-free guarantee faded away as I asked, “How many days after the surgery did you notice the redness and swelling?”

My sample work products became forgotten when I told the attorney, “The infection that your client acquired after surgery was not the result of mismanaged care because they did a culture and treated it in a timely manner.”

The attorney asked numerous questions: “How can you tell if it was the hospital’s fault? What can you tell from the medical records?” The attorney mysteriously became a patient as well. She wanted to know what I knew. I answered all her questions demonstrating how I, the Certified Legal Nurse Consultant, could help with her medical-related cases. I stated that in my opinion there was no medical malpractice in this case and that she should only pursue the personal injury claim. I explained vocational and functional capacity evaluations that could strengthen her case. As the conversation went on she was amazed at the information I provided. She was a criminal defense attorney and had people ask her about taking medical malpractice cases. She said she had five potential medical malpractice cases and set up an appointment with me for the next case.

That experience changed me. I had heard other success stories that sounded too good to be true; a CLNC^® consultant goes into an attorney’s office and walks out with armloads of cases. But this attorney was truly sincere.

I now remember that I’m a nurse when I market to attorneys, which is what I should have been doing all along. I am not a salesperson, I am proud to be a nurse. Now, when I go into attorneys’ offices, I hope I meet them and ask if they are in so I can meet them. I look forward to educating them about how I can cost effectively consult on their medical-related cases. The expertise of registered nurses is as important to attorneys as it is to patients. Thanks to Vickie Milazzo and the CLNC^® Mentors, this expertise is available to every attorney through all of us Certified Legal Nurse Consultants. It is our job to educate attorneys in every creative way we can.

Guest Blogger Profile

Diana Schmitt, RN, BSN, CLNC has 24 years experience in the health care industry and is the owner of Diana Schmitt & Associates Certified Legal Nurse Consultants. Her firm specializes in merit review, expert witness location, and medical literature research for medical malpractice cases.

That’s a pretty powerful question with many different answers. Back in June, I tweeted about a high-profile case that involved an MD who was blogging about his medical malpractice trial as the trial was in progress. I used this as an example to illustrate why Certified Legal Nurse Consultants should recommend that their attorney-clients check out social media (and the blogosphere) for postings by opposing parties (and their own parties), before and during a trial. That case ended in a substantial settlement for the plaintiff after the MD was shown to have exposed trial strategy, ridiculed the case and made generally inappropriate postings for which he was confronted during the trial.

Another MD blogged about a recently concluded medical malpractice trial. His blogging initially raised all sorts of HIPAA questions (which became a nonissue once the suit was filed and anything happening at trial became public). Just to be safe, the MD allegedly changed some of the “facts” as you can read in his disclaimer. This raises issues of what sort of information should or should not be exposed, even after a trial. Granted you can sit in a courtroom, listen to the testimony and see the evidence, but you are not privy to the thinking, reasoning and strategy decisions of the attorneys and the parties they represent. Perhaps that’s something an attorney wouldn’t want his defendant or plaintiff blogging about. Read the articles and analyses on both these cases and make your own decisions. Keep in mind that attorneys are under their own ethical restrictions that we’ll discuss below.

A famous poker player won’t appear on those poker television shows that televise a player’s hand. He doesn’t want people to see how he plays, bluffs or calls on certain hands because they could develop a strategy to beat him. Trial attorneys might feel the same way about having their strategies exposed.

That being said, let’s look at a different set of potential bloggers, the jurors and/or courtroom spectators. In our electronic age no one, and I mean no one, likes to be “off the grid.” Spectators blogging from the courtroom are the equivalent of news reporters and don’t present a problem.

Smart phones with easy Internet access like the Blackberry^® or iPhone^® have created modern day courtroom issues. Judges have always admonished jurors not to read about a case or view television trial coverage, but how many judges give jury instructions regarding blogging? Tweeting (micro-blogging) and even researching the basis of the parties’ claims raises issues during a trial. Even something as simple as texting can be problematic. Remember, jurors are supposed to make their decisions based solely on the information they receive in the courtroom – only the evidence introduced at trial. So if a juror reads a blog about the trial, that would be the same as viewing a news report about the trial or Googling the underlying claims. That sort of behavior risks prejudicing the case or raising the possibility of a mistrial. Attorneys should search social media and the blogosphere during and after trial for traces of this type of misconduct. Some people are shameless about what they post, so armed with a few keywords and content of text messages sent during a trial, it can be quite simple to discover and possibly render a juror liable for contempt.

So far we’ve discussed the plaintiffs, defendants and jurors – what about the plaintiff and defense attorneys? Any Certified Legal Nurse Consultant will remember from the Institute’s CLNC^® Certification Program that attorneys are ethically prohibited from disclosing certain confidential client communications without the client’s consent. This applies to the blogosphere both during and after trial. But what about statements made in advance of trial or while selecting the jury that might tend to influence a well-read jury pool? A few attorneys make money writing books about their high-profile clients but that’s well after the client’s gone to jail (or not). A gag order by a judge can preclude an attorney from blogging about an ongoing trial. Attorneys may use hypothetical postings as long as there is no reasonable likelihood the client or situation can be identified. With all this in mind, blogging, texting and even list serve postings will be an issue to watch (or read about).

Judges, like attorneys, are ethically restricted from discussing pending or ongoing matters being litigated. So, if you think you see the judge texting from beneath the bench, let your attorney-client know. They may not want to risk the ire of a judge who’s simply discussing dinner plans, but might infer the judge wasn’t fully present during trial.

Finally, there’s you – the legal nurse consultant. As you work closely with the attorney-client and the litigation team, you’ll have inside information about the case, the parties, strategies, etc. As an agent of the attorney you are also precluded from disclosing certain confidential information. If you value your legal nurse consulting business you must refrain from tweeting and blogging about a trial in progress (“The defense expert is getting blown away – we’re moving in for the kill with my questions on SOC.”) without your attorney’s knowledge and permission. In fact, I recommend you not discuss your cases at all on the Internet. Frankly, it’s poor business practice.

Social media and blogging are emerging parts of cyberspace and both sides in the legal arena need to explore and monitor their usage. It’s a brave new world of communications and communicability for legal nurse consultants and the legal profession. If you use your mind (while others around you are losing theirs), you’ll successfully avoid any amateur mistakes.

Success Is Inside!

I was speaking with a Certified Legal Nurse Consultant the other day who had just spent the last couple of days rebuilding her file system after a virus infected her computer. When I asked her why she didn’t reload her data files from her backup, she confessed that she hadn’t run a backup in over five months. The time she saved by not performing regular backups was minimal compared to the time it cost her to rebuild her system and search for “lost” files.

I backup my data files on my laptop to our corporate server every Friday. It’s a habit. I have a set of meetings I have to attend and those meetings run almost as long as my backup routine. When I get out of the meetings, my backup is almost done so it’s pretty painless for me.

“Hey Tech Tip Tom,” you might say to me, “How can I, one of your CLNC^® amigos, get the same backup ability?” That’s pretty easy. If you have multiple computers to back up, you can simply create a home network, jack in a portable hard drive like Western Digital^®‘s 500GB My Passport^® pocket drive which sells for just over $100. (Or, if you’re particularly flush, you could review my past blog and purchase a terabyte (1,000GB) backup drive), install the software and let it backup every evening or on whatever schedule you desire. Then, unless your home or office burns down (in which case you’ll have other worries), you’ll have a good backup of your legal nurse consulting business data.

If your computer gets wiped by a virus, lost or stolen or just plain crashes, you can simply restore the data to your new or cleaned computer from the backup. If you use a program like Norton Ghost (and have high-end computer skills) you can periodically image your hard drive, store the image (picture of all the contents of your hard drive) on the backup drive and then restore your computer from a good image (losing the data you created in between present day and last image).

These are fairly inexpensive methods (excluding “Ghost”) of creating backups because you buy the backup drive once and you’re good until it crashes or dies. It’s not for the faint of heart though. If you only have one computer to backup, connect it directly to the pocket or backup drive and skip the network.

Now I know some of you are thinking, “Holy backup beeper Tom, you lost me at hello!” Okay, I’m with you. Here’s the simplest, but not the cheapest method of backing up: an online backup service such as Mozy or Carbonite. These are great online backup systems that require ABSOLUTELY NO TECH SKILLS TO USE! Maybe I didn’t need to shout that, but it’s the beauty of these two systems. You simply sign up for the service, install the software, select the data you want to backup, the backup frequency and then just leave your computer on at night and it backs up to a remote server during “idle” time. Both systems encrypt the data so that it’s secure and can even be accessed remotely while you’re traveling (and your data is safe in the “cloud”).

Carbonite costs less than sixty dollars a year, Mozy costs under five dollars a month (so about the same) and both offer unlimited data storage. Here’s the kicker though, you’ll need to have a pretty fast upload speed on your Internet connection to make sure your backups run completely. You can test your Internet’s connection speed here. I’ve got about 30GB of data on my laptop including all my music and bunches of photos. At an upload speed of just over 640Kb/sec, my initial backup would take about 105 hours – not a great prospect. If I trim out the music and photos I’m down to about 5GB of data or about 17 hours of backup which is still not the most attractive prospect.

So, what can you do? First of all, get those vacation photos off your hard drive and back them up onto CDs or DVDs or onto a portable hard drive (we just spent more money). If you haven’t edited them by now you never will. See what else you can strip off that drive. You may be able to dump some of the music from your iPod^®. If you still have the source CDs you can always reload it later, it’ll take some time but you can do it. You can back up your “purchased” songs by burning them to a CD using iTunes’ built-in backup function. As for the rest of your music, experts tell us that once we’ve uploaded music to our iPods we can move the source files to an external drive (technically you can delete them but that scares me too much to try).

Once you take the time to get your backup data amount down to just what you think you need, excluding your operating system (OS) and installed programs (my OS and installed programs alone are 37GB), you’re ready to consider an online backup system like Mozy or Carbonite. That 105-hour initial backup could be done over a weekend, a very long weekend. All subsequent backups will be incremental and take much less time (only changed files will be backed up). If the amount of data with changes is still too much to backup in a reasonable period of time, then you should consider an external backup system.

Whatever backup solution you choose needs to work for you and your legal nurse consulting business. Take some time, evaluate the options but do make a decision to implement some form of backup. Can you afford to buy some backup solution? Yes, because you can’t afford not to.

Keep on techin’,

Tom

Certified Legal Nurse Consultants have long known that the pharmaceutical and medical device industries have a vested interest in not only making sure that their products get wide distribution on the market, but also that they gain favorable press coverage in the healthcare and mainstream media. The extent of the “full court press” they make to gain such coverage takes on different extremes. Everything from parties, trips, gifts and research sponsorships are used to help influence writers. Another popular but hidden measure is the use of ghostwriters. They are often hired by the pharmaceutical or device industries themselves to write the articles, which are then submitted under the signature of an “impartial” doctor. Sometimes the so-called “ghost” may simply have ties, such as a sponsorship from the related industry or manufacturer, but other times the ghost may actually be part of the industry being written about. Just to name a few, many of you will remember the controversy surrounding disclosures of this practice related to Fen-Phen, Vioxx^® and Premarin^®.

According to The New York Times, many major medical journals are taking baby-steps in the right direction to identify and hopefully stop this practice, while others are not yet committed to the process. The Public Library of Science in its PLoS Medicine journal has called for a “zero-tolerance” ban on such ghostwriting and has suggested various remedies, including sanctions in situations where the ghostwriting is not disclosed.

Given the fact that many medical and other healthcare providers rely on these journals for unbiased information to make decisions regarding the use of different drugs, devices and treatments or even when creating standards of care, policies and procedures, etc., the information should be free of slant, spin or other bias. But apparently this isn’t true or at least doesn’t happen as often as we would hope.

The author of an article should be the person or persons who wrote or contributed the majority of the article, not the person who signs their name to it or submits it to a medical journal or other publication. At the very least the ghosts should be disclosed in the article’s acknowledgments, contributions or references.

Unfortunately, it appears that the major medical journals have not completely adopted nor have they enforced this policy. I am also not aware of any research being done to determine whether the professional nursing journals have adopted a similar policy. Until an impartial organization looks into this, or at least until the nursing journals adopt a policy of transparency, we’ll have to assume that nursing journals have the same potential level of bias or influence as do the medical journals.

What should be done? First the journals (scientific, medical or nursing) should put into effect a sanction policy for those situations in which a ghostwriter, sponsorship or other potential for bias is later disclosed or discovered. The second is for those same journals to adopt a transparency policy which then should disclose such bias as soon as it is discovered.

It’s imperative that healthcare professionals and ultimately the consumer are able to fully trust professional journals. Until ghostwriting is “ghostbusted,” we’re not in a position to place that trust. Until that day, Certified Legal Nurse Consultants should continue to question and challenge the validity of research studies where indicated.

Success Is Inside!