CLNC

Even though I grew up in New Orleans, I love Texas, where I’ve lived since my college days. I agree with native Texans who say you never have to leave the state to experience what all the other states can offer put together. So, for the students and Certified Legal Nurse Consultants coming to the 2009 NACLNC^® Conference on the San Antonio Riverwalk, March 12-13, 2009, here are just 15 fun ways for you to enjoy your Texas-sized weekend.

1. Stroll the Riverwalk. Almost 2½ miles of footpaths, shade, restaurants, secret gardens and shopping. It’s magical in the evening when the trees are lit up, and your mouth waters from the delicious aromas coming from the fantastic array of restaurants.
2. Have tacos for breakfast. It’s the Texas way to start your day. Spice it up with some chorizo (Mexican sausage). Margaritas are optional.
3. Remember the Alamo! Yes you can’t go to San Antonio without a visit. Make sure you see Davy Crockett’s buckskin vest (bring your own coonskin cap).
4. Visit the Menger Hotel. Have a drink in the bar where Teddy Roosevelt recruited cowboys, cattle rustlers and Texas Rangers to form the Rough Riders he later led to fame in the famous charge up San Juan Hill. Take a wander around the hotel while you’re there – you may see a ghost (even before that drink).
5. Do your souvenir shopping at Market Square. You’ll find all the marimbas, maracas, piñatas, sombreros and coonskin caps you can carry as you walk these fun, pedestrian-only streets.
6. Take a meal at Mi Tierra Cafe y Panaderia. A San Antonio landmark, at least for tourists. It’s a great place to eat your first baby goat (cabrito – a Mexican delicacy). If someone’s already gotten your goat, then go to the panaderia (bakery) for some terrific Mexican-style pastries – a great choice any time of day!
7. Visit the world-famous Buckhorn Saloon and Museum. Proudly serving beer since 1881, it’s also home to the Hall of Texas History Wax Museum. Speaking of horny, it has over 1,200 trophy mounts from more than 500 species and “Old Tex,” the world’s largest mounted longhorn with horns that span eight feet, nine inches.
8. If you have a car, take a potty break at the Toilet-Seat Museum. It’s just ten minutes north of the city and I don’t think I need to say any more.
9. Military nurses might want to visit the Army Medical Department Museum at Fort Sam Houston (just one of four military bases in the San Antone area).
10. Eat a moveable feast by arranging for dinner on any of the barges that float up and down the San Antonio River – it’ll be a night to remember.
11. Think your spouse has big feet? Then go see the world’s largest pair of cowboy boots at the North Star Mall near the airport. At almost 40-feet tall and 20-feet long they’re even bigger than my husband’s feet.
12. Beat the heat with a root beer at Schilo’s Deli that is served in a frosted mug with a frothy head. Schilo’s has been a local destination since 1917. My favorite reason to go there – your second mug is free!
13. Ride to the top of the Tower of the Americas and look out over the beautiful Texas Hill Country – you can even wave to your ground-hugging CLNC^® friends far below.
14. Take a walking tour of San Antonio’s first neighborhood. La Villita is now a thriving art community that stands as a monument to San Antonio’s past.
15. Send your family to Six Flags Fiesta Texas for the day. They can feel like Superman on the Krypton Coaster, beat the heat in the water park or just hang out in the kiddie park. Whatever the age of your children – 5-55, they’ll love it!

Before you set out on your maverick tour of San Antonio, remember to come prepared to keep the pace at the 2009 NACLNC^® Conference.

• Come relaxed and ready to discover new ideas. The NACLNC^® Conference is much more fun when you’re rested, and you’ll learn so much more if you leave your stress behind.

• Pack energy bars, raw nuts and other healthy snacks to maintain your energy. The “Betcha Can’t” margaritas wear off quickly.

• Bring plenty of business cards to swap out with the 1,000 new CLNC^® friends you’ll meet.

• Go online and print the NACLNC^® Conference textbook sessions you plan on attending.

Have a great trip and check back on March 11, 2009 to read my tips on how to Master New Unconventional Strategies During the 2009 NACLNC^® Conference.

Success Is Inside!

P.S. Comment on your favorite fun things to do in San Antonio.

According to the Western Hemisphere Travel Initiative (WHTI) U.S. citizens traveling by land or sea to Canada, Mexico, Bermuda or parts of the Caribbean must show proof of citizenship in the form of either a passport, passport card or WHTI-compliant document (government-issued photo ID and birth certificate) to get back into the good ole’ USofA. So, if you’re a Certified Legal Nurse Consultant who is considering a future NACLNC^® Conference cruise, you’ll need to have one of the above to get back to your home office once your ship comes in.

The easiest form of proof of citizenship is the government-issued photo ID and birth certificate copy. Just make sure you have a readable, notarized copy of your birth certificate. Next easiest might be the so-called U.S. Passport Card (good only for land/sea travel – not international air travel). This is handy if you live near a border crossing and travel on a regular basis to meet your attorney-clients in such exotic locales as Tijuana or Montreal.

If you’re getting a new passport for traveling overseas as part of your CLNC^® business, or just for fun, you might be surprised to know that you’ll get one of the new e-passports. That’s right, an e-passport. Beginning in August of 2007 the Department of State has issued only the new RFID chip-enabled e-passports.

What’s the buzz about RFID? RFID chips are radio frequency identification devices that are really tiny microchips you can implant in an item of inventory, a pet or just about anything. Depending upon the strength of the chip, you can use it to identify and track inventory in and out of a building, the movement of chips around a casino (and betting patterns), the location of your French Poodle (not husbands yet – sorry Vickie) and today – an e-passport.

According to the U.S. Department of State, RFID chips in e-passports make them easier to scan and less prone to counterfeiting. Assuming (correctly) that even paranoids have real enemies, it is theoretically possible for the proverbial bad guy to walk through a crowd with a cell-phone-sized receiver and pick out the passport-carrying American citizens by the signals their passports give off (and not by their “I’m with Stupid” t-shirts and sneakers).

This frightened me until I learned of a solution – MobileEdge makes an ID Sentry Wallet that surrounds your passport in a cool-looking leather case that contains an imbedded shield that blocks the RFID signals from escaping. This turns you into just another face in the crowd. It does not interfere with the passport and so, is completely legal. By the way, the U.S. Passport Card also has an RFID chip embedded in it, but it comes with a shielded sleeve when you receive it from the government.

Paranoid? Maybe I should be. Safe? You bet I am. This ID Sentry Wallet is the best $30 travel accessory you can buy if you plan on going anywhere your passport can take you. Now, when you’re cruising the markets in Bariloche, Bangkok or Bumthang you can stop walking backwards in fear someone will sneak up behind you.

Keep on techin’,

Tom

I know that many of you readers come here, read what you want, make use of the information you want and go about your day without ever leaving a comment. One of the main benefits of a blog is the ability to start a conversation directly with Vickie and the other legal nurse consulting readers.

So, if you have been a silent reader of this blog and want to know the benefits of leaving comments, let me give you some tips on why you should be doing it.

1. You’re Alerting Vickie to Who You Are.

If you regularly leave comments on this blog, Vickie will start to recognize your name. Don’t forget the other regular contributors and hundreds of Certified Legal Nurse Consultants who read it daily. They will start to recognize you also.

If you leave some really interesting comments, Vickie may even ask you to “guest blog” some day.

2. You’re Building a Strong Legal Nurse Consulting Community.

A CLNC^® community is built around CLNC^® consultants and their views. Leaving comments is a way of showing that you care and want to share your opinion with others, including Vickie. The comments can be a suggestion, feedback, appreciation or even constructive criticism. Just be sure they aren’t spammy or abusive.

So, even if you are just stopping by, make that little effort and write a comment, even if it’s just a line.

3. You’re Getting What You Want.

You should leave a comment because that’s how Vickie judges what her legal nurse consultants want. Also this is how you can get your questions answered rapidly.

4. You’re Adding Traffic to Your Site.

When you leave a comment, your name will link to your website. People click your link to see what other interesting stuff you write about. Obvious but true. You might get some CLNC^® subcontracting out of it.

5. You’re Connecting with Nurses and Potential Clients That also Read This Blog.

It’s well known that Vickie is the nation’s most recognized expert on legal nurse consulting. Doesn’t it make sense that some attorneys may subscribe also? An attorney searching for information on a particular subject in Google can easily stumble on one of these blog posts. Then they will see your insightful comments, determine you are an expert and give you a call.

I actually had one new client find me through a blog comment. I ended up billing this contact more than $100,000 over the next year. The people who read the same blog post as I did, but didn’t leave a comment that day, didn’t get the business.

Blogging is not only about the author saying her piece, it is also about going out and joining the conversation where it is happening. It’s about reaching out to people and exposing yourself to new ideas.

There is no greater way to brand yourself as a legal nurse consulting expert than to leave insightful and regular comments on a blog like this one…you may even get some new business out of it.

So, let’s start today…everyone leave a comment and introduce yourself to all the other blog readers.

Guest Blogger Profile

Brian Horn is an Internet marketing consultant who specializes in search engine marketing, site optimization, social media marketing, link building and web data analytics. Brian has consulted with Vickie Milazzo Institute for over three years.

Brian also speaks at seminars and conferences throughout the U.S. and Canada on how to use the Internet to improve business.

Whether you are screening medical malpractice cases for plaintiff or defense, as a Certified Legal Nurse Consultant, you should be on the lookout for those obvious meritorious cases. When you see them, the red flags go up as long as there is significant injury or death. For example, maternal death gets everyone’s attention. The plaintiff CLNC^® consultant’s response is – this is one the plaintiff attorney should absolutely represent. The defense CLNC^® consultant’s initial response is – the defense should settle and settle fast.

Plaintiff attorneys usually want to see significant injuries, even in obvious cases of medical malpractice. They have to weigh the cost of litigation against the return. They must consider if it makes sense. They don’t want to spend $150,000 to win back $250,000.

The Centers for Medicare and Medicaid Services (CMS) recently made it so easy for plaintiff attorneys to successfully litigate 13 types of medical malpractice cases that plaintiff attorneys may be more willing to take on these 13, even if the damages do not meet their usual expected criteria.

To start at the beginning, the National Quality Forum (NQF) endorses a list of 27 serious, preventable and reportable “Never Events.” CMS, issued a ruling last year, effective October 1, 2008: CMS would no longer reimburse for 10 selected “Never Events” – events that should never happen and which are clearly caused by the hospital and/or its staff. Then, effective January 15, 2009, CMS issued another ruling adding three additional, surgery-related “Never Events.” In other words, CMS is trying to save lives by saving money.

Cases involving “Never Events” account, according to AON, for a large percentage (12.2% or more) of medical malpractice claims and will be difficult to defend and easy for the plaintiff attorney to settle fast, thus reducing their litigation costs. Insurance companies will fear taking these cases to trial and losing at great expense. They can settle out of court cheaper.

“Never Eventland” provides the perfect playground for a law firm’s new, young and inexperienced associate attorneys to practice on.

Add these 13 CMS “Never Events” to your “Plaintiff Alert Signal” list.

1. Unintentional retention of a foreign object after surgery.
2. Air embolism.
3. Blood incompatibility.
4. Pressure ulcers (Stages III and IV).
5. Hospital-acquired injuries from falls and certain traumas (fracture, dislocation, intracranial injury, crushing injury, burns and/or electric shocks).
6. Manifestations of poor glycemic control.
7. Catheter-associated urinary tract infections (UTI).
8. Vascular catheter-associated infection.
9. Deep vein thrombosis (DVT) or pulmonary embolism following total knee replacement and hip replacement procedures.
10. Surgical-site infections following certain orthopedic procedures, mediastinitis following coronary artery bypass graft (CABG) and/or following bariatric surgery for obesity.
11. Surgery on the wrong body part.
12. Surgery on the wrong patient.
13. Wrong surgery performed on a patient.

Educate your attorney-clients about “Never Events.” Offer to do a 20-minute presentation for all of the attorneys in the law firm. Even with attorneys, small wins are good.

Success Is Inside!

Read Part 1. Read Part 2.

How has your income level changed in this economy?

Dale: Vickie, I’m proud to say that last year I was a little ahead with my legal nurse consulting business compared to the prior year – which is saying something when so many other types of businesses experienced a downturn. I’m going to be away for most of January, on a trip to East Africa. People are amazed that I can afford to leave my business during this economy.

Every attorney I have a case with or who I am on the verge of getting a case from will have a contact number to call me directly, if I’m needed. I also have someone for them to call if they need a live body to take care of something while I’m gone. And I’ll be in contact with everyone by email. I’ll never disappear so that a client can’t find me, which gives them a level of comfort yet doesn’t keep me anchored to my desk. That’s one of the joys of being a CLNC^® consultant.

Do you still love being a Certified Legal Nurse Consultant as much as you did in the beginning?

Dale: More. I’m 60 years old and I can’t imagine ever retiring. Every case is different. Every situation is different. People often ask me what a typical day is like. There isn’t one – and that’s what I love about what I do. I feel like Columbo putting the pieces together in a puzzle that deserves my special kind of CLNC^® expertise, and it’s fun.

I think being a CLNC^® consultant is the best of all worlds for RNs. We get to use our nursing experience and expertise, we get to use our brains and we also get to be independent. We interact with people who appreciate us – working with attorneys is much better than working with physicians. Attorneys think we’re terrific.

Any CLNC^® consultant who is feeling bombarded by bad news in the media should just ignore the economy and keep doing what they’ve been taught by Vickie Milazzo Institute. The legal nurse business is out there, perhaps more than ever before. Attorneys need us, perhaps more than ever. Keep marketing, keep the lines of communication open and you’ll get where you want to be.

Success Is Inside!

Read Part 1. Read Part 3.

Obstacles have to be overcome in every economy. What obstacles are you facing now?

Dale: Vickie, my biggest obstacle is time. Particularly trying to squeeze in time to continue marketing every month. I’ve been a CLNC^® consultant for 9½ years, so I don’t have to market at the same level I did in the beginning, but I know that being busy is no justification for not marketing. You taught me to always keep marketing to assure the phone is ringing.

Another challenge during a tough economy is maintaining attorney-client relationships with attorneys who may be dealing with the stress of their clients. Do you have any suggestions?

Dale: One word: communication. In any situation, that’s the factor that enables me to enjoy an excellent relationship with my attorney-clients and to keep them coming back. I’m always a phone call away, and I never let much time pass without being in touch. But more important, anytime I decide to go a different route on a case from what we’ve discussed, or when I have some new ideas, I don’t go forward until I call and talk to my attorney-client. Usually, they’re fine with whatever I’m suggesting as the Certified Legal Nurse Consultant, but they appreciate being kept in the loop. Then, if they get a bigger bill at the end of the month, they’re not startled. Nobody likes surprises of that nature.

Also, if I see something in the record that’s not good for the attorney’s case, I pick up the phone quickly and lay it on the line. It may not be what the attorney wants to hear, but he always appreciates the heads up.

Forging ahead when the world is taking a “wait and see” position shows a very independent and entrepreneurial disposition. How has your independent streak contributed to your CLNC^® success?

Dale: Tremendously. Every day I do what I can to make certain my business is secure, my work is secure, that I have all my ducks in a row and that I have new business coming in. When the world seems to be falling apart around you, everything you do in your legal nurse consulting business takes on a different level of importance. For me, it’s about maintaining what I have and gaining a little too.

What is your best piece of advice to CLNC^® consultants getting started right now?

Dale: My biggest piece of advice is to be prepared for rejection and frustration and to keep plowing ahead. It will pay off. CLNC^® consultants who say, “I’ve spoken to ten attorneys and nobody’s interested,” are going to lose out. Business is a numbers game, and ten attorneys are nothing. Even CLNC^® consultants in rural areas, where attorneys are not as numerous as in cities, can succeed handsomely in their CLNC^® business. You don’t have to market only in your own backyard. You can market anywhere.

In any economy, you need to make a marketing plan and stick to it. Whatever marketing methods you use – whether contacting attorneys in person, on the phone or via mail – be consistent and follow your plan. And always follow up.

Vickie, you always say, “Do what works, not what’s easy.” I’ve known legal nurse consultants who created their marketing packet, mailed them, then sat back and waited for the phone to ring. They were surprised when no one responded. The same thing happened to me. Even when I sent out ten letters and followed up with a phone call, at least half the attorneys said they never received my packet and had no idea who I was. Attorneys, like the rest of us, toss mail they don’t readily recognize.

So I call my attorney-prospects before I mail anything. It takes more time but new CLNC^® consultants should try it.

If you can’t always get through to the attorney, that’s okay; ask for their voice mail. The attorney gets to hear your voice, who you are and why you’re calling. A brief voice mail presentation lets him know that you’re a professional who understands his legal practice. He knows you’ll be sending a packet and that you’ll be following up. I get a much higher success rate when I call first.

Success Is Inside!

Read Part 2. Read Part 3.

For the first time in my memory nurses are getting laid off in significant numbers. The deteriorating health of our economy is affecting almost every U.S. job – this includes nursing. But as I am hearing from the registered nurses I’ve trained, a career as a Certified Legal Nurse Consultant is a recession-proof choice.

My sincere gratitude to Dale Barnes, RN, MSN, PHN, CLNC for taking the time to talk with me about how the economy has affected the health of her CLNC^® business. Dale has been a CLNC^® consultant since 1999 and specializes in medical malpractice, bad faith insurance and general personal injury.

How is today’s economic climate affecting your CLNC^® business?

Dale: Vickie, I’m here to tell you working with attorneys is recession proof. I’m busier than ever. Everything a CLNC^® consultant does is related to medical issues and healthcare, and those cases are still pouring in. During a tough economy, some people look at a lawsuit as another revenue stream. So attorneys are busy. Even when I tell my attorney-client, “There’s no merit here,” I still get paid, plus it keeps nonmeritorious cases out of the system.

Are new attorneys approaching you?

Dale: Just last week a new attorney called and hired me as a legal nurse consultant for his bad faith insurance case. When people are financially strapped, an insurance claim becomes an asset. The claimant expects the insurance company to cover everything so when a claimant feels undercompensated or cheated, they call an attorney.

What other kinds of medical-related cases are you seeing?

Dale: Everything. I just finished a large home care defense case. A man’s wife had multiple sclerosis, and he was her sole caregiver, refusing to have anyone else in their house. Over the years, as his wife’s health deteriorated, the home care nurses noted that he was noncompliant with instructions for his wife’s care. He wouldn’t turn her every two hours, as directed, and she got one decubitus ulcer after another. She had a Foley catheter for a time and got a urinary tract infection. When she finally turned septic and died, the husband filed a suit, claiming that the wound care supplies the nurses used had caused her infection. This was off base, but the case went on and on. He was obviously trying to make a buck. I helped the defense put together a strong case, and the husband struck out.

You must have felt like a CLNC^® champion on that case.

Dale: Absolutely. I had another case recently that involved using restraints on a hospital patient. The nurses had orders to use restraints but decided not to. The woman fell out of bed, suffered a subdural hematoma and died. A terrible situation, in which fault and liability are not clear.

So the types of cases run the gamut. I’ve had a number of motor vehicle accident cases. I have one attorney-client who does nothing but dog bites, and he sends me several cases every week. They take a long time to come to fruition, because the cases usually involve children, but this attorney’s business isn’t down one bit, and I’m still getting all of it.

Do you handle more cases for defense or plaintiff attorneys?

Dale: About equal. Whichever side I’m on, if I see a weakness, I tell my attorney-clients up front. And, as you teach, Vickie, we are saving our court systems time and money by keeping nonmeritorious cases out of court – another plus in a down economy.

Do you use a network of CLNC^® consultants as subcontractors to help you with your busy caseload?

Dale: Yes. I use CLNC^® consultants for two reasons: 1) to leverage my time during those periods when my caseload is just too much for me to handle, and 2) when I get a case that is out of my area of expertise. Being part of the National Alliance of Certified Legal Nurse Consultants is the best place to look for my CLNC^® subcontractors.

Success Is Inside!