Even the best Certified Legal Nurse Consultants make mistakes and these veteran CLNC® consultants are proof that none of us are exempt. Follow their advice on how to avoid the most common mistakes in your legal nurse consulting business and you will enjoy the journey and more CLNC success.
- Not reading the attorney’s assignment thoroughly. Suzanne Arragg, RN, BSN, CDONA/LTC, CLNC confesses, “While it was a good problem to have, I received 10 cases within 7 days. Some of the cases were more time sensitive than others. After reviewing the attorney’s assignments I thought only two cases involved requests that had to be completed within a few business days. The following week, my attorney-client asked about the status of one of the assignments unrelated to the two cases I had identified. I quickly searched through my emails and sure enough, I had not scrolled far enough down the email chain to read the totality of the assignment for the case I had missed the deadline for. Apparently, I had only looked at the first line, ‘New file. Suzanne, please initiate work-up.’ I quickly shifted gears. I called the attorney to inform him of my oversight and that I was on the request. Luckily, he was able to work with my delayed delivery of the assignment.I felt embarrassed I had made such a silly mistake. I knew better than to rush through new case assignment emails. I was feeling the pressure of being bombarded with multiple assignments within a short period of time and failed to slow down enough to ensure I didn’t miss anything.
To avoid repeating this mistake, I have implemented deep breathing techniques and more frequent screen breaks. I tend to sit or stand at my desk and buzz right along for hours on end, without taking deep inhales and exhales. As RNs, we’re so accustomed to working in life and death environments, we forget that as a CLNC consultant, code blue is not a reality. So, while we have all heard the repeated recommendation to take breaks and breathe, implementing these techniques has proven to be difficult. Lesson learned. They make all the difference.”
- Not checking for conflicts of interest before accepting a case. Avoid discussing a case before you’ve done a conflicts check. Sandra Higelin, RN, MSN, CNS, CWCN, CLNC describes, “If you don’t check for conflicts in advance you can end up signing on for a case that you’re already consulting on for the opposing attorney. This happened to me. I got a call from an attorney’s assistant wanting me to take a new case. I had worked with this attorney before. I told the assistant that I needed to check for conflicts, so not to tell me about the case. She continued to give me facts about the case even though I asked her not to. I asked who the plaintiff attorney was and I recalled that I was already consulting on this case. I immediately stopped the assistant, informing her that I could not take the case. I then contacted the attorney I was working with and explained what happened. The opposing attorney contacted my attorney-client, requesting I be excused from the case. He also went to the judge to have me excused. I had not yet been designated as the testifying expert. The judge spoke to me about what had happened and said he realized how this occurred, but he had to instruct my attorney-client that I had to be removed from the case. I felt very bad about the outcome and felt I had been set up. This taught me to never listen to the facts of a case before checking for conflicts. I now keep a case log of all my cases so that I can check for conflicts. If an attorney catches me on the run and I’m unable to check my records, I advise that I will get back to them once I’ve checked for conflicts.”
- Not getting a retainer. Marcia Bell, RN, BSN, CAPA, CLNC advises, “The CLNC Certification Program teaches us to never start work with new attorney-clients until we have the retainer check in hand. Clarify when the retainer check will be sent. Let the attorney know when you’ve received the retainer check. Keep records of retainers due. Don’t submit a final report until the invoice is paid in full.”Forgetting to pay attention to the time. Marcia Bell recommends, “When you’re working on a case, track your start and stop time. If you take a lunch break, need to check personal email or get interrupted for any reason remember to account for that time.”
- Not communicating thoroughly. Communicating with attorney-clients is a basic success strategy. Marcia Bell states, “When I get a call from an attorney, I’m meticulous about asking when the report is due, when I should expect to receive the medical records, when the retainer will be sent and the approved budget for the project.”
- Not being objective. Marcia Bell discusses, “As the CLNC Certification Program teaches, ‘Give the attorney the good, the bad and the ugly.’ Review the case with the plaintiff and defense position in mind. This will make your report more objective. If there is a problem with the case, the attorney needs to know up front. If you come across any problems or notice something huge in the medical records, don’t just put it in your report. Pick up the telephone and call the attorney. If you don’t reach the attorney, email and request a phone call. The attorney may not want you to put damaging information in a potentially discoverable email.”Sandra Higelin adds, “Have a thorough knowledge of the facts of the case and why you support the case or not. If you don’t have full confidence in your opinion, you’ll waver in your presentation and rationale. In deposition or trial you’ll be easily manipulated into making contradicting statements about the facts and your opinion. Confidence and strength of conviction is your best asset.”
- Submitting a report without carefully proofing it. It is not uncommon for the spell check tool to miss subtle mistakes. Marcia Bell adds, “Read carefully and consider if you have stated your opinion simply. Remind yourself that not everyone has the same nursing knowledge you do. I once had to explain simply to a criminal attorney what diabetes is and how low blood sugar impacts a person. Don’t get too technical. Define medical terms in layman’s terms that even a jury could understand.”
- Not clarifying that a work product is for internal use only. Camille Joyner, RN, BSN, CCM, CLNC shares, “I handled Medicare appeals for a hospital, which included 12 cases in telephonic hearing, before the same Administrative Law Judge (ALJ). This was the hospital’s first experience. Although I had told the administrator’s assistant that I had already submitted everything needed by the judge, she thought she was helping and sent the internal form I devised for record review to the ALJ. This is a Case Facts and Observations form, and it included strengths and weaknesses of each case and areas that those testifying would need to be prepared for. Fortunately, the assistant only did this on one of the 12 cases. The ALJ asked me if that form was simply internal communication and not additional evidence and I said that was correct. I was absolutely horrified. He chuckled, disregarded the document and we won all 12 cases, meaning the facility was going to get paid for each claim as billed. But, it could have gone so much worse. After this experience, I added, ‘For Staff Review Only,’ in bold ink at the top of each document. I also made sure the administrative assistants knew the purpose of the ‘officially unofficial’ form, and why we were talking about it and not sending it anywhere.”
- Substantive error in the work product. Suzanne Arragg shares, “Sometimes the final work product includes a mistake or an error in interpretation. To correct this, be transparent and honest with your attorney-client. Communicate as soon as you identify the issue. Don’t fumble over your words or create excuses. Own it. Tell the attorney you have corrected the error and it has already been sent for review. Don’t hide the mistake or bury it in an email, hoping the attorney will come across it at some point. Attorneys are busy fielding up to a hundred emails daily. That’s why it’s so important to get out in front of the situation as quickly as possible.”To avoid errors, perform a comprehensive review of the medical records and pay attention to the minute details. Sandra Higelin adds, “You have to look at the medical records with a microscope, making sure not to miss hidden details that might end up being the most important in supporting your opinion. Always ask for missing medical records that are pertinent to your case. The patient’s history before and after the incidents in question are also very important.”
- Lacking a sense of humor. Caryn Jaffe, RN, BS, CLNC confesses, “I was retained as a testifying expert for a medi-port chemotherapy extravasation case involving administration of dexrazoxane, the only high-dollar drug that can reverse detrimental effects of an extravascular anthracycline exposure. Clinically, I had used the antidote under the brand name, Zinecard. It has another brand name, ‘Totect,’ used in this patient’s medical records. The antidote’s chemical name is spelled d-e-x-r-a-z-o-x-a-n-e, but pronounced, dek·sruh·ZAAK·sayn. I found this medication’s chemical name to be difficult to recall and even more challenging to pronounce.Unbeknownst to me and my attorney-client, in my testifying expert report, I repeatedly misspelled the drug under its brand name, Totect, spelling it T-O-T-E-C. While researching the case, I read and pronounced the drug name without it’s trailing T, pronouncing it incorrectly, like the final syllable in CYTOTEC. I was unaware of my error providing the opposing attorney an easy way to impeach my expert testimony.
Luckily, I was well prepared for my expert deposition and had some theater improvisation skills to pull from when I found myself unprepared to answer the opposing attorney’s question about my repeated spelling error. To my attorney-client’s relief, I was able to explain my error using a memorable communication exercise. With my quick wit and vivid, long-term memory I presented the reasonable explanation that I had used the drug under its brand name of ZINECARD, which has a straightforward pronunciation. Having never heard the pronunciation of Totect, I fell to the English language phenomenon of silent consonants when sandwiched in between or next to other consonants. Trailing Ts are correctly pronounced or omitted in many words. Whether I was pronouncing it correctly or not didn’t matter. The issue was, why I, the testifying expert, had not noticed the repeated mistake. If I didn’t have attention to detail in a written report, how could I be viewed as an expert? Here’s what I said.
‘Have you ever done the communication and leadership exercise where you are told to count the # of Fs in a Paragraph? The majority of people including me, will count all the Fs except for the Fs in the word OF. This is because OF is pronounced Uhv as if the F was a V. Our brain hears a V and doesn’t let us see the actual letter F on the page. Similarly, I read the name, Totect, speaking it in my head with a silent T. My brain heard the name ending with a C or K, not a T. It’s one of the nuances that makes the English language difficult to learn.
I further explained, the concluding T in TOTECT should be pronounced. However, when spoken quickly, the trailing T gets lost, causing the drug name to sound more like the last syllable of CYTOTEC. I provided a professionally reasonable and scientifically plausible explanation for my communication faux pas. My presentation during deposition brought all case players down to the same level. It saved my credibility and was not addressed further. However, despite my creative and effective attempt to rescue and reestablish my intelligence, the opposing attorney made sure to stress my error by pronouncing and over-emphasizing the sometimes silent T on the end of TOTECT any time he said the drug name during the final two hours of the deposition.
Learning from mistakes and being honest about them is an essential skill for all medical professionals, especially a Certified Legal Nurse Consultant in a testifying expert role. I encourage my colleagues to do what I do when faced with mistakes. Investigate your errors. Assess how things went wrong, how you can handle the issues now and prevent them in the future. If possible, I try to let go of and prevent self-ridicule that stops me from using my errors as a learning tool. When my outrageous life’s nursing journeys seem unrealistically off-the-wall both professionally and personally, I find the humor in the awkward moments and share them in that light. Laughter is often seen as the best medicine. I believe the power of shared humor keeps caregivers in the healing arena on the most difficult days. This philosophy has made me a better RN, CLNC, and person overall.
To this day, I take this concept a few steps farther. No matter how my day has progressed, how much work I got done, or the mood I find myself in, I make it a point to watch at least 20 minutes of stand-up comedy every night. In the pandemic world where we all have too much stress, this practice ensures I go to sleep with a smile on my face. It has allowed me to wake up in a better mood and sets me up to confront adversity and insanity with a smile.
It has evolved over time and ultimately has prevented me from getting bogged down with negative emotions about things I have no power to change. It has become so helpful, that I’ve continued a collection of funny things I’ve located in medical records and job descriptions. I keep them handy in a BIZARRITY folder and routinely share them with my RN and CLNC colleagues.
Using comedy to cope with the serious aspects of our jobs at the bedside and behind a desk may be the best practice I should have implemented right from the get-go. Seek out humor and share it. Learn to be a storyteller. Professionally share your unusual experiences. Embrace your personal bizarrities. I believe you will likely notice stress decrease with an increase in satisfaction of every aspect in your life. Give yourself the permission to learn, think, and feel. Come laugh with me fellow Certified Legal Nurse Consultants! Let’s share the laugh medicine we all need right now.”
Thanks to Suzanne, Marcia, Sandra, Caryn and Camille for sharing mistakes they’ve made and what you can do to avoid them in your legal nurse consulting business.
P.S. Comment and share mistakes you’ve made in your CLNC business and what you could have done to avoid them.