We asked the CLNC® Pros to describe their ideal legal nurse consultant job and some of their most challenging jobs. From communication challenges to urgent deadlines, take a look at how they rose to the challenge of handling their most difficult cases.
The Ideal Legal Nurse Consultant Job
“The ideal legal nurse consultant job is one in which there is open and straight forward communication with the attorney-client. The attorney listens to the strengths and the weaknesses of the case with an open mind. It’s always more difficult when you have an attorney who argues and tells you to find a way to make their case, when their position is weak. The ideal attorney is one who says, ‘Ok, what do we do next? How do we mitigate the weaknesses and strengthen the positives?’ When an attorney hands a case over to me and trusts that I will handle and organize all medical aspects of the case, my job is fun, smooth and easy. If communication goes poorly, I feel stuck and unable to move forward. I want the attorney to understand that I have the best possible outcome as my goal for every case. Having the trust of my attorney-clients makes my job fun.”
– Dale Barnes, RN, MSN, PHN, CLNC
“The ideal legal nurse consultant job is the job that comes to me. It’s a great feeling when an attorney calls back with a new case for you to review. The ideal job is also working with an attorney who communicates well. There are no hidden agendas. The attorney communicates what they need and respects your communication in return. As with any job, great communication makes life easier.”
– Carol Fridal, MS, RN, CEN, CLNC
“The ideal legal nurse consultant job is one that includes excellent communication between the CLNC consultant, the attorney and the support staff. Great communication from the beginning to the end of the case is vital for smooth case development. Communication involves everything from sending and receiving medical records, establishing expectations, communicating opinions via telephone, zoom and email and recommending and providing additional CLNC services. Confidence and providing facts and authoritative references are important for strong communication. When the attorney asks questions, I can confidently answer them with supporting facts and references.”
– Shequita Moore, RN, MSN, LNFA, CLNC
“My ideal legal nurse consultant job is one that runs flawlessly without too many speedbumps or one that requires me to step out of my comfort zone and offers an investigative challenge. I love a case in which I can confidently speak my opinion, based on my knowledge and expertise, and confidently identify causation and damage issues. I also love a case in which I have to do some research, challenge myself and collaborate with other experts. This allows me to learn and grow. The overall goal is to provide the attorney-client with an excellent work product that compels them to keep coming back for more. I feel extremely fortunate to say I have the ideal CLNC consultant job most of the time. I get to work from the comfort of my own home, create my own schedule and work with amazing attorneys who trust me with their cases.”
– Michelle Neal, RN, BSN, CLNC
Challenging Legal Nurse Consultant Jobs
“Over the years, I’ve had many challenging cases. The first case involves an attorney-client who expressed that he wanted and needed a positive outcome for his client. After reviewing the case, I had the task of telling this plaintiff attorney that the case was not meritorious. He proceeded to argue and tell me that the plaintiffs were close friends and he had to do well for them. I emphasized the facts of the case and repeated why, in my opinion, the case had no merit. The attorney told me just to come up with something. I had to protect my integrity, so I politely communicated that I could not proceed further with the case. This attorney never called me again, but it was no loss and certainly not worth the sacrifice of my integrity.
The other set of cases that stands out were all from one attorney. He hired me to attend defense medical exams (DMEs). When I first started, the attorney argued about why I didn’t need to see the medical records. After I explained why my review of the records prior to attending the DME was important, he relented and gave them to me reluctantly. After a few cases, the attorney gave me a very complex case. There were more pertinent records involved than in the previous cases. I charge my hourly rate for record review, attending the DME (including travel) and sending an audio recording and written report if requested. When I sent the invoice for the amount above the retainer for this DME, the attorney called and claimed my invoice was too expensive. I reminded him of the complex injuries sustained by his client and the large volume of medical records I reviewed. He suggested there were nurses out there who would do this DME for less. I told him that managing the DME for less was not possible for me. I’ve learned it is worth saying no in circumstances in which I am asked to compromise the value of my professional time.”
– Dale Barnes, RN, MSN, PHN, CLNC
“One of my most challenging legal nurse consultant jobs involved an attorney who was high pressure and quite direct about what he wanted. The case involved a patient who arrived at the emergency department (ED) via EMS. The charge nurse triaged the ambulance to the waiting room. The hand-off between EMS and the waiting room triage nurse did not occur. The patient was placed in the waiting room, but was never arrived, so the triage nurse did not know the patient was in the waiting room. The patient ended up having a seizure and the staff attempted to resuscitate the patient. The patient died in the ED. I reviewed the medical records and did not see deviations from the standards of nursing care because EMS failed to provide a hand-off to the triage nurse. No nursing staff signed off as receiving the patient. The attorney wanted the charge nurse or triage nurse to be in error. The situation was challenging and it was clear the attorney was not interested in my opinion. I chose to end the relationship with the attorney, as he did not want my professional opinion as a Certified Legal Nurse Consultant.
The second case involved a 6-hour deposition by the defense attorney. The case involved a patient that presented to the ED with an infection and waited in the waiting room for four hours. The patient showed signs of sepsis but was not identified. The deposition was challenging in two ways. The first challenge was the length of time of the deposition, and the second challenge was responding to the opposing attorney’s attempt at making the case about me. By focusing on not taking the attorney’s questions personally and remembering I was there to do a professional job, I was able to keep my composure throughout the deposition.”
– Carol Fridal, MS, RN, CEN, CLNC
“One of my most challenging legal nurse consultant jobs involved a fall case that included voluminous, unorganized medical records with a statute of limitations that was about to expire. Additionally, there were vital medical records missing. I set strict deadlines, stayed focused and worked long hours to complete the case and meet the attorney’s expectations. It was also challenging to get timely responses, which were vital to the case, from the legal assistant. I continued to communicate frequently and kept everyone informed of where I was with the case development. I was able to review the case, perform all relevant CLNC services and locate a testifying expert in a timely and expedited manner.”
– Shequita Moore, RN, MSN, LNFA, CLNC
“One of the most challenging cases I’ve consulted on involved a wound vacuum (vac) sponge left inside a patient. The patient had recurrent abscesses, multiple debridements, multiple wound vac placements and multiple wound vac changes at different facilities over the course of two years before the wound vac sponge was discovered. It was a very tedious process to confidently pinpoint causation and damages. After my review and analysis, I completed a detailed medical chronology, noting each wound vac dressing change over the course of two years. I also had multiple conversations with the expert plastic surgeon and wound care nurses. This case required recurrent record reviews as more records became available. It was like piecing a puzzle together without all the pieces, but we did end up finding that missing piece.
Another challenging case I have consulted on involved a motor vehicle accident which resulted in paraplegia. This case went on for years. The big challenge was the plaintiff’s significant history of drug abuse. Additionally, she had been involved in four prior accidents from which she sustained significant injuries. I drafted a detailed medical chronology, which included all past medical history, including all prior accidents and the injuries sustained from these accidents. I identified which accident caused which injuries. Then I evaluated how the most recent accident either resulted in new injuries, aggravated pre-existing injuries and/or how the prior injuries placed the plaintiff at increased risk for subsequent injuries. This case required a lot of research on spinal cord and orthopedic injuries. In addition to the significant injury of paraplegia, I had to evaluate how the plaintiff’s actions could have contributed to the accident and/or injuries. The plaintiff had a documented history of drug abuse, which included not only illicit drug use, but also prescribed anti-anxiety, anti-depressant and opioid medications. I developed a table which included the classification of each drug and their side effects, half-life and peak of drug effects. The case was complex and challenging. It was a great learning opportunity, and it really taught me the importance of paying attention to every detail.”
– Michelle Neal, RN, BSN, CLNC
Thanks to Dale Barnes, RN, MSN, PHN, CLNC, Carol Fridal, MS, RN, CEN, CLNC, Shequita Moore, RN, MSN, LNFA, CLNC and Michelle Neal, RN, BSN, CLNC for sharing how they’ve handled their most challenging legal nurse consultant jobs.
Success Is Yours,
P.S. Comment and share how you handle your most challenging legal nurse consultant jobs.