Regarding the Future of Legal Nursing as viewed in Spokane, Washington

Mijourney · Jan 13, 2007

Lindarn,

Do you think employers understand what the responsibilities of holding a nurse's license entails? Or, do you feel as you indicated in your post, they want the best bang for their small buck?

I personally feel it's rather denigrating to see a colleague lower their sights just to say they are a LNC. We want to uplift nursing, not bring it down. The ad you're posting about just goes to the mentality of outsiders about the nursing profession and what we nurses still think about ourselves.

hollyvk, BSN · Jan 14, 2007

Legal Nurses be forewarned- here in Spokane (not the highest paid region of the country), an temp agency called "Provisional Staffing", just had an ad in Sunday's paper for a law firm, who was looking for an RN/LPN to read review medical records, be able to sort our issues with medical history for clients, etc. When I inquired about the job on Monday morning (9:30 AM), I was told that the job was already filled. I asked what the pay was, and I was told that the pay was $14- 16 an hour!!
Now, Legal Nurses, do you see a problem in the future if this agency decides to expand its Legal Nurse work force, and markets more to lawyers? Why would a law firm pay an independant contractor $100 + an hour to review medical records, research, if they can hire this agency to get nurses to work for $14- 16 an hour?
My educated guess, is that the person who got the job was not an experienced legal nurse, but a wannabe, who just wanted to use his/her nursing knowledge at an easier job than bedside nursing (this was a part-time in house position). This has cast a huge chill in my perception of continuing as an independant legal nurse, and the future of the profession.
Lawyers in Spokane are as cheap as the hospitals, and want experienced legal nurses with alot of clinical experience, but cringe at the thought of paying a professional wage for it. They think nothing of paying doctors to review cases for $300 and hour, but do not think that they should pay nurses a salary commensurate with the years of experience, expertise, and education, etc., that bring as much to their practice as doctors do.
Obviously, I will have to sit and watch, how this pans out. But I am not hopeful for the future of Legal Nursing. We are becoming a dime a dozen, and it is getting harder to get a decent amount of work. I am open to suggestion. I will be happy to send the ad to anyone who is interested in looking at it.
Lindarn, RN, BSN, CCRN
Spokane, Washington

Hello all,

I am an RN, I am a lawyer. I've worked for healthcare facilities, I've worked for attorneys. And here is what I know to be true.

1. People providing eduction (nursing schools, law schools, legal nurse consultant trainers) are in the BUSINESS of promoting their educational enterprises. How you pay for it is your problem and none of them guarantees that with the training/education you've paid them for that you will find employment at an enhanced/elevated wage.

2. Attorneys are probably even more cost-conscious than healthcare facilities when employing contract employees (that would be you, contracting as a nursing consultant, to review medical records, provide advice concerning the case, and perhaps testifying as an expert witness). (Healthcare facilities pay a pretty penny for contract employees, aka "traveling nurses").

3. Most attorneys (and certainly litigation attorneys) are VERY SKILLED negotiators. If you think you can squeeze extra $ out of them without having some unique skill, you're kidding yourself.

4. Yes, physicians who are experts on litigation cases get paid quite well. And that's because you cannot put on a case without one, and because physicians make a lot more $ than RNs working in healthcare. I hear new radiologists fresh out of training are getting a starting salary of around $250K/yr.

5. Is it fair that this position was filled by a "wannabe" willing to work for less than RN healthcare wages? Well, not if you're envisioning yourself making lots of $ with your newly-paid for legal nurse consultant training, but since I don't foresee that designation having much of an impact on the American Trial Attorneys' membership, you should evaluate what effect "market forces" will have on your new "specialty."

The only RNs I know making decent $ doing legal work are the nurse attorneys or nurse paralegals who can stand to work with/for attorneys. And there few of those jobs available compared to the number of RN jobs. Again--market forces.

So before you shell out good $ for ANY training or education program, due diligence calls for thoroughly investing the realistic employment opportunities to be had with such training. And if you ONLY consider what the program's personnel are telling you, you do not have an accurate assessment.

HollyVK, RN, BSN, JD

(who has had to sue attorneys she's done work for in order to get paid--another problem you generally don't have with healthcare providers)

lindarn · Jan 15, 2007

Hello all,
I am an RN, I am a lawyer. I've worked for healthcare facilities, I've worked for attorneys. And here is what I know to be true.
1. People providing eduction (nursing schools, law schools, legal nurse consultant trainers) are in the BUSINESS of promoting their educational enterprises. How you pay for it is your problem and none of them guarantees that with the training/education you've paid them for that you will find employment at an enhanced/elevated wage.
2. Attorneys are probably even more cost-conscious than healthcare facilities when employing contract employees (that would be you, contracting as a nursing consultant, to review medical records, provide advice concerning the case, and perhaps testifying as an expert witness). (Healthcare facilities pay a pretty penny for contract employees, aka "traveling nurses").
3. Most attorneys (and certainly litigation attorneys) are VERY SKILLED negotiators. If you think you can squeeze extra $ out of them without having some unique skill, you're kidding yourself.
4. Yes, physicians who are experts on litigation cases get paid quite well. And that's because you cannot put on a case without one, and because physicians make a lot more $ than RNs working in healthcare. I hear new radiologists fresh out of training are getting a starting salary of around $250K/yr.
5. Is it fair that this position was filled by a "wannabe" willing to work for less than RN healthcare wages? Well, not if you're envisioning yourself making lots of $ with your newly-paid for legal nurse consultant training, but since I don't foresee that designation having much of an impact on the American Trial Attorneys' membership, you should evaluate what effect "market forces" will have on your new "specialty."
The only RNs I know making decent $ doing legal work are the nurse attorneys or nurse paralegals who can stand to work with/for attorneys. And there few of those jobs available compared to the number of RN jobs. Again--market forces.
So before you shell out good $ for ANY training or education program, due diligence calls for thoroughly investing the realistic employment opportunities to be had with such training. And if you ONLY consider what the program's personnel are telling you, you do not have an accurate assessment.
HollyVK, RN, BSN, JD
(who has had to sue attorneys she's done work for in order to get paid--another problem you generally don't have with healthcare providers)

I have not forked over any big money $$$ to "learn to be a legal nurse consultant". I started in this ten years ago, when I attended a two day seminar put on by the nurse attornesy from the Washington State Trial Lawyers' Association. I am entirely self taught, and I have educated my self.

My complaint is that even in house- legal nurses in other areas receive far higher salaries than $14 and hour. Paralegels make more money than that. The going rate for legal nurse consutants is $100- $150 an hour. I don't think that it is unreasonable to request that.

I have spent a lifetime learning about the medical profession, becoming proficient in critical care nursing, stay current in my certifications, that are difficult to obtain, etc. I do everything medical quicker, and with more understanding and comprehension, than either the attorney, or his legal assistant staff. This education, knowledge, and expertise, is what an attorney needs, and he cannot obtain it elsewhere. In my expertise, doctors who review medical records for merit, and/or a malpractice case, go into that endeavor with "tunnel vision". They are incapable of seeing the "big picture", because they do not know what the big picture is. They only see the small part of it, because that is all that they have to deal with. This knowledge, and expertise is worth a great deal to attorney, and I do not apologize for charging it. They think nothing of paying doctors $300 and hour, and up, for the same thing that I do for one third of that. I have been told that that I have given them better information, and I explain it better that doctors do. If they can pay doctors that kind of money, they can pay legal nurses a professional salary, as well.

Nurses see the "big picture", because we have to know everything that is going on with the patient, because we are dealing with many other departments contribute to the care of their patients. That is why nurses are a better choice to review cases because we can see this big picture, and can "read between the lines", in malpractice cases. Again, doctors cannot because they have no idea, and no experience that would give them the ability to "read between the lines".

There are many nurses making good money in legal nurse consulting. My complaint/criticism of this incident is the fact that there are too many nurses who sell themselves cheap in every aspect of their careers as nurses. I am including working in hospitals, as well. Nurses are treated like crap here, and their pay, benefits, and respect, (or lack thereof), reflect this. This is a main complaint with nurses all over the world. We are paid what I consider to be, high school drop out wages, for being the "back bone of the hospitals". Nurses are always selling themselves short. I am tired of it, and that is why I went into Legal Nursing.

These agencies are always short changing nurses, even the ones who staff hospitals. The collect three figures for nurses' services, and then pay the nurses a fraction of that. Nurses need to learn that they can be independant contractots, even in hospital, but that is another issue.

Again, the issue is, that a nurse's knowledge, and expertise is worth far more to a law firm than $14-$16 an hour. They know it, and so does the agency that placed the ad. My educated guess is that they are paying the agency alot more than $14-16 an hour, and the agency was "testing the water" to see how low they can pay and attract nurses to the job. My fear is that this agency will spread, and market to more attorneys, and the career of legal nurses will be dead in the water in a very short period of time. I rest my case.

Lindarn, RN, BSN, CCRN

Spokane, Washington

hollyvk, BSN · Jan 15, 2007

Lindarn,

Yes, I agree with most of your points. But if Joe Smalltime Attorney wants to try and hire an RN for less than $15/hr to review medical records for him and finds one who thinks, "Hey it's less $ than the hospital pays me, but it's much easier work, why not do it?" Well, that's still market forces at work.

One of the factors in the litigation scenario will be how much $ will have to be spent on the up front legal costs (e.g., copies of medical records, expert witness fees and costs, deposition transcription costs) before any money on the case is recovered from the defendant. Often the attorney himself/herself is bankrolling those costs, so of course the attorney will be looking the best bargain he/she can get.

But what I think you've left out of your discussion is the difference between being paid as an employee (the scenario all nurses are familiar with) versus being paid as a contract employee (where YOU are responsible for paying ALL the taxes associated with your work). And my rule of thumb from personal experiece is that you need to set your hourly charge to be double to triple what you want your actual hourly income to be, as half of it will be going for taxes, malpractice insurance, and business costs and expenses, and then there's your medical and disability insurance costs . . . . Most RNs have NO experience with this scenario.

Attorneys practicing on their own are, of course, intimately familiar with this difference how much you have to charge in order to achieve a decent income from the effort. And a seasoned, professional consultant of any type should be able to effectively market themselves as to what they can offer to assist the attorney in the way of case preparation and explain why their hourly charge is a valid reflection of their training, experience, and abilities to do so.

So yes, you should always ask for what you think you're worth money-wise. Just don't be surprised if someone else gets hired instead who's willing to work for less. If ALL RN refused to work for low wages, RN pay rates would rapidly increase. But we know that's never going to happen . . . .

Best wishes to you in your consulting activities,

HollyVK, RN, BSN, JD

Agnus · Jan 19, 2007

There will always be nurses who undervalue themselves. This profession tends to attract people who undervalue themselves. This profession offers absolutely no education in business, marketing, selling or anthing else that would tend to give the nurse the idea that she is autonomous and does not need the institutions that employ us.

A good many other professions are quite the oposite and encourage independent thinking and what an entreprenureal spirit in its workers. Nurses are infact discouraged from this bent. We hear over and over that we should not be in it for the money. Quite frankly I am in it for the money. I would not do what I do for anyother reason because much of what I am required to do goes against my personal ethics.

Health care industry today is not concerned with the whole person of the pt. they are concerned with efficiency cost containment. the motto in many hospitals is move em out . you have not even completed dischargeing one pt and you are admitting 2 more. Quantity and fast pt turn over that is the goal with hopefully a minimum of complaints from the "customer"

These institutions are more dependent on nurses than anyone else. Thier goal is to make the nurses believe they are the most despensable part of the picture. That nurses do not work efficiently and do not do enough.

Our hospital is laying off en-mass our CNAs. the can not lay off nurses because of the CAlif. staffing laws. They are laying off the CNA and telling the nurses we will care for the same number of patients. they are telling the public that nursing care will improve with this layoff because the RN will be porviding more direct care than before.

So if this does not happen. Sorry I am only human I can only do so much. It is the nurse's fault. If you keep telling someone they are not good enought they believe it.

At least once in every 3 days I hear a nurse afraid to call a doctor or ask the pharmasist something because she doesn't want to apear foolish, stupid ,you name it. I see calls put off all them time because the nurse is afraid. Even charge nurses tell us not to bother the doctor. \\

Doctors and nurses do no communicate about a pt well. When I see nurses asking questions or reporting something she uses tone and body language that is submissive. She tip toes around him like he is an abusive father.

Very tender hearted and idealistic women often come to this profession at least at first belileveing they can do something wonderful and really help people in this profession. They come because they just know this profession will be fulfilling and make them feel good about what they do.

The industry preys on that.

Keep telling nurses they are worthless and they will continue to oblige.

It takes more than telling them they are valuable over and over and worth $150 an hour for them to overcome the mind set that has so firmly been implanted in them.

It is no secret that many nurse in thier home and personal lives are "co- dependents" of one type or another. It is very common in this profession. More than many other professional fields.

Nurses after a bazillion years are still struggling to establish themselves as a profession and not merely a vocational field.

gemini81sg · Feb 6, 2007

I believe the legal nursing consultant has every right as a professional to expect $100-$150/hr. To work for $14-$16/hr is absolutely ludicrous! A well trained and experienced nurse has proficiency in assessment skills unlike any other as well as the ability to read between the lines. A nurse has the ability to see it as a "whole picture" as we must do in any real life situation.

A nurse assesses from every angle and analyzes each aspect of the patient. We are taught critical thinking. We are at the bedside seeing the symptoms both physically and psychologically. We critique everything including meds, diet, labs, pathophysiology, family, lifestyle and so on. We work hands-on with all dept's in a hospital...also deciphering physician orders and double checking for accuracy. We consider family circumstances, social services, and financial abilities. We review the charts from front to back. We must have the patience to deal with the sometimes irrational and cold feedback and behavior from physicians. And how many times has a nurse had to "submissively" try to offer an idea to the physician? Or point out something that was missed?

A nurse also holds the key characteristic of bed-side manner...and in this particular type of position a nurse can take those "submissive" feelings and use them to his or her advantage. Generally a physician is in a role where he or she doesn't have to be submissive. The physicians time is limited, and much more costly. This is what give the nurse a special inlet to the LNC role, because he or she will be able to talk to the attorney or interview a potential client as a human utilizing those "bedside manner" skills. A LNC can also remain behind the scenes protecting ideas and information from the plaintiff or defense. Information that would otherwise need to be disclosed as a expert witness.

I don't think the concern is so much whether or not the LNC has the ability to excel and offer a great deal of useful and hard-to-come-by insight, and to earn a demanded high wage, but the major issue is how is the LNC going to convince the attorney of his or her worth to regarding their individual cases. Skills, knowledge, and experience are a must. The LNC must learn how to market themselves in a way to educate and prove to the attorney his or her worth and value to their cases.

A nurse's role is one unlike any other and although it is not yet or may never get the credit for what it is worth, I believe it is in the perserverance of the individual LNC to make it known. To have the confidence and courage to effectively sell themselves and to prove and further back their abilities.

It is all politics really. Much like the battle of physicians and nurse practitioners/advance practice nurses. How is it that a NP can carry out the role of the physician, but not receive the same status or recognition? Why is it that a NP can carry out the same role, and not receive same compensation both financially and socially? Why isn't there a transitional education program designed for an NP to become a physician if he or she desires to do so? How many times have you heard that a friend or family member was much more satisfied with NP services versus an MD?

We are in a period in history where this is a slow transition of recognition, but I do believe it will improve with time. The barrier is bound to break when nurses begin to demand recognition for the skilled and educated professionals we are and to hold our heads up high.

The nurses that choose to limit themselves to these ludicrous $14-$16/hr jobs are guaranteed to find themselves feeling regretful, overworked, and underpaid once again. And once again seeking an outlet to their current situation.

I remember a while back I was working on a Med-Surg floor and one of the nurses said, "Quick, clean up the desk, the doctor will be here any minute." We were crazy busy that morning and I just thought, "It wasn't even clean for us for the past few hours...with all the call lights ringing, breakfast trays being passed, vitals and blood sugars being obtained, patients on bedpans, patients in pain needed meds asap...I could go on and on here" I just thought...respectively, that is not a priority, the patient is my priority. A clean desk versus a patient in need...how can this be compared? It's like loosing the whole idea of why I became a nurse. I certainly did not dream of all the ways I can keep a physician happy, my dream was to help and to care for another human being. And the nurses who fear to call the MD for a critical situation because it is 3am...that is also ludicrous! Why the fear? Why is there a line there as if the physician is the king who should not be disturbed? I think this is an old-school pattern that will fade with time because I feel it is usually the older generation nurses who spread this contagious "fear" and "submissive" behavior.

Times are changing...new nurses are coming in....more men are nurses....and patients are recognizing the lack of bedside treatment from physicians. I think there is a lot to be said about this new generation....it may take time and maybe lots of it, but I sense that there will be a higher recognition for other professionals in the future. Healthcare is constantly evolving, including the politics aspect....though slow as far as professional recognition goes. Rights for blacks and women did not happen overnight either. I see high hopes for the future of LNC's....it is somewhat of an undiscovered profession, but only we as nurses can make efforts to change the image, worth, value, and profession of a nurse. :nurse: :caduceus:

Agnus · Feb 10, 2007

gemini81sg, heck I was not talking about being afraid to call at 3 a.m. I work day shift. It is more like 3 in the afternoon! THAT is how bad this is. Just yesterday I heard a physician say, "the next 4 times you think about calling me, don't." This was not because the called him.

I had a brand new CLNC tell me that an attorney refused to talk $$ with her prior to her doing the work. She (the attorney) kept saying "I will pay you what you are worth." Unfortunately she had no contract nothing.

After she completed a work on a case involving numerour hours she received. $25. That is right a grand total of $25. Not an hour but for the entire job.

I was so stunned I didn't know what to say when I heard this.

Lesson learned. Some attorneys are more than cheap they are thieves. Have a cotract of YOUR design, signed and a retainer for 50% in your grubby hand before beginning work.

This is what an attorney requires before they start any work (with the exceptions of contigency cases) Even then they prepare a contract for the client to sign. They understand this way of doing business. It origniates from thier own profession. There fore they should have no problem doing business with you this way.

If they refuse. Then oh well. There are more attorneys where that one came from. For a long time (before I ever considered doing this) I cringed whenever I'd heard of another new attorney grad. or a student entering law school, because it is the (or was) the fastest growing profession. It was (or may still be?)growning faster than the need for attorneys.

I have had the occasion to know an attorney who literally worked from the trunk of his car. (It was not a luxury car)

I had the oportunity to walk into the "office" of an attorney who was oposing counsel in a case I was involved in. He invited me in it was literally a closet.

I have a couple of personal friends who are pi attorneys. They do not do badly but they are low priced in the attorney world. Even in the town where they work they are still less expensinve than anyother lawyer. They do dog bite cases and such. They only take cases they "know they can win" (don't they all) They work with a relatively poor segment of society. I can seen them not wanting to pay $150 but you can bet with the right case they would jump on a nurse they could get for $150.

We tend to think Lawyers are a breed and a class apart. They come from the upper echelon of society money power etc.

Most of the lawyers I have had the oportunity to know personally thoughout my 56 years have come from working class backgrounds, who's parents had not college. They still come from these back grounds.

My brother is a millionaire. A self made man. He is intimadating. He grew up in the poorest section of town. He was motivated to make his money because of that background and the snubs he received as a child by the middle class. I mentioned he is intimodating. I know the part of him that intimadates people is the part that is a shy insecure little boy.

He is actually in awe of those who were "born into money" He feels very inseecure. He is an insufferable snob. The kind that worries what other's think and criticizes those who seem to not share his obsessive concern of what people think.

We were driving though a prosperous middle class comunity where he was living temporarly while he was rebuilding his mansion in Boca Ratan. It was a saturday and he became very upset that someone was having a garage sale. (Nice stuff) It was not acceptable for him that anyone living there should do somthing so "lower class".

My point is don't let lawyers or anyone else intimidate you. They are no different than you and in some cases come from terrible backgrounds. THose who try to bully you walk away from. You are better than that, even if they are not.

Any sane person would like to pay less for anything they get. At the same time they also know that you generally get what you pay for. Cutting corneres on price too much does cut quality. The market in your area may not bear a higher price. If you live in a rural area consider marketing in a larger city near by. The case are more plentiful, the attorneys are more plentiful, and the number of prosperous attorneys are more plentiful. Frankly I have no interest in marketing to an attorney who lives no better than me, (or worse)

You are likely not going to be asked to work on a dog bite case, or a slip and fall. These are not that lucrative for even the attorney. Though they do provide the bread and butter for some.

hollyvk, BSN · Feb 16, 2007

I had a brand new CLNC tell me that an attorney refused to talk $$ with her prior to her doing the work. She (the attorney) kept saying "I will pay you what you are worth." Unfortunately she had no contract nothing.
After she completed a work on a case involving numerour hours she received. $25. That is right a grand total of $25. Not an hour but for the entire job.
I was so stunned I didn't know what to say when I heard this.
Lesson learned. Some attorneys are more than cheap they are thieves. Have a cotract of YOUR design, signed and a retainer for 50% in your grubby hand before beginning work.

REMEMBER: Attorneys are the only licensed professionals who have mandated annual ethics training (because so many of them engage in "questionable practices").

HollyVK, RN, BSN, JD

Caveat RN (let the RN beware)

Cave advocatus (beware of attorneys) :devil:

Agnus · Feb 20, 2007

I don't believe attorney bashing is necessary. They are very ordinary human individuals that come in all shapes, sizes, colors, ethics, philosophies, motives etc.. I don't believe they deserve more reguard than anyother person, nor any less reguard.

hollyvk, BSN · Feb 21, 2007

I don't believe attorney bashing is necessary. They are very ordinary human individuals that come in all shapes, sizes, colors, ethics, philosophies, motives etc.. I don't believe they deserve more reguard than anyother person, nor any less reguard.

I don't think anyone was attorney bashing (previous poster was just reporting her personal experience).

And I, being both an RN and a lawyer, have worked with both healthcare professionals and legal professionals, and I'm here to tell you that there is a big difference between the 2 groups. I don't want to see any nurse doing work for an attorney to be laboring under a mistaken impression that she/he doesn't need to address the terms of the work agreement in a proactive manner as happened to the previous poster.

The American public recognizes the ethical differences between nurses and lawyers, as evidenced by the annual poll conducted by Gallup. Nurses are the TOP profession (we should be very proud :nurse: ) with a rating of 84%, while lawyers are rated signicantly lower at 18% (the bottom rate of 7% goes to car salesmen):

http://www.galluppoll.com/content/?ci=1654&pg=1

http://www.galluppoll.com/videoArchive/?ci=25930&pg=

To the folks who have asked me over the years why I (with a law degree and licenses to practice law in 2 states) don't work as an attorney, my answer is, "If you were on a sinking ship and had to choose between getting in a lifeboat with filled with healthcare professionals or one filled with attorneys, which one would you choose?"

Just as I've worked with some truly wonderful nurses, physicians, and other healthcare professionals, I've also worked with a number of attorneys who are great human beings. But the two groups really are apples and oranges, so don't make the mistake of thinking they're not.

HollyVK, RN, BSN, JD

Been there, done that, ain't doing that no more

Havin' A Party!, ASN, RN · Feb 28, 2007

Agree wholeheartedly with Holly. Be careful of the hype and implied promises surrounding any training.