Education FAQs
What is a Legal Nurse Consultant?
The Legal Nurse Consultant (LNC) is a licensed, registered nurse who performs a critical analysis of clinical and administrative nursing practice, healthcare facts and issues and their outcomes for the legal profession, healthcare professions, consumers of healthcare and legal services, and others as appropriate. With a strong educational and experiential foundation, the legal nurse consultant is qualified to assess adherence to standards and guidelines of healthcare practice as it applies to the nursing and healthcare professions.
What does a Legal Nurse Consultant do?
A Legal Nurse Consultant can provide invaluable input in just about every type of medical event or issue. LNCs provide an unbiased analysis of adverse events or contentious medical/legal situations. They provide general assessment and opinions on nursing care in medical malpractice cases; interpretation of medical records, assessment of physical injuries, and determination of future care and costs in vehicle, property and workplace personal injury cases; they provide opinion on rehabilitation and work issues in Occupational Health and Safety; they assess trauma and comment on injuries in criminal cases; they assess incidents and abuse in government or care facilities and much, much more.
The skills learned in this course can be applied in risk management, patient safety, nursing administration and quality assurance roles.
Minimally - the skills learned in this course will help you be a better nurse - and that is very valuable in itself.
Who is suitable for this work?
You must be a registered nurse, preferably with 8-10 years of clinical experience. You must be thorough in your analysis of the case facts and able to provide a completely unbiased assessment of the situation. You will need to have excellent written communications skills and good computer skills - especially word processing. Self motivation and the ability to work alone is key. You should be inquisitive and skilled at analysis.
Why would I want to be a Legal Nurse Consultant?
This work is fascinating and you will be upholding the standards of care. Imagine receiving a box of documents and a basic description of an adverse event. Your job is to determine exactly what occurred, how and why it occurred and to provide expert opinion on the issues that contributed to the adverse event and the resultant outcome.
You will continue to learn as you research standards of care and delve into the details of each case. Your opinion must be based on a thorough analysis of the case facts based on accurate knowledge of nursing standards of care and practices.
This work is very important. The outcome of the legal action or investigation can have a profound impact on the people involved. You will have the opportunity to use your nursing expertise to make positive changes in healthcare delivery.
Legal Nurse Consulting can be an excellent change to your career and your life. You will have flexibility with when (no shift work!) and where (at home!) you work. The pay can be significantly better than nursing wages.
What qualifications do I need to be a Legal Nurse Consultant?
Many of us have the critical asset to be an LNC; that is to be a Registered Nurse, in good standing with your professional association, with 8-10 years of experience. Thorough knowledge within a single area of clinical expertise can be helpful, but general nursing experience is also extremely useful. You must be well versed and confident in the standard of care applicable to your area of nursing expertise. You must be able to provide a thorough, unbiased, defendable opinion on the nursing care.
There is no minimum experience to qualify as an LNC, but your level of confidence in your practice will improve over time and your nursing opinion is more likely to be valued in the courts as you gain experience. At least 3 to 5 years of general nursing experience followed by 3 to 5 years in a clinical specialty area is ideal. If you have less experience, you CAN take the LNC course and build your business while you continue to gain clinical experience.
There is work for all kinds of nurses: Diploma, Bachelors, Master, PhD and all sizes and levels of hospitals and care facilities. Lawyers need advice from all types of nurses!
The most important education you need is solid clinical nursing experience – in any background. Lawsuits occur in all areas of medicine; acute care hospitals, outpatient/day surgery clinics, long term care facilities, telephone advice lines, school nurses, home care, community health, air ambulance and doctors' offices and all types of personal injury.
I'm just about to retire after many years as a clinical nurse. Is Legal Nurse Consulting suitable for me?
There is no doubt that your education and considerable nursing experience you will be valued. You are in a well respected position to provide opinions on standards of nursing care. Legal Nurse Consulting is a perfect career for this time in your life and will provide you with a whole new way to use all of your acquired nursing knowledge. Many of the cases you will be asked to review will have occurred 5-10 years ago (cases in the Canadian courts move very slowly!) when you would have still been practicing as a nurse and very qualified to speak to the standards of care. You may also choose to use your nursing experience and specialized LNC knowledge to provide much needed education to nurses on the medical/legal aspects of their care or to personal injury lawyers who require general nursing knowledge.
How much work is there in Canada?
There are published statistics of at least 960 medical malpractice cases against physicians each year in Canada. The statistics for nurses are not known. Commonly, each case has three sides that require expert opinion; the plaintiff, the doctors and the nurses. The lawyer for each 'side' of the lawsuit may require one or more nursing opinions on the standards of care. This equals 3-4000 expert nursing opinions required yearly. Many more cases, which may not make it to the trial or settlement stage, will require nursing opinion to determine merit.
The bulk of the work in Canada is in the medical malpractice area where LNCs provide education and opinion on adverse events that occur in the clinical setting. This area continues to grow - steadily - as lawyers learn more about the Legal Nurse Consultant role, and how they can contribute.
We believe that the Canadian situation will mirror the U.S. situation - albeit on a smaller scale. In the U.S., there are as many LNCs working in personal injury as there are in medical malpractice. Personal injury cases include slips and falls, traffic accidents, work place injuries and other events that occur outside of the hospital. In personal injury, LNCs provide information on some mechanics of injury, are injuries consistent with the event, care provided, long term impact and future care costs to the injured.
There are also insurance companies, risk management companies, government agencies and Long Term Care Facilities that require expert opinion on the standards of care. Some law firms in Canada are now hiring 'in house' Legal Nurse Consultants as well.
Using the US as a guide, we estimate that there are 40,000 nurses trained as LNCs (22,000 by one facility alone), so far!
The rate of pay for LNC's in Canada ranges from $50 to $250 an hour depending on your nursing qualifications/experience, your experience as a Legal Nurse Consultant and the specific duties for the job.
What if I have to go to trial! Even the thought of that frightens me!
The good news is that, in Canada, approximately 90% of medical/malpractice lawsuits settle 'out of court' and never proceed to trial. Your written nursing opinion will be one of the very valuable tools that lawyers use in their settlement negotiations. However, you need to be prepared for the possibility that you will be asked to attend trial as an expert witness with most cases you review. While there is no doubt that this is a challenging experience, it also presents significant learning opportunity!
An entire day of the Introduction to Legal Nurse Consulting conference is spent preparing you for your role as an expert witness in court. A nurse/lawyer explains the language and definitions of the legal system while discussing the expectations of the nurse expert witness. A half day is spent in a mock trial - with top practicing lawyers, a judge, a court clerk and 2 expert witnesses putting on a mock malpractice trial. This will be a valuable exposure to the experience of 'being on the stand'. You will have the opportunity to ask questions and experience, first hand, what a trial looks like.
I understand Connect Experts provides opportunities for Legal Nurse Consultants. How much work can I expect to get?
Connect Experts has been providing opportunities to Legal Nurse Consultants since 2005. With our excellent reputation providing nurses (and physicians) to law firms, we continue to have a growing demand for LNCs. When we get requests our priority is always to try to find an LNC that has taken our courses.
It is impossible for Connect Experts to predict the type and number of requests that we will get. And it is important to note that ultimately, the lawyer will choose which nursing expert to retain. Although we do our very best to find work, there is no guarantee that we will have work for you once you've signed onto Connect Experts. We encourage you to pursue your own business while we continue to look for opportunities to get you started in your new career as an LNC.
And we continue to work at exanding the role of the LNC - similar to what we have seen in the U.S. This is not a trivial change - the legal environment is steeped in tradition and they are not quick to change. We are learning more of their challenges and work processes and do expect that we will see continued expansion of the LNC role in Canada.
Where can I get more information?
Check out the Legal Nurse Consulting Association of Canada at www.LNCAC.ca. The LNCAC has made some excellent progress on recognition of the Canadian Nursing regulation bodies.
Also look at the American Association of Legal Nurse Consultants at www.aalnc.org. They are excellent resources for information on Legal Nurse Consulting and what may happen with the Canadian environment. Legal Nurse Consulting is far more established in the U.S. with recognition by the American Nursing Association and by numbers of state Bar Associations.
In the U.S. the majority of LNCs work directly for law firms - something that has only recently started happening in Canada. There are also some differences due to the private healthcare vs public as we have in Canada.
You can also contact us by emailing us at . We're happy to answer your questions!
Case Outcome
The lawyer representing Dave in this malpractice lawsuit asked a Legal Nurse Consultant to review the medical record to provide expert opinion on whether Nurse Donna and Nurse Lucinda had met the standards of care. Their opinion was that Donna and Lucinda had not meet the standards in two important areas; first by not assessing Dave’s leg as thoroughly and frequently as required by hospital policy. Secondly, by not communicating his pain, weakness, colour change and sensory loss to the doctor in a timely manner.
Their opinion was that Nurse Donna should have called the doctor no later than 2 a.m., when she documented that that Dave had severe weakness and tingling in his right leg. Since this did not happen, their opinion was that Nurse Lucinda should have performed a full assessment of the leg at the start of her shift at 8 a.m. and asked the doctor to see Dave immediately.
The Legal Nurse Consultant said that nursing documentation in the medical record indicated a lack of nursing knowledge and critical thinking, as well as a failure to meet the standard of care surrounding both assessment and communication. The opinion was that the lack of communication contributed to a delay in accessing medical attention, which the medical experts stated ultimately contributed to the loss of Dave’s leg. Based on this, the case settled out of court for an undisclosed amount of money.
The doctor who performed Dave’s surgery was also sued, but later released from the lawsuit when it was discovered that the nurses had not communicated significant clinical information to him. By the time the Orthopedic resident examined Dave, and contacted the surgeon on the morning after surgery, Compartment Syndrome had already caused irreversible damage. The opportunity to prevent or minimize the injury was lost.
What is Compartment Syndrome?
Compartment Syndrome is a potentially life-threatening condition caused by high pressure in a closed fascial space. The most common site of compartment syndrome is the lower leg (Abramowitz and Schepsis 1994) and young men with traumatic soft tissue injury are known to be at particular risk (McQueen et al 2000). It is a potentially devastating complication of tibial fractures which requires prompt recognition and intervention; as early intervention is critical to avoid permanent damage to the muscles and nerves.
Symptoms of compartment syndrome can include pain that is disproportionate to the injury, pallor of the affected limb, altered sensation (numbness, tingling), tension of the affected muscles, pulselessness below the level of the swelling and, as a late sign, paralysis. Post-operative narcotic administration may mask or dull pain, which is often the first symptom of compartment syndrome. Therefore, careful monitoring for the other symptoms is important.
The nursing plan of care for a patient with a traumatic fracture must include, among other things, knowledge and awareness of the possible development of compartment syndrome. Monitoring of color, warmth sensation, movement and pulse strength may be required as frequently as every 15 to 60 minutes, but certainly every four hours in the early post-operative period.
Depending on the lines of communication in your department, signs and symptoms of compartment syndrome must be reported immediately to the charge nurse and/or responsible physician. Based on the expected knowledge that early intervention is key, the nursing standard of care would be to notify the physician immediately, provide an accurate clinical picture of patient status, request a ‘hands-on’ assessment of the patient. If the physician does not respond promptly to the request for assessment, the nurse may be required to raise the level of concern, act in the best interest of the patient and persist in finding appropriate medical attention. This may require repeated pages/phone calls to the physician, refusing to take doctors’ orders over the phone, notifying the nursing supervisor or accessing the appropriate chain of command.
Chris Rokosh is a popular speaker on medical legal issues in nursing across Canada and the U.S. She is an RN and founder of Connect Medical Legal Experts, a Calgary-based leader in Expert Witness Services, with a database of hundreds of medical, nursing and cost of future care experts across the country. Explore this website for more information on courses and books on Legal Issues in Nursing and the role of the Legal Nurse Consultant.
