Job Description: Legal Nurse/Expert Nursing Practice Consultant

What does a legal nurse/expert nurse practice consultant do?

Well, let me tell you what I do as a legal nurse.

This job requires some experience (let’s say minimum 5 years) in the field that you are an ‘expert’ in to be an effective in your role. It is generally an independent contractor position, so more of a side hustle than a regular gig.

I am presented with cases that involve a nurse(s) and as the expert, I am expected to be competent in the field in question and be able to speak to whether or not the nurse(s) acted as a normal competent nurse would have in that situation. Many times, the investigation is in progress or has already been completed by a non-nurse/non-medical field person who has reviewed the information and as the expert, I review all materials and then make my own conclusion. I do not make recommendations on punishment, that is the job of the Judge.

You may find jobs like these with attorneys who deal with nursing malpractice cases. The attorney may be for (defense) or against (prosecuting) and the nurse in question is known as the Respondent. The Board of Registered Nursing (BRN) also uses expert consultants. In my opinion, the BRN leans against the nurse(s) and the Board has their own attorneys and the Respondent has to attain his/her own counsel to defend him/herself.

Did you know that anyone can make a report against a nurse to the Board of Registered Nursing?

It can be the patient or a family member who feel that they did not receive adequate nursing care. It can also be a peer/co-worker, manager, administrator, or physician.

Not all cases end in a guilty verdict, but every nurse should have malpractice insurance which includes attorney fees to defend themselves in the event that this happens to you.

Once a complaint is received by the BRN and if the Board feels that the case has merit, it is assigned to a special investigator. The investigator may or may not have medical knowledge. Once the investigation is complete, the final report and all its evidence goes to an expert nurse consultant who reviews it and looks at it with nurse’s eyes. It is important to read through all of the material and come to your own conclusion because the investigator may not know the inner workings of the setting or nurse practices. Materials to be reviewed may include patient charts, MAR, interviews with witnesses, police reports, and photographs/videos.

After reviewing the evidence, the expert nurse will come to a conclusion whether or not the Respondent acted as a normal competent nurse would have in that situation.

Common cases involve alleged drug diversion, incomplete/inaccurate/poor charting and documentation practices, and questionable nursing practices. What is not charted is not done in our world. The world of nursing has entered the electronic age and with so many people apt to sue, it is very important to document like your license depends on it; because some day it may.

I have learned a lot by doing this job. It has made me more careful and I try to communicate with my peers the importance of certain things to avoid problems later on. If you are not sure of the communication, please clarify with closed-loop communication and document as needed.

Taking out narcotics from the automated medication dispensing cabinet (i.e. Pyxis) for yourself to administer, for another nurse who asks you to get it for them, or wasting with another nurse are all instances where there could be a problem. Any narcotic taken out by you should be administered by you. If you witness someone else’s waste, make sure they actually waste it. If you have to take out narcotics for another nurse, make sure they give it and document it – you took it out, you are responsible for it.

Not all cases are nursing shortfalls. I would say in about 10% of the cases I have reviewed, I do not find that the nurse has done anything wrong. For example, a patient is very ill and dies or suffers permanent physical harm – not due to nursing care, but because their condition is unrecoverable. Patients and families sometimes do not understand what a nurse is doing on their behalf and sometimes despite the greatest of efforts, a patient does not recover or gets worse. So remember to document everything significant that you do to provide care because it might just save you. If you are paging the physician, document that they have been notified. If you notify and they do not act and something goes terribly wrong, your documentation can save you from being considered negligent.

If family members or a patient is documenting everything, be mindful. Do not allow recording or video; in the facility where I work, that is not allowed and is reportable to management/security.

Once the expert nurse reviews all materials, he/she will write a report to document his/her findings and explain why the conclusion was reached. This report will be reviewed by the Board and based on all findings, the respondent may be offered probation, suspension, drug diversion program, continued practice with limitations/supervision, or revocation. The Board may forward the case to a hearing if they feel a Judge needs to be involved. The expert nurse is not a part of that decision.

The Respondent is offered conditions by the Board. The nurse can accept the conditions or they feel that challenging the case and going to an administrative hearing is warranted, the expert nurse is called to testify. An administrative hearing has a presiding judge, separate attorneys for both defense and prosecution, and witnesses.

The BRN’s expert nurse’s testimony refers back to his/her final report, any evidence reviewed in the case, and further verbal explanation of why you came to that conclusion. The expert nurse for the BRN may be asked to explain why they feel the actions of the Respondent were not the actions of a competent nurse in that situation. There are attorneys to both sides and an expert nurse will cooperate with whichever side he/she is working for.

Expert nurses for the BRN are paid by the hour. It is a public service to address nurses who have not been true to the profession, to improve their practice, or to remove them from practice if they are a danger to the public. The expert nurse may also present nursing knowledge to say that the Respondent didn’t do anything wrong.

Legal nurses should possess good communication, writing skills, and expertise in the field that they are being asked to evaluate. If the legal nurse feels that the case scenario is out of his/her scope of practice or knowledge or he/she has a conflict of interest with named nurse or facility, he/she should defer the case to another expert witness. This job is definitely not a ‘fake it till you make it’ job. When you are on the stand, some attorneys can be very verbally aggressive and you must be able to defend what you believe is right without waivering.

I hope this has helped you understand what a legal nurse/expert nursing practice consultant/witness does. Feel free to PM, DM, email me with questions.

There will be a second part to this on a later date that will explain what it is like to be on the witness stand ...so stay tuned!