What does a Legal Nurse do?
Well, let me tell you what I do as a Legal Nurse, AKA Expert Nursing Practice Consultant, AKA Expert Nurse Witness
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.
You may find jobs like these with attorneys who deal with nursing malpractice cases. The attorney may be for (defense) or against (prosecuting) the nurse in question (known as the Respondent). The Board of Registered Nursing (BRN) uses expert consultants also, generally the BRN is 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, 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.
When 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.
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. It is not your job to investigate, only to review the materials that you have been provided. If you need more information, you must ask for it.
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 a better nurse. It has made me more careful and I try to communicate with my peers the importance of certain things to avoid problems later on.
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 about 10% of the cases I have reviewed, I do not find misconduct or 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.
After the expert nurse reviews all materials, he/she may be required to write a report to document his/her findings and explain why the conclusion was reached. It is not your job to determine if the respondent is guilty beyond a reasonable doubt or to show motive, only to state if Respondent acted in an unprofessional manner or not. Degrees of Unprofessional Conduct may include incompetence or negligence and degrees thereof. This report is then 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 expert nurse is not a part of that decision.
If Respondent feels that he/she may do better by fighting the case and going to administrative hearing, the expert nurse is called to testify. An administrative hearing has a presiding judge, separate attorneys for both defense and prosecution, and witnesses.
An expert nurse’s testimony refers back to the his/her final report, any evidence reviewed in the case, and further verbal explanation of why you came to that conclusion. There are attorneys to both sides and the expert will cooperate with whichever side he/she is working for. There may be an expert nurse on the opposing side as well.
Expert nurses are generally paid by the hour, but more importantly, it is a public service to address nurses who have not been true to the profession and to improve their practice or to remove them from practice if they are a danger to the public.
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 scenario is out of his/her scope of practice or knowledge, 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!
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