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RNs earn $125-$150/hr as Certified Legal Nurse Consultants

Hi,

I have been a nurse for about 30 years and for the last 12 years of that I have been working as a legal nurse consultant.  I love this nursing specialty and have seen it grow from almost it's infancy.  There are, of course, positives and negatives to the field, as in any, I suppose.  I began my legal nurse consulting career in a large city in Florida, where there were many law firms that used legal nurse consultants.  I had  already had many years of nursing experience when I went back to get an Associate degree in legal studies in order to break into the LNC field.   At that time there were very few Legal Nurse Consulting courses like there are now.  After graduation, I was able to get my first LNC job with a law firm in Orlando, FL where there already were 3 other LNC's working.  It was sort of like my first job as an RN---a rude awakening---and I almost didn't stick it out the first month or so.  Law firms are not very kind and gentle, generally, and they expected me to be off and running from day one.  Well, once I finally got my bearings [and enough confidence to let my boss know he was being a bit of a bully], I really began to enjoy the work and thrive in the position.  I'm not sure what experiences other LNC's may have had on their first jobs, but that was mine. 

Positives of the field are that LNC's are beginning to be used in a lot of different areas aside from just law firms or as hospital risk managers.  Other areas that LNC's are now finding jobs in are insurance companies, Medicare/Medicaid agencies, Worker's Compensation companies,  life care planning, expert witness reviews and testimony,  and  independent  practice.  One of the downsides of the field is that , unless you want to work as an independent LNC and do your own marketing and travel, the positions for LNC's usually are found in more populated or urban areas.  I was fortunate to find an online internet medical analyst position for a litigation support company while living in a smaller more rural community, but in general I have had to travel to or live near larger cities to find work in my field. 

Regarding training for becoming a legal nurse consultant, there are now many Legal Nurse Consultant training and certification programs out there.  The American Association of Legal Nurse Consultants [AALNC] is our national organization and does have teaching modules for LNC education.  There also are several different certifications that are available, but in my opinion the certification of LNCC is the most credible [although that is very controversial].  That certification of offered through the AALNC and has been approved as an advanced nursing certification by the National League of Nursing in the same way that ER, OB, etc, nurses are able to test for and hold advanced nursing certifications in their specialty areas.  It is my understanding that the other LNC certifications aren't recognized in the same way by nursing's governing boards.  Since the LNC field is still pretty new in comparison to other nursing certifications, though, many attorneys don't really know [or care] which certification an LNC has....many don't care whether they are even certified, as long as they have the experience they are looking for on the resume, especially previous nursing experience and some legal experience.  I've seen a lot more requests for "certified" LNC's in my recent job searches, though  The type of certification was not specified, however. 

In most situations, an LNC is a registered nurse who has worked in the nursing field for five years or so [I believe is the AALNC's requirement].  How they receive their education and legal training  is not  of  great  importance, it seems.    Some  attorneys may  hire  LPN's  or medical  paralegals to  review  records for  them,  etc,  but  the  standard  is pretty much  for experienced RN's .   In order to take the examination for LNC certification through the AALNC, the RN must have worked in the legal field for a minimum number of hours within the previous few years.  Once certified, the LNC must not only pay the usual licensing fee for her RN license but additionally for her advanced nursing certification; and there are additional CEU's during each certification period that have to be obtained as well as the usual RN continuing education hours required.   Many working LNC's I know still have not become certified for those reasons, but slowly and surely the certification is becoming recoginized and requested by employers.  

As for the salaries mentioned by one of the posters, I can't say that I have ever earned nearly that amount since being in this field.  I have found that most positions keep up with what nurses make within hospital nursing.....although many do not; and , of course, it depends where you are practicing.  On the coasts the pay is better, I'm sure, as it is for nursing pay in general.  LNC's who work as expert witnesses and testify in deposition and trial as well as reviewing records and providing reports for the attorney do charge higher fees than the LNC's who work "behind the scenes."  Expert witnessing requires [in most states] that the nurse spends at least half of her work time in the clinical setting and practicing nursing in her field of expertise.  Many LNC's continue working in their clinical areas and work as LNC's part time, especially if they are working independently.   That way their pay does not dwindle if there is a lull between legal clients, as is often the case.  Many times there can be so much work for an LNC she will have to turn down LNC jobs; then at other times things may be very slow and she has to really spend a lot of time marketing [during which time she makes little or no money].

If you have more questions about legal nurse consulting, I would suggest you go to the website of the American Association of Legal Nurse Consultants.   [http://www.aalnc.org/]  They not only have many resources and educational modules, but they keep a roster of all their LNC members for possible mentoring, etc.  They have an annual conference every year in the spring that is really great for learning about the field, resources, networking, and the conferece provides about 30 CEU contact hours for attendees.   Also, there are local chapters of the AALNC in most major cities that we can belong to for additional education and networking opportunities.   Another networking opportunity is to sign up for one of the listservs out there.  I belong to LNCNurse that is a place where all sorts of questions can be asked and answered by LNC's from all over the country.  For information on the listserv I belong to go to:  spring@legalnurseconsultants.com or http://www.legalnurseconsultants.com. 

It's not for everyone, but for me, Legal Nurse Consulting is great.  Best wishes to you all in your nursing endeavors!  God bless ya.

beachd

[Deb Beach, RN, Legal Nurse Consultant]

Hi all LNC's/hopeful LNC's. Really LOL at "A Busy RN's" comment.  I hope the field is not too rough, because I'm attempting to go-it alone, after subcontracting for a small LNC consulting firm for the last few yrs.  I'm somewhat concerned, bec I signed a non-compete clause prior to starting w/ the small firm, I mainly worked for attys when needed to attend IME's. Anyone else have any experience w/this type of situation (non-compete). I don't know how they can hold you to this - as long as you don't target their clients/attorneys.

I did LNC for about 6 years (defense and plaintiff) and it was one helluva great job. Unfortunately, due to legislative changes in the state where i live, med mal damages have been capped at a certain amount and a lot of attorneys (plaintiff) no longer work in med mal because it's 'too expensive' to work up a case (which is what the insurance companies and the legislature wanted).  And.....the defense attorneys all closed their doors because there are few cases out there.

I have mixed feelings about all of this but i can say one thing: the only ones who won were the insurance companies (hah! the docs didn't see that coming!! They were promised that their med mal insurance premiums would be decreased if they supported the reform and gave their support. Guess what?? The docs STILL pay big med mal insurance and very few cases even get filed.  YEP. INSURANCE COMPANIES RULE!!!!  (tongue in cheek) Ask your friendly doctor that you chum with: "What do the insurance companies reimburse you for patient visits?" And that doctor's answer will be: "They don't pay swquat and that's why i am looking to start my own [laser hair removal]  [ liposuction] [aesthetics] [spa]....blah blah blah because i don't have to deal with insurance companies."

Back to being a LNC: There was a lot of tedious work involved, i like plaintiff work better than defense ONLY because the attorneys are more laid back and don't walk around with a holier than thou attitude. (You know the type...like some of the MD asses we've all worked with). Mostly, i liked the job because i did something different evey day and i felt that i was still an advocate.....for the patient in the plaintiff's firm.....and a nurse/MD advocate in a defense firm. Met some incredible people; learned oodles about the law, got out of the hospital for awhile, and learned some really incredible stuff that i want to tell nurses about so that they can protect themselves.

So, my advice: find out where your state stands on medical malpractice and if it's one of the 'capped' states, the jobs are few and far between for med mal. (Of course, you can do pharma, drug safety, etc auto safety, etc). Don't let any of the attorneys tell you at interview that you have 'no experience' and try to blow you down on the salary. They are hiring YOU as a NURSE, NOT A PARALEGAL!!! Do not forget that. YOU are a nurse and that is your expertise they are looking for.

Though you ARE NOT going to earn 75-100/hr (as advertised) when you start (whether as an individual consultant OR with a firm), it is usually easier to start in a firm so that you can see what it's like to work with attorneys and how they work up cases, etc edtc. Expect what you would make working a standard unit in a hospital that isn't specialized, no overtime, no weekends, etc. Sort of what you would get as a 'base pay' for that type of job. It goes up over time. Not great...but it gets you out of the drudge that got you thinking of being a LNC.

As you work a bit with attys, they will soon figure out what quality of work you do and word gets arouond that you are 'good' and jobs come your way. When you are comfy with yourself that you indeed DO know a lot for this type of work, then try it on your own; market yourself. Sell yourself (that's how to get the business!!). I still do occasional cases (60-65/hr) just going over records and giving an opinion on whether or not the STANDARD OF CARE was followed. I also review defense records to find facts that help defend a lawsuit. I've also gotten into some criminal stuff where they needed someone to review and opine on the medical records of fact pertaining to some crim cases. THe one thing you MUST do however, is to absolutely make sure, absolutely and forever, to make sure that there is no conflict in the cases that you are working if you do work for all sides. This would totally sink an attorney and his case if you are working both sides. You cannot do that. It is an abomination! (Best advice: work either defense or plaintiff, not both, until you know the law community and the attorneys you're working with well).

Hey Sunny42. No, you do not have to work both sides. No way. It was a decision that i made because i wanted to work as an independent consultant and i wanted to know how both sides worked. I just did it because i thought it would give me a better understanding of the entire process, from two sides as well as different mindsets.When i first started out, i was quite intimidated by what i didn't know (legal wise and how i as a nurse fit in the picture). I learned so much from the other nurses i worked with in the firm (there were 8 of us!) and looking back, there was no way i would have had the 'huevos' to walk into a firm and market myself. I didn't know the basic law terms, what meant what, how it tied in with what, etc. I guess i was also pretty much trained as a 'nurse paralegal' at the defense firm because i did a fair amount of stuff that para's do. Um.....you kinda get slid into that role without your knowing it. And of course, it depends on what the firm needs and for what. Me??? Man I love to learn so i wasn't put out by this. Other nurses i worked with hated being a 'paralegal' as well. But, to me, learning something new was what i wanted. (Besides.....i did the hospital thing and did not want to go back). So after working defense for awhile, I decided i wanted to work for the plaintiff to see 'their side'. It was way more fun and the atty i worked with was phenomenal.....he was very ethical (WHAAAATTTTT you say????), incredibly intelligent and loved to teach. What a great match for me! I felt blessed because he respected me (what's that you all ask? R-E-S-P-E-C-T ???) and my nursing background and we were a really fantastic pair. I was allowed to handle all the calls from 'potential clients' who felt they had a lawsuit (<5%) and out of that 5%, i interviewed them to get the facts lined up, would review some of their records if it appeared to be a possible case and then, and only then when i felt that the client's situation met all 'requirements' for a lawsuit, i would then talk with my atty and tell him i thought we had a 'good one' and we would then both pursue (or drop it...as HE was the atty, not me). My 'defense' nurse buddies thought i was a bad person.....a black hat.....but, when a patient is clearly harmed by someone who was really negligent, i mean NEGLIGENT, then am I not still a patient advocate when i stand for that patient? A number of plaintiff firms would take every thing that happened their way.....but  our firm didn't. The atty i worked with was very choosy and we didn't take the BS/frivolous/bogus stuff. There are firms that do that.....that are 'ambulance chasers.' 

On the issue about handling all the client calls: Nurses out there!!!!! The majority of calls i got at the plaintiff firm were from ANGRY patients, not patients who had been harmed. They were angry that so-and-so died and so therefore they blamed the  nurse/doctor/hospital, etc. Or, they would say that what happened in the ER to their grandmother was due to an ER nurse negligence. When questioned further, the patient described to me what had happened to which i told her: "This is what happens when someone codes. That is what sometimes happens when someone is intubated. That is what happens and this is what real nurses and doctors do when a patient comes to the ER with a such-and-such". Her response was that 'nobody talked to me and told me that.' After explaining to her that what she saw/heard/etc was NORMAL and apologized that the nurse or doctor didn't take the time to explain to her what was happening, she calmed down. Cried a bit. Thanked me and said that i was wonderful to explain this to her and now it all made sense to her and she wished me good day.

What I Learned: The majority of 'clients' who call wanting to sue, many times are just people who  the hospital staff/nurses/docs ignored or did not answer their many questions about their loved ones. When the client (patient) is ignored or not given  time to ask questions about what Aunt Tillie died from, they surmise that the staff did something wrong and they want to file suit. This all comes down to good communication with the patient and the patient's family. I can't tell you how many times i heard from people the  following: "I loved that nurse. She was good to us and even if she made that mistake, she didn't really mean it, she's just human, she really loved my grandma .....we could NEVER sue her"  It's all about how you treat that family with honesty and respect, try to take a few extra minutes to explain or answer their questions. We all can make a mistake, we all have. But, a good open relationship with your patients where you put yourself in their shoes and treat them the way YOU would want to be treated, goes a lot further than you know. Patients will NOT sue their healthcare providers if they feel  that you were their ally and that you did your best and you treated them with time, respect, etc. I saw this time and time again. (Ok. I went on and on and on). So, i was an advocate for the patient in the plaintiff's firm.....but behind the doors and on the telephone, i was a BIG advocate for the nurses and docs who some patients wanted to sue. True, those cases would have ended up in the garbage pile 1-2 years later, but if you have ever been on the end of being sued, whether or not the case went to trial, it will turn your life upside down, even if you WERE NOT negligent. There are law firms who DO take those cases, trying to get anything and docs and nurses lives are turned every which way just responding to the allegations. I wonder how much EXCELLENT communication with our patients and families while they were under our care would turn away their desire to sue us  IF we made a mistake and they were harmed.....?