Wednesday, January 7, 2009

Nursing Responsibility

I recently read a posting about a person who was admitted to the ED for c/o chest pain and SOB. This was a person with a hx of COPD and cardiac problems. Long story short, the progression through the ED was normal treatment and meds. However, the medications left the patient drowsy. The ED physician discharged the patient once the patient stated their chest pain was gone. However, the patient was so drowsy that he was "allowed" to stay in the ED until he was able to leave without being so drowsy. Now, all I have to go off of is what was posted but it was posted that this person was going to drive themselves home. Apparently a student nurse was assigned to watch the patient till they were able to leave.

This patient was later found on the bathroom floor and said they hadn't fallen but just wanted to lie down. The student nurse was the person who found the patient. The patient was placed in a wheelchair per their own request and the House Supervisor was notified. The patient was later found unresponsive, a code was called and the patient was later pronounced dead.

Now, I have several problems with this situation. First, why did the ED physician discharge the patient when they were so drowsy? If you are so drowsy that you are unable to walk and have no transportation home and have to stay in the department until you aren't so drowsy; then perhaps you aren't well enough to be discharged! Second, this student nurse was under a registered nurse and also an instructor. Where where they in the scheme of things? And, if the student was assigned to monitor the patient, where was the student nurse during the period where the patient was on the floor and then when at some point they coded? It sounds like this patient was put into a holding area and just left there.

I can see accountability of the physician, registered nurse, house supervisor, the student and of course the hospital and if the physician was part of a group vs a hospital employee, that group as well. Oh, and let's not forget the university that the student is attending would also be held accountable.

I cannot help but feel very sorry for this student nurse. When you are a student there are a lot of situations that you can be placed in but to have a patient you're assigned to monitor die must be horrible. I would doubt that the student would be called into a lawsuit as they generally have no money to pull from. As a registered nurse, the assigning nurse and instructor I feel hold a high level of responsibility for this issue as either they were overloading the student with patient assignments or the student just wasn't doing their job. Either way it is up to the assigning nurse and instructor to monitor that student and be a patient advocate. We also hold the responsibility as registered nurses to instruct our students in a manner that they will provide good and safe care. After this situation, where does this student stand? I would be feeling pretty bad as a student and there is the chance that the student would quit nursing school due to the severity of the situation.

Let's make sure that as seasoned registered nurses that we are training our students correctly and supporting them. This will give us better trained nurses and of course safer patients. We also need to instruct the students that they do have a voice and if they are over loaded it is their responsibility to speak out.

I wish I could know the outcome of this situation but I'm sure I won't hear what it is. But I do think we can all learn several things from it.

Sunday, December 21, 2008

Will Your Blog Come Back To Bite You

There is an issue on posting on the internet. You pick a topic that you believe in or have an opinion on and begin your blog. Do you stop and ponder where that blog is going to go? Or you make a comment on a listserv. Where does that comment go? Does that particular listserv archive or not? Is your comment something that one could find while doing a search on the internet? If you post your views online under your name, you are on record for your comments for a long time if not permanently!

When questioned in court as an expert witness, you need to recall postings that you have done and can be found as THEY WILL BE FOUND! Posting histories can provide a track record that makes a point of view hard to disprove when they cluster in a specific direction. If you are testifying in one direction but have a history of postings on the internet of the other direction your credibility has just been squashed. Consider that when you chat, post and blog.

The internet is a wonderful tool but tools can harm you if you don't take appropriate precautions.

Friday, December 19, 2008

What Is Being A Legal Nurse Consultant All About?

Legal Nurse Consultant Job Description
The daily work of a legal nurse consultant can vary greatly. It will depent upon where you decide to work. If you work for an attorney or insurance company where duties remain strictly in the medical-related legal field. Legal nurse consultants review medical records, conduct research, and prepare reports for attorneys to evaluate standards of care. The consultant helps the attorney prepare the legal deposition by explaining medical jargon and complicated health issues. A consultant may help prepare witnesses or take the stand personally as an expert witness. A legal nurse consultant may spend much more time in a courtroom or as a specialized member of a litigation team. If employed by an attorney, a LNC can expected to work on cases including medical malpractice, personal injury, criminal cases, and class action litigation. If you work independently the sky is the limit. You can be the consultant or the testifying expert. Just be sure to negotiate tha with your attorney up front. Your hours are up to you, but your work you get is up to you to market and get as well. Marketing is not an easy thing for nurses to do and the market can be dfficult.

Legal Nurse Consultant Salary
Salary can vary greatly for legal nurse consultants depending on the type of employment. Salary can be based on years of experience, location, and case load.
According to Medical-Legal Consulting Institute, an LNC makes anywhere from $100-$150 hourly. They typically work 40 hour work weeks with additional time when it is necessary for cases. According to, the median national salary of an RN is around $50,000 annually. When an RN becomes a legal nurse consultant this salary becomes considerably higher up to $80,000. If you are working independently the general hourly wage is $125.00 hourly for consulting. If you are in the realm of a Testifying Expert then the charge changes greatly around te country. The general hourly rate for a TE appears to be $175-$225 hourly.

Legal Nurse Consultant Job Outlook
Job outlook for legal nurse consultants is good, as jobs growth is expected to be high over the next ten years as medications and practices are reviewed in the courtroom or by government agencies.
According to the Bar Association, 25% of the 1 million practicing attorneys in the US deal with medical malpractice and personal injury cases. The exact number of legal nurse consultants is not known, however, with high demand for medical experts in the legal field, it is expected to be high. It is difficult to determine the actual number of legal nurse consultants since so many work freelance, and are registered with their primary career in nursing.
Legal Nurse consultants also find employment with insurance companies, government agencies, private corporations, and hospitals. In fact, legal nurse consultants are in high demand at all of these locations as well as attorneys offices. HMOs and other agencies are constantly seeking medical experts with legal experience.

Problems In The Industry
Payment! Getting payment when you are an independent LCN at times can be a major headache. I have had outstanding bills for 3 months sometimes. This is problematic at best.

Some information was obtained from: Healthcare Training

Wednesday, December 10, 2008

Legal Nurse Consulting of America LLC.

The Legal Nurse Consultant is a licesed registered nurse who performs a critical analysis of healthcare facts and issues and their outcomes for the legal profession, healthcare professions, and others as appropriate. The legal Nuse Consultant is qualified to assess adherance to standards of healthcare practice as it applies to the nursing and healthcare professions.

Legal Nurse Consultants have both medical and legal knowledge which provide valuable expertise in medically related litigation. They provide professional services, such as medical case review, records analysis, compilation of medically related litigation materials, and collaboration with attorneys on medical legal issues such as:
  • case screening for merit
  • expert witness locating
  • life care planning
  • identifying standards of care/deviations
  • summarize,translate and interpret medical records
  • literature search
  • case analysis
  • consult with healthcare providers
  • assisit in exhibit preparation
  • assist with depositions