About This Course
“The use of nurses as expert witnesses has evolved since the late 1970’s and early 1980s. Before then, physicians served as nursing’s voice and testified at court regarding the role and accountability of professional nurses.” (Guido, 1997) A nurse is the only professional with the knowledge, competency, credential, and right to judge whether the appropriate standard of nursing care has been delivered. As nurses stepped forth to assume this role in the medical legal system, the system adjusted to incorporate them and actively solicit qualified nursing assistance.
Unfortunately, the healthcare system has experienced an increase in the number of lawsuits. And nurses have stepped forth to expand their professional role within the legal system to educate attorneys, judges, and juries. Nurses are consulting into an expanding area of medical legal concerns such as personal injury, worker’s compensation, product liability, criminal custody cases, risk management, life-care planning, case management, healthcare licensing board issues, insurance industry, as well as expert witness. While many nurses work in law offices, and the insurance industries, nurses are also adopting an entrepreneurial spirit and starting their own businesses.
This exciting program prepares Registered Nurses and Physician’s Assistants for a career in the legal field as legal nurse consultants. Building on the medical education and clinical experience of RNs and PAs, this course provides the RN and PA with fundamental skills necessary to advise law firms, health care providers, insurance companies, and governmental agencies regarding medically-related issues and to appear in court as expert witnesses. The curriculum of this course is designed to comply with the educational guidelines specified by the American Association of Legal Nurse Consultants. Successful graduates will be awarded a Certificate of Course Completion from the university through which they are registered.
This course will provide a comprehensive analysis of the principles and practices of legal nurse consulting (LNC), with an emphasis on law and expert witness testimony. The course content will also provide a systematic review for those preparing to take the Legal Nurse Consultant Certified (LNCC) examination. While most of the main subject matter will pertain to legal nursing standards, professionals in other health care disciplines (pharmacy, physical therapy, physician assistants, etc.) may gain increased skills and knowledge of the medical legal system to enhance their roles as service providers and functions as expert witnesses, but participants without an RN background might not be able to take the LNCC exam after graduation. For more information about the LNCC exam, please contact the American Association of Legal Nurse Consultants at 877-402-2562.
This nursing continuing professional development activity was approved by the Colorado Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
- CLS by BARBRI, is not affiliated with, nor do we endorse, any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by or used on patients.
- There is no conflict of interest for anyone in a position to control content of this activity.
- There is no commercial support or sponsorship being received for this event.
- Define the role of a legal nurse consultant and explain history and evolution of the profession.
- Describe 2 major systems of law, the 3 types of law, and the 4 sources of law.
- Review the law of Intentional and Unintentional Torts.
- Identify liability concerns of healthcare providers.
- Analyze the role of the LNC before the trial begins.
- Review the methods of obtaining medical records and other evidence that is governed by the Rules of Evidence.
- Identify and review the legal documents used to obtain evidence.
- Explain informed consent, treatments decisions, and review the liability concerns of health care providers in each.
- Discuss criminal law and complex litigation scenarios.
- Discuss the history of the Specialty of Legal Nurse Consulting.
- Discuss the skills needed for entry into special practice.
- Professionalism and Ethics: discuss the standards of practice and performance expected of an LNC.
- Identify the 5 responsibilities of a LNC in the litigation process.
- Examine the role of the LNC in evaluating Toxic Tort and Criminal Cases.
- The damages stage of litigation: Identify the 4 types of damages available and discuss the factors that determine their application to the case.
- Recall the evaluation steps taken by the LNC in a professional negligence case.
- Identify and discuss the 3 different forms of Alternative Dispute Resolution.
- Discuss the LNC’s role in the Law Firm.
- Discuss the issues presented to LNCs in the insurance industry.
- Discuss the issues presented to LNCs in private practice areas.
- Discuss the issues presented to LNCs in Government Service.
- Discuss the issues presented to LNCs in Risk Management.
- Medical record analysis: discuss the protocol LNCs should follow when receiving medical records.
- Legal Writing: Review the writing techniques that will captivate your target audience.
- Discuss the literature research process and the methods of research.
- Discuss the advantages and challenges of working as an independent LNC.
Expectations & Completion requirements
Students must attend at least 80% of the course, pass every assignment with a 70% or better and complete the course evaluation at the conclusion of the course. This is an accelerated course. You will be expected to spend an average of about 10 hours per week reading and completing assignments outside of class. Please note that extensions will not be granted for this course. This course is the equivalent of 42 clock hours of study. 70% is the minimum passing score on all tests and assignments for this course.
Criteria to be awarded nursing continuing professional development contact hours
Students must attend 80% of the course and every assignment must be completed with a 70% or better to be awarded 42 nursing continuing professional development contact hours.
Course Goals Include
- Increase knowledge of legal terminology, medical malpractice, and the evolving legal system.
- Demonstrate the knowledge of professional skills necessary to enhance one’s medical legal consulting role.
- Identify new arenas for expanding one’s interests and skills for professional mobility and growth.
- Consider and contrast working as a full-time, part-time, or freelance legal nurse consultant.
Required textbooks for this course:
- Legal Nurse Consulting: Principles and Practices, 4th edition, edited by Julie Dickinson and Anne Meyer (2020). New York: CRC Press.
Highly Recommended Legal Resources:
- Oran’s Dictionary of the Law, 4th Edition, by Daniel Oran. Clifton Park: Delmar Cengage Learning
To order, call CLS by BARBRI at 1-800-522-7737, or visit our bookstore to order online.
Session One: Legal Theory and Practice
- What is a Legal Nurse Consultant?
- History and Evolution of Legal Nurse Consulting
- Early Nurse Consultant Practice
- Formation of AALNC
- Continuing Education
- Standards and Guidelines for LNCs
- Scope of Practice for LNC
- Discussion of Code of Ethics
- Standards of care: In that profession, At that time and place, Proven by expert witnesses, Sources for standards, Standards of performance-competence, Duty to treat, Refusal to treat, Negligent or intentional violation of standards of carE
B. LIABILITY OF HEALTH CARE PROVIDERS
- Diagnostic Errors
- Treatment Issues
- Communication Issues
- Vicarious Liability and Respondent Superior
- Failure to Properly Treat
C. ENTRY INTO SPECIALITY PRACTICE-LNC
- Always a Nurse First
- Intrapreneurial and Entrepreneurial Skills
- The Nursing Process in the Legal Environment: Diagnosis, Planning, Implementation, Evaluation
- Communication Skills
- Time Management Skills
D. PROFESSIONALISM, STANDARDS OF PRACTICE AND PERFORMANCE
- Nursing Process applied to Legal Nurse Consulting
- LNC as a Specialty Practice of Nursing
- Standards of Professional Practice and the LNC
- Legal Ethics and the LNC
- interaction with Clients (interview with plaintiff)
- Interaction with Lawyers
- Instructional Role of LNC
- LNC in malpractice defense firms (liaison with defendant)
A. INTRODUCTION TO THE COMMON LAW
- Two Major Systems, Common Law and Civil Law
- “Law is the Solemn Expression of the Legislative Will” (Louisiana Civil Code)
- Types of law: Criminal, Civil, Administrative
- Civil Actions at Law: Contract, Tort, Property, Domestic Relations
- Sources of Law: Constitution, Statutes, Administrative Regulations, Judicial Decisions
B. AN INTRODUCTION TO THE LAW OF TORTS
- Negligence: Breach of duty owed to someone, Resulting in damages
- Intentional Torts: Assault/battery, Mayhem, Failure to Treat, Failure to Properly Diagnose, False Imprisonment, Defamation
- Malpractice-a breach of duty (negligence): Failure to meet standard of care, Resulting in injury to patient/client
C. MALPRACTICE CLAIMS
- Prelitigation Panels
- Initiation of a Lawsuit
- Steps to Take: Summons and Complaint, Answer, Interrogatories, Requests for Production, Depositions
D. INFORMED CONSENT
- Communication to competent patient on proposed treatment
- Duty: patient/physician
- Reasonable Person
- Inherent Risks
- Material Risk
- Scope of the Duty
- When Consent must be Obtained
- Whose Duty is it?
- Who can Give Consent
- No need for treatment
- Emergency situations
- Therapeutic privilege
- Renegotiation of Consent with Laboring Mothers
E. TREATMENT DECISIONS
- Origin and History of the Right to Refuse Treatment
- Competence of Person Refusing Treatment
- Religious Motivation
- Control over Treatment
- Rights of Incompetent Patients
- DNR orders
- Living Wills
- Medical Powers of Attorney
- Active Euthanasia/Assisted Suicide
F. HEALTH CARE PROVIDERS’ LIABILITY IN SUCH CASES
- Wrongful death
- Wrongful life
- Violation of right of bodily self-determination
- False Imprisonment and Defamation
- 72-hour mental health hold
Session Two: Medical Records Review, Role of the LNC in Defense Medical Examinations, Case Analysis, Negligence, ADR, Types of LNC Specialities
A. ACCESS TO MEDICAL RECORDS
- What is a medical record?
- Standards/Regulations Governing Content
- Retention of Records
- Access by Patient
- Access by Third Parties without Consent
- Mandatory Disclosure
- JC: Sentinel Event and Tell-All Standard
B. EVIDENTIARY RULES
- Introduction to Evidence
- Hearsay Rule and its Exceptions
- Public Records Exception
- Best Evidence Rule
C. DISCOVERY AND DISCLOSURE
- Requests for Production
- Request for Admissions
- Physical and Mental Examinations
- Communicating with and interviewing plaintiffs
D. MEDICAL RECORD ANALYSIS AND THE LNC AS EXPERT WITNESSES
- Interacting with defense clients (health providers)
- Medical Record Analysis
- Compilation of complete medical records
- Review of hospital medical records
- Review of other medical records
- Comparison of allegations with medical records
- Re-review of medical records
- Altered medical records
- Summary of medical records
- Health care bill analysis and auditing
- Evaluating Professional Negligence Cases
- Key elements of professional negligence claim
- Filing a professional negligence claim
- Negligence in health cases
- Physician malpractice
- Nurse malpractice
- Hospital malpractice
- The Nurse as an Expert Witness
- Qualifying LNC as an Expert
- Treatment of Expert Witnesses
- Exception to Hearsay Rule
- Cross-Examination of Witnesses
- Scientific Basis for Opinion
- Credibility of Nurse as Witness
- Credentials equal to those of defendant
- Active practice
- Most income does not come from testifying
A. LNC Evaluating Damages
- Personal injury cases (auto accidents, etc.)
- Malpractice cases
- Life-Care Planning
- Vocational and Hedonistic Damages
D. LNC Evaluating Professional Negligence Cases
- Key elements-the 4 D’s
- Duty owed by defendant to plaintiff?
- Dereliction of that duty?
- Damages as a result of this breach of duty?
- Due to (or direct result of) negligence of the provider
- Was this action the proximate cause of the injury?
- Exception to proximate cause-loss of chance
- Selecting the best expert witnesses
- Well educated and experienced
- Current active practice
- Does not always testify for the same side
- Articulate, sophisticated presenter
- An effective teacher
- No prior malpractice cases against expert
- No “skeletons” in the expert’s closet
- Consistent opinions
- Expert testimony a small part of the expert’s annual income
- Defense LNC-realizing when a case is indefensible
- Effective triage of medical malpractice claims
E. ALTERNATIVE DISPUTE RESOLUTION
- Other private dispute resolution means
F. Legal Writing
- Actually, there is no such thing as “Legal Writing”
- Consider the Potential Audience
- Medical witnesses unfamiliar with legal proceedings
- Experts in law or medicine
- Forms of Legal Writing
- Informative Writing
- Commemorative Writing
- Inquisitive Writing
- Persuasive Writing
- Reader-Friendly Writing
- Short Words
- Short Sentences
- Short Paragraphs
- Omit redundant words
- Omit personal beliefs
- Rigorous Editing is required
- Use Plain English
- French and Latin words had a place in the law, but not today
- Clear transition from one idea to another
- Organize your text
- In a logical sequence
- With informative heading
- For long documents, a table of contents
G. Literature Research
- Research Process
- Issue Identification
- Outcome Identification
- Textbook Research
- Computerized Literature Searches
- National Network of Libraries of Medicine
- Internet Access to Biomedical Communication
H. LNC PRACTICE
- Claims Consultant/Adjuster
- Case Manager
- Benefits Coordinator
- Workers Compensation Manager
- Medical Policy Coordinator
- Utilization Review Coordinator
- Risk Manager
- Medical Malpractice/Liability Consultant
- Credentials and Certifications-specialized fields
Session Three: Role of LNC in Civil and Criminal Litigation, Toxic Torts, Life-care Planning, End of Life Issues, LNC Practice
A. LNC evaluating Criminal Cases
- Mental capacity of defendant
- Physical capacity of defendant
- Extent of injuries to victim
B. INTRODUCTION TO CRIMINAL LAW
- Question of Intent: General Intent, Specific Intent
- Prosecution’s burden-beyond a reasonable doubt
- Evidence: Testimonial, Physical, Scientific
- Pre-trial Procedures: Preliminary Hearing, Arraignment, Indictment
- LNC’s Role in Criminal Cases: Child Abuse, Elder Abuse, Domestic Violence, Driving Under the Influence, Death Investigations
C. COMPLEX LITIGATION
- Role of the Courts
- Class Actions
- Multi-district Litigation
- Mass Torts
- Toxic Torts
- Product Liability
- Role of the LNC
D. LNC Evaluating Toxic Tort Cases
- Introduction to Toxic Torts
- Physics of Chemical Exposure
- LNC rule in establishing and evaluating causation
- Identifying experts
E. Legal Nurse Consultants In Government Service
- State government-clinician and investigator
- Assist law enforcement
- US Department of Justice-investigators
A. Life-Care Planning
- Creating the plan
- Data collection and analysis
- Medical history and file review
- Life-care plan in litigation
- Role of the LNC
B. Medical Record Analysis
- Compilation of Complete Medical Records
- Records that May not be Part of the “Medical Records”
- Other types: Visiting Nurse or Home Care
- Incomplete Medical Records
- Organization of Records-job for LNC at law firm
- Indexing and Paginating of Medical Records
- Review of Other Medical Records
- Altered Medical Records
- Minimizing Loss, Fabrication or Concealment of Record
- Pitfalls in Medical Record Analysis
- COVID-19 Litigation
C. Legal Nurse Consultants In Private Practice
- Consultant to various law firms
- Avoiding Conflicts of Interest
- Managing the Business
- Marketing and Nurse Ethics
D. Starting A Business As An Independents LNC
- Legal and Economic Considerations
- Finding a Business Lawyer
- Finding the Right Business Entity
- Writing a Business Plan
- Conclusion-on your own!!!
D. Final Examination Congratulations!!!!!
Your grade will be based on your completion of 3 exams and class participation.
Your final grade will be figured as follows:
- The three exams are 100 points each and comprise 80% of your grade.
- Your participation in class participation assignments comprises 20% of your grade.
NOTE: Students must receive a 70% or better on every assignment to receive a certificate.
We understand that your schedule may change at the last minute and prevent you from attending this course. If you must cancel your registration, please call us at least one week in advance of the program and we will issue you a refund less a non-refundable $50 administrative fee. No refunds will be given after the first class meeting.