Friday, November 5, 2010

More Weight Equals Longer Hospital Stays -- Sociologists Weigh In On Obesity Increasing The Length Of Hospital Stays

Sociologists found a direct relationship between obesity and duration and frequency of hospital stays. Researchers found that, on average, obese persons stayed one and a half days longer than those with normal weight. Sociologists attribute the connection to disease--46 percent of obese adults have high blood pressure. Obesity is also linked to an increased risk of heart disease, diabetes, stroke and other illnesses. The researchers also note that the longer a person has been obese, the more likely their hospital stay is lengthened.

The numbers on our nation's scales are going up. A recent study puts Mississippi at the top of the list with the highest rate of adult obesity in the country. New research shows how extra weight is adding up to longer hospital stays.

Annette Armstead knows what it takes to stay healthy. Before she started exercising, she weighed 225 pounds.

"I was tired of people telling fat jokes," said Armstead. "I was in pain all the time. I was so heavy that my knees would give out on me, and I was always falling down."

Obesity is linked with increased risk of heart disease, stroke, diabetes and other illnesses.

"I had problems with arthritis and different health problems, and everything they were saying [indicated] I was too heavy and I needed to lose weight," Armstead said. A new study by sociologists at Purdue University found obesity also leads to more frequent and longer hospital stays.

"Obese people, on average, stay at least one to one and a half days longer than a normal-weight individual," said Ken Ferraro, Ph.D., a sociologist at Purdue University in West Lafayette, Ind.

The main reason for extra hospitalizations is disease. Forty-six percent of obese adults in the study had high blood pressure, and obese adults who have been overweight since childhood and carried extra weight into adulthood pay the highest price for being heavy.

"The longer the person is obese, the longer their stay in the hospital," Dr. Ferraro said.

Tackling obesity at a young age is crucial to staying out of the hospital later on.

"If you can tell other people that you're on a diet, a lot of them actually might help you to stay on that diet, but if you're silent to your friends, then obviously they can't support you," Dr. Ferraro advised.

Armstead credits her weight loss to diet and exercise and has never felt better.

"I feel healthier at 55 than I did at 25," she said.

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ABOUT TYPE II DIABETES: Type II diabetes is the most common form of diabetes. In this form of the disease, either the body does not produce enough insulin, or the cells in the body ignore insulin. This can stop glucose from moving out of the bloodstream and into cells. Cells need the energy that glucose provides, and too much sugar in the blood can cause damage to the eyes, nerves, kidneys, or heart. These complications are very similar to the threats from type I diabetes, though type II can sometimes be treated with medications and diet instead of insulin (obtained through injections or in an inhaled form).

WHAT IS BLOOD PRESSURE: Blood pressure is the force in the arteries when the heart beats, and when the heart is at rest. When blood pressure is high, there is an increased risk of heart disease (which leads to heart attack) and stroke. It is most common in adults over age 35, and is especially prevalent in African Americans, the middle-aged and elderly, obese people, heavy drinkers, and women who are taking birth control pills. Those with diabetes, gout or kidney disease are also prone to suffer from high blood pressure.

WHAT CAUSES HEART ATTACKS: Heart attack is the leading cause of death in North and South America and in Europe. It is usually the result of prolonged hardening and narrowing of the arteries that direct blood into the heart. When blood vessels are healthy, oxygen-rich blood flows easily to all the muscles and organs of the body. But if they become clogged by the buildup of fatty deposits on vessel walls, blood can be cut off, killing heart muscle cells. This is called coronary heart disease, and it can lead to heart attacks or strokes.

The American Sociological Association contributed to the information contained in the TV portion of this report.

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Understanding Childhood Immunizations | Seattle Mama Doc

It’s my true fortune that I spend the majority of my days with children–my patients and my own. But as a mom in the year 2010, I find I worry a lot. As a pediatrician, my job is to reassure. My experiences with these divergent, and then entirely interwoven roles, converge at one issue in particular: immunizations.

The reality is, we live in a vaccine-hesitant world. With my patients, my friends, and even my family, I hear many myths about vaccines. I hear truths, too. Mostly, I feel and witness worry. When it comes to getting shots, most everyone wants to know a little more. There’s no doubt that the things we read online and in the paper, or the mutterings we hear on the news and in line at the grocery store, have left us frightened about immunizations. I remember the fearful stories more than the reassuring ones. Don’t you?

Despite this worry, I believe that alongside the challenge of overweight/obesity, hesitancy about shots may be the biggest issues facing children, parents, and pediatricians today. I spend more minutes (hours) per day with vaccine-hesitant families than I ever imagined I would. So this is a part of my every day. But hold on a minute, this is not a post about the “rights” of doctors or vaccines or the “wrongs” of another group. This is a blog post to help illuminate your right to earnest, research-based information regarding immunizations. You need to have compassionate care rooted in scientific evidence; you need to know what science holds. What I mean is, you have a right to really understand why doctors recommend immunizations.

Vaccines are discussed nearly everywhere by nearly everyone. As a parent, be selective about what you read and with whom you discuss these issues. Not everyone at the water cooler has expertise in this area. And not everyone understands the enormity of the issue, let alone the repercussions of their advice. As the wise say, “Don’t believe everything you think,” either.

Some ideas about how to get what you need:

  1. Use the Internet. Yes, a doctor is telling you this. Don’t be shy or bashful about it. The clear majority of parents read about health information online (duh). And over 90% of parents who are online say they read about child health information. When you do this reading, find sources of information that reflect expertise (people who have training in medicine, science, or vaccines) not just experience with children.
  2. Print out information from the web pages or sites you use to make decisions. Bring this information to the office visit with your child’s doctor so you can have an informed, open discussion.
  3. There is wild myth that exists online regarding immunizations but there is also great, practical, scientific content, too. Keep in mind that when you read online, you can find any possible angle. The important thing to note is that nearly everything you read will sound like fact, no matter if it is factual, scientific, or quack. Vet the voices you listen to.
  4. Ask your pediatrician where (on and offline) to read about immunizations, particularly if you’re concerned at the end of a visit. If you worry about the risks and benefits surrounding immunizations, tell your pediatrician. Don’t assume they know how you feel.
  5. It’s always okay to ask questions! Don’t let the rituals of a doctor’s visit get in the way of finding out what you need to know.

What to ask at the office?

  • Which immunization(s) is my child getting today?
  • Why? (The short answer: immunity to and protection against life-threatening/life-altering infections)
  • How will my child’s body respond? (It will mount an immune response. Fever, and/or redness or soreness at injection site are common, normal responses to immunizations)
  • Will fever come? (Often yes. In some studies up to half of 2 month-old babies have temperature elevation after shots. This response proves their immune system is doing the right thing–responding with inflammation while building memory)
  • Should my child still have a shot even though he/she is on antibiotics, has a cold, or will travel very soon? (All yes! Fever over 101 is the most typical reason to hold off on an immunization)

There are very few easy answers to vaccine questions. The longer, more philosophical responses will require minutes of conversation. If you have questions about shots, help shape the agenda of your visit with the doctor; tell the pediatrician at the beginning of the visit you have questions about shots so you’re not rushed right at the end of the visit. Your pediatrician is there for you, not only for clinical skill, but interpretation and support, so that you have a real shot at understating the benefits of immunization.

Websites I recommend:

  • www.nnii.org : As one pediatrician put it, “I like NNii because it is independent of industry and government — takes no funds from either. The sole purpose is to provide science based, credible information in a manner parents can easily understand.”  
  • www.healthychildren.org : The AAP website designed for parents. It’s easy to read, has great information and backed by a force of 60,000 pediatricians making up the AAP. It’s a user-friendly ,and has up to date information.
  • www.immunize.org : A website designed for doctors, this can be a useful place to look for policy statements, WHO advice, AAP advice and news about changing recommendations.
  • www.ecbt.org Foundation co-founded by First Lady Rosalynn Carter to help families understand the need for timely (up to date) immunizations. There are videos and resources on getting your child’s shots if you can’t pay for them.
  • www.vaccine.chop.edu : Great resource for scientific information about shots. This is written by a world renowned pediatric infectious disease and vaccine expert and has information on every shot. Website includes videos, down-loadable information sheets and answers to typical questions.


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Thursday, November 4, 2010

Lessons From Geese, Inspirational Poems, Touching Stories

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Fact 1: As each goose flaps its wings, it creates an up-lift for the birds that follow. By flying in a "V" formation, the whole flock adds 71 percent greater flying range than if each bird flew alone.

Lesson 1: People who share a common direction and sense of community can get where they are going quicker and easier because they are traveling on the thrust of one another.

Fact 2: When a goose falls out of formation, it suddenly feels the drag and resistance of flying alone. It quickly moves back into formation to take advantage of the lifting power of the bird immediately in front of it.

Lesson 2: If we have as much sense as a goose, we stay in formation with those headed where we want to go. We are willing to accept their help and give our help to others.

Fact 3: When the lead goose tires, it rotates back into the formation and another goose flies to the point position.

Lesson 3: It pays to take turns doing the hard tasks and sharing leadership. As with geese, people are interdependent on each others' skills, capabilities and unique arrangements of gifts, talent or resources.

Fact 4: The geese flying in formation honking encourage those up front to keep up their speed.

Lesson 4: We need to make sure our honking is encouraging. In groups where there is encouragement, the production is much greater. The power of encouragement (to stand by one's heart or core values and encourage the heart and core of others) is the quality of honking we seek.

Fact 5: When a goose gets sick, wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it dies or is able to fly again. Then they launch out with another formation or catch up with the flock.

Lesson 5: If we have as much sense as geese, we will stand by each other in difficult times as well as when we are strong.

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Nursing Listservs, Nurse Listserv, E-mail Discussion Groups, Nursing Resources

Listservs or electronic discussion groups are the most popular means of communication on the Internet. You can exchange ideas via e-mail about topics in the health sciences. Leave the subject area blank when you e-mail your subscription, and when you get the initial subscription message from the listserv, save it because it will contain important information.

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CNS-L: - CNS-L is a discussion list that focuses on clinical nursing issues and topics.
To join, send an e-mail message to listserv@listserv.utoronto.ca
Text: sub CNS-L yourfirstname yourlastname. For example: sub CNS-L jane smith.

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GERINET: - GERINET is a discussion list for geriatric health care professionals.
To join, send an e-mail message to listserv@listserv.acsu.buffalo.edu
Text: subscribe GERINET yourfirstname yourlastname. For example: subscribe GERINET jane smith.

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GLOBALRN: - GLOBALRN is a discussion group for nurses, in general, and other interested health care professionals.
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HOMEHLTH: - HOMEHLTH is a discussion list for topics in the area of management, operation and other issues of Home Healthcare.
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NPINFO: - Nurse Practitioner Information is a listserv intended for nurse practitioners in various specialties, nurse midwives and nurse anesthetists.
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Text: subscribe yourfirstname yourlastname.

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NRSINGED: English (USA):"The NRSINGED Discussion List is open to nurse educators and interested others. The intent of the list is to provide a forum for the discussion of topics and issues in nursing education. Discussion is meant to be wide ranging from teaching methodologies to philosophical issues, in order to meet the diverse needs of nurse educators."
To subscribe to the NRSINGED discussion list, please visit the URL:
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NRSING-L: - Nursing Informatics is a discussion group with a focus on issues relating to electronic resources in nursing.
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NSGINF-L: - NSGINF is also a discussion group focusing on nursing informatics.
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NURSENET: - NURSENET is an unmoderated discussion group in the areas of nursing administration, practice, education, and research.
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NurseRes: - NurseRes is a moderated discussion group for nurse researchers. NurseRes can also serve as a resource to get in touch with individuals in your area of interest for collaborative research.
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PERIOP: - PERIOP is an electronic forum for perioperative/OR/theatre nurses world wide.
To join visit: http://mailman1.u.washington.edu/mailman/listinfo/periop

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PICU: - PICU is a discussion list for pediatric intensive care unit health care professionals.
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PNATALRN: - PNATALRN is a discussion list for perinatal nursing.
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PSYNURSE - This is a discussion list only for psychiatric nurses; you will be asked to fill out an on-line questionnaire pertaining to your work.
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SCHLRN-L: - SCHLRN-L is the school nurse network discussion list.
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Last updated by Andrew Lopez, RN on Wednesday, September 29, 2010

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Legal Eagles

Feature Article

Legal Eagles

Put nursing, law and business together and what do you get? The exciting field of legal nurse consulting!
by Barbara Marquand
Gloria Blackmon, RNC, BSN, LNC, LNHAGloria Blackmon, RNC, BSN, LNC, LNHA

Gloria Blackmon, RNC, BSN, LNC, LNHA, never met the young man who lost his legs, but after reading over his medical records, the compassion she felt for him was as strong as if he had been her own patient. The young man had been living in an intermediate care facility for developmentally disabled adults when circulation problems in his legs became so severe that both limbs had to be amputated. His parents sued the facility and it was Blackmon’s job, as a legal nurse consultant for their attorney, to review the records and determine if they had a valid case.

In poring over the reams of documents, she discovered signs that the staff had overlooked the classic early symptoms of circulation loss. Had they addressed the problem sooner, the young man might be walking today. Blackmon’s findings strengthened the family’s case, which led to a substantial settlement.

“It was one of those cases that spoke to my heart,” says Blackmon, principal of Blackmon & Associates, a legal nurse consulting business in Topeka, Kansas.

Although legal nurse consultants don’t work directly with patients, their behind-the-scenes work on medical-related legal cases can make a huge impact on the quality of health care patients receive.

“The most rewarding part of this work is being able to help somebody, whether we find merit in the case or help the person move on with their life by validating that the doctor and the staff did everything they could,” says Rose Clifford, RN, CLNC, a legal nurse consultant in Cynthiana, Ky.

Legal nurse consultants put their nursing backgrounds to work in the legal arena. They work on contract or on salary for attorneys, insurance companies, government agencies and risk management departments, and they can provide a variety of services. Among other things, they review records to identify standards of care, conduct research and summarize medical literature, identify and apply regulatory requirements, educate attorneys about medical issues, assist with depositions and trials, and screen initial cases to see if they have merit.

“You can draw from all your bodies of education,” comments Rosalyn Harris-Offutt, CRNA, BS, LPC, BCETS, CLNC, a legal nurse consultant in Greensboro, N.C. “No one knows medical care in terms of the service provided for patients better than nurses.”

Through her consulting business, Prima Medical Legal, Harris-Offutt is a testifying and consulting expert on medical malpractice, product liability and workers compensation cases. Her background as an advanced psychiatric nurse and licensed professional counselor with expertise in post-traumatic stress disorder enables her to also testify in personal injury and criminal cases. In addition, Harris-Offutt—whose father was Cherokee and African American and whose mother was Creek Indian—strives to bring cultural competence to her consulting work. She networks with minority attorneys to serve their clients and provides consulting to Native Americans both on and off reservations. “That work is important to me because it allows me to serve all my people,” she explains.

Making a Real Difference

“Many people think it’s a new specialty, but nurses have been doing legal consulting for decades,” says Donna Cardillo, RN, a career adviser and creator of “Career Alternatives for Nurses,” an audio and video cassette educational program.

Rose Clifford, RN, CLNCRose Clifford, RN, CLNC

The field has grown more prominent in the last 10 to 15 years as more nurses have gone into full-time private practice and demand for their services has risen. “Lawsuits definitely have been on the rise, and nurses are also looking for alternatives to bedside nursing,” Cardillo points out. Nurses’ specialized knowledge and experience are highly regarded and respected in the legal arena, she adds.

The American Association of Legal Nurse Consultants (AALNC), founded in 1989 and headquartered in Glenview, Ill., has more than 4,000 members. Another professional association, the Houston-based Medical-Legal Consulting Institute, Inc., claims to have trained more than 20,000 legal nurse consultants since it was founded in 1985 by Vickie Milazzo, RN, MSN, JD. Yet many nurses remain unaware of the opportunities this specialty offers.

“A doctor told me I’d be very good at this, but at the time I didn’t know what she was talking about,” recalls Rosie Oldham, RN, DS, LNCC, president of the AALNC. She had been a director of nursing at a children’s psychiatric hospital, responsible for risk management and quality improvement, when she heard about legal nurse consulting. After researching the field and networking, she started her own business, R & G Medical Consultants, Inc., in Phoenix, which now employs three nurses plus 15 who work as independent subcontractors. Oldham works with attorneys and insurance companies on cases involving medical malpractice, toxic torts and product liability; she specializes in large class-action suits, which can involve hundreds of individual cases at a time.

One of the greatest rewards of the work, Oldham says, is the knowledge that she is making a difference. For instance, there was the case that involved a 45-year-old woman who had died because the abnormal results of her mammogram were never relayed to her doctor. One year after the test, her cancer was discovered, but by then it was too late. Through Oldham’s research of the medical records, she was able to determine that someone had filed the mammogram results away before the doctor had a chance to see them. As a result of that case, Oldham says, Phoenix-area hospitals changed their notification procedures for mammogram results. Now hospital radiology departments, which used to notify only the doctors’ offices when there was an abnormality, also notify patients of the test results and direct them to their physicians.

An important part of Blackmon’s career is the work she does for advocacy groups for the elderly. These groups represent medically underserved clients who have little or no financial resources and whose cases would probably not be addressed without the assistance of attorneys and expert consultants who are willing to work pro bono or on a sliding fee scale. While Blackmon says she approaches this work with the same level of objectivity that legal nurse consultants must bring to all their cases, these special efforts provide the extra reward that comes from helping people whose voices might otherwise go unheard. “The same assistance legal nurse consultants bring to the legal world needs to be brought to the pro bono and advocacy world as well,” she believes.

 

Variety Is the Spice of LNCs

The work that legal nurse consultants do varies according to their interests and backgrounds. “I love what I do,” Oldham asserts. “Every case is different, so you never get bored.”

Blackmon became a legal nurse consultant five years ago after working in nursing management at long-term care facilities. In her consulting work, she focuses primarily on long-term care and rehab nursing issues. Much of her work involves reviewing patient records to determine what really happened. The work is intense and full of surprises.

“Every record I receive is like a mystery novel,” she says. “You never know the answer until you get to the last page. Sometimes I’ll find something in a lab report that makes me go back and realize that the case is much more complicated than I first thought.”

A patient fall, for instance, at first may appear to be a case about whether a facility took proper safety precautions. But the records may reveal that it was, in fact, related to overmedication of the patient.

Legal nurse consultants work in a variety of settings as well. About half of the AALNC’s members are in independent practice, 25% work in law firms and another 25% are employed in industry, government, HMOs, hospitals or insurance companies. Many legal nurse consultants work part-time when they are first getting started and then switch to full-time once they have built a client base, according to the association.

Milazzo says fees range from $60 to $150 an hour for independent legal nurse consultants, while salaries for LNCs who work for employers are comparable to nursing salaries in a clinical setting.

Legal nurse consultants must be RNs, and Milazzo recommends that they have at least three years of nursing experience. They can become trained and certified in legal nurse consulting through the AALNC or other educational programs, such as Milazzo's institute. (See “The ABCs of Legal Nurse Consulting.”) But certification isn’t mandatory.

Both Clifford and Blackmon say the education and mentoring they received through the Medical-Legal Consulting Institute gave them the tools to get started in the field. But nurses should shop carefully before they spend money on LNC training. They should make sure the programs are nursing-based, Oldham advises, and run by legal nurse consultants. Some paralegal training programs market themselves to nurses, but they train students to do paralegal work, which pays less than legal nurse consulting and includes legal areas that have nothing to do with health care, such as divorce.

How to Succeed in Business

Cardillo thinks the opportunities in legal nurse consulting are greatest for nurses who work as independent contractors: “I know many nurses who have built successful [LNC] practices, and they tell me they have more work than they know what to do with.”

Milazzo adds that the door is wide open, whether nurses want to work for employers or independently. However, those working for themselves, she notes, have greater autonomy and never have to worry about being downsized. “There’s no limit. You can take it wherever you want to go.”

But success doesn’t happen overnight. “Just like any consulting practice, you have to build a business and develop a clientele,” Cardillo emphasizes. And that’s not always easy.

“Nurses aren’t taught how to be businesswomen and businessmen,” Blackmon says. “There is a language of business and behavior of business that is brand new to us. Legal nurse consultants often find that the marketing aspect of the business can be challenging.”

Clifford agrees. Starting a business was scary, she relates: “I hate making cold calls.”

Clifford worked nine years as a consultant for a law firm before starting her own business six years ago, focusing on medical malpractice, Medicare fraud and product liability. She has built a client base mostly through word-of-mouth referrals. She also strategically places ads in legal journals and keeps her name in play by producing a newsletter that provides snippets of useful information for attorneys.

Because of this entrepreneurial focus, legal nurse consulting isn’t for everybody. To thrive in the specialty, nurses should be self-starters, strong communicators and have highly tuned critical and analytical thinking skills. Some cases are obvious, Harris-Offutt says, but many require reading between the lines to find hidden nuances.

Persistence is critical, not just in unraveling cases but in building a business, according to Milazzo. She feels that “it’s important to feel passion about what you’re doing. That’s what will help you make it through the rough times.”

Blackmon says nurses who decide to go into business for themselves as legal nurse consultants also need to be realistic, and shouldn’t enter the specialty just for the money. Although independent LNCs can make more than $100 per hour in some areas, they also have to bear the expenses of running an office, subscribing to industry magazines and training a staff. What’s more, the workload can fluctuate dramatically. “The work doesn’t come in regular eight-hour shifts,” Blackmon explains. “You will either have so much work you can’t see straight or you’ll have no work at all. There are times when I work 12, 14, even 16 hours a day, but there are also days when I have very few billable hours.”

 

How Do I Get Started?

Does legal nurse consulting sound like a career change you’d like to pursue? If so, here are some tips for how to get started in the field:

  • Read about legal nurse consulting. The American Association of Legal Nurse Consultants’ Web site (www.aalnc.org) is a good place to start. It has general information about the specialty, listings of educational materials and conferences, and information on how to contact local chapters and at-large directors. Also check out the Medical-Legal Consulting Institute’s site at www.LegalNurse.com.
  • Network with other legal nurse consultants. Oldham suggests joining a local AALNC chapter to meet others in the field. This is a good way to learn more about the specialty as well as an opportunity to begin building a client base. Oldham recommends bringing your resume to the first meeting as a way of introduction. If there is no AALNC chapter near you, try contacting an at-large association director to get help in finding legal nurse consultants in your state.
  • Get to know attorneys. Doing volunteer work through the local bar association is a good way to network with attorneys, says Oldham.
  • Consider gaining experience by signing on with a company that specializes in providing LNC services, such as Advanced Nurse Consultants (www.medical-legal-nurses.com) or Legal Nurse Consulting Services (www.lcinfo.com). To find more such firms, do an Internet search on “legal nurse consulting.”
  • Save three to six months’ worth of salary before quitting your job to start a full-time legal nurse consulting business, Blackmon advises. It will take at least that long to build a solid client base that will provide a decent income.
  • Find a mentor or coach. Oldham recommends that new legal nurse consultants hire coaches to guide them through their first few cases and check their work. Some LNC education programs also provide mentoring services.

The ABCs of Legal Nurse Consulting

Confused by the different legal nurse consultant acronyms mentioned in this article? Here’s a quick guide to what the “alphabet soup” is all about:

LNC = Legal Nurse Consultant (general term for a nurse who has completed an education program that provides the skills needed to work as a practicing legal nurse consultant)

CLNC = Certified Legal Nurse Consultant (professional certification conferred by the Medical-Legal Consulting Institute, Inc.)

LNCC = Legal Nurse Consultant Certified (professional certification conferred by the American Association of Legal Nurse Consultants)

Barbara Marquand is a free-lance writer based in Reno, Nevada.

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Doctors are quietly opting out of medicine

by Nancy Pando, LICSW

Dr. Ryan Flesher was working his usual shift in the Emergency Department that night in July of 2006.  The hospital was short-staffed, per usual, and patients continued streaming through the revolving doors.  Neither the people at the front desk nor the nurses saw Dr. Flesher slip quietly down the hall that night.

The following is a true story that occurred well before healthcare moved to its national platform, leaving uncertainty in its wake. The main character’s name could be substituted by half of the physicians across the country. But, for now, we will start with Ryan Flesher, MD.

His chapter one

The youngest of 6 in Huntington, West Virginia, Ryan’s Dad was a foreman at a truck body shop and his Mom was a homemaker. Ryan was an above average student with a mind for science and a simple desire to help people. Compassion, according to any study ever conducted, is the number one reason why individuals choose careers in medicine.

What happens to these young, altruistic people who enter the field of medicine? We toss them into medical schools and residency programs, many of which are run like medieval tournaments designed to undermine the confidence of each player and destroy all sense of collegiality. Med students and residents most commonly describe their medical training as follows: “They beat the good stuff out of us”.

In a recent commencement speech at Stanford University, Atul Gawande, MD, MPH acknowledges, “There is no industry in the world with 13,600 different service lines to deliver.  It should be no wonder that you have not mastered the understanding of them all. No one ever will.”  But the world will expect of them nothing short of mastery and perfection.

Free falling

Newly licensed to practice medicine, Dr. Ryan Flesher joins his fellow colleagues as they step onto a conveyor belt that is heading straight for a cliff. Whoops. Nobody built a fence.

Stumbling to their feet, young doctors often find themselves confronted by administrative and regulatory officials armed with clipboards. New hires come to discover that one’s training in the art of medicine and bedside manner pales in comparison to one’s business acumen. The plans they had of sacred time they would spend building relationships and caring for patients. Imagery, dreams.

When one has sacrificed 14 years of one’s life in pursuit of a concept, not a reality…there seems no turning back. Resigned, Dr. Flesher joins the legion of other physicians in white coats with bulls eyes emblazoned across their backs.

A sense of disillusionment began to slowly curl itself around him and creep upward like a deadly vine.

Imperfect storm

Cognitive dissonance is a dangerous mix of chemicals when buried. That’s just what happened to Dr. Ryan Flesher on that infamous night in the small, tiled room.

Years of forbidden emotions erupt and spill across the floor like shards of glass. “I hate being a doctor,” he says to himself.   These are words no physician ever wants to say out loud.  Panic surges through him; “What will I do? What will my family say? Have I wasted my life? Is there something wrong with me? Is there something wrong with medicine? Do I Leave? Stay? Fight? Go?”

The exodus

Doctors are quietly opting out of medicine or they are leaving this life altogether. According to Medscape Medical News, as recently as March 2010, “The United States loses the equivalent of at least one entire medical school class (approximately 400 physicians) each year to suicide”.  In other words: one, sometimes two, a day.

People often respond to reports of physician dissatisfaction by saying, “Well, I don’t like my job either.” But the role of a physician cannot be paralleled by any other. They have the least amount of rights of any profession; they must sacrifice approximately 14 years of their lives to the study and practice of medicine and they are held to a standard of perfection that simply does not exist here on earth.

Cradle and all

One of the most dangerous things people can do is to question the integrity of honorable human beings. The repercussions can be prolific. Physicians, in general, are good people.  They are daughters, fathers, sons and mothers.  Loathe to the notion of pity, they simply want what is fair and just.

An entire healthcare industry profits off the backs of doctors and patients. Without them, there is no industry. Problem is this unsettling shift in the foundation of medicine has caused cracks to form. How is it nobody thought to look at the structural problems before they built the skyscraper?

Our children, loved ones, all of us; we are falling through those cracks. And when the bough breaks … who will be left to take care of us?

Nancy Pando is a social worker, author and lecturer. She recently produced the award-winning documentary,
The Vanishing Oath.

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