By Darv Johnson
Long hours, low pay and high patient loads are driving more nurses into law offices – but not to sue. Instead they are using hard-won medical skills as springboards to legal careers. Some have topped their registered nursing status off with a legal degree; others may not have any formal legal training. Either way, the special combination of nursing skills is kicking open challenging career paths with better pay. Options include researching medical files looking for medical misbehavior, helping hospitals hone policies and procedures and cross-examining doctors.
Backed by degrees in nursing and law, nurse attorneys are at the top of this growing field. Virginia Fleming, president of the American Association of nurse Attorneys, based in Pensacola, Fla., says her organization has about 400 nurse-attorney members nationwide. But, she says, “We think there are thousands of us.” New Orleans has scores of nurse attorneys, says Donna Klein, head of the health care law section at McGlinchey Stafford PLLC and a local pioneer in the field.
When Klein left her position as an intensive care nurse at Ochsner Clinic Foundation to pursue a law degree and a nurse-attorney job in the late 1970s, she was one of just two or three in town. The ranks grew through the 1980s as the health care field became more highly regulated, she says. It wasn’t burnout that pushed her into law. Nursing “was very stressful, but so is being an attorney,” says Klein, who represents doctors, hospitals, insurance companies and others. She made the switch because she wanted challenges she couldn’t get in a nurse’s uniform.
The promise of higher wages is another incentive for nurses to hit the law books. The median hourly wage for a registered nurse is about $22, according to the U.S. Bureau of Labor Statistics. For lawyers, it is $42.
Legally trained nurse attorneys are hiring on as in-house counsel at hospitals or insurance company, or joining legal firms specializing in medical malpractice. Others, like Tonia Aiken, establish their own firms.
A graduate of LSU Nursing School, Aiken worked her way through Loyola Law School as a nurse two decades ago. Today, she is president of the Nurse Attorney Resource Group, and heads up medical malpractice cases for plaintiffs. Her nurse training, she says, helps her sift through reams of medical records searching for potential breaches of standards of care by doctors or nurses.
As a nurse, she says, “You know what a medical record looks like and you pretty much know what you’re looking for.” One step down the legal ladder, nurse paralegals have expertise of their own to offer. Cliff Cardone, an attorney with Cardone Katz & Hilton LLC in New Orleans, handles a number of nursing home litigation cases, has one nurse paralegal on his staff and hires others as consultants. The paralegal organizes and reviews medical records, screening for potential areas of medical misbehavior. When cases call for medical experts, the nurse paralegal checks their credentials. “We definitely find them useful,” Cardone says. “It helps a lot with interpretation (of medical records).”
For about $85 an hour, Margie Bixler and her partners at RNPara in Mandeville search a plaintiff’s medical records for possible breaches of standard of care. The process takes four to six hours, Bixler says. The company also takes medical depositions form medical experts and preps lawyers. RNPara boasts 250 clients, from Texas to Mississippi. RNPara uncovers incidents too subtle for the untrained eye to detect: a nurse who failed to deliver nutrition shakes to a nursing home resident suffering form bed sores, for example, or a nurse who didn’t restart an IV infusion causing inflammation in a patient’s arm – an omission that led to nerve damage.
Nurse paralegals are limited in their scope of research. “All we can do is point the plaintiff’s attorney to the research that we’ve uncovered,” Bixler says. “This is the incident and here is the standard of care.”
Indeed, the murky nature of exactly what constitutes a breach of standard of care explains why some lawyers prefer doctors as consultants. Jeff Mitchell of The Cochran Firm New Orleans, who specializes in medical malpractice for plaintiffs, says nurse paralegals are “extremely helpful” in preparing medical records for potential cases. But when it is time to screen cases for merit, he says, he relies on a Harvard University-trained doctor. “The standard of care is not something you can go to a book and look at,” Mitchell says. “It is a gray area and doctors disagree on it.”
One of the fastest growing fields is legal nurse consultant. While nurse attorneys and nurse paralegals need legal training to hang out their shingles, legal nurse consultants do not. A new continuing education program at LSU Nursing School coaches nurses on legal jargon and research skills. Their primary selling point is the medical expertise they gained from years of reading charts and caring for patients.
Even with that knowledge, according to RNPara’s Bixler, the transition from nurse to legal nurse consultant is difficult. The job demands a tenacious researcher of legal and medical issues. “Let me tell you, this is a hard field,” she says. “It’s not about how many years you’ve spent nursing.”
Still, as McGlinchey’s Klein notes, nurses might have an edge when making a tough career switch. “I really think that it takes a special kind of person to be a nurse, to be as flexible and as quick on their feet,” Klein says. “I think training as a nurse only helps somebody in a transition like that.”