Dear Ezine Readers,

I invite you to sign up for my new Blog today – “Vickie’s Blog” so you can receive my inspirational New Year’s message early. “Vickie’s Blog” is replacing the LNC Ezine.

LNC Ezine #26 publishing on December 23, 2009, will be my last issue.

Send your comments about blogging to feedback@LegalNurse.com.

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The cell phone rang (or rather vibrated) at the worst possible time – in the middle of a Vickie Milazzo lecture. We were in Orlando for the CLNC^® 6-Day Certification Seminar. We both had successful full-time careers and had performed some legal nurse consulting over the years. Our goal in becoming CLNC^® consultants was to continue our lifelong learning, rather than to change career paths.

The Magic Kingdom was distracting enough. And now in the middle of Vickie's lecture, that darn cell phone was vibrating.

At the next break, we returned the call to an RN we had met a few weeks earlier while consulting for her agency. We had mentioned our excitement at becoming Certified Legal Nurse Consultants^CM and she had told us about her grandmother's death at a local nursing home.

The RN was calling us to provide legal nurse consulting services for her family's attorney. The nursing home attorney had presented a settlement offer, but her family was not pleased with the offer. As Vickie teaches, we told her that we could only work directly with her family's attorney.

A few days after the seminar, the family's attorney called and hired us as consulting experts. After discussing the case, and with Vickie's teachings fresh in our heads, we asked the attorney for:

• The patient's nursing home records and hospital records.
• Nursing home staff competencies, evidence of licensure, performance appraisals, ongoing education and training records.
• Copies of state or federal licensing survey reports on the nursing home during the applicable period.
• A copy of the complaint.
• Any other documents relevant to the case.

We Planned Our Work

When the records arrived, we found ourselves frequently referencing the Core Curriculum for Legal Nurse Consulting^® textbook. The module on "Comprehensive Case Evaluation Strategies" directed the design of our work plan, which included these steps:

• Communicate with the attorney-client initially and throughout the case.
• Scan the case.
• Develop and implement a plan of action.
• Organize the medical records in chronological order.
• Assess the records and relevant documents.
• Use relevant records and documents to establish the facts and analyze the case.
• Identify and access supporting literature.
• Develop demonstrative evidence.
• Identify applicable standards of care and deviations from those standards.
• Assess the plaintiff's damages.
• Prepare and submit our report to the attorney-client.

With our new-found knowledge from Vickie Milazzo Institute, our CLNC^® credentials, the Core Curriculum, our work plan and free access to CLNC^® Mentors, we were ready to go to work.

Donna, the patient, had resided in a nursing home for several years. She had been alert and independent in her ADLs (activities of daily living) until she suffered a fall. Within two weeks, her health declined rapidly. Finally, at the insistence of her family, she was transported by ambulance to a local medical center. Donna was admitted to the medical center with sepsis, renal failure and an intra-abdominal viscous rupture. Her health continued to rapidly decline, and she died six days later.

We Worked Our Plan

Here we were, brand new CLNC^® consultants with our first case post-class. What had we just learned from Vickie? How could we help?

As soon as we reviewed the complaint, medical records and other documentation, we knew the case needed demonstrative evidence. We had never done this, but our favorite module in the CLNC^® 6-Day Seminar was "Helping Attorneys Develop Demonstrative Evidence."

We first developed a timeline of the patient's decline in the nursing home, starting with her fall. We identified dates, times and actions taken by the staff for these key indicators of decline:

• Complaining of pain immediately following the fall.
• Ongoing complaints of pain in the left hip and shoulder, chest pain, bilateral rib cage pain and lower abdominal pain.
• Elevated temperature 24 hours post-fall and spiking temperature thereafter.
• Increased confusion.
• Her abdomen becoming rigid and distended, and her screaming when her abdomen was touched.
• Diminished urine output.
• Spitting out and refusing medications.
• Oxygen saturation decreasing to 90 percent.
• Refusing all oral intake and intermittent vomiting.
• Becoming unresponsive.

Based on the hospital record, we then developed a timeline of the patient's care in the medical center. This timeline included:

• Arrival in the emergency room with sepsis, dehydration and acute renal failure.
• The hospital course:
• Diagnosed with an intra-abdominal viscous rupture.
• Deemed not a surgical candidate due to the extreme risk of surgery.
• Family requested a do not resuscitate order.
• Decline continued with high temperature, abdominal distention, few bowel sounds and response only to painful stimuli.
• Death on the sixth day.

Our final timeline detailed the lost opportunities to save Donna's life. This timeline showed dates, times, passive treatment by the nursing home staff and deviations from the standards of care.

The standards of care module from the CLNC^® Certification Seminar guided us in developing this portion of our work plan. We researched the state nursing practice act and state and federal nursing home laws. Using these standards, we defined numerous deviations in care:

• Failure to implement an appropriate fall prevention program.
• Failure to formulate a nursing care plan for new problems (pain and nutrition) with defined interventions and goals.
• Failure to observe a medication's action (pain medication was ineffective).
• Failure to identify uncontrolled pain as a problem.
• Failure to derive a nursing diagnosis or identify issues based on assessment data.
• Failure to monitor or observe a change in the patient's clinical status.
• Failure to communicate to the physician a significant change in the patient's condition.
• Failure to collect comprehensive data pertinent to the patient's health or clinical situation.
• Failure to make prompt, accurate entries in the patient's medical record.

Vickie's "How to Research Medical-Related Cases" module taught us the importance of creating a search strategy and obtaining additional relevant information. We accessed the state Department of Health and Environmental Control (DHEC) website looking for standards of nursing home care. Not only did we find the standards, we discovered that the nursing home had a DHEC survey on the very day Donna's family had her transferred to the hospital. The survey results were posted on the DHEC website as public information.

We developed another graph showing the results of the state survey inspection most relevant to the case. The following deficiencies were cited:

• Failure to give each resident care and services to attain or keep the highest quality of life possible.
• Failure to properly care for residents needing special services.

We also accessed the Centers for Medicare & Medicaid Services (CMS) website and found national, state and nursing home specific comparative data regarding appropriate staffing levels. We developed a graph demonstrating that the defendant nursing home was well below both state and national averages for:

• Licensed RN hours per resident per day.
• Licensed LPN/LVN hours per resident per day.
• Total licensed nursing staff hours per resident per day.

As Vickie taught us, we concluded our report by citing literature and Internet references.
We then submitted the report to our attorney-client for review. Following a telephone conference with our attorney-client, he discussed our findings with the defense attorney.

Our Findings Resulted in a 57% Larger Settlement

During the next settlement hearing, the defense attorney offered a 57 percent increase in settlement on behalf of the nursing home. The family accepted this new offer. Donna's granddaughter shared her family's sincere appreciation, not just for the increased settlement, but for bringing to light the nursing home's deficiencies from the state survey.

This case taught us the practical application of all the strategies and tools from Vickie Milazzo Institute's CLNC^® Certification Program. This case was memorable because:

• We received the first telephone call about this case before we even left the CLNC^® Certification Seminar.
• We were immediately able to implement many of the strategies we had just learned.
• We were able to start recovering our costs of the CLNC^® Certification Program immediately.
• We keep Donna's picture, smiling and happy, surrounded by her loving family, balloons, flowers and a cake, celebrating her birthday – just a short time before her fall.

Kathy J. Morgan, RNC, CLNC is president and consultant with HES, Inc. She had 13 years experience with the Joint Commission as a nurse surveyor and specializes in federal regulatory and accreditation-related cases.

Send your most memorable CLNC^® case to feedback@LegalNurse.com.

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I'm excited to announce that the new Nursing Leadership, A Concise Encyclopedia, edited by Harriet R. Feldman, features my chapter on legal nurse consulting.

I was honored to be invited to contribute to this important nursing reference. As the industry leader and pioneer of legal nurse consulting, I am proud to be able to continue to advance our stellar nursing career to the nursing audience. The book will be on the library shelves of nursing schools across the country and is a great reference for anyone in the healthcare field. My chapter highlights three primary elements of legal nurse consulting:

• Types of Cases Legal Nurse Consultants Consult On
• The Legal Nurse Consultants' Impact on the Legal System
• Legal Nurse Consulting Certification and Career Options

Now more and more nurses are learning about legal nurse consulting and the secure future it can provide them and their families. Call 800.880.0944 today to discover my special holiday offers toward any of Vickie Milazzo Institute's CLNC^® Success Systems.

Send your legal nurse consulting news to feedback@LegalNurse.com.

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My Wall Street Journal bestselling book, Inside Every Woman: Using the 10 Strengths You Didn't Know You Had to Get the Career and Life You Want Now is now published and available in Indonesian.

A friend and reader recently let me know that she was surprised to find my book on display in Indonesia.

"I found Inside Every Woman prominently displayed at a bookstore in Pekanbaru (the provincial capital of Riau in Sumatra). I walked into the bookstore and there it was. I bought a copy to share with an Indonesian friend. How exciting for you!"

– Ellen Houha, Louisiana

Inside Every Woman: Using the 10 Strengths You Didn't Know You Had to Get the Career and Life You Want Now achieved the #3 spot on Amazon's business books bestseller list and escalated to Wall Street Journal bestseller status in 2007. The book, now in its seventh printing, is also available in Polish and is being published in four additional languages.

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	Q.	I Have Been Asked to Subcontract for Another CLNC® Consultant. What are My Next Steps?
	A.	As a CLNC® subcontractor you will want to treat your fellow CLNC® consultant as if you are on an interview with an attorney-prospect. Sell your CLNC® services and why you are the right CLNC® subcontractor for this case. Ask any CLNC® consultants you subcontract for if any case themes, positions or strategies have been established. Be sure you know the key issues of each case and are clear on the attorney's perspective. Collaborate on the specific CLNC® services you will provide. Be familiar with the subcontracting process and review the business development principles module in the Core Curriculum for Legal Nurse Consulting® textbook and the CLNC® Certification Program.

Send your questions for Vickie to AskVickie@LegalNurse.com.

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For a full listing and more information about each event where I'll be appearing, please click the links below.

• Small Business Resources
  

• San Antonio, March 12-13, 2009
  

CLNC® 6-Day Certification Seminar in Atlanta.

• Las Vegas, March 31-April 5, 2009
  


• Orlando, April 20-25, 2009
  


• Chicago, May 11-16, 2009
  


• Houston, June 1-6, 2009
  

• San Antonio, Marriott Rivercenter
  March 12-13, 2009
  


• Las Vegas, Golden Nugget Hotel
  April 5, 2009
  


• Orlando, Marriott Orlando Airport
  April 25, 2009
  


• Chicago, Chicago Marriott Schaumburg
  May 16, 2009
  


• Houston, Houston Marriott West Loop
  June 6, 2009
  

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If you would like to talk to a full-time practicing CLNC^® consultant, call 800.880.0944 or click to call using the button below.

P.S. View my FREE Introductory Course on legal nurse consulting to learn more about Vickie Milazzo Institute's CLNC® Certification Program. P.P.S. See and hear Certified Legal Nurse ConsultantsCM talk about their CLNC® careers.

"Stunning! Watching Vickie's video left me absolutely stunned. So I watched it again and again and again. I put it on my iPod and watched it while I was on break. Stunned. Vickie is exceptionally talented and creative; she's like a musician. You know it when you hear it. She inspires and educates with an underlying positive life outlook. The Institute's ongoing commitment and support of the CLNC® consultants is so encouraging. This is really fun! WOW." – Tina S. Wooden, RN, JD, CLNC

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The 14th Annual NACLNC^® Conference, the world's largest conference for legal nurse consultants, will fire up the maverick inside you! Be prepared to kick it up a notch as I, along with keynote speaker Stedman Graham and the CLNC^® Pros, show you how you can pave bold new trails for your CLNC^® business success.

See Below for Your $200.00 Discount Coupon!

2009 National Alliance of Certified Legal Nurse
Consultants (NACLNC^®) 14th Annual Conference March 12-13, 2009 – San Antonio, Texas

Make full strides in your CLNC^® practice with these NACLNC^® Conference benefits:

	Choose from 21 riveting sessions. Pick from 3 tracks to find the workshops and presentations that match your CLNC® experience. Whether you're just stepping out or running at top speed, you'll discover the renegade secrets for breakaway CLNC® success.
	Outpace yourself as you master new, unconventional strategies that only CLNC® mavericks know. Expand your CLNC® practice immediately with new CLNC® services, fresh marketing strategies and up-to-date practice management techniques.
	Attend the interview workshop and you'll walk into every attorney meeting with confidence and walk out with a new case.
	Mix with CLNC® moguls during two days of intense networking with over 1,200 CLNC® colleagues at 2 FREE breakfasts, 2 FREE luncheons and the FREE networking reception.
	Visit with me at the CLNC® Resource Center where you'll discover an array of inventive tools for your CLNC® business.
	Seize an extra year of NACLNC® membership benefits. Extend your unexpired CLNC® Certification and mentoring privileges FREE for one year.

You'll love the Texas-sized conference hotel:

• San Antonio Marriott Rivercenter
  101 Bowie Street
  San Antonio, TX 78205
  210.223.1000 • 800.648.4462

Move like a Maverick and Save – For Legal Nurse Consulting Ezine subscribers, your conference tuition is ONLY $600 through December 12, 2008. That's a $200.00 savings off the regular registration cost of $800.

Click the coupon below and SAVE $200.00!

Past conferences have SOLD OUT. Don't wait another minute. Enroll now. Click the coupon above, call 800.880.0944 or visit NACLNC.org today for your special website savings.

Remember, attending the NACLNC^® Conference automatically renews your unexpired CLNC^® Certification for one year. For complete NACLNC^® Conference details, travel information and our risk-free conference guarantee, click here. Follow the footsteps of a maverick to San Antonio!

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