Nurse Paralegals: A Registered Nursing Career for Paralegals

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It would be hard to identify two fields that are more complex in their own right than nursing and law. Both careers require years of preparation and training to become minimally proficient, and both come with unexpected challenges everyday.

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The fact that some people choose to become both is somewhat amazing.

Nurse paralegals are a unique breed, highly sought-after for their ability to provide expert evaluation and analysis at the complicated intersection between law and medicine. Their dual-role expert knowledge is vital to legal cases concerning:

  • Insurance claims processing
  • Medical malpractice lawsuits
  • Personal injury lawsuits
  • Worker’s compensation claims

Nurse paralegals essentially serve as translators between the medical and legal communities.

Taking medical terminology and turning it into understandable English is a skill in and of itself. Nurse paralegals do this when they help explain medical concepts to laypersons, whether a judge or an entire jury. And in other scenarios, they turn the skill around and use their legal training to help doctors and nurses comply with the laws that pertain to their practices and the procedures they perform.

Becoming a nurse paralegal means trading in the stethoscope for paperwork. The position is a desk job without any clinical component. You can expect to spend most of your time reviewing medical records, case files, various studies and insurance documents.

This can offer a nice change of pace and a fresh challenge for any RN who feels that direct patient care has become a little too routine. There is always a new case waiting around the corner for a nurse paralegal.

In High-stakes Malpractice Cases, Nurse Paralegals Are In-demand

Nurse paralegals are must-have employees for law firms working on both sides of medical malpractice cases. Although lawyers may specialize in either malpractice defense or the plaintiff’s side, they rarely pick up an in-depth understanding of the medical issues involved in a complicated case. They may rely on expert witnesses to establish facts in court, but evaluating those experts and determining what medical facts are also legally significant requires someone who has a solid understanding of both healthcare and the law.

Some malpractice firms focus even further on particular medical specialties… hernia cases, for example. A nurse paralegal on staff at one of these firms is expected to not only have the legal training and education to assist lawyers as they prepare cases, but also the medical education to evaluate expert witness candidates, review medical records for merit, and explain standard medical procedures that may have been performed improperly.

Of course, nurse paralegals also have to take care of all the usual paralegal business when working malpractice cases. This means they are often responsible for:

  • Interviewing witnesses and assisting in depositions
  • Compiling and organizing case documentation
  • Creating exhibits and other visual aids for trial
  • Scheduling and keeping a case chronology
  • Meeting filing deadlines and other important deadlines

Keeping Cases Out of Court, Nurse Paralegals Administer Claims Questions

Outside of litigation, many nurse paralegals find themselves working as claims analysts for insurers. Insurance is largely a numbers game and insurance executives don’t necessarily know a great deal about the treatments or diseases their policies cover. When questions come up about the details of coverage for a particular condition or treatment, a nurse paralegal is likely to be the one reviewing the facts and making the call.

Paralegals working for insurance firms might have to write and serve subpoenas for medical records, using their specialized knowledge to manage the discovery process in an era of heightened concern about keeping medical records private and secure.

Whether working for hospitals or insurance companies, nurse paralegals are also the tip of the spear when it comes to ensuring organizational compliance with the HIPAA (Health Insurance Portability and Accountability Act) regulations that govern medical records privacy. They might even be responsible for helping healthcare providers and insurers create processes and policies designed to protect patient privacy, running the programs that provide oversight for HIPAA compliance.

2016 was a record year for fines, with 13 enforcement violations totaling more than $23 million. Most of the incidents could have been prevented, or at least mitigated, if an experienced legal professional had been there to put policies and procedures in place for those organizations.

In one case, for example, a hospital allowed surgical schedules containing the private information of more than 800 patients to get out. Despite recognizing the violation, understanding the requirements for addressing it, and having the capacity to make the necessary notifications, the provider dithered for more than 100 days and earned themselves a $475,000 fine.

What it Takes to Become a Nurse Paralegal

In most cases, nurse paralegals get their start as registered nurses, entering the field of nursing with little or no thought about how their careers might one day intersect with the field of law.

Most accumulate quite a bit of experience in the field before starting to consider where they could go with their careers by getting some legal training. This is the point at which RNs are faced with a decision: enter a paralegal program, or become a legal nurse consultant?

The Difference Between a Nurse Paralegal and a Legal Nurse Consultant

LNCs are not necessarily paralegals and nurses who are paralegals do not always have an LNC, but there is some overlap between the two.

Legal nurse consultants are usually contracted to offer their expertise as a resource for lawyers or organizations that have questions about medical standards or conditions that may relate to the kinds of cases they work on. They often work freelance and provide expert witness testimony based on their medical experience. Their legal experience, however, is largely accumulated on-the-job, without any formal training.

Nurse paralegals have a more extensive legal education and can function as a more integral part of a law firm or corporate legal team. While their knowledge of healthcare and health conditions is comparable with that of LNCs, as legal experts they work more closely with lawyers and provide assistance that goes beyond just consultation. They are capable of undertaking independent work on cases that involve both medical and legal questions.

Critically, LNCs who are certified must continue to maintain their RN license and stay active in the nursing field. Nurse paralegals, on the other hand, are not obligated to continue nursing, and may focus their careers almost entirely on the law.

It is certainly possible for an LNC to become a paralegal and for a nurse paralegal to provide the same degree of medical support and information as an LNC, but the American Association of Legal Nurse Consultants (AALNC), the certifying body for LNCs, considers paralegal training as distinct and unrelated to LNC work.

The American Bar Association, on the other hand, considers most LNC courses on par with paralegal programs under their guidelines for approved paralegal education.

Certification for Legal Nurse Consultants

The American Legal Nurse Consultant Certification Board offers the only nurse consultant certification (LNCC) accredited by the American Board of Nurse Specialties. To become eligible to sit for the LNCC exam, candidates must have:

  • A current license as an RN
  • A minimum of 5 years’ experience practicing as an RN
  • At least 2,000 hours of legal nurse consulting experience within the past 5 years.

LNCs must show evidence of at least 60 contact hours every 5 years to qualify for certification renewal. Contact hours may include continuing education, presentation information, academic education information, and publication information.

If you do not opt for an LNC course, you may, of course, select a regular paralegal program to attend for your legal training. Your nursing skills will come into play after graduation as employers consider your background in healthcare as an adjunct to the paralegal training.

Many employers, however, are comfortable hiring LNCs to fill paralegal positions. The decision will be made on a case by case basis and likely reflect the quality and degree of legal training you have had.

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