1 Feasibility Study for Hill Country Legal Nurse Consultants Re: Nancie Girgente Feld, LNC
2 TABLE OF CONTENTS I. Introduction 3 What is a Legal Nurse Consultant? 3 How to become an LNC 4 An education at what cost? 6 II. The decision to return to college 6 Nancie s background 6 Which college to attend 7 Narrowing down the search 7 III. Jacksonville University 8 Jacksonville University s RN to BSN program 8 How long will it take? 8 A matter of time 8 The monetary cost of returning to college 9 IV. LNC jobs 9 Job sampling 9 Salaries 10 Contract vs. Full-time 10 Competitive job market 11 V. Conclusion 12 VI. Bibliography 13
3 I. INTRODUCTION This feasibility study, for which permission was requested by a memo dated March 3, 2004 and permission was authorized by on March 4, 2004 by Nancie Girgente Feld, owner of Hill Country Medical-Legal Nurse Consultants will study the cost-effectiveness of sending said owner, a Registered Nurse (RN) and Certified Legal Nurse Consultant (CLNC), back to college to obtain her Bachelor of Science degree in Nursing. We live in an ever-changing society; certainly one in which the medical field is constantly adapting to new approaches and philosophies to its needs. Nursing is quite different than it was in the mid-70s when many diploma nurses became certified as Registered Nurses (RN). Throughout the 1980s and 1990s, obtaining a Bachelor of Science degree in Nursing (BSN) became more popular for students interested in the medical field. This path led to more research opportunities and focused a great deal on the managerial side of nursing. 1 What is a Legal Nurse Consultant? A relatively new field, Legal Nursing is emerging as one of the most popular outlets for nurses who are interested in the legal aspects of nursing. By definition, a legal nurse consultant is an individual with expertise in both nursing and law. This specially trained nurse assists those involved in the litigation process by acting as a bridge between the worlds of law and medicine. 2 For the purposes of this study, I am defining a Legal Nurse Consultant (LNC) as a RN or BSN working as a Legal Nurse in-house for a law firm or a RN or BSN who owns their own consulting business and has worked on cases as a Legal Nurse for monetary compensation within the past year. Though there are two types of Legal Nurse certifications, it is irrelevant for the purposes of this study. LNCs work primarily with attorneys, insurance companies, government agencies and the court system. They are also employed by healthcare facilities to provide risk prevention and management services. You would hire an LNC when you require a professional to conduct a thorough analysis of medical records, provide in-depth research of relevant medical information, review cases for merit, and provide additional services, enabling attorneys to focus on the legal aspects of the case. 3 Attorneys utilize the services of LNCs to work on malpractice cases and save money by providing the same case review as a physician. A nurse s review may even be a better source because they know the medical record inside and out. A 1 Domrose, Kathy. The RN Route. Nurseweek. Dec. 2001: Quoted by Pat Iyer, interview. 27 March Williams, Scott. Legal Eagles: Nurse lawyers make a case for RNs to apply their Medical knowledge to the legal field. Nurseweek. Feb. 2002:
4 LNC s case reviews and reports may focus on areas in which physicians do not normally take an active role. The physician is unaware of daily nursing issues; and, therefore, may miss critical facts or omissions within the medical record. 4 The physician works with particular aspects of the medical record only. There are so many specialties focusing on narrow aspects of the medical care. A nurse, who reviews the entire chart and coordinates care, acting as a liaison between the multi-disciplinary teams, is much more qualified and suited for this type of work. 5 How to become an LNC According to its Web site, The American Association of Legal Nurse Consultants (AALNC) sets informal rules for its members when it comes to this specialized Nursing field. To become a certified member of the AALNC, one must be at least a RN. 6 Some of the more sought after LNC positions, however, are beginning to require a minimum of a BSN, litigation experience as well as extensive clinical experience. 7 Legal Nurses fall into two different categories: Certified Legal Nurse Consultants (CLNC) and Legal Nurse Consultant Certified (LNCC). The difference between the two types of Legal Nurses is simple. A CLNC refers specifically to those who have taken a test. Vickie Milazzo, one of the industries pioneers of Legal Nurse Consulting, holds six-day seminars country-wide with a certification test on the sixth day. Nurses become a Certified Legal Nurse Consultant (CLNC) when they pass this test. Upon becoming certified, they may not have any experience in the field, as experience is not a requirement for this type of certification. 8 An LNCC is a certification given by the American Association of Legal Nurse Consultants (AALNC.) 9 To be eligible for this certification, one must be a licensed RN in the state they are practicing in, have a minimum of five years experience as a RN and produce evidence of 2,000 hours of Legal Nurse Consulting experience within the past three years. 10 Researchers and Legal Nursing experts alike are excited with the soaring popularity of nursing s new realm, but only state that a BSN is not required, leaving Legal Nurses clueless as to whether having a BSN will really make a difference when it comes to job openings and salary negotiations. 11 Vickie Milazzo s program, focuses on the great fusion of medicine and justice, two of 4 Frequently Asked Questions. Hill Country Medical-Legal Nurse Consultants. 15 March Quoted by Nancie Girgente Feld, Personal interview. 22 March Frequently Asked Questions. Certified Legal Nurse Consultants. 23 March Cambridge Professional Group. Monster.com. 24 March Spring, Nicole Marie. interview. 6 April Frequently Asked Questions. Med League Support Services, Inc. 27 March Becoming an LNC. The American Association of Legal Nurse Consultants. 25 March Barnes, Cindy. LNC Spotlight: Our Time Has Come. LNC Resource. (Dec ) 24 March 2004.
5 the world s most powerful professional fields, but fails to mention whether BSNs, with their greater administrative and managerial education, are better suited for legal nursing. Another professional organization, AALNC, mentions even that certification is not necessary for those nurses who choose to practice without it and Vickie Milazzo s marketing strategy is that you don t need a BSN at all. 12 Without clear statistics and studies performed RN, LNCs have no information to base their possible return to college on. Opinions differ greatly when it comes to whether or not one needs to be a BSN to operate successfully as an LNC. A poll taken from a large, national LNC group suggests a bias. Those LNCs who are older, more experience, graduated from a diploma program and thus, do not have a BSN, seem to think a Bachelor s degree is not as important the clinical experience. Younger, less experienced nurses that obtained their BSN disagree and claim the more education you have in the field of nursing, the better Legal Nurse you will be, regardless of clinical experience. In Texas, the numbers of RNs operating span a variety of different degrees. From diploma nurses to those with a PhD, the 161,719 nurses licensed and practicing in Texas have opposing views on the importance of higher education beyond that of the RN diploma program. 13 In Texas, the percentage of nurses with a minimum of a BSN is more than double the percentage of diploma RNs. 12 Becoming an LNC. The American Association of Legal Nurse Consultants. 25 March Statistical Information. The Texas Board of Nurse Examiners. 7 April 2004.
6 An education at what cost? In researching University programs, including Jacksonville University, which has a specialized online RN to BSN program, cost must be a factor to consider. In addition, how much time will be required per week for studies? For the average adult non-traditional student, after a full-time job and raising a family, is there time leftover at the end of the week to complete these studies? Realistically, will returning to college after more than 25 years to receive a BSN improve the salary expectations and job prospects of a working RN, CLNC? In essence, this study has two main purposes: to study the cost-effectiveness of an established RN, CLNC returning to college to obtain her BSN and to pioneer other studies, reports and articles on this topic. In the sections that follow, I will examine the cost, in terms of monetary and time of a RN, LNC returning to college as well as sampling different LNC positions throughout the country, their pay scale and requirements for their initial hire. I will conclude with a recommendation that professional organizations, certification programs and other LNC interest groups publish statistics of the number of certified LNCs that operate with and without their BSN, and the approximate positions available that require at least a BSN, in addition to studying the cost-effectiveness in this particular case. Though lack of previous study on the subject makes my findings less conclusive, I hope professional organizations will follow suit by performing further investigations and research on the subject. II. The decision to return to college Nancie s background Nancie Girgente Feld began her nursing career after graduating from Bayonne Hospital s Nursing School program in 1977 in Bayonne, NJ. At the time three year diploma programs were more prevalent and nurses received more experience on the floor. Like many old fashioned Italian parents, Nancie s parents refused to allow her to attend a more traditional college, as it was not for women within their culture. 14 Over the course of the three years in nursing school, Nancie accumulated many clinical hours or, hands-on training sessions required of nurses at the time, but a mere 18 transferable credit hours. A major professional stumbling block for Nancie over her 27 years as a RN, she made the decision to research returning 14 Nancie Girgente Feld. Personal interview. 22 March 2004
7 to college to obtain her BSN, though she remains unaware of the costeffectiveness of this maneuver, especially at the age of I have always felt professionally unequal in so far as my being in a lower stature than degreed nurses, she said in a recent interview. 16 Nancie s current position as a legal nurse at Fulbright & Jaworski, L.L.P. in Austin is temporary contract work because she does not have her BSN yet. Fulbright & Jaworski currently employs three in-house LNCs with approximately 50 additional working temporary on contract. Nancie s lack of degree currently prevents her from being hired on full-time. 17 Which college to attend For any non-traditional student deciding to return to school is a major decision. Once the decision is made, the next logical question is where to go. While researching Universities, Nancie used the following criteria to narrow her search: convenience, accreditation, cost and additional credits awarded for RN license and 27 years of nursing practice. Narrowing down the search Using these criteria, Nancie narrowed her search down to the University of Phoenix, Columbia Southern University, Kaplan College, St. Edwards University and Jacksonville University. Deciding that she wanted her full curriculum available online, one school, St. Edwards University, was knocked out of the running. While St. Edwards University offers more than a handful of classes online, it was far from a fully functioning distance learning center. In addition, it offered only a Bachelor s degree in Health Care Management. 18 Only four colleges remained as she further researched each campus. Columbia Southern University, she later discovered was not accredited by the same board as most colleges, so it was crossed off the list. 19 Price, of course is a heavy deciding factor and with the University of Phoenix s $440 per credit hour cost, it was also removed from the list. 20 After months of research, Nancie decided on Jacksonville University because of its more modest cost and easily understandable 15 Nancie Girgente Feld, Personal interview. 22 March Quoted by Nancie Girgente Feld. Personal interview. 22 March Bauer, Kathy. interview. 24 March Academic Programs. St. Edward s University. 24 March Bachelor of Science in Health Care Administration. Columbia Southern University. 23 March RN to Bachelor of Science in Nursing. University of Phoenix. 23 March 2004.
8 RN to BSN program. The program she chose offered her a transfer of 32 credit hours for earning her RN and an additional 45 credit hours for relevant coursework previously completed while in nursing school. 21 This would leave her a mere 52 credit hours shy of graduating. III. Jacksonville University Jacksonville University s RN to BSN program Jacksonville University offers a two-year RN to BSN program for nurses looking for a convenient way to update their skills and knowledge while advancing their nursing career and earning potential. Jacksonville University s School of Nursing offers one of the top online RN to BSN programs in the nation, allowing nurses to gain the credentials that will allow them to practice in all healthcare environments and will give them the greatest employment flexibility in your nursing career - without ever stepping foot on a college campus. 22 The distance education focused program, in essence, brings the classroom to the student through multimedia lectures. Students can attend class anytime, anywhere, 24 hours a day-seven days a week. No classroom attendance is required. According to a January 2001 survey sponsored by the Florida Hospital Association on Nursing Opinions on Solving the Nursing Shortage, RNs need: "flexible educational programs for advanced degrees, and improved access for associate and diploma nurses to obtain a BSN degree. Jacksonville University has designed a specific program to offer RNs an opportunity to complete their education while managing work and family responsibilities. 23 How long will it take? It is estimated by Jacksonville University advisor, Devon Turner that it will take Nancie approximately two years to complete the 52 credit hours required to obtain her BSN. Semesters last approximately 8-10 weeks with six semesters per year. The RN to BSN program offers the flexibility of taking semesters off if necessary for any reason. Over the course of two years, Nancie will enroll in two courses per semester, the maximum that may be taken in the RN to BSN program at Jacksonville University. A matter of time The time it will take to complete the degree is not the only factor to consider. Each course will take hours of study every night to complete successfully. Estimate that for each hour of time you spend in class, you will spend two hours 21 Nancie Girgente Feld. Personal interview. 22 March Nursing. Jacksonville University. 23 March Nursing. Jacksonville University. 23 March 2004.
9 outside of class. Despite the fact that this is online distance learning, you must still plan for online lectures, independent studying and note taking. Estimate that for each online course you will spend four hours of study time per week. Under normal circumstances this is already eight hours per week, if you are taking two classes, you will need to spend studying and learning material. 24 As a non-traditional student with a family and full-time job, Nancie s schedule would be extremely tight, leaving very little time for leisure. She is gone 10 hours per day for work including travel time, after which she must come home, take care of her family, and tend to household duties and study. Estimating that work is the first 10 hours of her day with dinner and family time for another two hours; will the last few hours of her day realistically be spent studying? Will a packed schedule each day cause burnout or lower performance levels in school? The monetary cost of returning to college Jacksonville University s RN to BSN program costs approximately $365 per credit hour, plus books, which are approximately $225 per semester for two classes. Over the two-year period it is estimated to take Nancie to finish her BSN, with approximately 52 credit hours left to complete, she can expect her tuition and book feeds to exceed $21,500. This figure estimated the cost over the two year period, assuming she never repeats any courses and finishes on time. IV. LNC jobs Job sampling Of a two-month sampling of LNC jobs throughout the U.S. on Monster.com, the total number of posted LNC jobs numbered a mere 14. Of those, 5 required a BSN and 9 did not. 25 One job advertisement at The Cambridge Group, requires not only a BSN, but also previous defense experience at a law firm, litigation experience, extensive clinical experience and a stable work history. The position, with its staunch requirements pays only $31 per hour. 24 Time Scheduling. Virginia Tech Division of Student Affairs. 29 March Legal Nurse. Monster.com. 4 April 2004.
10 Salaries Though many websites claim you can make up to $100 per hour doing Legal Nurse Consulting work, most LNC salaries were around $20-40 per hour. Nancie s current salary is $30 per hour, with no benefits and occasional overtime. If hired on as a permanent employee, she would gain benefits; however her salary would drop to approximately $23 per hour, with optional overtime. Of nine practicing RN, LNCs polled, none said they thought they would make more money if they had at least a BSN, citing experience as a selling point when it came to asking for raises and negotiating pay rates. Contract vs. Full-time Of course, not every LNC has to work in-house at a law firm. Some nurses choose to perform consulting work while running their own business. However, this is no easy venture. Beginning an independent practice is difficult and time consuming. Do not quit your day job thinking lawyers are just waiting for someone like you to come their way and that they will just throw money at you because you re a RN, advises a seasoned LNC. 26 If you do, you will be bankrupt in no time. Understand that consulting is one of the best businesses to be in, but that it is also one of the hardest and slowest businesses to start. Expect to work as a nurse in a hospital for at least a year while building your practice. In Nancie s 26 Beginning LNCs. Allnurses.com. 29 March 2004.
11 case, though she is only a temporary employee at Fulbright & Jaworski, LLP, she makes approximately $7 more per hour than she would if hired on full-time. Competitive job market As more law firms begin to search for degreed and certified LNCs, the job market becomes more competitive. When 50 LNCs apply for a position, attorneys will skim the without BSNs off the top to narrow their search for the perfect LNC. The equation seems simple, without a degree, less work will come your way. As per usual, money also plays a big part in many nurses willingness to return to school. In addition, many LNCs, felt a BSN was a necessity to get the respect needed in the industry. It [a BSN] is a requirement for our firm. I would estimate than 99 percent of LNCs have their Bachelor s degree, Kathy Bauer of Fulbright & Jaworski. L.L.P said. 27 Some practicing LNCs disagreed, as did Robin Heller, a RN, who responded a resounding absolutely not, when asked if she thought BSN would increase the amount of work available to LNCs or increase the salary cap. If I were looking to hire an LNC, clinical experience would pave the way, not her education. It s what you have done with your education that counts, she said. 28 Another nurse, Lisa Cuipers, added that in her three and a half years as a practicing LNC. She has never been asked about her education. 29 Of 20 practicing LNCs polled, eleven have a minimum of a BSN, some with degrees exceeding that. Nine of those have only a RN. Only four out of the nine non-degreed nurses said they thought that more jobs would be available to them if they had at least a BSN. 27 Quoted by Kathy Bauer. interview. 24 March Quoted by Robin Heller. interview. 4 April Cuipers, Lisa. interview. 5 April 2004.
12 V. Conclusion Based on my findings, it would not be cost-effective for a RN, LNC to return to college to obtain a BSN. There are several reasons for this finding, the first being money. With the cost of Nancie completing her BSN hovering around $21,500, she would have to expect to make that money back over the next fifteen years, until the estimated age of retirement at 65. After the estimated two years it would take to obtain her BSN, 13 years would be left to make back the approximately $21,500 she would be putting into school. With Nancie s current employer, though she would be offered benefits, she would be taking a $7 per hour pay cut to be hired on as a full-time employee, making it difficult to make back the $21,500 she put into college. It is impossible to measure the cost of time. However, by needing to spend approximately eight hours per week studying, averaging two hours per night, she would spend a total of 12 hours per day between work and college, leaving an unreasonably little amount of time for family, housework and leisure. In addition, of the nine LNCs polled, none thought they would make more money if they had a BSN and only four thought that more jobs would be available to them with the degree. My findings are less than conclusive because of the lack of published information on Legal Nursing in terms of degree necessity, but based on information gathered for this study, it would not be cost-effective.
13 VI. Bibliography Academic Programs. St. Edward s University. 23 March < Albee, Tracey. interview. 6 April Beginning LNCs. Allnurses.com. 29 March < Anderson, Charlene. interview. 29 March Bachelor of Science in Health Care Administration. Columbia Southern University. 23 March <http://www.colsouth.edu/distance_learning/college_degree/ health_administration.html> Barnes, Cindy. interview. 23 March Barnes, Cindy. LNC Spotlight: Our Time Has Come. LNC Resource. (Dec ) 24 March <http://www.lncresource.com/story.asp?contentid=7986> Bauer, Kathy. interview. 24 March Becoming an LNC. The American Association of Legal Nurse Consultants. 25 March Condon, Kathie. interview. 5 April Cuipers, Lisa. interview. 5 April Domrose, Kathy. The RN Route. Nurseweek. Dec. 2001: Eberhart, Kathie. interview. 5 April Feld, Nancie Girgente. Personal interview. 22 March Frequently Asked Questions. Certified Legal Nurse Consultants. 23 March <http://www.certifiedlegalnurseconsultants.com/faq/faq_01.html#q5> Frequently Asked Questions. Med League Support Services, Inc. 27 March Fyler, Patricia. interview. 4 April 2004.
14 Graham, Heather. Personal interview. 25 March Hartwig, Carol. Telephone interview. 4 April Heller, Robin. interview. 4 April Iyer, Pat. interview. 27 March Johnson, Cindy. interview. 4 April Legal Nurse Consultant. Monster.com. 24 March < Maag, Cyndi. interview. 4 April Moorehouse, Linda. interview. 23 March Mullin, Barbara. interview. 7 April Nursing. Jacksonville University. 23 March < O Connell, Debra. Telephone interview. 26 March Oliveria, Leslie. interview. 12 April Online Programs. Kaplan College Online. 23 March <http://www.kaplancollege.com/kco/programs/pl/default.aspx? GUID=280396EF8DE740D89D1D8819D073D > Pate, Joan. interview. 5 April Pfutze, Mary Jane. interview. 6 April Prerequisites to getting started as a Legal Nurse Consultant. Certified Legal Nurse Consultants. 23 March < Pritts, Debbie. interview. 7 April RN to Bachelor of Science in Nursing. University of Phoenix. 23 March < Spring, Nicole Marie. interview. 6 April 2004.
15 Statistical Information. The Texas Board of Nurse Examiners. 7 April < Time Scheduling. Virginia Tech Division of Student Affairs. 29 March < Turner, Devon. interview. 25 March Turner, Vickie. interview. 4 April Turissi, Julia. interview. 6 April Williams, Scott. Legal Eagles: Nurse lawyers make a case for RNs to apply their Medical knowledge to the legal field. Nurseweek. Feb. 2002: Woodworth, Cristal. interview. 12 April 2004.