5 Qualities of a MSICU RN which make a great Legal Nurse Consultant
ICU nursing, like most specialties, is a world of its own. Before even beginning to break down the different types of ICU nursing, lets focus on Medical-Surgical ICU (MSICU) nursing. After obtaining long term acute care experience I was easily able to find a RN job in the MSICU. Transitioning from the LTACH to the ICU was a dream come true, and I was ready to learn everything.
Working in the ICU comes with many challenges. Nurses are taking care of patients in the most critical condition. In a medical surgical ICU, there are a broad range of diseases (medical) and post-op surgeries (surgical) that we care for. Each MSICU experience can vary depending on the hospital capabilities, specialists, and policies. During my first two years in the MSICU we cared for patients with sepsis/septic shock, diabetic keto acidosis and/or coma, respiratory failure (varying reasons/conditions), pulmonary embolism, non-surgical strokes requiring alteplase (TPA), lung resection surgeries, post non-interventional cardiac events, post MI requiring induced hypothermia, gastrointestinal infections and surgeries, kidney/urinary tract infections and surgeries, overdoses, withdraws, and more.
So, how does being an ICU RN make a great Legal Nurse Consultant?
1. Deep knowledge & understanding of anatomy, physiology, disease process, . standard of care, and more.
2. Detail Oriented
3. Ability to prioritize & multitask
4. Effective communicator & educator
5. Medical Record Experts
Knowledge is Power
Critical care nurses are educated and trained to understand complex medical conditions so we can critically think when it comes to a client’s care. It is truly impossible to summarize the amount of knowledge an experienced ICU nurse has, from the basics of anatomy and physiology, pathophysiology, pharmacology and more -- to treating conditions like septic shock or diabetic keto acidosis, which are complex disease processes with many moving parts in care delivered. Furthermore, ICU nurses understand the complexity of each patient, some pressure wounds are entirely preventable, some pressure wounds are unavoidable no matter what the nursing staff does or doesn’t do. An ICU nurse can help an attorney differentiate and identify a break down or lack of break down in a client’s care.
Attention to detail matters
Caring for critically ill clients means paying attention to all the details and looking at the whole picture. The smallest of change in a patient condition will catch an ICU RNs attention, as will the tiniest detail in a medical record. While an ICU nurse is providing basic care, we are also monitoring the patient for changes, while also monitoring their heart rate and rhythm, while also monitoring multiple drips of highly concentrated medications, each serving a special purpose and another thing to monitor. For example, if I am running a heparin or alteplase drip I am monitoring for bleeding, if I am running a vasoactive drip, I am monitoring heart rate, blood pressure, and circulation, if I am running a sedative drip I am monitoring sedation and pain levels, and so on. Because ICU nurses must be so detail oriented it is easy for us to transition this skill into medical malpractice and personal injury cases. ICU nurses will pick up on the most miniscule detail that may be easily overlooked by someone who is unaware. An ICU RN can easily narrow focus on the injury at hand, then look for causation issues, ignoring all the distractions and evidence not related to the injury along the way.
Master of Multitasking & Prioritization
Providing patient care, assessing, evaluating risks, delivering, and titrating medications, communicating with the multidisciplinary team, communicating with the client and family -- nurses are literally trained to be multitaskers. With a superior ability to multitask we are also trained to master prioritization, having clients in as sick of condition as they are under our care, it is pertinent that we know what to address and when. Often vital signs in the ICU are going to be abnormal, just because a nurse did not notify the provider does not mean they are necessarily working outside of the standard of care. Often in the ICU we will have protocols, if the BP gets to this try this, if this doesn’t work do that, then notify if both interventions don’t work. I have seen it multiple times where an attorney tells me the nurse should have notified the MD right away, what does that mean? Was there a nurse communication to do something differently? Did the nurse make a notation that the MD would like to be notified when XXX? An ICU RN has mastered multitasking and prioritization, which is a skill that is more than helpful as a Legal Nurse Consultant. By transitioning these skills, a Legal Nurse can effectively work on the many moving parts of a case, or multiple cases, and we know what needs to be prioritized!
Effective Communicator & Educator
Nurses are trained to deliver complex pertinent information, not only to the rest of the healthcare team, but also to clients and their families -- nurses are educators. When discussing a client with a fellow nurse or MD we know they understand the medical lingo. However, when discussing care with a client we are trained to explain things at their level, no big medical words, in ways they can understand. This means that nurses can easily understand and translate complex medical issues to those who don’t understand or work in healthcare. This skill benefits an attorney because we can assist them in understanding their client’s medical story without the hefty expert fees. Attorneys are very smart, and you often easily understand the medical picture, this can be difficult to breakdown to a level that a client or jury can understand. No need to fret, because LNC’s can help attorney’s breakdown complex medical conditions in a way their client or a jury can easily understand.
Medical Record Expert
ICU nurses know where to find it all when it comes to medical records. Knowing that ICU nurses are so detailed oriented it is easy to understand that an ICU nurse will know how to find it all, or find a way, because we always have. One of the first things I learned as an ICU RN was to evaluate my client’s chart as soon as possible after morning report. Most ICU nurses will find the time to review past nurses charting, the last progress note, recent studies and radiology reports, lab work, and more. This ensures everything was handed off in report, that we know what is going on with our client, what the plan is, and what the MD’s assessment and plan is. Sometimes we even investigate social work or care coordinator notes if there is something about this client that triggers us to do so. Furthermore, nurses know how to easily interpret MD orders, plus ICU nurses know how to input nursing orders, or orders on behalf of MD’s, we call these verbal or telephone orders. Additionally, we know what components make those orders legitimate. In the hospital setting, nurses have the most general overview of the patient, particularly ICU nurses, because we want all the dirty little details, just like we do when reviewing a medical record for a case. ICU nurses are more than prepared for medical record reviews because we have been training to help attorneys without even knowing it, our medical record reviews are beyond efficient.
ICU nurses obtain a large set of skills which easily translate into Legal Nurse Consulting Work. A gem that medical malpractice and personal injury lawyers can use largely to their advantage with minimal risk or commitment. Particularly when utilizing us as a behind the scenes expert because this will give you, the attorney, an opportunity to learn all the pertinent information long before an expert witness is hired. Having this information earlier in your case can provide you with the ability to be more prepared, and who doesn’t want that?
5 Qualities of a MSICU RN which make a great Legal Nurse Consultant
1. Knowledgeable
2. Detail oriented
3. Excellent at Prioritizing & Multitasking
4. Effective Communicator & Educator
5. Medical Record Master
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