CLNC® SUCCESS STORY
How I Survived Downsizing and Divorce to Triumph as a CLNC®
by Dale Barnes, RN, MSN, CLNC
Seven years ago, I was Director of Home Care, Home Infusion, Hospice and Lifeline Emergency Services at a well-known hospital, a prestigious job with excellent salary and benefits. The work was challenging and fun, and I really enjoyed my co-workers, both administrative colleagues and my staff. I had built a cohesive team, doubled my department's revenues, decreased costs and implemented many new systems. I was proud of becoming a business woman while remaining a nurse, and I was on a "high." However, the hospital hired a new CEO who had very different plans. My job was eliminated, and they hired a non-clinical business woman to run the department. She had no idea about the staff's nursing and clinical needs. Two years later, they realized their mistake and went back to hiring a clinical person for the position.
Meanwhile, I found another similar job as head of a department for all home-care related services. This job presented two major challenges: the department had no computer system, and the employees were unionized. Just as things began coming together, the hospital was sold to a large hospital corporation. Within two months, my department was closed, and all employees received severance packages and were sent on their way.
I was the victim of downsizing yet again. As if these career catastrophes weren't enough, four-and-a-half years ago, I got divorced for the second time.
What was I to do? Here I was, divorced, jobless, and not wanting to go through another downsizing episode. My severance package would not last forever, and being dependant on my ex-husband did not appeal to me.
For a long time I had been receiving flyers on Vickie Milazzo's legal nurse consulting course. It sounded interesting, but I hadn't had time to pursue it. Now I pulled out one of those flyers and called for more information – and felt I had found my answer.
Determination Paves the Way to Certification
Many years ago, I had owned my own home-care agencies. I liked being my own boss. I had good business sense and people skills, and I enjoyed a challenge. My original background was in oncology, then home health and hospice. I got my master's in psych and worked in that arena for a while. I also had the business/administrative background. I knew such an eclectic background would serve me well as a legal nurse consultant, but I needed to earn money while pursuing my training.
I called on a friend in the home health field, the nursing director of a home infusion company who used to work for me. He said he needed another field nurse, and I jumped at the chance, knowing that as a per diem employee I would have a lot of flexibility.
I ordered Vickie's course on video and went back to clinical field work. I loved working with the patients and could work as little or as much as I chose. I watched portions of the videos almost every day. I was sure I'd be able to finish the course, study and take the exam in six months. But life has a funny way of throwing us curve balls.
On my 50th birthday, I boasted that I did not feel 50. Nine years earlier I had an inoperable, nonmalignant brain tumor. Even though I had an annual MRI to insure the tumor had not moved or grown, I felt well and healthy. But two weeks after my 50th birthday I got very sick. I had some strange auto-immune symptoms and was left with no hearing in my right ear and unsteady balance. I was told that the 8th cranial nerve had been permanently destroyed, but that the problem was unrelated to my brain lesion. I was unable to ascertain from which direction noise or sound was coming. That problem remains with me, but I have learned to compensate.
The most annoying and frustrating result was that I couldn't read or watch videos for a few months. I felt a sense of urgency about completing the necessary work for my CLNC® certification. Finally, eleven months after receiving the program, I finished it and took the certification exam.
Where to Start?
Although I passed the exam, I was bewildered about where to go from there. But I was anxious to get started and decided to be a little aggressive. First, I contacted attorneys I knew, regardless of their specialty, and asked who they could introduce me to. My attorney friends were intrigued by what I was doing. Most of them had never heard of a legal nurse consultant!
I made phone calls every day. I put together a packet of information to send new contacts who expressed interest. My first case came from a friend who practices estate law. She had me go with her to a hospital to help her assess a terminal patient so she could write a bedside will. I addressed the client's competency to make decisions based on her condition, mental status and any medication effects. This case brought more referrals from the estate attorney.
Another friend who practices labor law had no work for me himself, but passed out my flyers at a meeting of plaintiff attorneys. First thing the next morning, I got a call from an attorney who had picked up a flyer. He desperately needed the services of someone like me and asked how soon I could come to see him. I was in his office within two hours. The case was a personal injury case related to a motor vehicle accident. This attorney became a good client and gave my name to several of his colleagues.
Interestingly enough, my attorney-clients had never known that legal nurse consultants existed. Most of them had either plodded through the medical records or hired physicians. Many of them wanted to know why I thought I could do a better job than they could. They believed that because they had been doing it for so many years themselves, they really understood the medical issues. Fortunately, I was able to show them that they did need me, and that using my expertise was more cost-effective than doing it themselves. A couple of my best clients said they wanted to use me on every medical-related case. This was a good break for me, but unfortunately, these clients were not getting dozens of such cases every week. So I continued to work my day job.
Growth Through Networking
I joined three different networking groups and attended meetings religiously. After a while other members get to know you, understand what you do, and become confident in giving you referrals. Most referrals from these groups came not from the attorneys in the group, but from attorneys other members knew and had me contact. I also started sending out an information newsletter every other month.
My efforts started paying off. Before I knew it, attorneys I did not know or contact myself were calling me. Attorneys for whom I worked were giving my name to other attorneys. I also gained three steady clients from my newsletters, a good response, given that my mailing was only going to about 400 attorneys at the time.
One of these steady clients is an attorney who specializes in dog bites and manages cases from coast to coast. I get an average of 10-12 cases per month from this attorney. Once I get all requested medical records for a case, I summarize them and provide the attorney an 1-2-page overview describing the injuries, treatment and possible future treatment. Some cases are simple; others are complex involving disfiguring injuries. I charge for my time tracking and reviewing the cases and writing the reports. This client provides me with steady income every single month, and the work is the easiest work I do. I have other steady clients, but their work is more complex. The combination is exciting and challenging.
Word of Mouth Keeps the Business Flowing During Relocation
Last year I moved from Los Angeles to San Diego. About six months before the move, I asked an attorney friend in L.A. if he knew any San Diego attorneys. He came up with several association lists of both plaintiff and defense attorneys. I made numerous phone calls and set up appointments with as many of these potential clients as I could. I always used my friend's name, stating that he had referred me and given me their number. Although he only knew a few of them personally, no one came right out and said they never heard of him.
From these contacts came a multitude of new clients. One attorney actually handed me medical records as I left his office after our first meeting. Another attorney asked me to speak to his firm about the services I could provide on bad faith insurance cases. Another contact referred me to his buddy in the San Diego City Attorney's office, who became a client.
Word of mouth was again a plus for me. As of this writing, I have lived in San Diego for three weeks. About 60% of my client base is still in L.A., and the other 40% is in San Diego. I have stressed to my Los Angeles clients that their cases will continue to receive the same quality service as when I lived in L.A. Fax machines, email and FedEx are wonderful.
Making the Leap into Full-Time LNC Practice
Despite these successes, until recently I continued to see home health patients for two agencies to earn "bread and butter" money. At last year's NACLNC conference, Vickie talked about taking that leap and letting go of secondary work in order to build your CLNC® practice into a full-time business. I really wanted to do this, but it was scary. Up to this point, I always knew I could supplement my CLNC® income with home health visits if the phone stopped ringing for a few days. In addition, my home health work gave me the clinical continuity to feel comfortable testifying about clinical issues.
After that conference I went home and told both home health agencies to call me only if they were really desperate for a nurse. Slowly, I weaned myself away and was able to tell them to take me off their rosters. When attorneys asked about testifying, I told them I would find them a clinically active nurse to testify. I explained that although I still testified to the findings of medical record reviews, I no longer testified to clinical issues. This too was a leap, as my rate for testifying is double my consulting rate. I felt like I was letting go of a lifeline, but I kept reminding myself that testifying to clinical issues was not the bulk of my business. Then I took the plunge anyway.
My San Diego client base has grown, and networking here has helped. I have already received inquiries and requests for service from attorneys who heard about me through other attorneys. Sometimes I am so overwhelmed with work that I cannot possibly complete it all in a timely manner. In such cases I subcontract with other nurses I know. I either write or review and approve any report that goes out of my office. When I have my subcontractors write a report, they use a format I give them. I have subcontracted with nurses to attend IME's and to testify within their area of expertise.
What my LNC practice has brought me is total freedom. I feel emancipated. I no longer need the home health visit income; I have more than surpassed that. I don't have any desire to go back to a clinical setting. At times I do miss the patient contact, but I often get quite involved with the attorneys' clients. Many of them call me to ask for medical resources or nursing advice. I feel like I have the best of all worlds. I am so happy Vickie encouraged me to step out of my comfort zone. I love what I am doing, I'm busy, challenged and financially secure, and I am so proud to be a Certified Legal Nurse ConsultantCM.
BEST PRACTICES FOR TECHNOLOGY
Internet Searching Tips
by Thomas M. Ziemba, BS, JD
Most of us use search engines every day as part of our work. Search engines include:
Indexes, such as Yahoo!
Directories, such as Dogpile
Metasearch engines, such as Infozoid
Even auction addicts use search engines at sites like eBay (or else you'd never find your limited edition boonie baby dolls).
Here are a few tips to help you use these powerful research tools more effectively:
Boolean Search Tips
Many search engines use Boolean language to conduct their searches. What or who "Boolean" is doesn't matter. What's important is learning how to do a proper Boolean search. When your search engine uses Boolean language, the following simple tips will make your search more effective:
Use the word "and" or a plus sign "+" between two or more words to narrow your search. Examples: Dyslexia AND adults, Dyslexia + adults — finds only items containing both these words.
Use the word "or" or a slash mark "/" to broaden your search. Examples: College OR university, cats / felines — finds items that include either word.
Use the word "not" or a minus sign "-" to indicate that a word shouldn't appear in your search results. Examples: Dolphins NOT NFL, Dolphins - NFL — eliminates entries where both these words appear.
Use the word "near" when words should be close to each other. Examples: Crosby near Stills, Silicon near Valley
Use quotation marks to specify an exact phrase you're looking for. Examples: new nursing jobs (no quotation marks) gave 317,000 returns on google.com but "new nursing jobs" gave only 47 returns (and they're all filled).
If you don't know what type of language your search engine uses or you want a short-cut, look for a drop-down menu or button that gives you options such as:
– All words — finds pages that contain every one of the words in the search box.
– Any of the words — finds pages that contain any of the words in the search box.
– Exact phrase — finds only pages that contain the exact phrase in the search box.
Know Where to Look
Many search engines only search their own listings or the directories they've created. Some search engines, such as Yahoo!, allow you to look at results from certain other search engines. These searches are run simultaneously and often appear near the bottom of the results list.
If you still can't find what you need, try a metasearch engine instead of a traditional search engine. Metasearch engines search several search engines simultaneously. Good metasearch engines like the following often return a broader range of information and give you more options when searching:
Finally, if you are researching a highly specialized topic, use a specialized search engine that concentrates on the area of interest. Two of the best examples search for US government information:
