FROM THE EDITOR
Dive Deep — Your Success Is Only One Breath Away
by Vickie L. Milazzo, RN, MSN, JD
In the IMAX® film, "Ocean Men," two deep divers strive to break the depth record for diving and returning to the surface on a single breath. Imagine taking one huge breath and plunging hundreds of feet into the ocean — so deep you need a light to see where you're going — and returning to the surface safely. Never mind diving, just try holding your breath for 8 minutes! That's what these divers do when they set their seemingly impossible records. Yet these remarkable achievements have much in common with what we must do to excel as CLNC®s.
The first diver featured in the film is a constant-weight diver who uses only a pair of fins to propel himself down along a guide line to his target depth. He has no artificial help, but is entirely dependent upon his own strength. The constant-weight diver must swim incredibly hard while using minimal oxygen and exertion. Yet he looks like a dancer in the ocean, each movement graceful and fluid. In fact, he trains with dolphins to improve his fluidity. No energy is wasted; every bit goes into pushing toward his goal, a record-breaking 262 feet.
The second diver is known as a "no limits" diver because he rides a weighted sled rapidly down the guide line to the selected depth. He then releases himself from the sled and, using balloons to speed his ascent, returns to the surface. At maximum depth, the sled diver's heart rate slows to 14 bpm. To conserve oxygen, the blood in his arms and legs squeezes into the center of his body. Water pressure compresses his lungs to the size of oranges. As he ascends and the pressure decreases, he must constantly release air from his lungs to keep them from rupturing. Not surprisingly, this aggressive diver trains by swimming with sharks in order to set the sled-diving record of 531 feet. This is deeper than any human has ever gone on a single breath of air.
To survive these extremes and break records, each diver must push himself on deeper and deeper training dives. For a dive lasting mere minutes, the divers endure 10 months of training. They must run, lift weights, diet, practice holding their breath and achieve startling levels of concentration. As one diver says, "The first challenge is convincing my body that oxygen is unnecessary."
Each day the divers challenge themselves to improve upon their prior efforts. As they train, they discover small but impactful ways to push that one breath even further than before.
Embrace the Deep Diving Challenge
It is amazing that deep divers survive, yet continue to explore and test the limits of human possibility. Like these ocean men, we must prepare to dive deep into our businesses. We must constantly train and educate ourselves, not just to dive deeper but to dive more effectively. Without training, the divers and we as CLNC®s would not be able to advance to deeper and deeper depths.
Here are some additional business lessons these amazing deep divers teach us.
Dive deeper every day. My company has grown every year for the past 20 years, and I attribute this growth to diving deep. Each year we add new layers, new depth, to our business. We add more powerful and effective marketing programs, new products and improved benefits for our students and CLNC®s. We make sure we are cost-effective, working effectively, ie. smarter, not harder. We constantly ask ourselves if there's a better way to do what we are doing. As a result, we can dive deeper and stronger.
Take the plunge and do what it takes to succeed. The divers must set aside a big portion of their lives for training, planning, preparation and execution. They must practice their skills over and over until they become automatic. As CLNC®s, you must also be willing to set aside the time necessary for training until your CLNC® skills become a deeply ingrained part of you. Then you must devote the time and energy necessary to use those skills in growing your business.
Perfect your instinctive expertise. At each stage of a dive, a free diver must know exactly what to do. Being able to take the correct action instinctively without consciously thinking can make the difference between survival and drowning. The diver must learn not to panic, but to act proactively, not reactively. When you face a challenge in your CLNC® practice, these same skills will serve you well — if you've practiced until you can make the right choice automatically. Don't panic, be proactive — and you'll rise to the surface with ease.
Compete only with yourself. Free divers think about competing only with themselves. Thinking about their competitors is a dangerous distraction. Every movement, every thought uses up precious oxygen. Worrying about competing divers is a thought of which the free diver simply can't afford to indulge. As a CLNC®, you must be aware of any competition, but you must not allow it to distract you from your mission, your vision, of providing the best services you can provide to your attorney-clients.
Visualize your own record-breaking success. Before he even enters the water, the constant-weight diver visualizes his entire dive (including his successful return to the surface, breaking his previous record). He sees each kick of his fins, sees himself pulling the tag off the depth target and returning to the surface. In his imagination he becomes his goals and desires. When he is finally prepared, he has already succeeded in his mind. As he mentally pictures his record-setting day, the outside world doesn't exist for him. He is completely within himself. Visualizing your success as a CLNC® will allow you to set aside the outside world and propel yourself to greater depths faster and smoother.
Build your ocean-deep support system. While each diver must make the dive on his own, he isn't doing it by himself. He has a team of family and friends on the surface providing emotional support. Other divers are stationed at different depths below the surface. These divers provide a safety net, each carrying an alternate air supply in the event of an accident. They also clap metal plates together as the deep diver goes by, making noise that lets the diver gauge his progress both to the target and back.
Like these divers, no CLNC® is an island — you are not alone. You need — and have — a strong foundation of support surrounding you.
You can create an enthusiastic audience of family and friends who will clap and cheer for your every step toward success.
You can tap the experience and force of the National Alliance of Certified Legal Nurse Consultants (NACLNC®). This is the largest group of supportive peers you could ever wish for.
You can also call on the power of the Institute's CLNC® Mentors. If you hold an active CLNC® Certification or are a current student in one of our programs, you receive FREE mentoring. The CLNC® Mentors are there to support you in diving deep and stretching the limits of your comfort zone.
When you start your CLNC® practice, you can build a network of vendors and subcontractors and coach them to provide you with the same stellar service that you provide to your clients.
Take charge of your own diving success. Ultimately, though, each diver has to breathe deep and dive deep on his own. So do you. No one but you can take your CLNC® practice to the next level. No one else can condition your business life for deep breaths and deep dives.
If you want record-breaking results for your business and for your life, you must push yourself to apply these principles. You must prepare, train and educate yourself, and visualize the success you want to achieve. Even something as simple as taking one action step each day will generate dramatic results over a one-year period. To dive deep you must expand the borders of your comfort zone. You are only one breath away from reaching the huge goal you really desire.
I encourage you to dive deeper, not only in your business, but within yourself. The diver experiences the essence of a successful dive when he goes deep within himself and becomes one with the ocean. The deeper you go, the nearer you are to your possibilities. Choose your own dive, but remember it's your one breath. Make it count.
MY MOST MEMORABLE CASE
"The Notorious 13" — How I Used My CLNC® Expertise to Create
Order from Chaos
by Suzanne E. Arragg, RN, BSN, CDONA/LTC, CLNC
My experience as an infection control consultant for long term care and a director of nursing in a skilled nursing facility has worked to my advantage as a CLNC®. I know the inner workings of these facilities and can get into just about any nook and cranny of a building. This expertise benefits my attorney-clients who often tell me, "Suzanne, get in there and find it!"
That's exactly what I did when I had the opportunity to work on a group of 13 cases. The "Notorious 13" all came from one attorney-client representing one skilled nursing facility. The "ring leader" of the plaintiffs was a very vocal family member who believed one facility resident had received substandard care. Family members of other residents joined in her crusade, resulting in 13 separate civil suits. Naturally, the work load for the law firm was enormous, and chaos ensued.
The Interlocking Cases Required "Outside the Box" Investigating
The major allegations in the law suits included:
Elder abuse
Negligence
Intentional infliction of emotional distress
Fraud
Pain and suffering
The overwhelming list went on and on and the plaintiffs were alleging that they were entitled to punitive damages. At first glance, I could have become emotionally involved and sided with the plaintiffs. But with Vickie's training and manuals as my guide I gave each complaint careful thought, and an overall theme became apparent: The families were not happy and wanted to be heard.
Once I received copies of the records from the facility, I rolled up my sleeves and dug in. I reviewed each and every page. I identified missing pages or documents; created flow charts, care grids and nutritional analyses; analyzed the pre-existing conditions; and provided a detailed summary and analysis of the medical record, complete with specific analysis relating to the significant care issues identified in each complaint. This was phase one of the investigation.
Phase two included conducting interviews and participating in depositions that were being taken to affirm or disprove the allegations in the complaints. This phase included talking with family members and residents who could communicate and were not cognitively impaired. The issues I investigated included staffing, bruising, personal hygiene, pressure sores and, of course, documentation.
My role was to educate the attorney about why nurses would or would not document certain events. I also identified Standards of Care and determined whether the staff had adhered to them or deviated from them.
On my visit to the facility I assured the nurses of confidentiality and just started talking to them. I learned that the facility followed every recourse to achieve proper staffing levels, and that the department heads supported and assisted them to assure the needs of the residents were met. The department heads could not be included in the staffing ratios. Of course, the national nursing shortage was also used as a defense. This kind of information is never found in a resident's medical record. I gathered information to show that "reasonable care" was indeed provided.
As the CLNC® my role was to:
Investigate beyond the chart
Ask lots of questions
See the situation from the point of view of both plaintiff and defense
Draw reasonable conclusions
Above all, EDUCATE
Because I successfully fulfilled this role, all but one of these cases has settled in the civil courts. The information I gathered proved priceless to my attorney-client. Naturally, the one case outstanding was that of the "ring leader" who initiated the "Notorious 13."
Overwhelming Paperwork Demands an Organized Approach
Organization was paramount because of the volume of paperwork these 13 cases produced. We had to work fast to meet the insurance carrier's and skilled nursing corporation's deadlines. Unfortunately, we didn't have time to think about systems to keep us organized.
Our team of three included the attorney and me along with his paralegal. But we needed more help. The three of us spent many sleepless nights at the sacrifice of being apart from our families. "NEVER AGAIN!" became our motto.
The lesson we learned was to take the time to work out a system for managing a large number of cases in a very short period of time. This system includes delegation of duties. We developed the following detailed procedure for future complicated or overlapping cases:
Once a file is assigned, we visit the facility. During this initial visit:
The CLNC® reviews the original record, prior to the coordinated arrival (on the same date) of the copy service.
We search for missing documents.
We obtain reports from DHS licensing and certification survey and compliant visits along with any policies and procedures specific to the sentinel event or incident.
We set up a meeting between the CLNC® and the administrator or director of nursing for a brief discussion of the event.
We identify additional witnesses for interviewing on a later date, following analysis of the medical record.
The CLNC® returns to her office and cranks out the analysis, usually within 30 days. This often requires the assistance of CLNC® subcontractors.
The CLNC® meets with the attorney when the report is complete or to discuss the significant issues of the case, identify potential experts needed and develop phase two of the investigation.
We schedule a second facility visit in writing with the administrator. The letter requests any additional documents needed, asks that certain individuals be made available and sometimes seeks contact information for individuals no longer employed by the facility.
The CLNC®, along with the attorney, makes the second visit to interview all employees involved in the incident.
The CLNC® prepares a second report and holds another meeting to develop phase three: mediation, arbitration or trial. The CLNC® assists the attorney in preparing for these proceedings as directed.
This procedure has proven valuable in every long term care case I have worked up since the "Notorious 13." Not that we don't go crazy sometimes, but this step-by-step system has truly made a difference between order and chaos.
Suzanne E. Arragg, RN, BSN, CDONA/LTC, CLNC, is the owner of SEA Consultant Company in California. Her firm specializes in long term care cases.
