NEWS FLASH Pittsburgh Business Times Interviews Vickie About
Nurse Entrepreneurs
In a January 2003 article about nurse entrepreneurs, the Pittsburgh Business Times discussed different career routes nurses take to get out of the hospital and use their nursing expertise in a different way. According to the article, this migration from the bedside to entrepreneurship is happening because nurses are "so disenchanted with the hospital setting that they're opting to start their own businesses."
Vickie L. Milazzo, RN, MSN, JD, "the nurse who is credited for pioneering the legal nurse consulting profession," is quoted as saying, "Working conditions in the hospital are a lot worse than they were 10 years ago....The workload on nurses these days is a lot more than it used to be."
One of Vickie's students, Leigh Ann Chermak, RN, CLNC, is also featured in the article. "Part of the reason I'm doing this is to be at home," says Leigh Ann, who is expecting her first child. "You have to market yourself and get your name out there....The overhead is minimal with only a computer, fax and business stationery needed to get started."
Like Leigh Ann, many nurses are turning to the Vickie Milazzo Institute for training and certification in legal nurse consulting. The most obvious benefit: nurses-turned-consultants earn more while working less. Certified Legal Nurse ConsultantsCM (CLNC®s) typically earn $100-$150/hour. In addition, the flexibility, the low start-up costs and the chance to use hard-earned nursing expertise in exciting medical-related legal cases make this lucrative profession even more appealing to nurses.
FROM THE EDITOR
It's Not Why RNs Are Leaving – It's Where We're Going
by Vickie L. Milazzo, RN, MSN, JD
A recent American Nursing Association (ANA) poll indicates that 18.8 percent of registered nurses (RNs) in the U.S. do not work in nursing. A study by the Center for Health Outcomes and Policy Research reveals that 22.7 percent of RNs plan to leave their hospital jobs in the next 12 months. Despite record-breaking salaries and bonuses, RNs are leaving hospital jobs in droves, resulting in the nursing shortage that has captured the attention of the American public.
As an RN, you know this shortage is not a new trend. Since the average nurse is 46, I'm sure many of you remember the "bonus" days of the early 1980s when a nursing degree and a pair of clean white shoes got you a job anywhere. Today we've come full circle – a nursing degree and some brain activity will do: "Thank you for the emailed resume. Can you start today?"
The reasons RNs are leaving the profession today are equally familiar. The complaints from two decades ago still apply: RNs are understaffed, underpaid, under-appreciated, under-insured and under-you-name-it. On top of all that, RNs must work 26 weekends and at least five holidays a year and endure nightmarish schedules.
In addition, today's nursing shortage is being intensified by three new phenomena: managed care, on-the-job health risks and alternative careers for nurses.
Managed Care Compromises Nursing Care
In spite of giving more than they have to give every day, nurses in all settings can no longer deliver the level of care of which they are capable. RNs who remember the "good old days" battle the shame of knowing they're partially responsible for the deaths of 98,000 patients in hospitals every year. That death toll is equivalent to a jumbo jet crash every other day, yet the number doesn't even include patients who become victims of injury and illness while in the hospital.
Why are patients dying unnecessarily? Nurses have less time to see more patients. They have more to do and fewer tools to do it with. They must contend with increasingly complex equipment and less trained staff. LVNs/LPNs, nurse's aides and nursing assistants are replacing skilled RNs at the bedside. Yet RNs still get little respect and face more responsibility when everything turns sour. In this "dark age" of medicine the words "quality of care" are becoming an oxymoron.
This trend goes against our education and against our very nature as nurses. Certainly some people get into nursing solely to make a living and don't progress beyond that stage. They're part of the problem. For most of us, though, nursing is more than a profession – it's a calling that attracts the "best and the brightest" who want to make a difference in people's lives.
You won't find a more caring group than nurses. Try having an anaphylactic reaction at a lawyers' conference and see how many people come to your aid without a business card in hand.
Yet today, despite all our caring, we're denied the ability to provide quality care. With the exception of a few great facilities around the country, we can no longer find jobs that allow us to fulfill the mission we defined for ourselves when we entered this profession. No wonder so many nurses are quitting.
Nurse Healers Fear For Their Own Health
Not only are RNs exhausted – we the healers fear for our own health. On-the-job health risks for nurses range far beyond bloodborne pathogens and latex allergies (not to mention feeling like aliens dressed in our goggles, masks and gloves). We face obvious occupational hazards, such as back injuries from long shifts pounding hospital halls and doing more lifting with less help.
We also face the less obvious hazards that aren't just physical. Sheer exhaustion from our overwhelming schedules and our unsupportive work environment take a heavy toll.
Look around you at how many nurses smoke, drink and are overweight. These are signs of deep unhappiness and of not having time to take proper care of ourselves. Between juggling life, family and jobs, nurses often find it far easier to wolf down fast food on our 10-minute lunch break than to prepare a healthy brown-bag meal.
Isn't it ironic that the injured and disabled are treating the sick? No wonder the RN's dangerous workplace is yet another reason for the flight of such talented caregivers.
RNs Choose a New Career and a New Life
The bright spot in this grim scenario – and the most distinctive aspect of today's nursing shortage – is that we can enjoy better, more satisfying careers as RNs elsewhere. Admit it, you know nurses who've left traditional nursing and are prospering and much happier in their new positions. Today, we're leaving younger, smarter and better qualified than ever before. We are creating our future rather than being victims of it.
Without even leaving the hospital setting, we are using our skills and training in areas we never thought possible: risk management, utilization review, accreditation and research. Beyond the hospital we're experiencing success selling medical- and nursing-related products, such as equipment, instruments, drugs and blood products. We're starting companies selling our own products and services, running our own agencies and working for insurance companies and major corporations.
Many of us are becoming Certified Legal Nurse ConsultantsCM (CLNC®s), both in-house and independent. Most importantly, CLNC®s have just begun to penetrate the legal industry. I look forward to the day when it's considered legal malpractice for an attorney to work on a medical-related case without a Certified Legal Nurse ConsultantCM (CLNC®) on the team.
Wonder-Working Nurses Can Do Anything
Why am I confident that no RN must be a victim of poor working conditions? Because we're trained to do three things simultaneously. For example, we make rapid, informed life-saving decisions while listening to the physician's orders and at the same time we console the patient and family members.
The average ICU has more complex instruments and monitors than the bridge of the Starship Enterprise, and we operate every one of them! Forget Superman, Spiderman and Wonder Woman. I'll take a wonder-working nurse any day.
You deserve to seek a new life for yourself. You've worked hard and made many contributions. Now it's your turn. Join the ranks of RNs who have taken their nursing careers to new heights, new horizons and a brave new world. We're already doing more than we ever imagined, and I'm sure we will continue to surprise ourselves.
Your career outside of traditional nursing can provide you with a new purpose, a new attitude, new challenges, new rewards, new wealth and new respect. Enjoy these benefits guilt-free. One place to find all these pluses and much more is in legal nurse consulting. If this field is not for you, look farther – the sky's the limit these days. The only way you'll find your star is by reaching for it.
BEST PRACTICES FOR TECHNOLOGY
Keep Your Electronic Communications Liability Free
by Thomas M. Ziemba, JD, BS
Two benefits of our electronic society are email with its instantaneous delivery of messages and the World Wide Web with its ability to allow people in far-flung locations to share information. But every benefit has its price. For electronic communication, two of the biggest risks are interception and liability.
Always keep in mind that email is easily forwarded and printed without permission of the original sender. Email messages are easy to intercept or retrieve, they persist on each computer they pass through on their way to the recipient and linger on hard drives long after the sender and reader hit their "delete" keys.
Although email is notoriously insecure, attorneys, experts and clients increasingly use it to exchange messages. Healthcare providers also use email to communicate with patients, other providers and payors. A growing number of these messages include patient-identifiable information and medical records. Plaintiff and defense law firms create and maintain electronic versions of medical records, and many also set up Internet and intranet depositories for sharing information about cases within their firm and with other firms, experts, etc.
HIPAA, the 1996 Health Insurance Portability and Accountability Act, raises many questions regarding patient privacy. This act requires healthcare providers and covered entities to obtain patients' affirmative consent prior to disclosing protected health information (PHI). Simply stated, the public nature of the Web and email would seem to require patient consent prior to using these methods of communication. Additionally, the Privacy Act of 1974 and the Freedom of Information Act require hospitals, insurance companies and other intermediaries to protect patient medical records related to Medicare and Medicaid.
Conceivably these regulations could extend to any party communicating personal medical records or PHI, including LNCs, attorneys and expert witnesses. If your email about an attorney-client's case falls into the wrong hands, whether by accident or because someone intentionally forwarded or intercepted your message, you could find yourself involved in a privacy-related tort claim.
What is a CLNC® to do in this brave new world?
Contact your malpractice insurance carrier to determine what methods of electronic communication your policy covers. If the insurer cannot provide guidelines, take a conservative approach. Do not transmit patient-identifiable information via unencrypted email or post it on the Web, even on a corporate intranet.
Make sure your contract or letter agreement with any attorney-client covers liability issues involving electronic communication with the attorney, her experts, other consultants or insurers.
If you email a patient, attorney, expert witness, another CLNC® or insurer regarding your attorney's client, any patient-identifiable information should be deleted from the message, or encrypted either within the message or in an attachment.
Keep hard copies of electronic communications with or about your attorney's client in the correspondence section of your legal files. If possible, also keep "native" electronic copies of all email communications in the electronic data file regarding that client. In other words, treat these communications as you would any other communication, such as a nursing note, physician's note or incident report.
Be careful what you say in your email messages. Remember, any email you send can be forwarded indefinitely, even to opposing counsel.
If your attorney-client has an Internet portal for sharing client information, ask the following:
a.
Is this portal password protected?
b.
Does it use internal controls to limit access on a "need to know" basis?
c.
Are policies and procedures regarding access to these files in place and adhered to?
d.
Are law firm staff members trained to promote awareness of these issues?
Education can go a long way to protect you and your attorney-clients in this field. Common sense tells us not to discuss patient-identifiable information in email any more than we would in a public elevator or the lunchroom. With a few simple steps you can safeguard yourself and your practice from a privacy-related tort claim.
Visit www.HIPAA.com for details on this important act.
Thomas M. Ziemba is the general counsel and information systems manager for the Vickie Milazzo Institute.
