1. Develop a notebook of varied work product samples and report lengths and formats, and take it with you on every initial appointment. If the attorney-prospect doesn't know what she wants – and many attorneys won't – or if she is open to something new, show your samples, quickly highlighting features and benefits of the different report styles, lengths and formats. Find out what will be most helpful for her purposes, budget and learning style. Establish whether she wants a brief, moderate or comprehensive report and gain consensus on format (e.g., chronological timeline).
   
   In essence, your sample book allows the attorney to "place an order" for exactly what she wants. By presenting samples you can influence her decision and show just what a Certified Legal Nurse Consultant can do for her. Or she may have a specific outline for you to follow or important issues she wants you to address. Clarifying these points in advance will save you time when preparing your report, and will prevent surprising the attorney when you send your invoice.



2. Establish up front whether you are being retained as a consulting expert or a testifying expert. If you are retained as a testifying expert, a briefer written report is indicated. Knowing your role up front saves time and money for both you and your attorney-client.



3. Before you type a single word, review your assignment. Based on a collaborative meeting with your attorney-client, review what the attorney wants and needs. You should know this up front and nail it down in your written contract. It is your job as the professional consultant to educate and guide the attorney regarding what you can do for her. Attorneys don't always know what they need even if they think they do. On the other hand, if you ignore the attorney's requests and preferences, you probably won't hear from her again. Would you hire a consultant who ignored your directions and gave you something you didn't want?



4. Note your deadline for submitting the report and the attorney's budget for your CLNC^® services, along with your time spent on the case so far. When you first received the assignment, you should have gotten a clear commitment on the deadline and budget. Now that you're ready to write up your results, make sure you can still meet these requirements. If you can't, alert the attorney immediately, request a larger budget and explain how the increased budget will benefit the attorney. Attorneys don't like surprises, so never submit an invoice that exceeds the agreed-upon budget without approval.
   
   

5. Begin by putting the following thoughts out of your mind:
   
   
   • "This report has to be perfect." Aiming for perfection blocks you and makes it difficult to even get started.
   
   
   
   • "I should be able to write the final report in one draft." Your report is always a "work in progress" - one draft at a time. Ditching perfectionism during your first draft allows you to focus on your ideas. Most of us cannot effectively address the big issues and the small commas at the same time. Focus too small here and your message will suffer.
   
   
   
   • "I should be able to write this report in one sitting." Your report will benefit when you tackle it over multiple sittings. This will make it seem much more doable and gives you space to think about it for a longer period. If you do write in one sitting, sit down the next day and check it – it's probably not the "perfect" report you thought it was.
   
   
   
6. As you write, keep the attorney's requirements in front of you. Additionally, refer to your previous reports for ideas on formating, organizing the data and presenting it effectively. Don't reinvent the wheel.



7. Approach the report with a vision of what you would like the final product to look like. Visualization allows you to focus on what is important and fill in the blanks as you write.



8. To jump-start your first draft, jot down key issues or points you want to cover without regard to style, neatness or format. Putting the major points down on paper releases the creative energy you need to write your report. Genius strikes at the oddest moments, and by capturing every thought, regardless of where it fits in the report, you preserve that genius forever (or at least until you need it). You think you'll remember it later, but the gods of forgetfulness will snatch it from you. You can organize your ideas and fill in the details on subsequent drafts.



9. Start strong by addressing the major theme of the case. Journalists do this when writing newspaper articles, and it works just as well for legal nurse consulting reports. This kind of opening helps direct and focus your review and keeps you from going down rabbit trails and including interesting (it's all interesting) but irrelevant information. It also gets the attorney focused and lets her know what to expect from your report.

10. Review the writing resources from your CLNC^® training: the "Comprehensive Case Evaluation Strategies and Report Writing Techniques" module from the CLNC^® Certification Program and the "Report Writing for CLNC^®s" portion of the 2-Day NACLNC^® Apprenticeship. Study the reports in the Advanced CLNC^® Toolkit. These 59 real case reports guide you in mastering the process of analyzing cases and putting your opinion on paper.



11. Get the help you need. Contact Vickie Milazzo Institute and request a consultation with a CLNC^® Mentor for a critique of your report. Mentoring is a free benefit as long as you remain certified as a Certified Legal Nurse Consultant. You can also take a writing course or hire a grammar teacher who will edit your report for a reasonable fee.



12. Hire smart. Require all subcontractors and employee candidates to provide writing samples. For any nurse you hire, CLNC^® status should be a requirement. Their training and experience in writing reports will make your job easier.

13. Follow an organized format and present the information in a logical and easy-to-follow sequence. The type of case should also guide your choice of format.
    
    For example, a personal injury case may lend itself to using a chronology of treatment rendered including dates of service, providers, care rendered, medications and billing information. The attorney can easily incorporate this format into the settlement package. The chronology also helps you spot missing medical records and bills, and the missing information can simply be added to the existing document when received.



14. Include all relevant components and features.
    
    
    • Introduction - Include a list of materials reviewed to date, missing records, your bottom-line opinion and problems with the case. Consider this portion of your report an executive summary.
    
    
    
    • Pertinent medical, psychiatric and family history (as applicable) - May also include a table or chronology highlighting in as much detail as needed: vital signs, lab values, test results or clinical symptoms leading to the event or issue in question.
    
    
    
    • Summary of case facts - May be a brief narrative summary or a detailed chronology or timeline.
    
    
    
    • Literature review - If addressing more than one relevant issue, cover each one under a separate subheading (e.g., ischemic chest pain and cardiopulmonary arrest). Be sure to address etiology, standard of care, treatment, risks and complications. This section may be extensive or brief, depending on the attorney and the complexity of the case.
      
      Cite references to the medical literature by author and date within the body of the report, for example: "A study by Smith and Jones (2005) found this outcome in 43% of such cases." Be sure to include a complete list of references at the end of your report, with each citation presented in a complete and appropriate format. See the references section at the end of the Core Curriculum for Legal Nurse Consulting^® for examples of reference listings. You may wish to group your references by type of source, with each type under a subheading such as Books, Journal Articles or Websites.
    
    
    
    • Specific deviations from the standard of care - List each potential defendant and their deviations from the standard of care. Include supporting literature and references, as well as comments on strengths, weaknesses and possible defenses.
    
    
    
    • Recommendations - Offer suggestions on how you can assist further with case development. You want to help and attorneys need your help. You can recommend additional medical records needed, potential expert witnesses and questions to be addressed through experts. You can also provide interrogatories, requests for production and requests for admission.
    
    
    
    • Conclusion - Include a brief bottom-line opinion on the merits of the case plus an open invitation to contact you again and a statement regarding how you will follow up.


15. Explain complex information in simple terms. Insert the definition of the medical term next to its first use in the text to make it easy for the attorney to understand the content better as she reads. For longer reports consider adding an alphabetized glossary at the end of the report.



16. Present clinical information in an understandable format. Remember, you're dealing with attorneys, not rocket scientists or other nurses. You'll understand many things related to nursing and healthcare that the attorney won't. Her job is to take complex nursing and medical topics and explain them to a judge, jury or another attorney in terms a lay person can understand. Your job is to explain this information to the attorney in those same terms so she can do her job. Comprehension and simplicity start with you.
    
    The significance of the data must be clear and easy for your attorney-client to use in developing the case. Lab values, EKG and radiology reports, vital sign changes and other data can be effectively presented in a table, graph or timeline format. A comparison table is useful for cases where you are illustrating evidence of tampering or conflicting documentation among providers.
    
    Always take your attorney-client's needs and preferences into account when presenting such information. Depending on her request, a chronology may or may not contain your comments and analysis. Some attorneys prefer verbal rather than written comments.
    
    The amount of detail you're including will also determine the format you use. For example, in a brief report or an initial report a narrative format may be appropriate for presenting a chronology. As the case progresses, the chronology may become more detailed and in subsequent reports may be presented more effectively in a table format.
    
    Whatever format you choose, continually verify that the information you're presenting is relevant, adds value to the report, is not redundant and is presented in the most effective manner.



17. Give the attorney the bottom line. Most attorneys want the bottom line first. They don't want to have to read through your reasoning process before seeing the bottom line. Include this at the end of the introductory paragraph, right after stating the reason for the report. Answering the big question up front interests the reader in learning why or why not.



18. Offer definitive opinions or recommendations. While attorneys appreciate that the law is not always black and white but consists of many varying shades of gray - what they expect from you is black and white, or at least an explanation of why it's gray. This is what attorneys pay you the big bucks for, not to sit on the fence. State your opinion clearly, avoiding excessive qualifiers.
    
    On the other hand, never, never put anything in your report that you cannot absolutely support or defend. Putting speculation in your report only raises doubts about your credibility.

19. Give your first draft a thorough edit for content, grammar, style and format. Allow enough time to put your report aside for a day or two before editing it. You'll notice more areas for improvement when you look at the draft with fresh eyes. Here are some key things you want to accomplish when editing your draft:
    
    
    • Ensure that the information in each section is relevant, is not redundant and is in the most appropriate section.
    
    
    
    • Be sure you've included all the information you promised the attorney when you received the assignment. In medical malpractice cases, review the four elements to ensure you have addressed each one.
    
    
    
    • Make the report concise and to the point. This saves both you and the attorney time in reading, understanding and explaining. Staying on point also makes it easier to review the report quickly months or years down the road.
    
    
    
    • Fine-tune individual sentences and paragraphs for conciseness and clarity, eliminating excess words and unnecessary adverbs and adjectives, trimming wordy phrases, and deleting any irrelevant, unrelated or unimportant details.
    
    
    
    • Focus on using the active voice instead of the passive, and on strong verbs instead of weak verb-noun combinations. These two approaches will strengthen your prose and make your writing clearer. For example:
      PASSIVE VOICE (weak): The patient's vital signs were taken by the nurse.
      ACTIVE VOICE (strong): The nurse took the patient's vital signs.
      WEAK VERB + NOUN: The doctor made the decision to proceed with the surgery.
      STRONG VERB: The doctor decided to proceed with the surgery.
    
    
    
    • Check grammar, spelling and consistency of the format and fonts throughout the report.
    
    
    
    • Keep the report visually clear and uncluttered to make it easier to read.
    
    
    
    • As you build confidence in your writing skills, you'll develop your own personal professional style. Don't be afraid to use that style to make your report stand out.


20. Seek feedback. Attorneys come in all shapes and sizes. Satisfying one doesn't mean you'll satisfy the next. What works for one may not work for another. Demonstrate your agility by always asking your attorney-client what features of the report were especially helpful and which features could be eliminated next time for more cost-effectiveness. This simple strategy will help you retain clients for life. One client can be worth hundreds of thousands or millions of dollars over a lifetime.
    
    Most attorneys are masters of written and spoken language. It pays to tune in to their response to your work product and take their comments and criticisms seriously. If the attorney is not satisfied for any reason, remedy the problem immediately. This challenge won't derail your client relationship if you listen and respond quickly.

Vickie L. Milazzo, RN, MSN, JD is the founder and president of Vickie Milazzo Institute. She is credited by The New York Times with pioneering the legal nurse consulting profession in 1982. Inc. named her to the Top 10 Entrepreneur list. She is the recipient of the Nursing Excellence Award for Advancing the Profession and the Stevie Award (business's Oscar^®) as Mentor of the Year. Vickie has revolutionized the careers of thousands of RNs. She is the author of Inside Every Woman: Using the 10 Strengths You Didn't Know You Had to Get the Career and Life You Want Now (published 2006 by John Wiley & Sons, Inc., now in its fourth printing and ranking in the top 5% of all business books being sold).

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