A client walks into the law firm and states that a family member has suffered from unfair treatment and, as a result, acquired a pressure injury while in the hospital. The firm gathers the information, and the lawyer tells the family member at a later appointment what is needed to start the process. The lawyer will most likely give the family member some forms to fill out with a list of paperwork that needs to be gathered. The new person in the initial interview was a nurse paralegal who had just been hired.1 What can a nurse do when a malpractice suit comes through the firm's doors? Nurses are trained to gather information, analyze it, and form issues to report to a doctor. Paralegals are trained in the IRAC method (Issue, Rule, Analysis, and Conclusion).2 How do these 2 ways of thinking work together?
Nurses have been a valuable asset to law firms in medical-related litigation for decades, especially in malpractice cases. As expert witnesses, nurses can describe complex medical concepts in simple terms for laypersons and identify protocols, omitted information, and other nuances within the medical field that would easily slip past those without their experience.1 Developing since the late 1980s and solidified in 2006, the specialty practice of Legal Nurse Consultants (LNC) was officially recognized by the American Nursing Association (ANA).1 LNCs differ from nurse paralegals, although they may have similar duties. Unlike paralegals, who need specialized education, legal knowledge is not required to practice as an LNC.1 Often, since LNCs tend to be fast learners when practicing within the legal system, they may be assigned tasks typically assigned to paralegals, further muddling the difference.
A paralegal is hired to take on some of the lawyer’s tasks, while nurses are hired to handle a doctor’s workload—similar positions but in different parts of the system. Paralegals help gather data needed for a case, similar to how a doctor needs a nurse to collect information to reach a diagnosis. As previously stated, paralegals approach a case through the IRAC method, comparable to how nurses approach care. For instance, patient issues are why patients go to a hospital. Legal issues are why clients enter a firm and how the legal system finds the rule of law. After the client presents the issue and the lawyer identifies the rule of law, the next step for the paralegal is analysis. Paralegals often will begin a research plan detailing the problems, the medical documents that come into the firm, and the interview with the client.3 The nurse paralegal or LNC should put items in chronological order, assess data, and itemize the important elements of the case. The paralegal often will call for documents from other sources to ensure that the issue is truthful in presentation. During the last step of the IRAC method, the conclusion, the nurse paralegal or LNC will bring together a few sentences for a lawyer's quick reading of the case, similar to how a nurse's documentation aids a doctor in a hospital.
The rule of law is comparable to diagnosis. It is the reason for the case to go to court. Primary research will back the rule of law this case does or does not support.1 Paralegals should present the study in a way that ensures there is a winning case for the client. Malpractice can be described as owning a task, a breach of that duty, causation, and damages. With knowledge of standards of care, the proof of breach of duty is better supported by a nurse paralegal or LNC. The ability to do medical and legal research is an invaluable asset for any law firm specializing in personal injury law. Primary sources are needed when assessing rules of law, using Federal and State acts and Cases, and are required when working within the legal system. Similarly, the health care system uses peer-reviewed studies for best practices and standards of care.
The legal analysis combines information to prove or disprove the identified rule of law. Paralegals often use case law to support or show weakness in a case. This step would be comparable to a nurse analyzing tests performed and supporting the diagnosis that the doctor recommends. The proper diagnosis, like the appropriate rule of law, is only sometimes upheld by the facts of the case. This concept is why analysis is critical when assessing the issue that supports the client’s position.3
The client mentioned in the introduction presented the issue that their family member acquired a “bedsore” while in the hospital. The rule of law, in this case, is identified as malpractice. Analysis of this case will include issues related to hospital-acquired pressure injuries and an assessment of what information is needed to prove the case. For instance, when analyzing previous cases of a similar subject matter, the LNC might ask the following question: Did the court agree with the plaintiff or the defendant, and why? A nurse paralegal or LNC's knowledge, experience, and skills can help determine if the standards of care are not apparent. Once the analysis is complete, the final step is the conclusion. The conclusion of the case analysis is just a summary of the facts, the issues, and the information gathered to allow the firm to make the best decision for the client.2
Nurse paralegals or LNCs can allow law firms to accept cases that would have been cost-prohibitive in the past. “Freed has opened the door for nursing experts to testify in medical negligence actions as to medical diagnoses, which their professional license and scope of practice clearly prohibits.”4 A nurse paralegal must remember that as a nurse, their position is to support patient care and ensure that ethics is primary. This concept is also true when working in a law firm; the firm's ethics is essential to a lawyer’s role.
About the Author
Lydia Corum RN, MSN, CWCN has been in the nursing profession since 1996 and has been in wound care for over 15 years. Ms. Corum is currently a Wound Care Coordinator for West Hills Hospital & Medical Center. Having worked as a clinical manager in wound clinics and hyperbaric centers, she has developed a strong passion for education through her positions and within the wound care community at large. Ms. Corum currently has her Masters in Nursing from Keiser University. Her background in multiple care venues and educational roles professionally gives her expertise in a wide range of patient care situations. Her nursing philosophy to "heal wounds as quickly as possible" is the guiding force behind her educational pursuits, both as a teacher and a student.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.