What Is A Nurse Expert Consultant?

While you may have heard about Nurse Expert Consulting, you may not be entirely clear what it entails. So, if you’re curious and want to find out more, read on. This article attempts to explain and clarify what nurse expert consulting is all about.

The Role

The primary role of a legal nurse expert consultant includes being a good detective by understanding:

• the medical record system for the incident involved
• the process of admission
• the treatment of specific needs of the individual
• the handling of specific orders
• understanding the process a patient or resident would go through from admission through discharge 

The nurse expert consultant understands the nursing standard of care and the nurse practice scope for the event's state. The consultant will guide the attorney through the nursing process and help educate him or her from the nursing perspective.   

The nurse expert role includes but is not limited to evaluating and sorting through the medical records, assessing for deviations in nursing care.  

The review of documents includes the following questions:

• Was there follow up on orders and diagnostics?
• Were medications, treatment, medical equipment, and personal care provided as ordered?
• Were they provided according to the nursing standard of care in alignment with federal and state regulations?
• Was there follow-through of communication between the different health team members?
• Was the necessary care provided?
• Were opinions concerning medical issues and health outcomes delivered?
  
  

Nursing Opinion

At first, your nursing opinions may be verbal, so the organization of your notes, spreadsheets, and supporting information are essential.  

Initially, provide your opinions to the attorney. Later, if requested by the attorney, the nurse expert consultant will draft an opinion or affidavit within the required timeframe.  

Remember, all of your reviews and opinions are from a nursing aspect…

As nurses, we do not speak to medical opinions because we are licensed nurses. We are not medical providers unless you are licensed as one. Usually, though, there will be a medical expert on the case if necessary.
  

Quality of Care

One of the guiding principles in long-term care is the quality of care and how it is delivered. Was the nursing care provided as it should have been, following the nursing standard of care?

An excellent requirement to understand and follow as you conduct your reviews as a nurse expert consultant is the following from “Requirements for States and Long-Term Care facilities:” 

Ҥ 483.24 Quality of life.

Quality of life is a fundamental principle that applies to all care and services provided to facility residents. Each resident must receive, and the facility must provide the necessary care and  services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, consistent with the resident's comprehensive assessment and plan of care.”[1] 

The nurse expert review includes if the facility and staff followed the Federal, State, and professional standards of care, regulating professional conduct in the long-term care facility.  (42 CFR 483.75) 

You will be a “good nursing detective” as you review the medical records but  “stay in your nursing lane,” within the scope of nursing practice. As you review the medical records for continuity of care and outcomes, at times, you may find “surprises.”   

As you review and analyze the medical records and supporting documents, other records and documents may and usually do show up later. I’ve had additional information presented, or actually, I should say “waived” to me on the witness stand, as the case was in court.  

When I say “waived,” I mean waived…

I had to ask to hold the paper physically and ask the judge for a moment to review the “newly presented document” that had not been discovered in prior requests via the court. So be prepared with your “opinions with the following clause,” so you don’t get caught against the wall.  

End your opinions and affidavit with:

 “All of the opinions stated are expressed within a nursing probability, based on my education, training, and experience and upon my review of the records listed in this statement. The letter is not intended, nor does it contain all of the opinions that I have reached as a result of my review of the records of (resident/patient name). I reserve the right to alter my opinions in the event of further information and materials as they become available.”

 Each state will have its own wording, slightly different when you state your professional nursing expert opinion. Some states use “nursing probability,” while others may use “nursing certainty.”  

Requirements

What does it take to provide services as a nurse expert consultant?

From an educational and licensing point of view, the minimum requirement is a current license as a Registered Nurse; it all starts there. You also want to show relevant experience of actually working in the area you consult.

And while various accreditation programs are available, they are not a requirement for providing nurse expert consultation.

[1] https://www.law.cornell.edu/cfr/text/42/483.24