Legal Nurse Consultant

Legal nurse consultants (LNCs) are like the Sherlock Holmes of the healthcare world. LNCs sift through medical records for clues about why a patient might have experienced a particular outcome. They also use their nursing expertise and critical thinking skills to help attorneys understand the medical aspects of legal cases. 

Whether you’re intrigued by the prospect of being your own boss or you’re craving a break from bedside nursing, this guide has the information you need to understand if legal nurse consulting is right for you. So, grab your magnifying glass, and let’s dive into the fascinating world of legal nurse consulting!

This guide has everything you need to know about legal nurse consulting, including:

  • What is a legal nurse consultant?
  • Where do legal nurse consultants work?
  • What does a legal nurse consultant do?
  • How LNCs help patients (and healthcare providers!)
  • Background and experience for legal nurse consultants
  • Certifications for legal nurse consultants
  • Salary ranges for legal nurse consultants
  • Pros and cons of working as a legal nurse consultant

What is a legal nurse consultant?

A legal nurse consultant (LNC) uses their nursing knowledge and clinical experience to provide expert insight into legal cases involving healthcare issues.

An LNC might review medical records to determine whether the standard of care was met in a medical malpractice case or provide context around causation in a personal injury case. 

The LNC might provide expert testimony in court or work behind the scenes to produce educational information for the attorney. Or they might write reports for a legal team to help them understand a specific condition or treatment process relevant to a legal situation.

As an LNC, you will use your clinical experience and nursing knowledge to provide insight and clarification on topics like:

  • Clinical documentation
  • Causation of injuries
  • Deviations from standards of care
  • How healthcare teams work together to care for patients

Where do LNCs work?

Legal nurse consulting is a great career choice for nurses who want to be their own boss, as most LNCs work as independent contractors. This allows LNCs to set their own hours and choose their own clients. 

Many entry-level and mid-level LNCs work as subcontractors for larger firms or agencies. This allows individual contractors to focus on the actual LNC work instead of worrying about marketing or finding new clients. In exchange,  the agency takes a cut of the fee.

Working as a subcontractor can also be a great way to gain experience. And subcontractors still have a lot of freedom: they can decide what work to accept, when they work, and how much they want to work. However, subcontractors rarely receive benefits like sick leave or retirement contributions.

Some LNCs work as part of an in-house legal team. In-house work can be freelance or salaried. Working as a salaried in-house LNC can be a good option for people who prefer a stable paycheck and guaranteed benefits. This type of position can also provide steady hours and the chance to see a case from inception through trial.

Other LNCs run their own businesses. Similar to freelance health and medical writing, independent LNCs must balance client work with marketing, developing client relationships, and bookkeeping. Some LNCs hire their own subcontractors.

“The biggest complaint that I hear from other LNCs is an inability to get attorneys to hire you. One way to combat this is to have a heavy presence on Linkedin. I have been able to grow my business in big ways simply by being active on Linkedin.”

What does a legal nurse consultant do?

There are also two main types of work that LNCs perform. Some LNCs serve as expert witnesses. This requires answering questions under oath and being cross-examined by the opposition. Expert witness work typically pays (very) well. 

Other LNCs focus solely on behind-the-scenes work, like preparing medical chronologies. 

To prepare a medical chronology, the LNC must review every single line of the medical record – which can be thousands of pages long – to identify information that is relevant to the case. The LNC then pulls these passages into a single “chronology,” typically accompanied by a summary report, that the attorney can use as part of their case development. 

Maryjane Duquette is an LNC in Maine who also hosts the podcast Just Culture. In her words, “You might get 10,000 pages of records. We review them, summarize the important points for the attorney, and identify the relevant points. We bring 10,000 pages down to 30 pages that the attorney can manage.”

LNCs may also prepare reports about common conditions or treatments for a legal team, summarize or interpret clinical documentation through written reports, or provide testimony as an expert witness during a trial.

Freelance LNCs must also engage in marketing, relationship-building, and networking. This might include tasks like:

  • Building a website
  • Managing the books and paying self-employment taxes
  • Obtaining a business license
  • Maintaining a social media presence on LinkedIn
  • Reaching out to potential clients
  • Managing a team of subcontractors
  • Attending networking events with attorneys
  • Preparing educational materials for legal teams

How LNCs help patients…and healthcare workers!

It’s critical that someone with a medical background is involved in preparing the medical chronology. Nurses are particularly well-positioned to recognize when standard procedures aren’t followed or if administrative issues like staffing ratios could have impacted patient outcomes.

Nurses can also read between the lines to recognize what’s not in the chart. Maryjane gives the example of when a nurse charts something like, “Doctor notified. No new orders given.” While an attorney might not see anything unusual about this documentation, most nurses recognize the unwritten “…but they should have been.”

“I’ve never felt like more of a patient advocate than I do in this role, but I also get to advocate for my profession when claims are unfounded.”

LNCs don’t always work on the plaintiff’s side. “Our role is to be objective,” says Megan Allen, BSN, RN, who works as an LNC in Pennsylvania. 

“After reviewing the medical records, we may find that doctors and nurses were not liable or negligent,” she continues. “Then, we can help the attorney understand why so they can explain it to the patient or family in an empathetic and digestible manner. We can help the patient or family by providing answers and closure during a difficult situation. In this way, we also defend healthcare providers if they have practiced within the standard of care.” 

An attorney can look up the standard of care. But they can’t look up those insider points, like staffing ratios. We can anticipate orders. We can read between the lines of nurse documentation. This is what makes us valuable.”
Maryjane Duquette

Background and experience for legal nurse consultants 

Legal nurse consulting isn’t for new grad nurses. You need a few years of bedside experience to gain essential skills and knowledge, like:

  • Critical thinking skills
  • Analytical skills
  • Attention to detail (and knowing which details to pay attention to)
  • Prioritization
  • Time management
  • Self-discipline
  • Insight into how healthcare teams work together
  • An understanding of standards of care

However, there isn’t one particular area of clinical practice that is more useful than another. “There is no one specialty or background that you need to be successful as an LNC. There are so many different cases out there – there’s something for everyone,” explains Megan.

What’s most important is simply building an understanding of how nurses think, what it’s like to work in the clinical environment, and the standards of care common to all nursing specialties.

Maryjane is emphatic that “any nurse can do this.” However, she is clear that you must love writing and be able to manage large projects. 

She continues, “My average report is 30-40 pages. You have to be disciplined to sit there and summarize those cases. And also enjoy detective work. That’s essential to what we’re doing.” 

A Bachelor of Science in Nursing (BSN) is helpful but not required. However, it is useful to have advanced education in research and writing, which a BSN (or a bachelor’s degree in any field) can provide.

Certification options for legal nurse consultants

The field of legal nurse consulting is not regulated by a certifying body, and technically anyone who is a Registered Nurse can perform legal nurse consulting duties. However, training can help you understand how to perform specific tasks, like how to prepare medical chronologies and how to interact successfully with attorneys. 

The American Association of Legal Nurse Consultants (AALNC) offers a Legal Nurse Consultant Certification (LLNC). The exam costs between $360 and $495, depending on whether or not you are a member of the AALNC. To be eligible, you must have a minimum of 5 years of clinical experience as well as 2000 hours of documented experience in an LNC role during the last five years.

“Being certified as a legal nurse can showcase an LNC’s dedication and excellence in the field, but it’s not required,” Megan explains. “You can still practice as a legal nurse without obtaining certification. Attorneys may not even know what it means. Most attorneys seek a legal nurse out for their nursing and healthcare knowledge, years of clinical experience, and their quality work product.”

The AALNC also offers continuing education, including an LNC professional course starting at $3,828, depending on the upgrades you choose. 

Individual LNCs also offer courses to help people learn about the profession and build their businesses. One popular training program is offered by LegalNurse.com, which provides various certification “packages” ranging in price from $3,497 to $15,000. Legal Nurses Rock is another popular program that costs approximately $13,000.

Maryjane says it took her about six months to complete her training. She states, “I wouldn’t even recommend one program over another. Do the research and find one that speaks to you.”

There’s also more to being a successful LNC than simply doing good legal nurse consulting work. It’s also important to understand how to run a business, including marketing, bookkeeping, and managing contracts. These freelance and entrepreneurial skills can be learned (or hired out) through many different sources.

“I am my own boss and have a work-life balance like never before. I am available for my children and home more than ever before. And, I can prioritize my attention as needed if illness hits or business gets busier.”

How much do legal nurse consultants earn?

One of the best parts of legal nurse consulting is growing your career on your own terms and setting your own definition of success.

Many LNCs start consulting as a side gig, taking on a few cases in addition to clinical work. As far as income potential, this is like taking an extra shift.

Mid-level LNCs work full-time as consultants and usually earn between $30-$60 per hour, depending on the case and their experience. At this stage, it’s reasonable to earn between 65-125k per year once you have experience.

It can take anywhere from a few months to a few years to reach this level, according to Megan. “It all depends on the amount of work that you put in. Are you still working full-time at the bedside? Are you marketing and actively looking for clients? How much time are you putting into growing your business?” 

At the next level, LNCs can run their own businesses or even hire their own subcontractors to help with the workload. They are responsible for developing relationships with attorneys and legal firms, finding clients, and building trust with their clients. 

In addition to their LNC work, they may develop their own courses or products. The income potential at this level can vary widely based on what you offer and the relationships you build with both attorneys and your subcontractors.

Pros and cons of working as a legal nurse consultant 

There are many benefits to working as an LNC, particularly for those who want more control over their careers and who enjoy entrepreneurial work.

Some of the benefits of being an LNC include:

  • Flexibility – work when you want, take breaks for family or other responsibilities as needed
  • Autonomy 
  • Work from home
  • Be your own boss
  • Determine your own definition of success
  • The opportunity to be creative and develop solutions for client problems
  • Serving as a patient advocate
  • Serving as an advocate for other healthcare workers by helping attorneys understand when healthcare workers are not at fault
“Flexibility is the best part. I can flex hours and projects around my kids and family obligations.”

This type of work does have its downsides, though. This career path can include long hours and low pay, especially when you’re just getting started. Several experienced LNCs reported that it takes about a year of hard work to fully establish yourself as an LNC.

Some downsides of working as an LNC might include:

  • Financial risk of starting a new business
  • Highly technical writing
  • Projects can be very large and require the ability to understand how to break down tasks into manageable components
  • Steep learning curve in the beginning (though most LNCs say that once you master the basic skills, it’s not difficult)
  • Must understand (or be willing to learn) how to market and run a business
  • If you freelance or work as a contractor, you won’t receive benefits like PTO, retirement, or health insurance

It’s also important to have strong communication skills. Maryjane explains, “You have to love writing. It’s not fun writing. It’s very dry, research-based writing, even more so than scientific or academic writing. You have to be okay with that.”

Some nurses worry about finding clients or dealing with attorneys. It’s true that this process can feel overwhelming at first. Maryjane says, “Finding clients is as scary as you make. You have to be willing to put yourself out there, to meet new people, and to make new connections. This whole business is about connections. The more people you meet, the more relationships you build.” 

“Attorneys can be scary, but I just remember back to the scariest doctor from when I was new grad. I survived that, I can survive this.” – Maryjane Duquette

Are you interested in working as a legal nurse consultant?

Legal nurse consulting is a meaningful and flexible career that is perfect for nurses who want to be in complete control of their careers and who have an eye for detail. It also provides a valuable opportunity to serve as a patient advocate and educate others about the nursing profession.

If legal nurse consulting doesn’t sound quite right – or if you prefer a more standard employment agreement that comes with a benefits package – then utilization review/utilization management, data abstraction, or clinical documentation integrity might be a better fit.
In the meantime, check out the Nurse Fern job board for the latest opportunities in remote nursing jobs!