Nurses can provide support to legal professionals, such as attorneys and insurance adjusters. In years past, only physicians would give opinions on diagnosis and treatment issues in the legal arena, but that has changed.

In the early 1970s, insurance companies took a new look at how to lower their expenses, and sought medical teams that could offer plans to lessen permanent disabilities. In walked the rehabilitation nurse and the physiatrist (MD specializing in rehabilitation).

I was one of 13 rehab nurses hired by one of the "big five" insurance companies at that time. The country was divided into regions, and my region was the Southeast. The role was new, and the job description was evolving. My objective was to get the claimant as well as possible, as quickly as possible, with as little disability as possible. Under the physician's supervision, I directed the patient's care from the onset.

As legal professionals became aware of the great knowledge and ability of RNs, they integrated us into many aspects of their practice. The field is still evolving today.

Textbooks have been written on the roles of the legal nurse. The following descriptions are in the simplest terms, and are not meant to be all-inclusive.

• Legal nurse consultants review cases that involve injury and provide an insider's view of the medical aspects of a case.

• Nurse paralegals review cases and offer opinions based on their legal and medical knowledge.

• Life care planners develop financial plans for the future care of an injured person. These plans are used mostly in litigation.

• Case managers work for insurance companies or for the patients themselves, and plan the patients' care.

• Rehabilitation nurses plan the care of an injured patient when there is potential to lessen the disability.

• Elder care managers work with the geriatric population and plan their care. They are usually hired by the person responsible for paying for the care. This may be a family member or an elder care attorney managing a trust.

• Forensic nurses work with patients who are allegedly victims of criminal acts.

• Medicare set-aside consultants develop a portion of a financial plan that outlines the amount of money to be set aside for future medical care.

The work status of the legal nurse can be as an employee or as a consultant (independent contractor). Consultants usually work out of their homes or private offices. Some legal nurses only work with the medical record and never see patients. A legal nurse working full time as a consultant can make $100,000 or more a year.

You don't need more education to practice in the legal field. You do need to be an RN and know how to do the job, which you can learn from a book, by taking a course, or by working with an experienced nurse who will mentor you. Although you don't need certification to practice, if you choose to be certified, or if your employer requires it, look for the association with an independent certifying board that gives an examination. Some certification boards require up to two years' practice in the field to qualify for the exam.

If you are interested in learning more about legal nursing, browse the Web sites of the associations that represent that field. They offer a great deal of detailed, free information. To find out more about what you can expect, contact representatives directly. See if they have local meetings, and ask if you can visit.

As always, feel free to e-mail your questions to me via smullett@advanstar.com
—they may appear in future installments of this department.

Ask Pat

Q. I am struggling to start a business. Could you render any assistance (suggestions for books, counseling, etc.)?

S.O., RN

A. When venturing into self-employment, the first step is to research the field and see what other nurse entrepreneurs are doing.

One way to do that is to visit the National Nurses in Business Association ( http://www.nnba.net/links-members.htm) Web site and click through the many links to nurses in business. The association also has a book written by 33 entrepreneurs. They share their secrets, admit their mistakes, and offer advice to future nurse entrepreneurs. After you get a sense of your options that build on your nursing skills and knowledge, decide what type of business interests you.

The next step is to learn about small business and how to bridge the gap between nursing and business. Before starting, make sure you have the money to operate the business and the knowledge to provide the service.

Other resources include the Small Business Administration ( http://www.sba.gov/) and your local Small Business Development Center. See http://www.sba.gov/localresources/index.html for a map to your local center.

Do you have a question about entrepreneurship? Send it to smullett@advanstar.com