Case Review

Attorneys know the law and how to represent their client in a courtroom.  As an Advanced Practice Registered Nurse (APRN), I know patient care and recognize when deviations from the standard of care have occurred.  This translates into a wonderful partnership between myself and the representative of a patient who has been harmed by negligent or absent care.

The hard reality is that errors happen every day in healthcare.  Unfortunately, some organizations and providers are less than forthcoming when these mistakes happen.  I am able to delve into the case to determine what actually happened.  This research is tedious and takes time.  Electronic medical records are complex and multilayered; information is often buried.  When reviewing a record for missed opportunities, it is often not what is documented but determining what documentation is lacking  regarding the care provided, that is key.  These details can make or break a case.

In addition to documenting the excellent care I personally provide to each and every patient, I also have extensive experience reviewing medical records:

• While serving as a Quality Initiative Nurse, I reviewed medical records concurrently, while patients were actively hospitalized.  When a deviation of care was recognized, I was able to direct staff to correct the problem prior to the patient’s discharge.  This ensured patients received evidence-based care, which improved outcomes.
• As a Case Manager, I did both discharge planning, as well as utilization review.  I would examine the chart and submit the significant and relevant details to support continued inpatient care for patients to their insurers.  This made certain the hospital was reimbursed for care that had been provided.  I would also review records to determine the next level of care that would be needed, as patients progressed through the healthcare system.  My recommendations were then passed onto the provider, so they could incorporate this into the plan of care.
• As an Adult Gerontology Clinical Nurse Specialist, I served on a committee that met weekly.  We reviewed safety events and ranked them according to the severity of injury sustained by the patient.  I would create targeted presentations, designed to educate staff about the circumstances, to prevent such occurrences from happening again.  Performance improvement methodologies were employed to correct the faulty systems that initially allowed the error to slip through the cracks.  Examples are processes like root cause and apparent analyses.

Expert Witness

If the case makes it to court, I am the ideal expert witness.  I draw upon my excellent educational preparation, having received my Master’s degree from Old Dominion University (ODU) and my Bachelor of Science from Virginia Commonwealth University (VCU).  I am Board Certified by the American Nurses Credentialing Center (ANCC) as an Adult Gerontology Clinical Nurse Specialist (AGCNS-BC).  I also hold two other special certifications in nursing:  Critical Care Registered Nurse (CCRN) from the American Association of Critical Care Nurses (AACN) and Accredited Case Manager Registered Nurse (ACM-RN) from the American Case Management Association (ACMA).  Certifications are not required but demonstrate competence in selected areas of nursing.

I am also an active member of many professional nursing organizations:

• American Association of Critical-Care Nurses
• Virginia Clinical Nurse Specialist Association
• National Association of Clinical Nurse Specialist

I am presently an active participant of the Virginia Clinical Nurse Specialist Association’s Legislative Task Force.  We recently petitioned the Virginia Board of Nursing to amend regulations related to the registration of our group of Advanced Practice Registered Nurses (APRNs) in this state.  We have a long way to go to address how Clinical Nurse Specialists practice in Virginia but with persistence, I am sure we will successfully elevate our practice to national standards.  The residents of Virginia deserve access to the entire spectrum of care we are educated and prepared to provide, as APRNs.

Given my extensive experiences in nursing and my demonstration of attaining and maintaining excellence in practice, I am certainly qualified to be able to answer the question most jury members want to know:  What would a prudent nurse have done?