September 18, 2006
From scrubs to suits | Nurses find unique roles in health care policy and management by combining their experience in patient care with a law degree
By Samantha Depoy
When Alison Mynick was a nurse, healing happened at high-speed. If a patient was in pain, she could dispense drugs that would provide immediate relief, or assure a patient that a surgery was scheduled soon.
These days, in her work as a nurse attorney at Briggs and Counsel in Rockport, the fixes aren't as quick. In January of 2005, she filed a case on behalf of a woman who refused a request to donate her deceased husband's brain for research, only to later find out that the organ had been taken anyway. Nearly two years later, a trial date has yet to be set. "The immediacy of the result is what I really miss most about nursing," admits Mynick. "It's hard to tell people to go on with the rest of their lives while such a big part of their life remains unresolved. I have to tell them that if their case goes to trial, this could take a while."
The frustration of slower solutions is offset by the greater good Mynick believes she is able to administer as an attorney. "There is nothing as fulfilling as helping with your own hands someone who is in an immense amount of pain. But when I am doing patient nursing, I can only help one patient at a time," she explained. "Through my work as a nurse attorney, I am able to send a message to the insurance companies that people deserve to be treated fairly and compensated justly."
Mynick is one of the 20 or so nurse attorneys working in Maine who found they could be more helpful by combining their nursing experience and education with a law degree. As a nurse attorney, she handles plaintiff personal injury cases. She calls herself and other nurse attorneys "the translators," who can help decipher a client's thick medical file and transfer that medical knowledge into the equally specialized world of law.
Janet E. Michael, a nurse attorney in Portland who serves as president of the New England chapter of the American Association of Nurse Attorneys, estimates there are between 5,000 and 10,000 nurse attorneys in the United States and says she has 160 New England nurse attorneys on her mailing list. The opportunities available to those specialists are as varied as the personal and professional reasons nurses seek out law degrees, says Michael. Some handle risk management for hospitals, practice elder law or teach the legal aspects of medicine at nursing schools. Others help shape health care policy or serve as in-house counsel at hospitals.
While nurse attorneys certainly aren't new ˆ the New England chapter of TAANA was founded in 1989 ˆ they are in demand more than ever. As government regulations regarding patient privacy, malpractice and other concerns become more stringent, says Marilyn Westerfield, a nurse attorney in Yarmouth, the field will "continue to boom." At TAANA's 25th annual meeting next month, workshops will cover topics like ethical and legal issues in stem cell research, tort reform initiatives across state lines, drafting cyber technology contracts for health care clients and disaster response and business continuity planning ˆ all issues that are unique to the 21st century.
While nursing has always been a predominately female field, the percentage of women attorneys is now nearly 10 times higher than it was 30 years ago, and nearly half of all law students are now female, according to the American Bar Association. Michael estimates that about 95% percent of nurse attorneys are female, and as the legal profession welcomes more and more women, it's likely that the number of nurse attorneys will continue to grow.
A problem-solving approach
Some nurse attorneys, like Mynick, practice law, while others like Myra Broadway, Executive Director of the Maine State Board of Nursing, find work in government. Broadway worked for nearly two decades as a nurse, but decided to head to law school when she realized her work in New Hampshire as a quality assurance coordinator at an Air Force hospital required a deeper understanding of the law each year. "I became interested in the law because I appreciated the legal system and I loved the precision of words," Broadway says. She adds with a laugh, "My mother always said I loved to argue."
Broadway graduated from Franklin Pierce Law Center in 1990 and began her career in Maine as the assistant executive director at the agency she currently heads. Executive director since 1998, Broadway says her nursing background allows her to fully understand the implications of any decision the board makes from the perspectives of the nurses the ruling may impact. At the same time, her legal background ensures that the board's rulings are aboveboard.
Janet Michael also is well aware of the legal impact that Maine State Board of Nursing rulings can have. With a master's in nursing and a law degree from Northeastern University in Boston, Michael now represents nurses before the boards of Maine, New Hampshire and Massachusetts ˆ the three states in which she's passed the bar exam ˆ who have been cited for disciplinary action or terminated from their employment based on allegations of errors or misconduct.
In addition to helping clients prepare written responses to the board, she advises them on how to speak at their hearing. "I am huge on the truth but you don't need to volunteer extraneous information and you need to write in complete sentences," she says.
Besides arguing cases in court or before boards, nurse attorneys are uniquely positioned for roles in health care and health care policy, says Michael, because they speak the language of the courtroom and the patient's room. Nurses, she says, also have a time-honed approach to problem solving, being trained as the first person to assess a patient, establish a plan of care, then implement that plan and evaluate it. "I think that kind of thought process that becomes ingrained in nurses comes in handy when they move into the legal field because it's a structured way to solve problems," she says.
Additional degree, added influence
For nurse Marilyn Westerfield, working toward her law degree helped her break out of a position in which she felt increasingly powerless. After six years working as a nurse in critical care units like the ER, nursing shortages began putting a crunch on Westerfield and her colleagues. Despite the added hours and increased stress, she felt she was given no additional control over the care she administered. More and more, Westerfield says, she felt like a middleman. "It just felt like I had a lot more responsibility but not a lot of power," she admits. "People love nurses but because you are in a mass group, you're faceless. You don't have a lot of individual power."
She had an associate's degree in nursing, but didn't see the benefit in going back to school to get a bachelor's in nursing. The time and financial commitment weren't worth the payoff, which Westerfield says would have been a pay increase of a mere 10 cents an hour. Instead, she decided to go back to school to major in political science and as she heard her classmates eagerly conversing about law school she thought, "Why not me?"
In 1990, she graduated from the University of Cincinnati's law school, one of six nurses in her law class. "I felt like I could be more effective making changes in health care if I understood the system," she says. "Law teaches you how to objectively look at your obstacles and logically remove them. And when you are a lawyer, like a physician, you have instant credibility."
But for Westerfield, getting a law degree wasn't about an increase in pay. While attorneys generally have a higher earning power than nurses, nursing shortages leading to more competitive pay and increased overtime lead some nurse attorneys back to the bedside because they realize they can make more money, said Michael.
After clerking for the Ohio State Court of Appeals for six years, Westerfield began working as in-house legal counsel for the Children's Hospital of Cincinnati, one of two attorneys at the 300- bed hospital. Handling everything from employee contracts to custody cases, it was a position she loved. "Before, I felt like I was in the middle of a fight and now, I felt like I facilitated a lot of good things without necessarily being in the trenches," Westerfield says. "I was a lot more effective."
Having both nursing experience and a law degree was crucial to many of the situations she faced, says Westerfield, because there often was lots of gray area that required nurses on the floor to make quick decisions which she then had to legally justify. What's more, as a former nurse, Westerfield says she got the jokes and the lingo that are unique to that profession and helped her win the trust of the hospital's nurses. "I felt like I could make two worlds that don't speak well to each other finally connect. I didn't feel like a suit and I don't think they perceived me as one," she explains. "I'd always say, 'When in doubt, practice good medicine. Do what is right for the patient and we'll figure the legal stuff out.'"
In 1998, she moved in Maine for a looser lifestyle and now is a part-time attorney, handling health care law. While the compassion that nurses are known for may make them unlikely players in the legal world ˆ a field that has gained a cutthroat reputation thanks to a few sharks and a repertoire of raunchy jokes ˆ Mynick believes the two fields are a natural pair. "Caring about the person is something that's easy to shift between nursing and the law," she says. "We're both helping professions."
These days, in her work as a nurse attorney at Briggs and Counsel in Rockport, the fixes aren't as quick. In January of 2005, she filed a case on behalf of a woman who refused a request to donate her deceased husband's brain for research, only to later find out that the organ had been taken anyway. Nearly two years later, a trial date has yet to be set. "The immediacy of the result is what I really miss most about nursing," admits Mynick. "It's hard to tell people to go on with the rest of their lives while such a big part of their life remains unresolved. I have to tell them that if their case goes to trial, this could take a while."
The frustration of slower solutions is offset by the greater good Mynick believes she is able to administer as an attorney. "There is nothing as fulfilling as helping with your own hands someone who is in an immense amount of pain. But when I am doing patient nursing, I can only help one patient at a time," she explained. "Through my work as a nurse attorney, I am able to send a message to the insurance companies that people deserve to be treated fairly and compensated justly."
Mynick is one of the 20 or so nurse attorneys working in Maine who found they could be more helpful by combining their nursing experience and education with a law degree. As a nurse attorney, she handles plaintiff personal injury cases. She calls herself and other nurse attorneys "the translators," who can help decipher a client's thick medical file and transfer that medical knowledge into the equally specialized world of law.
Janet E. Michael, a nurse attorney in Portland who serves as president of the New England chapter of the American Association of Nurse Attorneys, estimates there are between 5,000 and 10,000 nurse attorneys in the United States and says she has 160 New England nurse attorneys on her mailing list. The opportunities available to those specialists are as varied as the personal and professional reasons nurses seek out law degrees, says Michael. Some handle risk management for hospitals, practice elder law or teach the legal aspects of medicine at nursing schools. Others help shape health care policy or serve as in-house counsel at hospitals.
While nurse attorneys certainly aren't new ˆ the New England chapter of TAANA was founded in 1989 ˆ they are in demand more than ever. As government regulations regarding patient privacy, malpractice and other concerns become more stringent, says Marilyn Westerfield, a nurse attorney in Yarmouth, the field will "continue to boom." At TAANA's 25th annual meeting next month, workshops will cover topics like ethical and legal issues in stem cell research, tort reform initiatives across state lines, drafting cyber technology contracts for health care clients and disaster response and business continuity planning ˆ all issues that are unique to the 21st century.
While nursing has always been a predominately female field, the percentage of women attorneys is now nearly 10 times higher than it was 30 years ago, and nearly half of all law students are now female, according to the American Bar Association. Michael estimates that about 95% percent of nurse attorneys are female, and as the legal profession welcomes more and more women, it's likely that the number of nurse attorneys will continue to grow.
A problem-solving approach
Some nurse attorneys, like Mynick, practice law, while others like Myra Broadway, Executive Director of the Maine State Board of Nursing, find work in government. Broadway worked for nearly two decades as a nurse, but decided to head to law school when she realized her work in New Hampshire as a quality assurance coordinator at an Air Force hospital required a deeper understanding of the law each year. "I became interested in the law because I appreciated the legal system and I loved the precision of words," Broadway says. She adds with a laugh, "My mother always said I loved to argue."
Broadway graduated from Franklin Pierce Law Center in 1990 and began her career in Maine as the assistant executive director at the agency she currently heads. Executive director since 1998, Broadway says her nursing background allows her to fully understand the implications of any decision the board makes from the perspectives of the nurses the ruling may impact. At the same time, her legal background ensures that the board's rulings are aboveboard.
Janet Michael also is well aware of the legal impact that Maine State Board of Nursing rulings can have. With a master's in nursing and a law degree from Northeastern University in Boston, Michael now represents nurses before the boards of Maine, New Hampshire and Massachusetts ˆ the three states in which she's passed the bar exam ˆ who have been cited for disciplinary action or terminated from their employment based on allegations of errors or misconduct.
In addition to helping clients prepare written responses to the board, she advises them on how to speak at their hearing. "I am huge on the truth but you don't need to volunteer extraneous information and you need to write in complete sentences," she says.
Besides arguing cases in court or before boards, nurse attorneys are uniquely positioned for roles in health care and health care policy, says Michael, because they speak the language of the courtroom and the patient's room. Nurses, she says, also have a time-honed approach to problem solving, being trained as the first person to assess a patient, establish a plan of care, then implement that plan and evaluate it. "I think that kind of thought process that becomes ingrained in nurses comes in handy when they move into the legal field because it's a structured way to solve problems," she says.
Additional degree, added influence
For nurse Marilyn Westerfield, working toward her law degree helped her break out of a position in which she felt increasingly powerless. After six years working as a nurse in critical care units like the ER, nursing shortages began putting a crunch on Westerfield and her colleagues. Despite the added hours and increased stress, she felt she was given no additional control over the care she administered. More and more, Westerfield says, she felt like a middleman. "It just felt like I had a lot more responsibility but not a lot of power," she admits. "People love nurses but because you are in a mass group, you're faceless. You don't have a lot of individual power."
She had an associate's degree in nursing, but didn't see the benefit in going back to school to get a bachelor's in nursing. The time and financial commitment weren't worth the payoff, which Westerfield says would have been a pay increase of a mere 10 cents an hour. Instead, she decided to go back to school to major in political science and as she heard her classmates eagerly conversing about law school she thought, "Why not me?"
In 1990, she graduated from the University of Cincinnati's law school, one of six nurses in her law class. "I felt like I could be more effective making changes in health care if I understood the system," she says. "Law teaches you how to objectively look at your obstacles and logically remove them. And when you are a lawyer, like a physician, you have instant credibility."
But for Westerfield, getting a law degree wasn't about an increase in pay. While attorneys generally have a higher earning power than nurses, nursing shortages leading to more competitive pay and increased overtime lead some nurse attorneys back to the bedside because they realize they can make more money, said Michael.
After clerking for the Ohio State Court of Appeals for six years, Westerfield began working as in-house legal counsel for the Children's Hospital of Cincinnati, one of two attorneys at the 300- bed hospital. Handling everything from employee contracts to custody cases, it was a position she loved. "Before, I felt like I was in the middle of a fight and now, I felt like I facilitated a lot of good things without necessarily being in the trenches," Westerfield says. "I was a lot more effective."
Having both nursing experience and a law degree was crucial to many of the situations she faced, says Westerfield, because there often was lots of gray area that required nurses on the floor to make quick decisions which she then had to legally justify. What's more, as a former nurse, Westerfield says she got the jokes and the lingo that are unique to that profession and helped her win the trust of the hospital's nurses. "I felt like I could make two worlds that don't speak well to each other finally connect. I didn't feel like a suit and I don't think they perceived me as one," she explains. "I'd always say, 'When in doubt, practice good medicine. Do what is right for the patient and we'll figure the legal stuff out.'"
In 1998, she moved in Maine for a looser lifestyle and now is a part-time attorney, handling health care law. While the compassion that nurses are known for may make them unlikely players in the legal world ˆ a field that has gained a cutthroat reputation thanks to a few sharks and a repertoire of raunchy jokes ˆ Mynick believes the two fields are a natural pair. "Caring about the person is something that's easy to shift between nursing and the law," she says. "We're both helping professions."
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