Taking Advocacy to the Next Level: What It’s Like to be a Nurse Attorney

If you feel a special connection to your role as an advocate for your patients, perhaps you should consider adding the title “attorney” to your current title of “nurse.”

“Many nurses realize that they are advocates at their patient’s bedside and beyond from the beginning,” says Kimberly Cleveland, PHD(C), JD, MSN, RN, C-MBC, a nurse attorney, educator, and recording secretary of The American Association of Nurse Attorneys (TAANA). “That’s actually what I think draws most of the nurses who’d like to become attorneys into wanting to go to law school. They really believe and feel that their role is to create safe systems, to advocate for patient needs and ethics in healthcare.”

As an educator, “I love sharing how nurses and healthcare providers can use what they know within the healthcare system to be able to provide for social justice and for equal access to healthcare for all,” Cleveland says. She notes that The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity2020-2030 calls on nurses to help ensure equitable care is extended to everyone.

“Attorneys have a special role in that because attorneys can also advocate for policy,” Cleveland notes. “One of the things that I find the most rewarding is that many times I’ve been called to weigh in on very large policy issues, and to help make sure that we’re considering all the stakeholders around the table when we’re coming up with our ideas about how to administer healthcare across the United States.”

“Nurses are positioned by the unique disciplinary preparation that they have to be outstanding advocates,” says Cleveland. “The critical thinking that nurses do at the bedside and within their roles as nurse leaders and clinicians really does help to prepare them to become outstanding lawyers. The key is really determining if that is where they want the focus of their practice to be, because as nurse attorneys we’re really advocates as well as problem solvers.”

Rigorous process

To become an attorney, you’ll need to go through the same process as every other individual who wants to practice law, notes Cleveland. “What I tell students is that law school is a very rigorous, iterative process. It is a profession that is full of details, of rigorous study, and of the ability to advocate and to write clearly.”

Although you’ll need to follow the same pathway as others, as a nurse you have unique attributes that can single you out. “Nurses have a wonderful opportunity to distinguish themselves from other people that want to be lawyers because they have such a broad experiential base,” says Diane Knoblauch, JD, MSN, RN, a nurse attorney and president of TAANA. “They come from so many different walks of life, and they have worked in so many different environments with so many different kinds of people and in so many different settings.”

Range of settings

As to where nurse attorneys practice, “There are as many roles for nurse attorneys as there are unique aspects of nursing,” according to Cleveland. “There are nurse attorneys working in family law because they have experience with being able to look at age appropriateness and communicate with children. There are nurses working in administrative law because very clearly, as nurse leaders, we are very keenly aware of the regulatory and administrative law aspects that impact health.”

“There are nurse attorneys,” says Cleveland, “that work on either the plaintiff or the defense end of medical malpractice because we understand the issues. There are nurse attorneys working in licensure for healthcare professionals, not just nurses but pharmacy and physicians and dentists. We see nurse attorneys actually working outside of the capacity of what you would consider a traditional nurse attorney in a courtroom, where they actually use their attorney skills as CEOs for hospitals, as CNOs in hospitals, or in quality areas, or even the vice president of legal counsel for a hospital.”

It’s not about the money

If you believe you’ll earn a high salary as a nurse attorney, you’ll need to rethink that assumption. Staff nurses, notes Knoblauch, make more annually than a nurse attorney, unless you graduate in the top 10 percent of your law class. In that case, you may be able to join a larger firm and make an income that would exceed a staff nurse’s salary. Knoblauch herself took a more than 50 percent cut in pay when she left her nurse practitioner position at the University of Michigan. What’s more, you’re likely to work at least 60 hours a week.

Analyzing complexity

With experience as a nurse, a nurse attorney can tease apart and analyze the complexity of today’s healthcare system. “Because many of us have worked in very complex systems, we’re also very adept at analyzing situations at a very high level to see how different sectors of healthcare administration come together to provide quality care,” Cleveland says.

“Because we are the patient-facing part of health care, we’re able to put together the complexity of the medical record, how patients come through the intake system, how patient handoff occurs, and how licensure and decisions about those types of things impact the ability to have privileges at a hospital.” Nurse attorneys, she notes, can also help analyze the system of care a patient is going to have, the quality that’s going to be delivered and what outcomes will be measured and reported.

“Healthcare is becoming increasingly complex and the issues that nurses and other healthcare providers are facing are almost overwhelming,” says Knoblauch. “More important than we could possibly imagine” says Knoblauch, are the critical thinking skills nurses are taught, “in being able to analyze all of those different elements and the components and what goes into putting a system together and making it work.”