Comment from Kethra: Correction: Title changed. Intended to read, "had" seven months experience. Ms. Levicy indicated in 2003 she was going to enroll in an NP program. If she
indeed did that, she could be in her clincals and thus doing SANE by virtue of
the NP (shudders). If not, as it now appears, Duke allowed a nurse who is barely off Graduate
Nurse probation do a SANE exam, I would have to call into question the
competency of the Nurse Manager for Duke ED. I would feel that way even if Ms.
Levicy was in NP clinicals given her extreme lack of experience. Excellent post! Thank you for your comments Kethra! I have read your excellent posts as well. I double checked the educational and clinical requirements for
NP programs at various universities. U of. MD. has an excellerated
program for those who hold a BS degree in fields other than nursing: "MS Accelerated – Clinical Nurse Leader
Modified 1/8/07 4am
The CNL is a generalist clinician with education at the master's degree level. This pre-licensure program will allow individuals with degrees from other disciplines to earn a Master of Science degree in nursing by building on the foundation of their bachelor's degree.
A second bachelor’s degree will not be awarded. Upon completion of the program, students will be eligible to sit for the national licensing exam (NCLEX) to earn RN licensure."
Most of the others I found required a BSN first; many required prior clinical nursing experience.
I find it hard to believe that they would allow someone to go from not being a nurse at all to being a nurse practitioner. No offense intended to anyone, but to allow someone to diagnose and prescribe medicines, who had no prior clinical nursing experience, is just mind boggling - and very disturbing! I agree with you, Kethra. I shudder at the thought!
---------------------------------------------------------------------------------------------------------------------
The book learning, even advanced degrees, are great. But as Kethra and I, and millions of other nurses know, there is far more to nursing than what comes out of a book. Theory must be put into practice and that practice must be continuous over a lengthy period of time in order for everything to come together.
I still remember what it was like when I was fresh out of nursing school. There was no way, at seven months, that I would have considered myself an "expert" in any type of nursing. I was still following the other nurses around, asking a million questions.
Oh sure, the day to day routines, such as changing dressings, handing out medicines and charting, were easy enough to learn. But it was the ability to translate what we had learned in school, to apply the theory to the actual picture of what was going on with that patient, that took time to develop.
It took time, and additional hands on learning, to realize that something that seemed so straight forward in school really wasn't when it involved different types of patients, of different ages, and in different physical conditions.
It takes time to develop the ability to make snap decisions needed in emergency situations. It takes time to learn about things like the bio-mechanics of trauma and patterns of injury. It takes time and skill to recognize personality disorders and manipulative and attention seeking behaviors that some patients will exhibit.
You can't just learn about these things in a book. You have to see and experience them first hand in order to apply the knowledge that was obtained in school.
Nursing school is just the beginning. It can take years to learn the rest.
Privately, I offer both forensic and legal nurse consulting services. Many forensic nurses are also legal nurse consultants. I've belonged to various LNC professional groups for several years now. Often, a nurse, maybe a year or two out of school, will express interest in becoming an LNC.
That person has always been told, by the majority of group members, to wait until he/she has gained more experience. That person has always been told that you usually need a good 10 years of solid nursing experience before considering legal nurse consulting.
Why? Well because the primary job of an LNC is to be able to review medical records to determine if there has been any deviation from the standard of care (SOC) provided to a patient.
The LNC also must be able to educate attorneys on a wide variety of things, such as medical terminology, anatomy & physiology, the pathophysiology of a particular disease process as it relates to their clients; to usual nursing practice and procedures, to management and staffing issues. Often, the LNC is retained to testify as an expert in court.
In order to fulfill all the requirements of the LNC position, one must have a strong clinical background which can only be obtained through years of hands on practice.
It's the same for nurses who train as FNE's in our state. That person is required to have a strong clinical background, backed up by several years of recent experience, before being qualified to take the SANE training course and obtain their certification.
Sure, they can collect the evidence competently. Technicians do that out in the field. That's the easy part. The hard part, the part that requires the nurse to interpret what she's seeing, must be based on clinical expertise. As I said before, most of the FNE's I know have years of experience under their belts.
This information on forensic nursing is from my other website, www.HarfordMedlegal.com:
"The definition of forensic nursing is the application of nursing science to public or legal proceedings; the appreciation of forensic aspects of health care combined with the bio-psychosocial education and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity, and traumatic accidents." [Lynch 1989]
Forensic nurses are registered nurses with advanced, specialized training in forensic sciences and the law. Forensic nurses apply this knowledge in the care and treatment of victims of abuse, the collection of evidence, and provision of testimony for criminal investigations.
To quote Dr. Mary Dudley, Chief Medical Examiner for the Sedgwick County Regional Forensic Science Center in Wichita, Kansas [from whom I took my death investigation training], "The forensic nurse must obtain specialized knowledge of trauma, forensic psychology, criminalistics, forensic science, and legal issues for expert testimony." (Forensic Nursing, Mary H. Dudley, M.D., M.S.N., R.N.)
There is no way I would have even considered becoming a SANE nurse with only a few months nursing experience, much less walk into court to testify as an "expert". I'm glad that my own state has the high standards and stiff requirements that it does for our own FNE's.
Since I'm always interested in other professional opinions, I questioned several of my colleagues, both within the forensics field and out, as to their opinions of an RN with only seven months experience providing SANE exams. Their reactions mirrored my own. Mouths flew open, "You're kidding!"
No, unfortunately, I'm not.
Daubert Requirements
Rule 702. Testimony by experts
How does one maintain they have "specialized knowledge" when they haven't even finished their training yet?
I know what SANE "in training" means. It can mean anything from still trying to get their initial GYN training exams done, as well as the other training requirements, to having completed less than three SANE exams.
It means you have almost zilch experience. It means, according to myself, as well as other FNE colleagues, that you should still be supervised by an experienced SANE nurse during any exam.
I mean no disrespect to Ms. Levicy. However, while I'm sure that Ms. Levicy has completed her training in the last year, she was still "in training" at the time of the Duke Lacrosse accuser's SANE exam.
It was her opinion, at that time, that should matter. An opinion that Durham DA Mike Nifong specifically stated he relied upon to aide in bringing charges. An opinion that led to the indictment of the three Duke Lacrosse players. An opinion, from the "sexual assault expert", that helped rile a community, inflame racial tension, and send the media into a feeding frenzy.
An opinion based on what? Seven months experience as an RN and almost zero experience as a SANE nurse?
If I knew that my own "expert" testimony might be used to convict anyone - I would want to make sure that I had enough knowledge, training, AND clinical background experience in order to feel comfortable rendering that "expert" opinion.
Here are some other opinions from professional colleagues in various fields:
From Rick, an RN : "... 6 months is not enough time to be an expert on anything. We grow into our positions learning more every day. An expert needs to have a goodly amount of hands on experience beginning as a novice and progressing through out the various stages until reaching expert. I wouldn't consider anyone an expert without a minimum of 10 years. "
From an insurance investigator:
"I can say from experience that from an insurance company standpoint, a good expert that would be credible on a witness stand would be someone who has at least 5-10 years experience in their field.
In regards to nursing experts, someone who has a masters degree and teaching experience would be an ideal"expert". In addition, how they would perform in front of a jury is key to being a good expert. Someone with less than 5 years experience is still learning their craft and would be a very unimpressive witness."
From another investigator:
"If they are using an expert classification to establish a point, ask them to cite the articles that they wrote on the subject, the cases that they testified in, their education studies on the subject, which court certified them as an expert, what research they conducted ..."
From John, a retired Matron of a forensic hospital in England:
"A person can have 20+ years as a forensic nurse but their 'experience and expertise' can be limited. I think that it has to be a combination of experience (clinical and/or managerial - all in the field of forensics), academic achievement and the verification and endorsement of at least two others in regards to the area of expertise"
From Fred, an insurance fraud investigator and educator:
"We are a provider of insurance fraud
education to the insurance industry. We recently began offering our courses to
the private investigator industry. Many times we feel these individuals believe
they are well trained, but they in a lot of cases, they are not. Many do not
believe they need to be kept up on training. Many never receive additional
training once they enter into that industry."
From Brent Turvey, Forensic Scientist:
"I use work-product to estimate expertise. Using this standard is far more
useful
in terms of separating those who have some grasp of what they are
doing from
those who do not ... real experts don't need to tell you how many years
they've been doing what
they do, or how many letters come after their name,
to support their
conclusions; they show their work and render conclusions in
such a way that
makes their expertise clear to any reader."
From Kethra, an Emergency Room RN:
"I cannot imagine any new grad nurse being subjected to a SANE course. It
is not that they could not do the course work, you and I both know this, but the
sheer experience needed to make judgement calls simply comes with time and time
only.
For any nurse manager to subject a new nurse to this is beyond the pale.
I understand we are in a nursing shortage, but to subject both the patient and
the nurse to this type of experience is unprofessional in the extreme."
Diffuse Vaginal Edema
The following is quoted from Dr. Dudley's book, Forensic Medical Investigation. It's an example of court questions of an expert:
" Q: You've got lacerations of the scalp. We will talk about that. But what you have here is focal hemorrhage of neck muscles, right?
A: That's correct
Q: Focal, that means focused, correct? Am I right in that?
A: The way I use the word "focal" is it's localized vs. diffuse. And what I mean by focal, it means it's not spread out all over. It's got a definite area. "
Dudley, Mary H. Forensic Medical Investigation. A Comprehensive Review 2002
As far as recognizing " diffuse vaginal edema" goes, a SANE Medical Director, an M.D. and co-author of a forensics trauma textbook, recently said that, with all her years of experience, she didn't know if she could recognize it.
So, I have to ask :
If a Medical Director, with many years experience in both trauma and sexual assault, as well as other FNE's with years of experience too, couldn't be sure that what they were seeing was diffuse vaginal edema, how could someone with only seven months nursing, and almost no SANE experience be so certain?
We're so lucky to have a source like Kethra at Liestoppers message board.
Appreciate all you've shared on the case and the fact you praised our inside source, Kethra!!
Thanks again,
Kent
Posted by: kbp | January 08, 2007 at 11:30 AM
You're most welcome Kent. It was my pleasure!
Posted by: Kathleen | January 08, 2007 at 12:32 PM
An Open Letter to Michael Nifong
by William L. Anderson
Hello, Mike. Had I written this open letter last summer, I doubt you would have heard of me, but my sources in Durham (and they are good sources, Mike) tell me that I pretty much am on your enemies list. I’m glad I could accomplish that feat, but from what I can tell, that list is getting longer while we speak.
However, in this letter, I come to you in peace. I’m offering you advice, good advice, I might add, and if I were you, I would take it. Don’t get me wrong. I really hope that you not only lose your law license and your job, but since you were trying to take away the lives of three young men who had committed no crimes, I do hope that you have the opportunity to do a stretch in prison, or at least have to face that horrifying prospect. After all, there are people in this country who belong behind bars, and you are one of them.
But even though I want you to go to prison, I am going to offer you advice that I think very well not only could keep you out of what Lew Rockwell calls the crowbar motel, but also could save your career. Think about that, Mike. I am trying to help you keep your law license, your freedom, and maybe even your job, so you need to listen to me.
The first and most important thing is that you need to drop the kidnapping and sexual assault charges against Reade Seligmann, Collin Finnerty, and David Evans. I mean drop the charges the way that Duke University receivers drop passes at crucial times during a close football game. Those charges need to disappear, and fast, for if you insist on pushing them forward, it only will get worse for you.
As I give you this advice, let me caution you not to listen to people like Wendy Murphy. She has been on television championing your cause, and wrote this abomination of an op-ed for USA Today that declared your dropping the rape charges, but keeping the others, to be a "brilliant move." Trust me, Mike; you don’t want Murphy being your only cheerleader, for I can give you a list of law-abiding and respectable people who would refuse to spit on her grave only because they hate standing in long lines.
No, listen to me. Dropping those charges leads to my second point. For the past nine months, you have been telling the world you had a great case. Last spring, while reading something by your political allies, I saw where you had a "mountain of physical evidence" that pointed toward those three men having committed what the black journalist Cash Michaels called a "brutal rape."
As you know, that mountain never was on your side; it was on the other side. My guess is that you had that figured out the minute you spoke to Brian Meehan of the DNA lab last April (before you secured the indictments against Reade and Collin), as he gave you the bad news that the only thing DNA was going to do would be to further discredit Crystal and, by definition, your case.
That is when you made your biggest mistake. You lied, and then tried to cover the lie, and when you were caught, you gave a litany of excuses that rivals anything John Belushi would have given in one of his movies. Despite Murphy’s contention that you simply were trying to protect the "privacy" of the unindicted lacrosse players, reason tells the rest of us that you were not too worried about protecting people whom you publicly had labeled "hooligans" and "rapists."
Mike, I can assure you that Judge W. Osmond Smith III was not taken in by your various excuses that range from "I didn’t know" to "the dog ate my homework" to "no harm, no foul." Maybe another judge might have looked the other way before this case became The Story nationally. When the Los Angeles Times is writing editorials calling for your head on a platter, you have to understand that this no longer is a Durham case. It is a national case, and you cannot stuff that thing back into your little jurisdiction.
Thus, literally everything you bring into that courtroom on February 5 is going to undergo scrutiny from every news outlet and every legal analyst in the country, not to mention overseas. Believe me, that is not something you want to happen, as the outright dishonesty of your "evidence" is going to be hung out for the world to see. It is one thing for that to happen in the current arena dominated by writers and talking heads, where nothing official has happened.
However, once you put this dreck before a judge, and the court gets to see exactly what your "evidence" really is, you are going to be in much more trouble than you are now. At this moment, you still are guilty only of "bad judgment." If you walk into that courtroom with your witness in tow, your "investigators," and your "medical evidence" (or, better put, your medical non-evidence), at that point you are going to be seen as the D.A. who has perpetrated a fraud. At that point, Mike, you will have openly committed a crime for which will make you vulnerable to spending time in the crowbar motel. That is fraud, Mike, and I am using that term in the legal sense.
There is a way out. You can go to the courthouse today – right now, I urge you – and make the following declaration:
I am announcing today that I have dropped all charges against Reade Seligmann, Collin Finnerty, and David Evans. There will be no further charges, and no more investigations of the alleged events that occurred on March 13 and 14, 2006.
At the time the accuser made the charges, my conversations with police officers led me to believe there had been a rape and sexual assault of the woman in question. As a prosecutor, I was duty-bound to investigate and the information that police gave me was of the type that required me to pursue this case and seek the indictments.
However, after further examination of the charges, I no longer can conclude that they are credible, and if I am not sure myself of the credibility of the accusations, by law I cannot further pursue this matter in a court of law. From the start, I have made it clear that this office takes rape allegations seriously, and we will investigate those allegations.
I do regret any actions I took which might have appeared to be overzealous, but at no time did I act against the letter or spirit of the law. While I take responsibility for mistakes that I might have made during this episode, let me assure all of you that those mistakes were made in the pursuit of what I thought was a just course of action.
Granted, about everything I have written for you is a lie, but since you already have lied repeatedly as an officer of the court, one more lie won’t hurt you, especially since it will have been told in the course of your ending this legal fraud. After all, you did not make the initial rape allegations; it was a woman with a history of drug abuse, prostitution, and mental problems (she was hospitalized in 2005 for those). She was trying to keep from being involuntarily committed to a mental institution when she made the charges, and that hardly was your fault.
But if you drop the charges with the above declaration, you have something you can bring to the representatives of the North Carolina Bar Association, who already have summoned you to appear before an investigative body. You can claim you were trying to make sure that a possible rape victim who is black and poor would receive justice. You can claim you were overzealous, but sincere in your actions.
(You might even try to repeat some of the acting talent you showed when you demonstrated on national television the alleged choke hold that the accused put on the woman. You sure were convincing when the cameras were on you.)
If the members of the legal cartel – I mean, your fellow attorneys of this august body – act within their usual scope of things, you might just get off with a reprimand, provided you have not tried to bring a lying accuser, lying police officers, and anyone else who would be torn apart by defense attorney, into a court of law. If you go that far, you can bet that the authorities will have no choice but to throw you to the wolves.
Remember, there are prosecutors in North Carolina who tried to get someone executed, even though they had exculpatory evidence in their possession (which they failed to give to the defense of Alan Gell). They got off with bare reprimands, and both of them are gainfully employed in the law. You might want to speak to David Hoke and Debra Graves about how to grovel in front of the Bar Association investigative committee, so that you, too, can get your free get-out-of-jail card.
Above all, Mike the key is dropping these charges now. Take my advice, please. I may not like you, but I believe that it would be best for everyone involved if you were to punt, including you. If you refuse to take my advice and continue this fraud, then people who have some authority over you are going to dismiss the charges, and then they will deal with you. Mike, you have an opportunity to see that this humiliating experience does not happen, and I recommend that you take the proper course of action today.
December 29, 2006
William L. Anderson, Ph.D. [send him mail], teaches economics at Frostburg State University in Maryland, and is an adjunct scholar of the Ludwig von Mises Institute.
Copyright © 2006 LewRockwell.com
http://www.lewrockwell.com/anderson/anderson161.html
Posted by: Burt | January 10, 2007 at 02:46 PM
Thank you Professor Anderson!
Posted by: Kathleen | January 13, 2007 at 07:13 AM