Clinical Review Legal Nurse Consultants

November 1, 2011 Carlienne Frisch

Teaching Well

Professional St. Peter healthcare educator that wears many hats throws her latest into the ring.

If tomorrow is likely to look like yesterday, Cyndi Zarbano will do something to change that today. She sits forward on a chair in her St. Peter home and says, “This life is not a dress rehearsal. I believe life’s a journey, and I don’t want to keep doing the same thing. I love bedside nursing, but I believe educating others to be better at what they do is an equally important calling. I believe I’m a good intensive care nurse, both as a bedside nurse and an educator.”

That’s why in 2008 Zarbano formed Clinical Review Legal Nurse Consultants as a limited liability corporation to review medical-legal cases for merit, locate experts, and work with insurance companies to review records. The services segued into presenting seminars on medical topics as a subcontractor for other companies. In July of this year, she formed Fostering Professional Development, Inc., an “S” corporation that in January 2012 will begin offering a variety of speakers nationally on healthcare issues. Zarbano will become one of her new company’s speakers by sub-contracting through Clinical Review.

Instead of continuing to operate her business out of her home, Zarbano recently bought a 4,700-square-foot Victorian-era house on South Minnesota Avenue in St. Peter and in it set up the Fostering Professional Development office. Tammy Rosburg, a friend of Zarbano’s with a long history of management, fills the role of company vice president. Zarbano’s ex-husband, Sam, is the new company’s operations manager. Zarbano hopes to add five employees—including a travel coordinator, print materials coordinator, administrator and janitor—by year’s end.

“I want to bring jobs to St. Peter in my business,” Zarbano said. “I chose to buy real estate and to open the business in St. Peter with hopes of further making an impact here.”

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The public face of the business is already in place. “I have speakers on contract whom I have interviewed,” Zarbano explained. “I tweaked their proposals and the manual that gets handed out at the beginning of each presentation. Then I scheduled their presentations for next year. Most presenters have another job, so they have one topic, although a few have two. We have 15 topics for January, 12 with new speakers, and three that I will present. In February, we’ll add five more topics. My goal is to have 50 different presentations.

“I like to think the unique component is that I get to decide what topics to present. I currently have a list of 20 topics that seminar attendees repeatedly have told me they want or need to make their practice better. Most are nurses, nurse practitioners, respiratory therapists, physical therapists, occupational therapists, dieticians, and pharmacists.”

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“I’m good with people, at education, and at nursing,” Zarbano said. “Every job I’ve ever had, I’ve loved. When I was 14, my parents helped me get a job as a kitchen assistant at a local nursing home. I loved the geriatric population and their eagerness to share their journey. I always wanted to be a nurse, but didn’t think I was smart enough, so I got a Bachelor of Science degree in psychology, with a minor in sociology, from Minnesota State. As I grew older, I became more self-confident and decided to try to become a nurse. I don’t like taking out loans, so I joined the Naval Reserve and competed for a stipend program for nursing. I was one of 32 people chosen nationally and was commissioned as an officer (ensign). I got an RN degree, and then, in 1995, my bachelor of science in nursing from MSU.” (Zarbano also has 28 credits toward a master’s degree in Family Nurse Practitioner. She is considering applying them toward a Master of Science in Nursing Education degree, which she can get online from MSU.)

“I owed the Navy five years in return for my education and gave them a little over six,” Zarbano said. “I loved my Navy time as a nurse, mostly in ICU (intensive care unit) in naval hospitals in Bremerton, Washington, and San Diego. I became an assistant division officer and then a division officer in Guam, as well as a critical care flight nurse there on medivac flights.” She achieved the rank of lieutenant commander before leaving the military.

After working at various hospitals as a psychiatric nurse and critical care nurse, Zarbano saw another purpose to which she could put her experience and expertise.

“I wanted to become a certified legal nurse consultant,” Zarbano said. “In 2008, I attended a certified legal nurse consultant course in Atlanta. After becoming certified, I came back and contacted attorneys. I offered a “brown bag” educational opportunity for lawyers to learn about traumatic brain injuries. I also contacted insurance companies about reviewing medical records for merit. One attorney asked if I would be willing to do national seminars for PESI, an Eau Claire, Wis. seminar company, and I began to do that while continuing to work as an ICU nurse. Several similar national seminar companies approached me, and I began to do more speaking at seminars.”

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When preparing to deliver a program, Zarbano explained, the process begins with a period of intense research, using current journals, texts, and research websites such as CINAHL (Cumulative Index to Nursing and Allied Health Literature). She purchases some of these sources and accesses others using the Internet. Her role as a legal nurse consultant has included researching topics and standards of care—skills she finds beneficial when preparing a seminar topic. Her goal is to have at least 80 percent of her reference materials no older than three years at the time she begins the presentation of a new program. It takes Zarbano up to five months to prepare information for the manual and the paired PowerPoint accompaniment for each program. She finds her most productive research time is when she’s sequestered in her office, but it often occurs on the road while presenting programs.

“Because I travel four or five days most weeks, I have become very efficient working in airports and hotel rooms,” Zarbano said. “In my role as a legal nurse consultant, I have helped find experts—a neurologist, for example—to review records and testify as needed. And I’ve done some of that work myself. I no longer promote this service, but I want to try to keep cases that don’t have merit from stressing health care professionals. If legal cases come to me now, I usually subcontract to another expert Nurse Consultant. I try to get people to do the right thing.”

Zarbano’s public speaking soon became the focus of her business. Her credentials provide credibility and reflect her expertise. In addition to being a registered nurse and having bachelor of science degrees in psychology and nursing, Zarbano is a certified legal nurse consultant, a certified nurse life care planner, a certified critical care nurse, and a certified medical-surgical registered nurse. Among the seminars she offers are courses to prepare people for taking the CCCN and CMSRN exams.

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Although having no typical day, Zarbano’s weeks do reveal a pattern. Monday mornings, she works from the Fostering Professional Development office and takes an afternoon flight to her speaking location, usually in the United States, occasionally in Canada.
“I have the best job in the world,” Zarbano said. “I travel, meet great people, stay in nice hotels, and eat great food. I’m always on vacation. I recently was on a ten-day Alaska cruise during which I did four presentations on ‘Critical Care Essentials.’ Each speaking day was four hours long for the four days we were at sea. I waived my honorarium and did 16 hours of work to get a ten-day cruise for myself and Sam in exchange.” She’s going to Alaska again in December (no cruise this time) to speak on the subject of how to complete a thorough health assessment.

Zarbano’s usual schedule is more mundane than a trip to our 49th state. On Tuesdays, she does six hours of speaking in an eight-hour seminar and drives (usually 1-2 hours) to the next day’s location, where she conducts Fostering Professional Development business from her hotel room. Wednesdays and Thursdays are repetitions of Tuesday. After the final day of presenting, she normally hops a plane home and resumes her work in St. Peter on Fridays (and frequently works on weekends) before the cycle begins again Monday.

Although her list of recent seminar topics is unlikely to raise either the eyebrows or the blood pressure of non-medical readers, Zarbano has developed a solid following—one might even call them fans—in the healthcare field.

“I’ve had groupies—nurses and a nurse anesthetist—follow me from state to state,” Zarbano said. They come to hear her speak on topics such as “Effective Physical Assessment” (Montana, New Jersey, Washington and Texas), “Mastering Lab Interpretation” (Illinois, Pennsylvania and New Jersey), “Medical-Surgical Certification Preparation” (Florida, California and Louisiana) and “Fundamentals of Critical Care” (California).

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Although Zarbano usually arrives home on Thursday, sometimes it’s Friday. (“I sleep well on a plane,” she said.) Until recently, she would leave for her nursing job in Minneapolis on Saturday evening.

“On Saturday and Sunday nights I had been working in ICU at Abbott Northwestern Hospital,” she explained. “I would go home to sleep Sunday during the day and return to Abbott on Sunday night. In the military, I routinely did 80 to100 hours a week. Challenge invigorates me. I think I do this a lot better than most people. I like to have a lot of irons in the fire. A lot of my journey is avoiding boredom. I’m a terrible ‘waiter,’ so I want everything to happen now. But if it did, I’d be bored. I’m pretty happy with the way things are going.”

Despite being an expert juggler of activities, Zarbano has accepted the fact that there is no way to stretch a seven-day week into nine days. As she grows Fostering Professional Development, Inc. she has had to let go of the bedside nursing career she dreamed of as a child. Her last day at Abbott Northwestern Hospital was in late September. She doesn’t feel, however, that she is deserting patients.
“There is no shortage of registered nurses in Minnesota,” Zarbano said. “I like doing the right thing for the right reasons. I’m bringing information about evidence-based practice, called EBP, to practicing health care providers. They don’t have time to read all of the recent medical journals to learn about proven standards as they change.” Her goal is to help improve professional practice by having herself and the speakers for her company do the necessary research and to bring information about those changes to health care professionals.
Zarbano not only brings EBP to seminar attendees throughout North America, she also makes that education available through other methods that she calls “products”—webcasts and “webinars.” The latter are CD-Rom presentations (she hopes to have them available early next year) that offer training, a quiz and a continuing education unit credit. These will allow a buyer to view a program at home on a computer instead of driving to a session in order to meet the requirements for the training. Upcoming topics for the one-hour “webinars” include “Life-Threatening Electrolytes, “ “Gastro-intestinal Assessment,” and “Critical Thinking.”

“We want nurses to use critical thinking to assess a situation and to make the right choices,” Zarbano explained.

While letting the door to ICU shut behind her, Zarbano is adding a seminar to her February 2012 speaking schedule. Its title is “Healthcare Providers as Entrepreneurs.”

“That’s a new one I’m putting on for the new company,” Zarbano said. “My journey has taken me where I’ve wanted to go. I have no regrets.”

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Feline Affinity

Current family: I have four indoor cats, my mother lives two houses down, my father lives two blocks away, my siblings all live in Minnesota and my ex-husband, Sam, is a close friend.
Hobbies: I love to read murder mysteries and general fiction. I listen to classical music. I like to bake and cook. I watch birds at the bird stations in my back yard. I love to travel, and I’m learning to garden.
Accomplishments of which you are most proud: a) Having served my country, which made me not only a nurse, but also a leader, and b) going back to school to get a nursing degree.
Possession you value most: My cats.
Intangible you value most: My integrity. I really try to do the right thing for the right reasons.
Three words that describe you: Hardworking, generous, and loyal.
If you weren’t in this business, what would you be doing? If I wasn’t a nurse, I’d probably be a social worker, and I would resume working on a novel I began writing one summer when I was bored.

Early Preparation

Childhood: I’m the youngest of four children. I was named Cynthia and called ‘Cyndi’ with a ‘y’ because my father, Robert Johnson’s, nickname has been ’Cy’ all of his life. I graduated from St. Peter High School in 1982.
Favorite school subject: English—I love to read and write.
Least favorite subject: Physical education—I was pretty introverted and not competitive back then, and I didn’t want to interact physically.
Preparation for your business: Life experience, nursing, writing college papers, public speaking in the military, which you do as you move up in ranks. I’ve done a lot of educating, both to students and to other educators.

THE ESSENTIALS