Nursing Expert Witness Reports: 10 Tips for Presenting Facts and Opinions

I have written or read thousands of nursing expert witness reports over the last 26 years. Your nursing expert witness report will be read by the attorneys on both sides, claims adjusters, the risk manager, the judge, and opposing experts. You must be able to craft a powerful nursing expert witness report in order to effectively present your expert opinions.

Format of nursing expert witness reports

Use this clear format for your expert witness reports:

• List the documents you reviewed.
• Summarize the medical events.
• Explain the standard of care.
• If you are hired by the defense attorney, explain how the nurses followed the standard of care.
• If you are hired by the plaintiff attorney, explain how the nurses deviated from the standard of care.
• Summarize your opinions.

Components of an Expert Witness Report

1. List the documents you reviewed. Provide the dates of admissions or physician office records, depositions and expert reports. This list will be invaluable when you are asked the question in deposition or at trial, “What did you review before you wrote your report?”

2. Next, after listing the documents you reviewed, give a summary of the medical facts. This helps to humanize the patient, to make him or her real for the reader. Succinctly provide details of the patient’s medical history and what happened. When I say “succinctly” I mean that the majority of your report should not focus on what happened.

Your report should contain a balance between what happened and your explanation of the standard of care and how the defendants followed or did not follow the standard of care.

3. Explain the standard of care. Remember the concept of “evidence does not explain itself.” Don’t assume that the person reading your report understands nursing or what nurses do. Spell it out.

4. Keeping in mind whose side you represent, discuss what the defendants did in relation to the standard of care.

5. Follow a logical format for presenting the key points.

Establish the key points early, and then return to them as you elaborate. It is easier for people to follow your structure if they know in advance what you plan to discuss. The adage that guides teaching also helps readers understand the structure: tell them what you are going to tell them. Tell them. Tell them what you told them.

6. Once you have laid out the terms of your argument, your job focuses on linking and building the structure of your opinions. Spell out the direct link between the medical evidence and testimony and your conclusions.

Follow the formula, “Because of this (fact), I believe that…” Consistently refer back to and develop the points you have told the reader you’ll be sharing with them.

7. Help the reader see the transitions as you move from point to point. Repetition guides the readers and enables them to follow your argument.

Take a word or phrase from your first point and repeat it at the beginning of your second point. If the readers do not see the transitions, they will get lost in your nursing expert witness report.

8. Offer your conclusions. Here is an example of a plaintiff position: “The standard of care requires the nurse to inform the physician of significant changes in the patient’s condition. On February 4, 2016, Nurse James deviated from this standard of care by failing to inform Dr. Kinnest about the new symptom of loss of sensation and motor function in the patient’s legs.”

9. Consider when you should make concessions. Admitting that different viewpoints exist often has the paradoxical effect of making your position stronger. By acknowledging and dealing with counter evidence, you establish yourself as trustworthy. Concessions bolster your credibility.

Here is an example of a defense position: “Mr. Hewlett testified at his deposition that he put his call bell on and waited for 20 minutes. He claims he got out of bed when no one responded. However, the nursing notes state that Nurse Thomas checked on him just 10 minutes before finding the patient on the floor in his room.”

10. Spend some time figuring out how you’ll summarize your opinions. Wrap up by highlighting the key points you want them to remember. For example, “Nurse James deviated from the standard of care by failing to perform the neurovascular assessments according to the frequency that was ordered. He failed to recognize the significance of the new onset of lack of sensation, dismissed the patient’s concerns about an inability to urinate or move his legs, and failed to inform Dr. Kinnest about the new symptom of loss of sensation and motor function.”

Grab the crucial information you need to be effective in your role as an expert witness. Order How to be a Successful Expert Witness, one of Pat’s 2016 books.

Pat Iyer MSN RN LNCC is president of The Pat Iyer Group. She spent 20 years testifying as a liability expert witness. In her role as president of Med League, she proofread and edited thousands of reports.