From providing researchers and product developers with expert guidance to consulting in legal realms to educating the next generation, nurses are needed in all corners of society. Two ONS members share how they’ve pursued nursing in alternative careers and what factors make nurses qualified for roles beyond the bedside.

Nursing Expertise Shines in Medical Science Liaison Jobs

A medical science liaison (https://www.themsls.org/what-is-an-msl) (MSL) works in industries like pharmaceutics, biotechnology, and medical devices and focuses on specific therapeutic areas or disease sites. MSLs serve as in-house experts to ensure a product is effectively developed, used, and understood throughout its lifecycle. They also establish and maintain relationships with leaders at major academic institutions and clinics.

ONS member Carrie Riccobono, MSN, RN, ACNS-BC, OCN®, is a senior MSL at Legend Biotech in Somerset, NJ, a multinational biopharmaceutics company focused on cell-based therapies. Riccobono specializes in hematology and chimeric antigen receptors (CARs) and provides high-level scientific support for research, publication, education, and consulting initiatives both at Legend Biotech and beyond. MSLs, Riccobono said, lead medical affairs studies and generate new data. They also facilitate advisory board meetings to gain scientific feedback from key opinion leaders.

“MSLs focus on the science, mechanism of action, and clinical trials of the products in our pipeline. We are actively involved in the research phase, and once a product is commercially approved, MSLs are involved in training and addressing any medical questions that arise,” Riccobono, member of the Southeastern Wisconsin ONS Chapter, said. “I cover multiple states from Wisconsin to Texas, mostly focusing on large academic transplant centers. My core work is with genetic engineering of T cells, a type of white blood cell, to express either CAR or T-cell receptors for the treatment of advanced solid and hematologic malignancies.”

Riccobono was an oncology nurse for more than 20 years when she found her first MSL job by chance. She came across Kite Pharma, another biopharmaceutics company focused on cell-based therapy, was inspired by the company’s tagline (focused on the cure), and applied. With an oncology nursing background, Riccobono stood out as a candidate.

“It was baptism by fire, but the great mentorship from my manager and a PhD colleague helped me transition,” Riccobono said. “The majority of medical affairs is reactive. We are not promotional in any manner, so we do not actively seek out to meet or offer data updates unless clinicians ask. As a nurse, and an advocate by heart, this piece was the hardest to learn.”

Riccobono was fascinated with how science moves from the bench to bedside. But her history as an oncology nurse shed light on a misconception that she had about MSLs—and other nurses may too.

“When pharmaceutical reps would call me in practice, I loved learning from them, but I never realized or understood the difference between medical affairs and commercial. MSLs are not selling you anything. We are here to be your medical support on the products you may be working with in research or practice,” Riccobono said. “The most crucial piece I want fellow nurses to understand is that MSLs are committed to health care. We are professional nurses just like you, functioning in a different manner to move evidence-based care forward.”

MSL Prerequisites

Nurses who are fascinated with cutting-edge treatment modalities and comfortable asking questions might enjoy the MSL role, Riccobono said. They must also be willing to build relationships with product scientists, communicate effectively, and have strong emotional intelligence.

Most MSL positions require an advanced degree, although the number of MSLs with an RN degree and several years of experience in a particular therapeutic field is growing (https://www.indeed.com/career-advice/finding-a-job/medical-science-liaison).

“We are everywhere, behind the scenes for any product or company touching your patients with cancer. I often say we are like the Wizard of Oz behind the red curtain,” Riccobono said. “You just have to ask to see us.”

Knowledge of clinical trials is another crucial skill (hint: ONS Voice has a U.S. Food and Drug Administration [FDA] topic tag (https://voice.ons.org/topic/us-food-and-drug-administration-fda) to keep nurses up to date on trials and approvals).

Advice and Resources for Aspiring MSLs

“Don’t be afraid to speak up as research protocols are being written if you think another process might be better,” Riccobono said. “My small biotech company gives me the opportunity to provide input as trials are being written.”

A robust professional network, both locally and nationally through professional organizations, helps oncology nurses stand out—both as a candidate and in the MSL role. “My reputation in Wisconsin’s oncology sphere allowed my abilities to shine and catch the attention of someone who thought I would make a great fit for an MSL,” Riccobono said. “You never know who is watching you. It’s all about relationships.”

Riccibono recommended the Accreditation Council for Medical Affairs (https://medicalaffairsspecialist.org/), which offers multiple resources for future and current MSLs, as well as the Medical Science Liaison Society (https://www.themsls.org/) for nurses interested in the role. Nurses can also seek out medical affairs booths at annual meetings through organizations like the American Society of Clinical Oncology (https://www.asco.org/) or the American Society of Hematology (https://www.hematology.org/).

“It is a beautiful thing to know you are making an impact,” Riccobono said. “I had an amazing opportunity with Kite Pharma to take axicabtagene ciloleucel (https://voice.ons.org/news-and-views/fda-approves-axicabtagene-ciloleucel-for-large-b-cell-lymphoma) from the early days of clinical trials through to FDA approval, which has produced incredible outcomes for patients with diffuse large B-cell lymphoma.”

Law and Order Meets ER When You’re a Legal Nurse Consultant

A legal nurse consultant (http://www.aalnc.org/page/what-is-an-lnc) (LNC) is a licensed RN who performs critical analyses of clinical issues in the legal arena. LNCs evaluate facts and testimonies regarding delivery of care and then render informed opinions about health outcomes and the cause and nature of injuries. They serve (https://www.registerednursing.org/specialty/legal-nurse-consultant) as analysts, collaborators, strategists, researchers, and educators and are employed in law offices, insurance companies, hospitals, and government agencies.

ONS member Susan Rux, PhD, MSN, RN, PHN, ACNS-BC, CHEP, CNE, CPCC, CPRW, LNCC, NEA-BC, OCN®, is an AALNC director-at-large, dean of academic affairs at Chamberlain University in North Brunswick, NJ, and founder and chief executive officer at SR Strategic Solutions, LLC, an executive strategy consultancy in Hamilton Square, NJ. She says that LNCs:

• Collect, organize, and analyze healthcare records, medical literature, standards, and guidelines to identify record tampering, omissions, and contradictions.
• Prepare chronology or summary of medical events and interview witnesses about medical cases or claims.
• Evaluate cases for one or more of the four elements of a medical-related tort claim (duty, breach of duty, damages, and causation).
• Educate attorneys about the clinical facts and issues in a medical case or claim.
• Serve as liaison to clients, experts, and other witnesses.
• Draft medical portions of legal documents.
• Collaborate with legal teams on case strategy.
• Testify as a nurse expert or fact witness.

Rux, a member of the Mercer County ONS Chapter, found her career as an LNC by participating in quality improvement projects, coordinating oncology nursing grand rounds, and representing nursing on tumor boards.

“In my more than 25 years of diverse nursing experience from direct patient care, advanced practice, and administration, the legal aspects of health care have crossed all sectors,” Rux said.

LNC Prerequisites

Nurses who enjoy medical problem-solving, researching and analyzing information, and working with others might be interested in the LNC role (https://nurse.org/resources/legal-nurse-consultant).

LNCs need a bachelor’s degree from an accredited nursing program and a solid clinical background. Although not required, LNCC certification (http://lncc.aalnc.org/) is an option (https://nurse.org/resources/legal-nurse-consultant). Rux also recommended that nurses pursue certification in their specialty, such as oncology (https://www.oncc.org/certifications/oncology-certified-nurse-ocn) or blood and marrow transplant (https://www.oncc.org/certifications/blood-marrow-transplant-certified-nurse-bmtcn).

“Certification is a process to recognize your qualifications and knowledge,” Rux said. “With in-depth knowledge of nursing, medicine, and the healthcare system, our contributions as LNCs are essential in all types of claims and cases in all medical-legal settings.”

Advice and Resources for Aspiring LNCs

Find a mentor, Rux said, and participate in your institution’s quality and performance improvement work. Also, reach out to local attorney offices to gauge their need for nurse consultants.

Rux recommended AALNC for mentors and other resources, such as free webinars, the LNC code of conduct and ethics, and the American Legal Nurse Consultant Certification Board (http://lncc.aalnc.org/), which offers information on certification requirements and frequently asked questions about eligibility.

The Juris Educational Resource Knowledge (https://thejerklnc.com/) is a private forum and e-mail service for LNCs to brainstorm, educate, and provide professional and personal support. The group is tailored for RNs who are certified or working toward their LNC certification and who are considering or in business for themselves to provide LNC services.

Even though she’s no longer in direct patient care, “being a nurse is a strong core of my existence,” Rux said. “I value the human experience and care for others in the manner that I want others to care for my loved ones. Now I teach others the same basics of nursing principles.”

Educators, Nonprofits, Disease Sites—Opportunities Are Endless

Riccobono and Rux both pointed to the plethora of opportunities that oncology nurses have at their fingertips, both at the bedside and beyond. NurseJournal (https://nursejournal.org/) is a comprehensive tool to help RNs explore alternative career paths.

“The academic sector will always need educators to prepare the next generation of nurses,” Rux said. “Nurses can consider obtaining an advanced degree, volunteer, or participate in extern- or internships.”

Indeed, a shortage of nursing faculty is one of the key factors in today’s overall nursing shortage (https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage). Nurse educators have at least two to three years of clinical experience and likely need a doctoral degree to teach in the university setting, although an MSN degree may meet the requirements (https://www.allnursingschools.com/nurse-educator) for other settings. Certification (http://www.nln.org/Certification-for-Nurse-Educators/cne/eligibility) isn’t required, but many academic centers prefer teachers with the certified nurse educator (CNE) designation.

“From patient and provider advocates in the nonprofit sector to diagnosis-related group specialists or research coordinators within health systems,” Riccobono added. “Nurses have endless opportunities.”