To Kathy Birt,
Congratulations, and welcome to the ranks!
Well, having been a hospital RN and lactation consultant for many years, I
can tell you that this sounds par for the course, and I understand
completely how you feel about being asked to do the nutritional assessment &
plan of care, in add'n to everything else you do. Here's what I found, when
the same thing was requested of me:
1) it's not really so bad, because if you refer out complicated ones to
dietary, you can pretty much develop a standard care plan, and it doesn't
take too long. Plus YOU are really the one who will be working with the pt.,
not dietary, so you will be able to do it better, except in very complicated
cases which you refer out.
2) it's pretty easy to work a good-enough-for-the-purpose eval into your
assessment of the pt; really it's almost just part of a normal-sounding
review of how they're feeling, what they normally do, etc. Special needs
will come up, and can be dealt with in more depth by the nutritionists. MOst
of what you do re: diet w/preg. & pp moms ends up being teaching, which is
really part of your other piece as LC. And you're gonna do that anyway when
you're talking about self-care, right?
This is all much easier if you have what we called a "teaching checklist",
signed by both the nurse & the pt. before DC; the list includes dietary
teaching appropriate to each mother and baby's situation. This list can then
be keyed to a longer, more official-looking policy/procedure that lays out
exactly what's covered by each topic, so when JCAHO or "the state" comes
prowling around you show them that while the form that mom signs the says
"nutritional needs of pp/BFing/formula fding mother" might look pretty
vague, the policy that defines it addresses every little nit-picky thing. So
you're covered. Trust me on this - I developed such a system when I worked
in the hospital, and the powers-that-be were falling all over themselves
admiring and praising it - the state inspector even wanted to copy it & take
it with her as a model! The time factor comes in developing the
policy/procedure piece; you must tell your supervisor that you need serious
chunk of office time to work on this, and time to inservice all staff, but
that once it's done all this pesky fussing around will go away and the unit
will have a model plan of care that will make the hospital look good, meet
the needs of the patients, and be less time-consuming on a dailybasis for
staff!
3) when you do it yourself, it gets done. You do it, you chart it, you have
a standard care plan that you "individualize" (which, if your hospital is
anything like mine was, means you check off a couple of boxes, and deal with
anything outstanding as a concern, but mostly takes about 2 seconds), you
know it's done and in the chart, you don't have to hassle with trying to get
someone else to come and do it and you know it's been done well!
Having said all that, I do think it's the RN part of your credentials, not
the IBCLC, that "qualifies" you to do all this. True, you will know more
about nutrition for the BFing mother, but in all honesty it's pretty
straightforward in most cases - and to assume full responsibility in those
complicated cases outside your area of practice is not acceptable in any
case. ALL the RNs, or all the primary care nurses or whatever your hospital
calls it, should be doing this! NOT JUST THE LC!
My two cents' worth...
Cathy Bargar RN IBCLC Ithaca NY
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