Hello, All:  I agree with Jean's assessment of the nursing profession.  One
thing that I think needs to be considered when pondering the nursing
profession is that the primary role of the nurse in whatever setting s/he
practices in is one of case manager.  It is the responsibility of the nurse
to plan the patient's care based on diagnosis and drs. orders and oversee
the plan's implementation and evaluation of progress.  The nurse is
responsible for assessing the need for other services (such as PT, OT,
dietician, social services, etc) and making sure follow-up occurs.  Nurses
are the primary facilitators of care conferences in which all appropriate
disciplines are brought together to evaulate and update a patient's ongoing
care.  Our SCN holds weekly care conferences on all our SCN babies.  The
disciplines involved include, neonatology, primary nurses, clinical lead of
lactation services, social services, discharge planners and care co-
ordinators on a regular basis, with other disciplines being called upon
based on specific needs.  I guess what I'm trying to say in a round-about
way is that "the buck stops here - with nursing".
The feeling I'm getting from many of the posts on this subject is that
lactation needs to be separate profession (which it does!) but there is no
way it is ever going to be an independent entity. We are always going to
have to answer to another and I can guarantee it will be to both nursing
and medicine, based on the current healthcare set-up in the US.  I
frequently get told by other nurses that they have to legally follow a drs.
order as RNs.  Well, the last time I looked, my license is still active,
meaning I am just as bound legally to follow a drs. order!  The only
difference being, I will readily question a drs. order (with the dr.) I do
not believe supports lactation.  And with evidence-based practice to stand
behind, I very rarely have a problem "discussing" an order with a dr.

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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