Kelly asks:

< and PAs (Physician Assistants...I think that is like an RNP, but you need
not be an RN first). Feel free to correct me if I am wrong. >

I too feel sorry for consumers, as well as for people hoping to become
health care professionals, in making their choices. Very little in anyone's
training actually guarantees that they will be effective in helping support
the mother's choice to breastfeed her child. I do know that in Ohio at
least, and probably in other states as well, it is illegal to use the term
"nurse" in referring to onesself unless one is legally licensed either as a
registered nurse (RN) or as a licensed practical nurse (LPN), the latter
being the same professional level of training and responsibility which other
states have named licensed vocational nurse (LVN). There is a State Board of
Nursing with authority over licensure over these two professions and I
believe some evolving health care roles, such as dialysis technicians among
others.

From initial information that nurses were given when the Physician's
Assistant role was first created by the medical profession itself, I got the
impression that the PA's training is medically specific to "extending" the
services of physicians, and that a PA, when s/he gets a job, is "attached"
or "sponsored by" a single physician (or group of physicians) to "extend"
the practice capabilities of the MD by following that particular MD's
protocols, and that moving on to a new job or a new physician or group of
physicians is a very difficult thing to do legally and human-relations-wise.


In that regard, I am under the impression that the autonomy in the
employment situation of a nurse practitioner, while still involving
protocols limiting the scope of advanced practice, is very different from
that of a physician's assistant. Another large philosophical difference
seems to be the health and wellness maintenance focus of the nursing
profession versus a more "disease treatment" orientation philosophy provided
by the PA's training. Care versus cure, for short.

(The large issue remains, I believe, about RN reponsibility regarding
following only the orders directly received from a physician versus orders
issued by or transmitted by or signed by PA's.)

At any rate, there doesn't seem to be any real comparison between the
strictness and legality I have observed in these professions versus the
"lack of strictness and control" in the lactation world. It seems to me that
Pandora's box got opened early on in the lactation field, and I sincerely
doubt if there is any effective way to close it at this late date. One
wonders the fate of other health care professions in the wake of recent
aspersions regarding the medical profession's apparent desire to limit
practice of other professions. I think we are all wondering if and when and
how the "other shoe will drop" in regard to our own freedom to help
breastfeeding mothers and children.

Jean
********************
K. Jean Cotterman RNC, IBCLC
Dayton, OH USA

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