Thus far I haven't seen anything that outlines my kind of practice.

I'm a Public Health Nurse as well as an LC.  That means I tap-dance between the slightly different standards of practice and ethical standards for LC's and for RN's in this province.  A fair number of Ontario LC's are RN's working in hospital or public health or attached to a clinic.  There are also LC's in private practice.

My clients usually have a family physician, but there is a shortage and some do not, especially in the community where I'm located.  The family physician is the gatekeeper to most services that are funded by the provincial health care.  In general the FP sees both mom and baby for all routine care.  Some FP's don't deliver, so Mom see an OB/GYN for late postpartum care and delivery.  (Or if she requests one, has complications or wants a type of delivery not done at our two rural hospitals).  After one postpartum checkup basic care returns to the FP.  The baby might be seen in hospital by a pediatrician, but routine immunization, and checkups is also done by the FP.  Some clinics have a Nurse Practitioner, but this option is not yet widely utilised.  Our rural physicians are really leery of them.

However, all babies (in theory) are referred for public health follow-up by phone and by home visit.  And that's where some of my referrals come from.  If the PHN who took the case feels the mom needs more intense breastfeeding counselling.  The rest come from our baby clinics, where Moms self-refer, or from telephone inquiries.  I might see a mom in clinic, but more likely will arrange a 1:1 visit in the home.  All these are free of charge.  

We don't sell or rent anything.  We do loan some items, but there is no cost.  And while we offer as many choices as possible, we do recommend some items over others.  Obviously that whole aspect of practice doesn't present too much of a problem.

My documentation is kept with the client's record, on permanent file for a gazillion years (maybe 15).  

We consulted the College of Nurses about discussing clients with their FP.  The opinion was that this _may_ fall under sharing with other members of the health care team, and that verbal consent may be sufficient.  We're working that one out.  However, I do not routinely contact FP's about problems unless I believe mom needs a prescription -- say for an antibiotic -- or baby needs more extensive examination.  Usually though Mom is quite prepared to take on the task of reporting on, and my report is only needed when the FP is reluctant.

Some of the moms at clinic come just for weights and to see other moms. I wouldn't dream of sending a report on that or a latch problem to the doctor.  Our moms are given a weight record for our clinic.  A Child Health Record has been introduced but is not mandatory for use. If I encounter significant issues I would likely obtain a written consent for sharing information with the FP.  With any other outside agency, that would be an absolute given.  Only the FP would be exempt.   

As a btw, the only official required record is the immunization one.  Immunizations of children are currently mostly done by FP's (and their willingness to give it up very low).  Moms constantly forget to take the immunization record and constantly lose it.  On school entry they go into a panic because they have to give us a copy and may not have it.

We're all a little different
Judith


  

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