>>> Lisa Updike wrote:
 "Apparently a person (not a Dr.) in a supervisory role had
told her that only "hospital personnel" were allowed in patient
rooms and that I was a risk to the patients because I had not
been tested for TB !?"

Lisa, I agree with you that policies such as the one you
encountered make it difficult to gain supervised clinical
practice. However, don't think you were singled out because
you aren't a doctor. The rules likely apply to them, too. The
difference is that the medical and nursing students not only
have a practice pathway -- they have a bureaucratic pathway
(for lack of a better term).

Facilities that "allow" clinical observation usually have
policies (red tape) setting out guidelines that must be
followed. It is prudent for hospital administrations to have a
way to control who is allowed access to patients. It is easy
to see how unrestricted access could lead to problems -- for
patients, personnel, administration, and trainees. In providing
patient care, the hospital is also responsible for protecting
patient confidentiality and assuring safety.

I had my last baby at a large teaching hospital, and I (the
patient) had to sign -- on my admissions packet -- whether or
not I would allow myself to be observed or cared for by
medical staff-in-training.  In the facility where I presently work
I cannot have anyone shadow me who hasn't been "vetted"
by the administration. There is a sheaf of paperwork that
must be filled out by the applicant detailing the extent of
access allowed. A TB test is required. And the OK is a
decision that has to pass a committee (all non-US 'netters
must be ROFL at this point).

Medical and nursing students are (generally) ushered into
medical facilities through their schools. We LCs, at this
point, don't have many facilities open to us via this
"traditional" pathway. We need to find ways to do this. There
may be places here in the USA that still "hang loose" -- but
in this CMA (a.k.a.: litigation conscious) society I think there
must be very few.

A discussion on this subject (i.e., pathways, red tape, what
has worked at your facility) would be valuable. How about
those of you in private practice? What formal policies do you
have?

Margery Wilson, IBCLC
Cambridge, Massachusetts, USA
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