Dear Melissa,

Welcome to the world of the LC. I don't envy you the road ahead (beginning
LC services in a typical hosp setting) which can be quite difficult to
navigate.  Reading your post, there are multiple issues one could explore
(incorrect advice to a pt post breast reduction, probable primary lactation
insufficiency, donor milk availability, financial and equipment constraints
of the moms, and scope of practice issues). I'll share some thoughts with
you.

You ask "My question is:
1. Can I recommend a herb/drug and, or, the dose/strength of a herb/drug
to a client without risk of penalty or loss of my nursing license?"

My answer would be "that is open to interpretation." There are quite a no.
of posts in our archives which debate this very issue. Refer to your
standards of practice and ethics and your nsg standards of practice since
you are probably hired as an RN there. My main recommendation in regards to
these types of situations is to be very careful.  It takes awhile usually
(years) to gain respect from the docs and other staff. You cannot function
solo, esp. in a hospital practice, so you have to have collegial
relationships. *Share information* with the docs and the parents. Try not to
get too upset if a doc does not proceed w/ your recommendations. It takes
time. You have to prove yourself. Over time, most LCs become trusted,
respected colleagues and get referrals from the very docs and staff that
looked at them suspiciously years before. (There can be one or two holdouts
too, but that's another story - don't sweat it.)

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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