Dear Wise Ones,
I am hoping that you can tell me what is done in your institution regarding
IBCLC's taking a doctor's order for supplementation of breastfeeding baby who
is not nursing effectively and is losing weight. I have searched the
Archives, but did not find anything specific to my situation.
A little background... I am an IBCLC working in the local community hospital
(800 births/year) for 32 hours/week as the lactation program coordinator. I
happen to be an RN, but that was not required for my newly created position
in Sept 2006. I see the most of the moms who are nursing, but some days only
get to work with the ones who have having difficulties (there are a lot of
non-latching, ineffectively feeding babies, so I am busy.) My day off during
the week is covered by a special care nurse who is also IBCLC. My hospital is
a "closed shop" and all non-management nurses (even nurse practitioners) who
work there must be in the union. My manager did not want the RN credential to
be required for my position, so that I would not be expected or required to
practice as a nurse, or be required to join the union, just because I have RN
after my name.
A few months ago, I called a pediatrician to report my concern with a baby
who had lost over 10% of birth weight, was not feeding effectively, had poor
output, and appeared to be getting dehydrated. Mom had risk factors for delay
of Lactogenesis II. The discharge order had been written earlier in the day.
The pediatrician considered my evaluation and told me to hold the infant's
discharge and gave an order for supplementation of hypoallergenic formula. Our
written policy is to supplement breastfeeding babies by finger-feeding or
cup-feeding or at the breast, depending on the situation and what the mother
wants to do, as she can always ask that the baby be given a bottle. I asked the
clinical team leader if I should record the doctor's order in the baby's
chart, or did I have to get an RN to do it. She thought for a moment, and said
that I would be able to document the telephone order, as I am, after all, an
RN. As an aside, we do all our other documentation in the computer, and my
discipline is listed as "Registered Nurse" as there is no listing for "Lactation
Consultant."
The same situation happened again this week and one of the special care
nurses questioned my ability to take an order from a doctor, as I am not "hired
or practicing as a 'nurse', and since this is a nursing function, might not
the union have an issue with it, etc" expressing this concern to my manager.
My manager asked me to get input from other IBCLC's who are nurses in
hospitals, but who are not doing RN duties in addition to their LC functions. There
is no precedent for this here, and my manager wants to be on solid ground
when she replies to the nurse who brought this issue to her attention.
The IBLCE competency statement includes the following:
1. Possess the skills, knowledge, and attitudes to provide competent
comprehensive consultation and education in routine and special circumstance
lactation, from preconception to beyond twelve months.
5. Utilize appropriate communication skills in interactions with clients
and health care providers.
10. Function and contribute as a member of the health care team, provide
follow-up plans, and make appropriate referrals to other health care providers
and community support resources.
ILCA's Standards of Practice for IBCLC's include Standard 3 Clinical
Practice:
3.3.7 Document and communicate to health care providers as appropriate:
• assessment information
• suggested interventions
• instructions provided
• evaluations of outcomes
• modifications of the plan of care
• follow-up strategies
My position and my LC function in the hospital is that of a "clinical
specialist" in breastfeeding. The pediatricians (most of them) recognize this and
work with me closely. I am not sure how they would feel if I had to tell them
that they have to give their order to another RN, that I cannot receive it
even though it specifically addresses breastfeeding issues or a lactation plan
of care. In the meantime, until there is a clear resolution to this
concern, I will hand the phone to a nurse who can take the order, as I don't want to
be cause any legal difficulties for the hospital with the union or cause
problems for my manager or clinical team leader, both of whom are very
supportive.
I would like to hear from other IBCLC's who are nurses and have faced this
same situation. Please reply to the list or to me personally if that is more
comfortable to you. As always, thank you in advance for any assistance or
guidance you can provide.
Mary-Jane Sackett, RN, BSN, IBCLC, RLC
Pittsfield, MA USA
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