I believe it is a requirement that ANY patient including healthy newborns must 
have orders -such as diet orders.  It is my understanding most maternal child 
areas will have standing orders that read:  Breastfeed ad lib per protocol (in 
my facility there is a protocol about the minimum but none for maximum, and 
even an order that mother's choosing to breastfeed-the nurse must initiate 
breastfeeding within 1 hour) or Formula feed- parent's fomula of choice per 
protocol.  These again are standing orders, which reflect department policy 
and procedures.    The doctor just has to "sign-off" on standing orders within 
24 hours thus the pediatrician does not need to be called in the middle of the 
night for a healthy, stable newborn.    If the facility does not have standing 
orders, the facility must obtain orders upon admission (or birth).  Without 
orders, policy and procedures, Nurses would be consider to be practicing 
beyond the scope of a nurse's practice.  It's a legal thing.  JACHO does not 
care if there are standing orders. They only care that there are orders and is 
the hospital following it's own protocol for obtaining orders, are nurse's 
following orders etc.

Renee Palting-RN, IBCLC, RLC
-former Risk Management for OB/GYN  in AZ

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