LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
"Christine Erland RN.IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 26 Oct 2006 21:37:01 -0400
Content-Type:
text/plain
Parts/Attachments:
text/plain (20 lines)
I want to thank Dr Wight for her post on ABM and also for the protocols, also Kathy Lilleskov's post, it said so many of the things I feel. I don't post to Lactnet often, so many of you are so much more eloquent. I have been an IBCLC for 21 years, recertified for the 3rd time, and an RN for 391/2 years. I love my profession and have worked pretty continuously. I do however have real concerns about the Scope of practice from IBLCE. I will admit that I hadn't read it  until it was discussed of Lactnet. Thank you for informing us Jan.
I believe the activities listed outside the scope of practice came about because of fear of litigation or to encourage a diplomatic dialogue.I think this SOP could be a slippery slope and lead to more litigation. Perhaps  more of  this should be in the code of ethics. 
My specific concerns are "prescribing or recommending the use of alternative therapies" Will this not allow me to use RPS,suck training, or try new techniques? This needs to be clarified.
"Contradicting or ignoring  the advice  of a client's healthcare provider" I could do this without knowing this was occuring . I have frequently seen patients who ask a question such as: Should I give my baby an ounce of water after breastfeeding until the jaundice is gone? I give a valid answer and then the patient tells me that this was what her Ped recommended. I try to remember to ask a patient first what prompted her question. I do strongly feel that professionals should treat each other with respect, I appreciate the same treatment when I am wrong. When I see a patient and I disagree with the plan of care, I usually say I didn't see what your( --- doctor ,nurse) was seeing on another day and there may be something I don't know about your baby. I will call your provider and discuss this with them.At times a patient misinterprets advice.When I give a reasonable rationale for my plan of care the provider usually comes around. Conflicting advice can erode trust. You all know!
 this and I find LC's to be among the most professional people I know.I'm just making a point that I can try my best to be as  respectful and professional as I know how to be and still run afoul of the SOP. Sometimes I don't make the call from the patient's house to allow more discussion. Sometimes I quote the AAP and fill their mailboxes with articles. Doing all this, I could still violate the SOP. This is a real example, I saw a dyad where the infant was diagnosed with thrush by Ped. The mother had red sore nipples despite good latch and effective transfer of milk. She had a hx of  repeated yeast infections even systemic yeast.I called the OB and he said he had never seen nipple thrush in 20 years and refused to prescribe medication. Her husband was an internist and asked me what he should write a script for.I said I couldn't do that and handed him Dr. Hale's book. I have scarier examples: I sent one infant to the ER via ambulance, the infant had an episode of apnea, became !
limp and gray in color. I was reamed out by the Ped  for sending patient to ER via ambulance instead of parent's car. The infant had a hematoma and it turned out also an intracranial bleed and was hospitalized for a week. Another infant was lethargic,low temp,poor turgor, huge weight loss, poor feeding and no BM's  since discharge , this was day 7. I called the Ped and he said not to send to ER I was unduly scaring patient's parents, Breastfed babies lose weight and sometimes don't have BM's.I insisted they take the infant to the ER. This baby was admitted with dehydration and scary electrolyte levels. I had never had a patient of these MD's before and they didn't know I don't panic easily. I fortunately worked for Visiting Nurses and we were allowed  to call an ambulance and use our judgement in deciding when to call. We are to call the physician before or after the call depending on our clinical judgement. I have never sent a patient directly to the hospital that wasn't admi!
tted. But what about non RN LC's, I know many non RN LC's with knowledge far superior to mine, are they not going to be able to make a critical clinical judgement call? The hospital system I work for has a "Speak up policy" patients are given a form that tells them to speak up if they don't understand something, or something doesn't seem right, as this will prevent errors. 
I truly hope the IBLCE will reconsider and clarify this SOP, I am getting close to retirement and don't know what I will do if I must abide by this SOP as written. Chris Erland

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html

ATOM RSS1 RSS2