Hi, Renee and others:  Renee, you hit the nail right on the head.  In the
hospital and clinic settings, HCPs are LICENSED by their state (in the US)
and practice under their clinical practice area's (OT, PT, RD, LSW, SSLP,
MD, etc.) "practice act".  This is a legal document that dictates what the
individual can and cannot practice, depending on their clinical license.
Many of the practice areas overlap within the clinical specialties.  For
example, as an RN with a license to practice nursing in the state of
Illinois, I can give an injection, but I cannot write a prescription or
order the medication I will be injecting into the person.  I must have an
order from an MD first.  APNs (advance practice nurses) are still fighting
for across the board prescriptive priveleges - many other states already
grant APNs this.  I believe CA is one of those states.
I also must have a doctor's order before I see any breastfeeding mom - for
inpatients, the order is part of the standing orders in each mom's chart.
Standing orders save everyone the hassle of writing/obtaining the same
orders on each patient.  Much of the routine care for patients is "canned",
the same for each.  There, of course, is plenty of space on the order sheet
for the doctor to "customize" orders for each individual patient.  For
outpatients, I also use standing orders, since many of my outpatients are
self-referred.  If a mom will be seeing her doctor before coming to see me,
I will ask her (or if a dr is referring, I ask that they write a scrip and
give it to the mom) to get a scrip from the dr before she comes to the
office.  Insurance companies are starting to move towards not paying claims
unless they physically have a written drs order in front of them.  Nurses
can also take verbal orders, which means it's considered a legal order if
the dr tells me an order face-to-face or gives me an order over the phone.
I must then document it on the drs order sheet as either a verbal or
telephone order.
Non-licensed HCPs have no legal recourse (or protection) at this time
within the system.  Frankly, I admire anyone who is so willing to put
themselves so far out on the limb in this (the US) law-suit happy society
and practice without a license.
Those of you who have been venting your frustration over RN LCs vs non-RN
LCs need to stop taking your frustration out on us poor RNs. We probably
got picked on to co-ordinate lactation services in hospitals because we are
considered in the hospital setting as the "jacks-of-all-trades and master-
of-none".  Nurses have historically and traditionally been responsible for
co-ordinating a patient's care with all health care team members involved
in a particular patient's care.  That is what we do. Unfortunately, this is
the way the health care system works in the US and until someone is willing
to take on the overwhelming task of effecting change, we have to deal with
it.

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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