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 *********************************************** 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 mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html