As an L&D RN, can I do home visits without MD oversight?

[Nurse Beth, MSN]

Congrats on your business! Parents evidently highly trust you to be asked repeatedly to do postpartum home visits.

Yours is an excellent example of what nurses have to market and offer. Postpartum visits are a niche uniquely suited to highly experienced Registered Nurses such as yourself.

The answer to your question is No. You do not need physician oversight as long as you remain within the scope of practice. 

There isn't a list, per se, of what qualifies as an independent nurse visit, but professional guidelines are embodied in the CA Nurse Practice Act.

Here's an overview that can help clarify your situation regarding the need for medical oversight for home visits.

Scope of Practice

RNs are trained to assess, plan, implement, and evaluate nursing care. This includes conducting postpartum assessments and providing education and support regarding newborn care, breastfeeding, and maternal health. You are uniquely qualified to provide this service.

"The activities comprising the nursing practice are outlined in the Nursing Practice Act, Business and Professions Code Section 2725. A broad, all inclusive definition states that the practice of nursing means those functions, including basic health care, which help people cope with difficulties in daily living which are associated with their actual or potential health or illness problems, or the treatment thereof, which require a substantial amount of scientific knowledge or technical skill." and: 

"Independent Functions Subsection (b)(1) of Section 2725, authorizes direct and indirect patient care services that insure the safety, comfort, personal hygiene and protection of patients, and the performance of disease prevention and restorative measures." 

from https://www.RN.ca.gov/pdfs/regulations/npr-b-03.pdf

 As an RN, you can offer educational support and assistance with newborn care, lactation support, and postpartum education without the direct supervision of a physician.

International Board Certified Lactation Consultant (IBCLC)

As an IBCLC, you are certified to provide expert breastfeeding support and education. This role focuses specifically on breastfeeding issues, making you a valuable resource for new parents.

The practice of lactation consulting is distinct and does not typically require a physician's oversight unless there are complications or specific medical concerns that must be addressed. With your experience, you would be able to recognize these.

Need for Medical Oversight

Generally, home visits for educational purposes, such as breastfeeding support or postpartum care, do not require a physician's oversight. As long as your services fall within your professional scope and do not involve diagnosing or treating medical conditions, you do not need a physician to oversee these visits.

However, if you encounter any medical issues that require clinical judgment, diagnosis, or treatment beyond your scope, refer the family to their pediatrician or healthcare provider. 

Situations Requiring Medical Oversight

If the postpartum visit involves complex medical care, such as administering medications, managing medical devices, or addressing specific health concerns of the newborn (like jaundice or other health issues), it may require a physician's oversight.

Collaboration with a physician is essential if there are complications or medical decisions to be made.

Liability Insurance and Coverage

It's good to hear that you have current Liability Insurance and have verified that your activities are covered. Ensure that your insurance provider understands the specific services you plan to offer, as this will help clarify what is included in your coverage.

Clarifying Regulations

To find out specific regulations regarding nursing practice in California, you may want to consult:

The California Board of Registered Nursing provides resources and guidelines about RN practice, including scope and regulations, and you can ask them questions directly. However, their answers to direct practice questions are usually obtuse and lawyered up enough that they don't always help.

California Nurse Practice Act. This act outlines the legal framework for nursing in California and gives insight into what is allowed and requires physician oversight.

• Professional Organizations. Organizations like the American Nurses Association (ANA) or the International Lactation Consultant Association (ILCA) can provide additional guidance on best practices and legal considerations.

Conclusion

In summary, as an RN and IBCLC, you can conduct postpartum home visits to provide education and support without requiring a physician's oversight, provided that you stay within your scope of practice. However, you should be prepared to refer families to a physician if medical issues arise.

It's always good practice to stay informed about the regulations governing your practice and ensure that your insurance aligns with your services. If in doubt, consider seeking legal advice or consultation from nursing boards or professional organizations for more specific guidance related to your business.

You didn't ask about your fees but don't underestimate your value. You have extensive experience and knowledge. You are providing education and peace of mind to new parents. Charge accordingly for your professional services. Trust me, the parents who seek you out will likely not blink an eye. All things being equal, a higher price can signal a higher value.

Best wishes,

Nurse Beth

 

[NRSKarenRN, BSN, RN]

Also check out California Dept of Health regs with a lawyer regarding providing skilled nursing in the home.

Quote

A State license is required to operate as a Home Health Agency (HHA) in California. An HHA means "a private or public organization, including but not limited to, any partnership, corporation, political subdivision of the state, or other government agency within the state, which provides, or arranges for the provision of, skilled nursing services, to persons in their temporary or permanent place of residence", pursuant to Title 22 of the California Code of Regulations (CCR) section 74600(a).

You should not need physicians orders if private pay clients.  Billing to insurance companies often require PCP/physician order.

Best wishes for such a needed service to decrease infant mortality AND get the new family off to a good start.