IBCLC Scope of Practice

[missnurse89]

I am needing some clarification from IBCLCs out there. I was informed by an IBCLC that as an IBCLC, it is within the scope of practice to diagnose maternal breastfeeding related complications (such as mastitis). I have read through IBCLC Standards of Practice and Clinical Competencies and I don't see that diagnosing is within an IBCLCs scope of practice. I thought only physicians could diagnose. Is this correct that IBCLCs cannot diagnose maternal BF complications?

My next question is, how does the scope of practice for an IBCLC differ from that of a specially trained R.N.? After reading through IBCLC documents, they seem similar as far as assessing, developing a POC and follow up. I see that IBCLCs are held to a higher standard of care d/t their specialized knowledge and clinical skills; However I am confused on the main differences between the standards of practice for an R.N. and IBCLC. I am taking the IBCLC exam next April and need to have a better understanding of this. Can an IBCLC clarify this, please?

[klone, MSN, RN]

A couple things....first - you will probably get more responses if you post this in the OB/Gyn nursing forum.

Second, the exam has historically only been offered one day a year, and it's always at the end of July. Did they change it?

Now, with regards to your questions...no, technically an IBCLC cannot "diagnose" unless she is also an APRN, MD, or other LIP who diagnoses through their normal scope of practice.

What an IBCLC *can* do is assess and make recommendations (to the mother, to the mother's provider, to the pediatrician). Her documentation needs to reflect that. She cannot say "patient has mastitis" but she can say "erythema present on left breast from 6-9'o'clock, as well as 2cm mass palpated internally. Green discharge noted from nipple. Consulted with Jane Doe, CNM - Rx for Dicloxacillin 500mg QID #28 given to patient per CNM Doe." Now, in practice, is that how it works? Typically not. I work in an OB/Gyn clinic with CNMs, and there is a peds clinic right next to us, so sometimes the pediatricians will pull me over for a consult. In reality, I will examine the mother, ask her some questions, then go back to our CNMs and say "Hey, she's got mastitis - these were her symptoms. Can you Rx her some abx?" and I will make a *recommendation* on the most effective antibiotic. Is that diagnosing mastitis? Yeah, pretty much. Does my documentation reflect that? Nope, my documentation would read as I wrote above.

As far as how it differs from a "specially trained RN" - it really doesn't. We're not recognized as LIPs, we do not have prescriptive authority or special scope of practice to offer diagnoses. We cannot bill for services as a "level" visit unless we do it as an "incident to" and a LIP lays eyes upon the woman/infant. Further, "lactation consultant" is not a protected title, and anyone can hang a shingle and be a "lactation consultant" if they want (which is why the distinction between "LC" and "IBCLC" is SOOOO important and so protected by those of us who are IBCLCs).

[missnurse89]

A couple things....first - you will probably get more responses if you post this in the OB/Gyn nursing forum.

Second, the exam has historically only been offered one day a year, and it's always at the end of July. Did they change it?

Now, with regards to your questions...no, technically an IBCLC cannot "diagnose" unless she is also an APRN, MD, or other LIP who diagnoses through their normal scope of practice.

What an IBCLC *can* do is assess and make recommendations (to the mother, to the mother's provider, to the pediatrician). Her documentation needs to reflect that. She cannot say "patient has mastitis" but she can say "erythema present on left breast from 6-9'o'clock, as well as 2cm mass palpated internally. Green discharge noted from nipple. Consulted with Jane Doe, CNM - Rx for Dicloxacillin 500mg QID #28 given to patient per CNM Doe." Now, in practice, is that how it works? Typically not. I work in an OB/Gyn clinic with CNMs, and there is a peds clinic right next to us, so sometimes the pediatricians will pull me over for a consult. In reality, I will examine the mother, ask her some questions, then go back to our CNMs and say "Hey, she's got mastitis - these were her symptoms. Can you Rx her some abx?" and I will make a *recommendation* on the most effective antibiotic. Is that diagnosing mastitis? Yeah, pretty much. Does my documentation reflect that? Nope, my documentation would read as I wrote above.

As far as how it differs from a "specially trained RN" - it really doesn't. We're not recognized as LIPs, we do not have prescriptive authority or special scope of practice to offer diagnoses. We cannot bill for services as a "level" visit unless we do it as an "incident to" and a LIP lays eyes upon the woman/infant. Further, "lactation consultant" is not a protected title, and anyone can hang a shingle and be a "lactation consultant" if they want (which is why the distinction between "LC" and "IBCLC" is SOOOO important and so protected by those of us who are IBCLCs).

Thanks! I wasn't sure where to post so I might bump it. Beginning in 2016, the exam will be offered twice a year.