This is an interesting discussion and I'd like to add my thoughts.
In theory, the iBCLC being in charge of educating staff and policy writing/implementation only seeing the most difficult cases with the staff nurses doing most of the breastfeeding support sounds great but is just not working in my part of NJ.  Parents come home disappointed and dismayed with the little assistance they received from anyone, complaining still that everyone who came into their room including the nutritionist told them something contradictory. The consultants are only obligated to see the moms once before they go home and being overwhelmed themselves can only see them for a few minutes-which just isn't enough.  Usually by then the baby has already been given formula due to wgt loss(most of which is normal). 
I agree with Nikki, we need more consultants on the floor teaching- hands on, 
face to face.  If I had it my way, the LC's would work the night shift instead of the day.  For a few reasons, babies tend to be noctural eaters with cluster feeding etc, as you all know, parents struggle with this believing it is abnormal and commonly quit or start supplementing.  The unit tends to be quieter at night and there are no visitors.  Since nursing is predominately what babies do when awake or half asleep, why aren't we concentrating more of our expert staff to helping with that instead of spending time and money on other tasks - which are mostly meaningless.  Also I believe the hospital LC's need to having a closer working relationship with the community LC's..... Expecting parents to fend for themselves in desperation is just not right. According to the CDC, only 25 percent of the hospitals in NJ provide any followup or referrals for their discharged breastfeeding moms.

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