My heart is with you Dani. I have worked and continue to work in a similiar situation. The NICU environment is always stressful for ALL- the docs, nurses, unit secretaries, housekeeping, and most of all the parents and families of these fragile tiny sick patients. I have many days when I feel I am a worthless lactation consultant because I have chosen to put on the NICU nurse hat and jump in and help with starting lines, setting up chest tubes, getting an art. stick for the nurse who's other baby is crashing, going on a transport because the on-call nurse's child came home sick from school, or spending time with the grieving mother who will not need the breast pump after all. It's hard to not be a NICU nurse when you know they need one and you've been one for 19 yrs. Its VERY painful to let your technical skills go stale. Its also hard to know that the hospital took your position(FTEs) away from the NICU nursing budget without replacing them, have just downsized the nursing staff and forced everyone to be crosstrained to the another floor. (And I still drive home muttering,"This day sucked".)_ So I look at the alternatives. I could avoid NICU and stick with the healthy moms and babes, or stay in my office and remain focused on the phone call-backs or working on an inservice or policy which is also very important and needed. But I'm not sure the NICU staff would be as helpful to me when they know I'm swamped with moms who need some help. At present they are great at getting a mom started with pumping, renting her a pump when I'm off, putting babies skin-to-skin with mom, and reminding the neos to order breastmilk and not ABM for their patients. I'm convinced there needs to be a lot of flexibility, respect, and cooperation among all staff. You are so busy giving this difficult case all your time and energy. Please don't worry about the things you can't get to. I have seen some PIH moms who started to get an increase in milk around day 10. I don't know if it was the continued faithful pumping or simply faith itself. I have also seen some moms who never pumped more than 10-15 cc at each pumping after 6 weeks total even though they claimed they were pumping 6-8 x and we were using SNS, keeping skin-to -skin, using relaxation techniques, etc. (I haven't been able to get any OBs to prescribe reglan. Another battle) You know how to get this mom through this. There are probably 1100+ people on this great list who could give us some good advice on juggling our responsibilies effectively without feeling like we failed. Ahhh.....why can't we be easier on ourselves? Carrie Edwards RNC MOM IBCLC- who is so proud of Pat Young for standing up and saying that she didn't study for the IBLCE exam and passed 11 points higher than 10 yrs ago!!! and Congratulations to all new IBCLCs!!!!!!!!!!!!!!!!! Caroline Edwards RNC IBCLC Atlantic City Medical Center-NICU Atlantic City, NJ 609-441-8186 [log in to unmask]