I'm following this discussion pretty closely as our hospital has recently
mandated that all of our employees attend corporate compliance training,
which includes a discussion of waste, fraud, abuse and conflict of interest
issues.  We recently had an FBI agent in our hospital to investigate a
couple of departments involving contracts, announced by badge only. No
evidence of wrong doing was found, but this isn't just happening to the
Columbia's-it's happening right here in the Heartland.  We have been told
that the government is dedicating more dollars each year to combat Medicare
and Medicaid fraud.  So anyway, my department (Educational Services) has
been selected to presentthe training to 700 employees and we are almost
done.

I think there is some truth to what Barb has said about prosecution, though
I  asked about the rental station issue over a year ago and was told it's
not a problem as long as patients are provided with information about
everything that is available in the area and are able to select from that
list and it doesn't occur during my work hours at the hospital.  I would
NEVER go to a patient's bedside and do what Barb said these nurses would
do-I don't think ayone on this list would.  This part of Kansas is
underserved by lactation specialists and before the pump stations came,
patients only had the choice of the crummy pumps at discount stores that
I've gone on and on about before.  We had to beg the pharmacies to stock
the quality pumps and supplies.  I know there are other rural communities
like us with similar situations.  I'm guessing, though, that Barb must live
somewhere urban, to be able to lose 12 nurses and still be able to run an
OB unit.

As an OB RN, I find it hard to believe that all of Barb's nurses are
equally competent in managing the complex breastfeeding situations that LCs
handle.  Developing and consulting with our hospital's managers regarding
competency issues is one of my responsibilities as the director of our
Educational Services department.  After doing this for a few years, I would
have to say that "you can lead a horse to water but you can't make them
drink."  So you have made them jump the BF competency hoop because it is a
requirement.  How many nurses though, have the passion and knowledge about
BF that an LC does?  How much "buy-in" is there toward BF when something is
manadated by the unit manager?  You can't mandate passion!  Yes, I
definitely think these competency have some value, otherwise the gods at
JCAHO wouldn't mandate competency like they do.  However, I think
abolishing LCs altogether from the hospital because of this incidence does
your community, your hospital, your unit, your nurses and most importantly,
your patient's, a great disservice.

Maurenne Griese, RNC, BSN, CCE, CBE
Birth and Breastfeeding Resources
Manhattan, KS  USA
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