I was saddened and pleased (misery loves company!) to read some of
the discussion re: time management and number of patients. I am a new
hospital-based LC as of last year. We do about 100 births a month. I have
spent a good deal of time training staff prior to this and trying to slowly
modify our culture here. Administration decided awhile ago that we needed an
LC so I was picked because of my background. The plan is that I'm to spend 1
hour each day that I'm here (2 days and 1 evening per week) to:  (in this
order) 1. see the "tough" cases  2. see the other breastfeeders  3. perform
staff education.  I frequently end up frustrated for many reasons, but am
trying my best to help as many people as possible. I have plenty of other
things to do so I really can't spend more time as an LC, although of course
I often do. At this point there is no charge for LC services. Fortunately
there is a community-based LC here and another at a large local Peds
practice, so follow-up is possible.
        Question to other hospital-based LC's: Do you have, or can you
suggest, a list of conditions/symptoms that warrant LC referral? In my one
hour of allotted time I need to make sure I'm seeing those who really need
it. I rely on staff nurses to tell me who to see, but at times I find out
that I've missed people I should have seen, or I'm called to see them after
things have become worse, or called to see the baby who hasn't fed much and
is sleepy but is only 8 hours old (I'm "weaning" them of this!).  Our
Breastfeeding Committee will be discussing this but I thought I'd ask the
experts first!
        Thanks in advance for any suggestions you can provide.
        -Diane
Diane Elliott, MS, RN,C, IBCLC
State College, PA

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