Bonnie:
My hat is off to you, girl, for taking on your hospital! I'll admit to being
so burnt-out by my own experience working in the hospital that I just quail
at the thought, but I am sure that it is only when people like you (and all
you loyal, dedicated Lactnetters who fight the good fight) keep taking up
the battle, again and again, that things change.

One thing I think "hospitals" (well, the people who run them, anyway)
respond to is the bottom line. Anything you can present to them as a
money-saver for them, or a "facilitative process" (I'm not kidding,
admiinistrators talk like that), or as a consumer attraction, they will be
more likely to pay attention to your recommendations. (Of course, if you
look at it from a coldly cynical point of view, breastfeeding keeps babies
out of hospitals, and I am quite sure that this serves at some level as a
disincentive for full-fledged BF promo.) So make your lists for your own
use, then look at how you can present the changes you need to see as
money-makers or money-savers for the hospital. "My" hospital, for example,
was unwilling to even look at mother-baby nursing (routine rooming-in,
couplet care, no more central nursery, etc.) until they realized that they
could do it with fewer nurses; once they realized that, it was full-steam
ahead! Administrators are big on all the current "quality management"
jargon, too; they don't want you to talk about problems, but if you can take
a "pro-active stance" and "action opportunities" (God, I hate this stuff!),
they will eat it up. But don't talk to the real nurses that way!!! Don't go
to the admin with lists of problems - go with an offer of research-based
up-dates to some of the current practices.

And yes, probably working evenings & nights for a while is one of the most
effective things you could do. I hated it myself, but I have to say that in
my experience it was the evening & night nurses that perpetuate some of the
most egregious BF "advice". (NOT ALL - please, I am not dissing night
nurses! Honest!)  When I did work those shifts, I found all kinds of stuff
going on that had been pretty much banished from the day shift. I also
encountered a certain amount of eyeball-rolling, like, oh, here she goes
again. Good thing I'm tough. My experience is that the PM shifts have much
more of a tendency to view the babies as "theirs", probably a hang-over from
the days when the babies all went back to the nursery for the night, in the
name of "mom needing her rest". Certainly that was when babies were most
likely to be given glucose water and formula bottles.

I'm weary and discouraged just thinking about this. Good luck - I know
you'll find effective ways to carry out your mission!!

Cathy Bargar, Ithaca NY