Chris,

As a former NICU nurse, I certainly empathize with the situation! I always got better results when I'd remember why all the other NICU nurses were there: They love working with babies. They care about the babies -- sometimes very, very much -- and really do want to do right by them. They're not evil, and they're not simpletons. But they're like much of the rest of the public in that they often don't understand the huge differences between breastmilk/breastfeeding and formula/bottle feeding. They've seen tiny babies grow on formula and often view problems such as feeding intolerance and NEC (necrotizing enterocolitis) as related only to prematurity and not to the baby's food.

As far as educating the nurses, I think it's helpful to point out to them one or two specific NICU-related areas where formula has been shown to be detrimental, rather than giving a long list or a long inservice. Too much information, especially if the "audience" is indifferent or resistant, can be too much information! So I'd bring in a study about formula's link to NEC, for instance. People don't necessarily need a long list of benefits to get on board with breastfeeding; they just need one or two reasons that really speak to them.

Unfortunately, I saw a boost in our unit's breastfeeding-friendliness only when we got a new pair of neonatologists who essentially told all the patients' mothers that they *would* be pumping for their babies. The LCs and other breastfeeding-knowledgeable nurses had been giving inservices and trying to spread the message all along, but some nurses seemed to need the physicians' strong endorsement before they took the subject seriously. But at least they finally did. So perhaps you could speak with the unit's head neo?

But even though in the big-picture view I'd try to be understanding of where the nurses may be coming from, in your particular incident the nurse clearly knew she was in the wrong because she lied to you! I would probably file an incident report. This sort of thing needs to be viewed as seriously as a medication error. Especially if the baby's doctor had written an order for breastfeeding, the nurse's refusal to carry out that order should be addressed.

Good luck, and let us know what happens!

Jennifer Herrin, RN, IBCLC
Heidelberg, Germany

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