I can only write about the hospital where I work as I don't know how it works elsewhere. I'M a Rn LC and I do beleive that without my Rn license I would sometimes be limited in my work. It isn't about been aked to work in L&D as I only work as an LC even if their are short on staff. It is a matter of legal responsability. I'm from Canada ,but I beleive the scope of practice is about the same  elsewhere.  Only a RN can take charge of a patient that isn't stable or can perform a complete assessment, not even a RPN who can take part in the assessment but must work together with a RN. I agree that I could perform only LC stuff without any nursing, but I would find myself  limited If I had to depend on a RN when it comes to mobilise a mother with a fresh C/S, perform glycemia, apply a protocol or  bring medical argument to the  team not to apply it when in a grey zone or "unplug" monitors in the NICU and assess the infant during all my intervention to identify when he needs to go back. I'm frenquently allowed to work with infants that would otherwise not be allowed off monitoring or at mothers bedside if parents were alone, because of the infant's medical condition. these infants would sometimes not be allowed to breast as frequently without direct supervision because of time restrictions of the nursing staff.  Unlike other profesionals, LC spend 1-2 hours at a time with a patient. Since there is very little medically accepted reason not to BF we frequently work with clients in need of acute care. Even if LC's feel like they can take charge of these situation because their acquired some knowledge, legally speeking they can't.

I would estimate that about 20% of the clients I see  need care that are out of the scope of pratice of an LC, that leaves 80% of the families who would benefit a LC without any other certification as I beleive that they are totally competant in the LC scope of practice. I do not think that a RN LC do more than an LC when it comes to LC consultation, but RN LC can go a little further without requiring another professional for the same intervention.

I would love to see more non RN LCs in hospitals as they have a different eye on BF and may bring changes toward BFHI more easily.

Emilie Trepanier , RN, IBCLC
Ottawa, Canada

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