Martha, I work in a community hospital where we have great LC coverage 7
days/week.  We have between 1800-2000 births a year.  We have supplies available
to the staff which includes nipple shields.  We no longer require a consent to
be signed when a shield is given out but request that a LC consult be filled
out.  We have also offered inservice to all the staff and maybe a quarter to a
third have attended.
I feel very strongly that shields should not be given prior to 24 hours
postpartum.  At this time period many mothers have some areola edema, which makes a
deep latch with a shield difficult. Also since there is only small amounts of
colostrum, using a shield at this time does not allow the infant to get much
if any of the colostrum.  I teach the mothers hand expression (including
reverse pressure) and feel that droplets of colostrum on a baby lips is better than
just sucking on a shield with no intake.
We have many big hurdles to leap.  Good luck on your endeavors.
Ann Perry RN, IBCLC
Boston, MA

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