As a non-RN, IBCLC, who also happens to be a Certified Health Education
Specialist (and I have a PhD and MPH, in two subspecialties of public
health), I find the insistence that IBCLCs be RNs exacberating.  There's a
small part of me that thinks many jobs should require a CHES certification,
but that's a whole other ball of wax.  Licensing, certification, and
accreditation are supposed to provide a base standard for quality within a
field.  Unfortunately, when one looks at the Health Services Research
literature for quality (in particular for certification), the evidence is
very mixed.   Indeed, this is both hard to accept and to type.  I, for one,
am proud of my IBCLC and CHES, and do advertise the "gold standard" for LCs
as the "IBCLC."  However, in many fields certification becomes nothing more
than a means to monopolize the field by locking others out of a profession.
I don't think that is the case (yet) with lactation, but others may have a
different view.  As our health care industry has become more and more
specialized (subspecialized), I think we need to be wary of this happening
with IBCLCs (such as the RN-IBCLC).

We have had clinic and hospital positions advertised in our state--that are
clearly for education and lactation--completely lock out some exceptionally
qualified candidates because they insist on an RN (yes, I take this
personally even though I'm not looking for a hospital-based job).  I think
that this is another instance where we (all IBCLCs) need to do  a better job
of educating what we do within health care communities and the general
public.  There have been many times that I have had to describe what it is
the field of public health is about because someone assumed that I inspected
toilets or that I was automatically a nurse because they had once met a
public health nurse.  Public Health suffers from the same "image" problems
partly because it is a multidisciplinary field encompassing upwards of 60
different subspecialties.

Please understand that I respect the education and training that RNs have as
distinct (in some ways, but there is considerable overlap) from my own;
certainly, the floor nurses I know have some of the hardest jobs in the
world.  I also find that many RNs, especially in the litigious US, have been
trained to be somewhat hierarchical in viewing authority and unfortunately
some have adopted the territorial nature of medical licensing.  This
probably colors their perception of what is "necessary" when writing these
job descriptions.
'Just my 2 dropperfuls (okay, maybe 6 dropperfuls)

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