Judy,
Over the past 10 years we have evolved what LC's do in our hospital. Currently what we are doing seems to work well. We have educated and trained our nurses to do basic breastfeeding support. And as we give ongoing training and education, they are getting better and better. We have a breastfeeding training module that all staff have taken and all new staff take...with CE's. We do a lot of on the job training...have the nurses accompany us as we work with patients. In the beginning we saw all patients. But, now we see by referral only...We have a list of 
criteria for the nurses which includes "patient request". So even if they don't have a problem on our problem list, they can request a visit from us. Our list includes such things as latch problem, sore nipples, baby less than 37 weeks etc. Also cover NICU patients.We now really feel like Lactation Consultants. We can spend more time fully assessing and helping a mom.(have developed a Consultant Form that we all like. Tooks us MANY revisions) And we are still VERY busy. We have about 5-6,000 births per year. We have a great working relationship with the nurses.  Mutual respect is the key. We also follow all the patients whose problems were 
not resolved in the hospital by phone, have someone in the office each day to do these calls. to answer calls, and to do outpatient visits. We also teach prenatal breastfeeding classes and conduct weekly support groups.
Hope that is helpful. If you have any further questions, email me privately.
Thanks!
Carol L'Esperance, Albuquerque, NM

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