Talking about JCAHO.....my friend who works labor & delivery told me that
accordingly they can no longer take verbal orders.....disempowering the nurses
again....everything goes in cycles.  However, the state of Illinois is presently
in a crisis mode (I believe) with malpractice insurance skyrocketing!
There's a large OB group in an area hospital moving their practice across the border
to Wisconsin, and today I heard about a breast specialist moving her practice
to Pennsylvania.  My brother's a general surgeon and he says moving his
practice across the border would reduce his malpractice costs tremendously.  As a
result of the malpractice crisis here, and the rise in baby boomers, and the
lack of enough nurses in the organizations, and finally, the lack of value in
lactation.....I believe that this is going to impact current lactation positions
in the hospital settings.

I believe that without administration's buy-in to lactation in many
circumstances, they will fill nurse positions with warm bodies, even when it means
closing lactation services so that these warm bodies can serve in the capacity of
nursing care.  Quality clinical care is not their priority.  They're in
survival mode and will cover costs, or rising costs with the "scarcity principle",
meaning using the LCs to do patient care - the must-be-done tasks.

I hope I'm wrong about this, but my gut feeling is that it's only going to
get worse before it gets better.  I fear there'll be more cutbacks in the
future.  There has to be with less # of deliveries....less OBs mean less deliveries,
with position cuts right behind!  Hospital administration will only look at
the numbers and correlate patient care hours to finances....end of story!

How do we overcome the cutbacks?  I'd recommend the following:  1.) Designate
lactation as its separate departments (not under nursing), such as other
ancillary disciplines ie. physical therapy, 2.) charge for our services -
inpatient and outpatient, 3.) unite as a profession to be recognized as its own
entity, and 4.) submit billings for our consults with proper codings for insurance
reimbursement (with the understanding that full coverage may not be possible).

Just my 2 cents.....

Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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