Luanne and Others:  Why would it be "unfortunate" that a state licensure 
supersede a certification?  Until the thinking gets straightened out, I, 
personally, have defined myself as a nurse clinical specialist.  I function as an 
RN whose clinical specialty is lactation.  I do not work staff and haven't for 
over 20 years - I work full-time as a nurse clinical specialist.  And I use my 
nursing education (as well as my degree in biology) every minute of every 
single day that I am at work in the hospital as an IBCLC.  Now...the challenge 
is to get the profession of nursing to formally recognize lactation as a nursing 
clinical specialty!
For those IBCLCs who do not practice under a State (here in the USA) 
Practice Act and function in the hospital setting, you should be practicing 
under a very specific written job description.  Formal job expectations help 
protect you legally within the murky health care system here in the US.

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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