If shields are starting turf wars, the policy should be revisited.
Especially since they are not a controlled substance, it seems unreasonable
to have to be playing shield police.  Any mother can buy one herself; is
that better?

My ideal shield policy for ward staff is simple.  If you aren't able to
follow the dyad or see to it that someone does, until they don't need it
anymore, then find another solution, don't introduce a shield.  Corollary to
this policy is, if you introduce a shield, provide the mother with written
instructions after demonstrating correct application, and document that you
gave it to her and why, and make sure she has a follow-up appointment.  

It has reduced the number of mystery shields on our ward.  Before, they were
handed out furtively, and not charted, and the mothers were often as unclear
about why they'd gotten them as I was, though an amazing number of them had
been warned that I would be very upset if I learned they were using shields.
A lot of them feared I would be angry with THEM - ouch.  It has also led to
some good conversations among staff on duty, when they troubleshoot together
to try and avoid resorting to a shield.  It strengthens their skills to be
able to bounce their ideas off each other, and it increases pride in work,
which makes for happier staff, and mothers benefit from that.

The difference was when we in the breastfeeding vanguard started treating
the whole staff as adults who could be responsible for their actions,
instead of as children who couldn't be trusted to use all our supplies right
and so had to be monitored.  In retrospect I see that that attitude really
undermined getting the whole staff on board for improving all our
breastfeeding guidance skills, though at the time I thought that control was
the only solution.  I'd encourage you to foster open discussions about the
situations in which we do find shields helpful, because it will help the
staff to understand why restrictive use is important, while acknowledging
that sometimes they are a valid aid.

Rachel Myr
Kristiansand, Norway

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