Hi Rachel,

Your comments about treating the staff like adults that are responsible for 
their decisons is right on.
I's an "old" LC. so much of what we used to do was so patient centered and 
so new to the staff that they did feel isolated and that our care sometimes 
smacked of we versus them mentality. Most of us (staff and LC's) have grown 
through the years to have a much more collegial relationship.

I agree completely about shield follow-up. That is pretty much our practice. 
Insurance pumping, supplementation, most always a bit and a 2 day follow-up 
to reassess latch and weight in our lactation center. Most of our moms so 
sustain the breastfeeding relationship and go on to do quite well. We have 
very few problems and quite a few of the people given mystery shields in the 
hosptial do not really need them by then.

LuAnn Smith RN, BSN,IBCLC
York, PA .

>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
>Rachel Myr
>Kristiansand, Norway
>
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