What concerns me about canning all the IBCLC's is not RN or non-RN IBCLC.  Outside vendors do not have permission to document in the patient's chart in many institutions.  That means - the LC must report to the RN in charge of patient care. The RN then has to document in the medical record, something she has not personally done, but is responsible for.  Just because no one has sued YET, doesn't mean the hospital or nurse is not vulnerable.  By definition in our state, RN's are the only bedside caregiver (not LPN's) who are qualified to provide assessments and plans of care for inpatients.  They document this in the medical record.  If physical assessment is part of the RN job, and BY LAW, this is required to be done by RN's, not just licensed personnel (LPN's or CNT's for example), then it follows that only RN-IBCLC's would be eligible for hire. Unless states license LC's with stringent standards which include passing of the Boards AND documented clinical hours (might be advanced degree), hospitals are right in wanting to protect themselves with RN-IBCLC's.  But by the same token, it doesn't seem right to have outside contractors providing services with no coordination or documentation of plan of care, etc.  This is just an example of damning with faint praise and putting the responsibility back on the mom.  If she REALLY wants to breastfeed, she will take the initiative, spend her own money, find the right resource WITHOUT support by government or medical establishment.  The in-fighting needs to stop among IBCLC's and a joint effort happen to bring the profession to a free-standing profession like OT's, SLP's, RD's and PT's.  A respiratory therapist who decides to be an RN still has to go to school and take a board exam and get clinical experience to work as an RN.  There is no cross-recognition from one profession to another.  The problem seems to be lack of respect and competence that is properly assessed AND PAID FOR! 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Fay Bosman
Sent: Sunday, November 13, 2011 10:02 AM
Subject: Re: non-nurse IBCLCs don't belong in hospitals?

FYI - I wrote Dr Bartick last night. Here is my letter:

Dear Dr Bartick,

I was very sad to hear that UMass Memorial Medical is eliminating all of its RN-IBCLCs, and commend you on your letter, posted on your coalition web page. 

However, may I ask you more about your comments in points #6 and #7? 

*    "Lactation consultants are currently not licensed in any state, so hiring non-RN lactation consultants would mean there is no government oversight or consumer protection for these individuals providing clinical care at your hospital." 

*    "It is standard of care for hospitals to provide RN-IBCLCs, especially those of equivalent size as UMass Memorial, with a level 3 nursery. Whoever will fulfill the role in the NICU should have experience and training in caring for critically ill preterm infants. By assigning this care to non-licensed personnel without a nursing background is risky for the infant, the mother, and for your institution."

You clearly highlighted the need for IBCLCs (not CLCs) to provide qualified lactation care, referencing various sources. However, these sources do not infer that the IBCLC should necessarily also be a RN to be adequately qualified. I am curious about why you believe that hospital-based IBCLCs (especially those who might work in level-3 NICUs) should also be RNs? While IBCLCs are not licensed currently, there is most certainly "consumer protection" (through the IBLCE and their Scope of Practice and Disciplinary Procedures, which is accredited by the National Commission for Certifying Agencies). Can non-RN IBCLCs not provide excellent lactation-specific care either alone or in conjunction with RN-IBCLCs?

I fear that your view is echoed by many, and that this severely limits opportunities for IBCLCs to practice and share their passion and skill, and puts an unnecessary cost burden on medical facilities. Of course, until licensure for IBCLCs is instituted, reimbursement for care by non-RN IBCLCs is a problem. I feel that it would be in the best interests of ALL to encourage the use of non-RN IBCLCs - even in hospitals. Perhaps the IBCLC who cares for the extremely fragile babies should be an RN too, but for most other families, an IBCLC does not need to provide nursing care, just lactation care.

There is a large hospital group in the Portland, OR, and Vancouver, WA area, that hires both non-RN IBCLCs and RN-IBCLCs. They have a level-3 NICU. I think that their approach to lactation care is ideal. However - they are the only hospitals to do this, that I know of.

I would appreciate your sharing your reasons for your views with me, as I truly don't understand.

With the utmost respect,

Fay Bosman, IBCLC
President, Clark County Breastfeeding Coalition, Vancouver, WA Lactation Consultant, Clark County Mother Nurture

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