In my experience, the reason why hospitals require you to be an "RN" is because they do not have a "true" LC position. They hire an LC by stealing an RN "FTE". I have been a hospital-based LC hired in an RN per diem position for many years now. I started as a staff RN on our unit, became IBCLC only after 10 yrs, left after 13 yrs, was rehired as an LC only (still under an RN slot) 6 yrs ago. Our hosptial has never asked admin to make an LC FTE position. They just take one of their RN positions and make it into an LC position. 

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