My understanding is that you could have all 20 hours technically be one on one if you like. But you have to have a minimum of 5 hours one on one with a trainer, and the other 15 hours can be classroom. Although they do not specify that it has to be an IBCLC. You could train someone, if you felt they were competent to provide clinical lactation support, to help you with the clinical time. But this time is meant to be spent working with patients. In fact, when you are with the patients, the trainer is really not supposed to be working with the patient, but only observing the nurse as she interacts with the patients. I was told by another IBCLC that they did set up for one of their 5 hours, a clinical practicum, in which nurses went to various stations and practiced setting up a breast pump, hand expression, etc. But each station was manned by one person so the time was one on one time, then they did 4 hours with patients. And you might want to clear that
 with BF USA first. Of course, these are all minimum times, some people are going to need more time. At least where I work, we are in the classroom portion now. But I can see in the future that some of the nurses are going to need a lot more than 4 to 5 hours clinical time.

Tricia Shamblin, RN, IBCLC

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