In a message dated 97-03-21 19:43:57 EST, you write:

<< Date:    Fri, 21 Mar 1997 14:42:47 +0000
 From:    Sue Jacoby <[log in to unmask]>
 Subject: job descriptions

 There have been two posts today which prompted me to write about the
 IBCLC credential.  Frances asks about writing a job description for a
 Lactation Coordinator- one who would do home visits to trouble shoot
 breastfeeding problems.  And Debbie is a RN who is now seeing her
 hospital's breastfeeding mothers, and encountering questions for which
 she says she has little experience.  Please do not take the following
 comments as a criticism of any of you wonderful people working to help
 mothers and babies...

 Frances, you mentioned the following:
 > At this point we guess the CLE or IBCLC eligible (took class, not finished
with
 > all homework/clinical time or whatever) is the primary consideration and
 >whether person is RD, RN or other health specialty is important but less
 >absolute...

 *I think it is important to point out that there is a VAST difference
 *between what the CLE and the IBCLC initials represent.  As I understand
 *it the CLE is a "program completion" certificate.  Meaning that someone
 *has attended a class, like the five day ULCA course on breastfeeding.
 *But there is no examination similar to the IBCLC exam involved.

         There are different CLE programs.  The one I took at UCSD, while
based on the UCLA program, was spread out over a month or so.  It required a
LOT of reading and written homework plus attending rounds with an IBCLC
working in a hopital setting, then writing up each different encounter.  Our
"final" that had to be turned in before you could receive the certificate was
a detailed curriculum for a 3 hour prenatal BF class- that's purpose, goals,
objectives, topical outline, teaching notes (annotated with exact page
references to counter the "well, what's your reference on that" ) and other
studies.  I felt it prepared me to teach, to do basic counselling and to
carry myself in conversation armed with a clear knowledge of fact VS fiction
and the references to prove it.   Gini Brinkley taught the core of the course
and other guest speakers gave lectures on certain topics.  It was a wonderful
course, and the intent is for the student to continue with self study, hands
on for experience and then sit the boards.  I'm not sure I could have retained
 that amount of knowledge if it were completed in a week with no opportunity
to actually "study-as-you-go".   This is an area that needs to be explored.
Just as we pick and choose which conferences to attend based on what we think
we'll get out of the program, we need to be good consumers when it comes to
education in our field of specialty.  There is another analogy with
childbirth education...  There are two lengthy programs that provide didactic
training and in contrast at least one or two weekend "certification" courses.

 >In my community, it is incorrectly assumed that RNs, simply by virtue of
 >their previous nursing school training, (or perhaps simply because they
 >nursed children of their own) are adequately trained to see breastfeeding
mothers           >with problems.

I agree partially here...  I know of nurses who are very skilled at getting
babies on the breast  and I have certainly seen my share of never bending -
bottle is better and easier types.  The fact is they are LICENSED as nurses
and are accountable for their actions.   I could counter with "would you send
a floor nurse to provide anesthesia in the O.R.? "  I don't think so....but
it doesn't happen because the nurse isn't certified as a nurse-anesthetist.
 get the drift?     Nurse -midwifery falls along this same thread.   We are
not going to be recognised and paid as IBCLC's until it is a true "Allied
Health" field and there is a license to go with it.

 >Frances, I would urge you to make the IBCLC credential the standard for
 >your breastfeeding position, if that person will be doing hands-on
 >breastfeeding assistance.

When our Naval Hospital wanted to start a lactation program, approved the
proposal and sent it to the human resources department, they were told that
they could not require  the IBCLC  because it's not a DOD requirement or
required by the state board to practice.

  >I'm concerned, however,  when I hear that, *in spite of a lack
 >of credentials,* hospitals are going ahead and presenting staff members
 >as experts.  It seems it not only must be confusing to the patients, but
 >it also puts you (as the nurse covering the lactation cases) in a bit of
 >a bind, knowing yourself that you really are not fully trained and
 >certified.  Would this happen for other health services, such as speech
 >pathology, dietetics, physical therapy, etc?
       I repeat, those "professionals" are licensed by the state.  I do,
however,  take umbrage at hospitals who misrepresent the facts in order to
attract customers.

I think your letter is great and brings up a fairly sensitive topic....who's
qualified and who isn't.  As I said in my letter to the editor of the Globe
last year, we are going to have to address this eventually.   These are
called growing pains,  just ask other "allied health professionals"   I am
being paid as a nurse, not as a Board Certified Lactation Consultant.
Liz Flight, RN, CLE, IBCLC  (recently hired as a "nurse specialist" at Naval
Hospital Jacksonville)