Having been an LLLL for 9 years then an IBCLC for 11 and an RN for 8 (these all
overlap...) so that I feel the need to comment on this discussion...

1. In my job at the hospital with the _very_ sick babies in NICU I am glad not
for  _my_ RN degree, but for the specialists there on the floor.  In other
words, I can't think of a better place for an IBCLC _without_ the RN than on the
NICU floor where there is a nurse or a doc nearby that I can call at any moment.
My RN does not prepare me to deal with these little ones.  I am strictly an
IBCLC there and let the RN's deal with problems.  I educate, support, help moms
latch babies on, watch moms, watch, look and listen for signs of distress, but
when an emergency arises it is the staff on the floor that takes over.

2. The RN needs to be careful not to "medicalize" lactation.  If RN was your
first degree, and you have years of experience in this profession, it is hard to
turn off the RN and be willing to watch and wait (per Chris's post) and NOT put
glucose, bottles, etc. in the baby's mouth when the tincture of time will
suffice.

3. The IBCLC who is on the road or in her office needs to be very aware of
possible medical emergencies that may occur in her office or at the home visit.
CPR, having good referral resources and knowledge of where to go for an
emergency is essential.  (Here calling 911 is not the solution - you need to
know where to GO.)   In fact, it was those scares that pushed me into getting
the RN (that an a swift kick from Kittie Frantz.).

The list of what we need to learn is interminable - people are surprised I'm
traveling to the US AGAIN for a conference - but the more I know, the more I
know I need to know...  And as Linda put so well, OJT (on the job training) is
OK for some jobs - but can be devastating on those who we are "training" on!

Jeanette Panchula, BA-SW, RN, IBCLC, LLLL
Puerto Rico
[log in to unmask]