In our hospital the LC's that are hired as such, and practice only as such.  They only work four-hour days, therefore cannot be pulled to a staff assignment.  They have more work than can fit into their allotted time, and they have to be very strong not to put in 8-hour days for 4-hour pay.  It is the RN who gets pulled into the LC role, because there is no LC the other 20 hours/day.  Because I usually  work in tandem with at least a care partner(for max 5 moms and their babies), and often with an LVN, as well (then 7 dyads) babies; and because my team is especially BF friendly, I spend most of my day teaching breastfeeding and doing paperwork.
My team does the rest.  The good thing about this approach is that I do not have to keep running to answer lights when a mom needs someone with time and patience, as well as skills to assist her.

I like the idea of offering a hospital based course for non-RN's, to learn to work at the bedside and to learn when she/he must call for the RN.  Perhaps like the mom-volunteers at Evergreen. 
 I have thought that one way many aspiring LC s could start getting the hours they need to sit for the exam, would be to do an orientation with the hospital LCs, follow the LC around for a period of time, and then volunteer for one or more 4-hour shifts per week when the LCs aren't in house.  This would increase the no. of hours per day that parents  have that additional person to pay attentiion only to BF.
Just think, the hospital could offer an LC program, like they offered a doulah program.  Maybe they could even charge the participants, thus bringing revenue into the department, to pay for more official LC time...dream on, Chanita.

Sincerely, Chanita

From:   Katharine West[SMTP:[log in to unmask]]
Sent:   Thursday, May 29, 1997 4:36 AM
Subject:        LC qualifications

> As someone who has trained RNs for years, I can tell you that their > curricula is not rich in bfg. theory and
> technique.  The wonderful and dedicated RNs practicing as LCs have
> essentially learned what they do the same way non-RNs do:  through courses,
> self-study, apprenticeship, and by experience.

It seems to me, the way lactation consulting as a profession as well as
mgd care is evolving, one solution would be to require the equivalent of
a one-semester course in Basic Maternal-Infant Care for the non-RN LC.
It could cover basic anatomy & physiology, and basic pathophysiology in
the immediate postpartum. It could include student observations in the
maternity unit. This is similar to the minimal basic nurse skills
training required of licensed psychiatric technicians - from time to
time, they need to function as "nurses" with their patient population
(how to make a bed, wield a bedpan, watch an IV). This approach does not
teach them to become RNs, but does teach them enough to know when an RN
is needed for further assessment. I know this sends groans through the
audience who are having a hard enough time finding LC mentors, but maybe
this could be an option for those seeking hospital-based practice. It is
just an idea.

I happen to think there IS a place for the non-RN LC in-hospital. For
one thing, the non-RN LC would not be pulled to be a RN when staffing is
short - the LC would be left to be an LC. With less and less bedside
care being managed by RNs, those providing care (CNAs, LPN/LVNs, etc)
simply need to know WHEN to call the RN in for an evaluation, not become
an RN.

The answer provided (why the LC needs to be an RN) sounded fine on first
reading. But I take offense that the LC must be an RN "because there is
less contact with the RN anymore." Surely this borders on delusion and
self-importance, as not all moms even get to see the LC - unless there
are several LCs providing around-the-clock 7 day-a-week staffing <- THIS
I have yet to see!

Katharine West, BSN, MPH
Sherman Oaks, CA