Hi all,  my apologies -- the post I sent somehow had several paragraphs deleted in transit -- oh those renegade electrons!!!  Also, I see that the heading above may be construed to mean that I am defending mediocrity--
   NOT!!

I'm going to put asterisks *before and after* the previously missing portion.
My humblest . . .

 
Thank you all for your reactions and very positive support after my bizarre reprimand.

To answer the common theme of statements toward my institution and my department manager:

My manager does indeed commend me for my concern for and care of my patients.  She also supports our decisions when we defer circs or keep moms that extra 24-48 hours to get good breast feeding going.  She is very pro-breastfeeding; but also very CYA conscious with wanting protocols in place, and wanting to make sure follow-up is in place, which has both its plusses and its own drawbacks.  I think it must be very hard to create change in a very large institution that must connect up to many outlying networks -- as opposed to being a hospital that is its own entity.

I work at Kaiser Hospital, in San Francisco, which is an HMO with its own clinics and hospitals here and in surrounding areas, as well as allying with some hospitals outside of the city for in-patient care.  At the moment, each Kaiser has its own nursing protocols and procedures -- some of the Kaisers actually do have alternative feeding protocols in place.  And our hospital is also working to establish the same, both in NICU and in the perinatal unit.

We have two LC's officially hired to the perinatal unit, who are only paid for 20 hours a week.  Their job includes all the staff education ( and all the nursing caregivers on the unit have had an 8-hour inservice on lactation and latch, and use of LATCH scores), seeing the patients with breast-feeding problems, returning calls on their warm line, and developing projects, such as enhanced protocols, etc.  To make their job even harder, they have a different set of priorities than their boss, so they get pulled in two different directions. 

 Their personal priority for this year is to establish the guidelines and teaching and followup for the alternative feeding methods.  I have been of some help in this, by accumulating cup-feeding protocols from around the country (thank you all who have sent yours), ****pulling the articles from the assorted bibliographies -- and have volunteered to write our protocol as well, as an unpaid project.  So, hopefully, we will soon have this protocol in place.  The SNS, I understand, is soon to be ready.

What we start in our unit is followed up by HomeHealth visiting nurses, some of whom are very able regarding breastfeeding.  And then we have LC's at most of our clinis, to which the HH nurses can refer women having continuing problems.  Ideally, I would have several more LC's attached to our unit, and have all the follow up done by us, so the same people start and finish -- but that's another story.

Lastly, I wish to state that most of the RNs and LVNs of my perinatal unit (postpartum, LDR and antepartum) have been teaching breastfeeding for five to 20 years, keeing up with the changes in understanding and practice.  Most of us who have children were/are breastfeeding moms.  Several are CLC and preparing to sit for the IBCLC exam.  Some are LLL or other community-based support resources for prenatal education and breastfeeding counseling and support.  Some of our nurses in the unit are also maternal/child PNPs, and several nurses have midwivery backgrounds and/or licenses.  In other words, I am not above the norm in my institution -- maybe I'm just more vocal about our inabilities.

What I do have, that especially the nurses on evening and nights don't, is more time to spend on these concerns, because staffing on days is better -- even though babies are born and have breast feeding problems with no respect for the clock.  We are in the middle of a changeover regarding delivery of care (it will now be called "member-focused," and is similar to the old team approach) which COULD work to our benefit, but most of us fear it will leave us less time for our hands and care, rather than more.  That will remain to be seen.

I have long considered myself lucky and grateful to be in San Francisco, which has been at the forefront of many sorts of change.  I also am glad to be working with Kaiser, because we have always seemed to be even one-step beyond our own rules, providing very supportive care for most of our patients.  Especially as I read the problems people have elsewhere, I am glad to be here.  But I get impatient when change is slow, or when we still are behind what I would consider an attainable ideal.  (Maybe if I go out to each of the hospitals in and around SF, I will find one single hospital doing something more than we are, then it will speed our need to act.)****

Once again, I feel very supported by all of you.  Thank you for the chance to vent, for the positive comments and the communal scream.

Chanita, San Francisco