In response to Melissa V. Kirsh's post about 24Hour IBCLC coverage in hospital
I'd like to say  that I totally agree but don't see that as a reality in most
hospitals unfortunately. I have lobbied my administration for over a year,
wrote two proposals, spoke to the CEO, DON etc. I have not had the proposal
for another parttime LC approved as yet but I was recently told that I could
have another IBCLC come on as a per diem. It's a start. Should IBCLCs be
seeing every breastfeeding patient? We are consultants. Consultants should be
dealing with the problem situations above and beyond the skill level of the
staff nurse. I get called into situations in the NICU and on the floor all the
time when all it took was a little extra time from the Nurse and some basic
breastfeeding Know how.
In reality, 1 IBCLC in a moderate size hospital can't be expected to be able
to solve all the problems. We all know how labor intensive and time intensive
some situations are. If I know a mom has had a lot of BF difficulties I try to
follow up on her but in reality I can't always. So I do refer to private
IBCLCs many times. I work 27 hrs. a week,M-F , in a hosp that delivers 1600
and has a 13 bed NICU.  I am so busy being Lactation Consultant, its hard to
keep up with my job as Lactation Coordinator which implies overseeing and
making sure our breastfeeding program is implemented properly. I need to plan
inservices so that the nursing staff is up to date and more skilled. It's hard
to plan when there is little extra time in my day to do that. You guessed it .
It's done on my off time!
As much as I've tried to enlighten the administration it seems to fall on deaf
ears. Change comes slowly but when youkeep hammering away you get there I've
learned.
I take a new strategy lately. A lot of  patients have called to complain to me
about the lack of LC coverage on the weekend and how disappointed or mad they
were when they found out there was only 1 LC M-F and they had a weekend
delivery and NEEDED more than the staff could give them. I tell them that I
agree but that the administration listens to the consumer more than me. Put it
in writing and send it in!
They have been. We'll see where that gets us!
Walk in the hospital LCs shoes for a day. She's usually overworked,
overburdened, understaffed trying her darnedest to teach, support, problem
solve, cheerlead, plan,
follow up, answer phone calls etc. She's usually working on a postpartum floor
that is minimally staffed with  RNs and a high census of moms and babies. The
RN gets 5 dyads but only gets credit for 5 patients when she really has 10.
Does she have time to do all the teaching necessary? Where does the IBCLC come
in? On busy days she most likely picks up the pieces that the RN didn't have
time to do. Is this what my job should be? NO! Do I do it? You bet! I do
plenty of basic teaching one on one during rounds. I have found that if don't
do that too many patients leave without enough info because they do not always
take the initiative to come to BF class .
Jane Ciaramella