Don't know if this will work for others but it has for me. Luckily, I was a
staff nurse at my facility for quite a few years before becoming the first
IBCLC in our dept. and accepting the position as the only hospital based LC
here. Anyway...
First: Do you have a protocol for care of the breastfeeding couplet? If
not..develope one!!  It's the hardest step sometimes but after that
everything else is "cheese" as my daughter says. Use ILCA's Evidence Based
Guidelines, AAP, Surgeon General for references. Management "loves" to hear
that the ILCA guidelines being used by JCAHO teams..so that's a
manger "sell" point ( I also point out that including necessary discharge
teaching regarding the breastfeeding componant such as lactogenesis,
feeding patterns, normal expectations, etc. covers the "hot" concern of
JCAHO regarding readmissions of BF jaundiced infants due to inadequate
discharge education ..another risk management issue also)
Second: After the protocol is in place ( and you have inserviced staff on
it) develope a "Clinical Skills Checklist for Breastfeeding Support" for
your Maternal Child Staff. Stressing that provision of up to date care is
not only a community standard but also a client satisfaction factor while
preventing risk management issues, most managers and administration can buy
into this. Requesting that this also be part of their education tracking
for staff  also puts it under the catagory of "performance
appraisals" ...see where I'm going?
Lastly: Do a survey of patients pending discharge as a "quality assurance"
issue. Aske what help they recieved,who helped,who didn't , etc.... that
becomes your documentation for administration for staff who are unable to
improve their patient care skills to meet community standards of care.
If all these tools are in place, this also becomes grounds for counciling
the staff who wantonly choose to not provide quality standard of care.
I'm too old to get into an arguement with nurses who can't keep up to date
in their field...it's too tiring to argue with "mules". If the tools are in
place, it becomes an administrative,customer service, quality assurance,
risk management and marketing issue..and those folks can affect that nurses
pay and promotions...
( If I feel really pissy..I work with the managers to  assign that nurse on
the QA team to moniter and develop programs to meet the standard of care
regarding breastfeeding support and education.)Good luck......
Lisa JOnes RN IBCLC

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