We developed a Triage list of sorts. All except the Discharge Class are by
MD Order or RN rqst. No, we do not go room to room to see everyone
individually. We make up for it with Item #1.

1. Teach a quick (20 minute), basic howto, whyto, in the daily Discharge
Class. Reaches all moms at once, BFing or not. (Ped teaches newborn care,
OB-RN teaches mom's PP care, Soc Srvc teaches personal safety / DV &
resources, Car Seat lady teaches correct / safe use.)
2. Moms who are D/C today and who have problems - by referral.
3. NICU moms (who should already have a pump in use because the OB RNs have
set them up.)
4. Special feeding / latch problems - by referral.
5. Administrative duties: prep for & teaching Education events /
inservices. (Remember Dr. Wight's VLBW baby feeding protocol that says one
major barrier to effective BFing help is the staff's misconception that
Lactation help is the sole purvue of a limited number of specialized
staffers. Not so. It is *everyone's* job to help nursing moms. But you have
the job of teaching them how.) Researching specific questions i.e. "Can she
BF if....?" This is high on the list because it gives global help to your
moms by helping staff with their jobs. Our RNs are supposed to document in
the mom's or baby's chart what they do to help w/BFing & how much time they
spent in that effort. It is hoped that such documentation will help with
staffing issues.
6. and others in no particular order.
"She's ready to feed NOW and has a bottle in her hand...!"
First feeds in L&D.
Readmits on the Pediatrics floor.
Others.

Of course these are not absolute. You are always taking requests as they
come up.
But when you are reaching Overtime - which is not allowed in yours and my
hospital - you can give warning, then say "no" if you can. In my state,
there are laws that hourly waged persons cannot continue to work without
pay. There are good arguments on both sides of that issue: follow the law
so the hosp doesn't get in legal trouble w/State; help the moms anyway
because they need it and you can't stand leaving them; risk of burnout for
you (esp with your statement that your nurse-manager is not willing...);
quietly keep doing a 30-40 hour job for 20 hours of pay and the hosp is
very happy. Make friends with the staff, teach them one by one as you work
with their moms, and maybe they can add to the chorus that you are needed
full time or they need another 20-hour LC.

We have 2 FT with 4000 to 5000 births a year. We go to PI mtgs,
Collaboratives. We give inservices and more are planned. We go everywhere
in the hosp & the Clinics want us on a regular basis. We are frequently
turning down multiple requests that come at the same time and can't be
delayed because mom is here NOW for a limited time (Peds, Peds Clinic, Peds
ED, NICU, PICU). It's a difficult balancing act. We do charge our time to
each Dept on our timecards: 1hr Shift-1 to Clinic, 1.5 hrs Shift-2 to
Med-Surg, 17 hrs NICU, 22 hrs to PP, etc. You get the idea. It spreads the
"cost" of our wages/salary around and eases everyone's budget. But it does
make our personal timecards a nightmare.

Hope this helps.
Phyllis


> I work at a hospital that has 500-600 births a year and we have 1 part
time
> position allowed for lactation coverage.  The nurses are wanting 24/7
> coverage and the nurse manager is not willing to increase the number of
> lactation hours budgeted.  What do other facilities do to cover the time
> when lactation support is not in house?  Do you take call?  Do you split
> your hours to cover days and nights?  I am only allowed 20 hours per week
> and I am struggling with when the best time to be here is for the moms and
> babes.  I also think my role is getting confused by many staff nurses.  Do
> any of you use a screening tool so you just see high risk couplets, or do
> you see everyone?  Currently when I am here I see everyone and go over all
> of the education with the patient regarding breastfeeding.  Many times
when
> I am not here the packet of information is handed to the mom and she is
> told "Here is some breastfeeding information".  Any suggestions would be
> helpful.
>  Thanks,
> Kim Rehling-Anthony BSN,RN,CLC
> North Platte, NE
>


--- Phyllis Adamson, IBCLC, RLC
--- Glendale, AZ, USA
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