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 *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html