Nurses have the opportunity to take on new and advanced roles through certifications and degree programs. For nurses working in maternal/child health, a lactation consultant is one such role to pursue. A lactation consultant, formerly titled IBCLC (International Board Certified Lactation Consultant), is a health care professional who may work in a variety of health care settings and specializes in the clinical management of breastfeeding. IBCLCs have been proven to improve breastfeeding rates, lower health costs, and improve consumer satisfaction and trust.
Many nurses and the general public may not know exactly what a lactation consultant does on a daily basis. Daily Nurse interviewed Robin Franzoni, a lactation consultant at a teaching hospital in central New Jersey. Robin worked as a NICU nurse for many years before she became an IBCLC. Here is what she had to say.
What first sparked your interest in becoming a lactation consultant?
When were you first exposed to an IBCLC?
My passion reaches back to when I was a new mom and getting ready to nurse my first child. My mother nor my aunt ever breastfed. I was one of the first one of my friends to have any children. My exposure to breast milk and pumping while working in the NICU was what really spurred my own decision to breastfeed. There were no lactation consultants at that time, but I saw how much better the babies did on their own mothers’s milk. I had horrible pregnancies and preterm labor with all three of my kids but I felt like the one thing I was successful at was nursing my own kids. So my success at breastfeeding and exposure in the NICU is what kind of gave me the interest.
What would you say your typical
day is like? What are your day-to-day responsibilities?
I see my discharge patients first and make sure they’re going home with all their questions answered and information for follow up after discharge, especially the ones who have had some difficulty latching or feeding or are losing too much weight. Then I see all the first time moms and assess the latch and get them motivated to start positioning the baby themselves. A large part of it is preparing them for what’s expected at home because they have such a short time in the hospital. Then after I’ve gotten through most of the first time moms, I see any other mothers having difficulty or who have asked for a consultation. But really my first priority is seeing, stabilizing, and supporting the first time mother.
What’s your favorite part of
I think being the person who has gotten a baby on for the first time or seeing a baby who’s been struggling and all of a sudden it clicks and they start eating. And the look of mom’s wonder on her face like, “Oh my gosh, it’s kind of happening.” I’ve been to hundreds of deliveries over my career and it used to be so exciting to watch a baby being born and they take that first breath. Seeing that baby eating for the first time is just as thrilling as watching the baby being born. It’s the culmination of many different things that are finally in perfect sequence and everything clicks and to me it’s really wonderful. It’s establishing that connection with the baby by nursing that is not only for the nutrition but the connection with the baby.
What’s the most challenging part
of what you do?
It’s the preconceptions people have that negatively impacts nursing. It’s unrealistic expectations and misinformation the mother has received from family members or friends. It can be like trying to knock down a barrier that’s been erected around themselves. But I think it’s mostly the lack of good education about breastfeeding.
How do you work together with
nurses when giving care to a patient?
Well, I feel that I’ve been really fortunate. I developed this routine that after I’ve seen the mother and the baby I usually go to the bedside nurse. And I think it’s just evolved into what I do because I’m counting on the bedside nurse to carry the ball after I’ve left. The reality is I’m probably only going to see that patient once on day 1 postpartum and at discharge. So the rest of it falls onto the bedside nurse. Teamwork gets it done. I want every nurse to feel that she is part of the breastfeeding support and that I’m depending on them and trusting them.
Do you have any advice for
nurses who may want to become an IBCLC?
I think they need some really good mother/baby or NICU experience first. I think you need a base and then after building that base then think about doing it. It’s something I really think you have to have a passion for because it’s one of the toughest things I’ve done to date. I thought it would be less stressful than the NICU, but it’s just a different kind of stress. You’re shouldering not only the baby and assisting them, but you’re also responsible for the emotional well-being of the mother and part of the physical well-being.
If you are interested in learning
more about the professional role of a lactation consultant you can visit www.uslca.org or www.ilca.org.
Information about obtaining certification can be found at www.iblce.org.
Subscribe to Clinical Lactation
Clinical Lactation is the official journal of the United States Lactation Consultant Association and a benefit of membership to the USLCA. The aim of the journal is to advance clinical practice for lactation specialists who work in a variety of settings: hospital, private practice, WIC, and mother-to-mother-support organizations.
The key to finding work as an ER nurse is to be proactive before and during nursing school. Keep reading for pro tips on how to position yourself during school and after graduation.
The availability of ER nursing jobs—especially for new graduates—depends on the needs and financial status of the institutions and geographic area in question. As reimbursement becomes more and more dependent on patient reviews, hospitals strive to update the accommodations and technological capabilities to satisfy their patient populations. The expense of these updates can limit the hospital’s ability to hire or even cause a hiring freeze.
Most managers would prefer to hire a nurse experienced in the ER because it is very time-consuming and expensive to train a new nurse. Furthermore, it delays the increase in staff numbers that the nurse is hired to relieve. Many hospitals have created fellowship programs, which include a stepwise process of training for new grads to fully integrate them into the world of ER nursing. These are valuable programs for nurses who seek a comprehensive understanding of emergency nursing and an ongoing support system.
They are, however, pricey to the hospital, and lengthy: nurse fellows receive full salary and benefits, and these programs last between six months and two years. For new nurses, these fellowship programs can be very competitive.
As with any professional field, building bridges is a key to success. For ER nursing hopefuls, forming relationships within the ER can be a very strong indicator for acceptance into the fellowship program. This can be done by finding work at the ER as ancillary staff or volunteering.
Working as a nursing assistant before and during nursing school is a great way to expose an individual to the life of a nurse, and either reinforce or redirect their goals. If a position working directly in the ER isn’t available, then employment in other parts of the hospital can still build those relationships and improve your chances of getting a job in the ER.
Although acute care is a part of every nursing school curriculum, emergency room nursing is not. Nursing students interested in the emergency room can find out if their school has a relationship with a site that might allow them to shadow in the ER. They can also request through their nursing school administration to do requisite clinical work there.
A capstone in the ER is a highly effective way to set oneself up for employment there. It introduces the nursing student to nurses and management, which gives the student an opportunity to demonstrate work ethic and nursing acumen.
If opportunities for work, volunteering, or clinical shadowing are not available, developing relevant skills for the ER is another way to make oneself more marketable for work there. Many emergency medical technicians (EMT) go on to become nurses and already have highly sought-after skills when they graduate. Similarly, medical assistants, phlebotomists, radiology technicians, and scrub technologists all have skills and experience that are valuable to the ER.
Because nursing schools follow a general curriculum, there is no formal way to get into the ER as a nurse. The individual who hopes to be an ER nurse must take it upon themselves to be proactive in learning about the ER, building relevant relationships, and developing the skills necessary to be successful. Being proactive during training is a skill-building opportunity in itself, as the best ER nurses are highly motivated, humble enough to remain teachable, and bold enough to advocate for a seemingly unlimited range of patient populations.
Fast Facts for the ER Nurse is the only orientation guide and reference designed specifically for new ER nurses and the preceptors responsible for their orientation. The book includes disorder definitions, signs and symptoms, interventions, drugs, and critical thinking questions.
As a resolution for the new year, prepare to take a stand against bullying. Sadly, new nurses are often lost to the profession for the most disturbing of reasons: workplace bullying. Even the greenest nursing student soon hears the phrase, “nurses eat their young,” which was first used by nursing professor Judith Meissner in 1986. As Katherine Colduvell, RN, BSN, BA, CBC notes on Nurse.org, “[the saying] refers to the bullying and harassment of new nurses, and those four simple words can cause a great deal of anxiety for new graduates. In fact, researchers propose that at least 85% of nurses have been bullied at some point in their nursing career.”
Why Nursing is a Fertile Ground for Bullying
Even before entering the workplace, nurses face bullying as students. After they enter the profession, new nurses have to confront the stresses involved in dealing with patients, being slighted by doctors, exhausting shifts, and even the miseries of sore feet. However, instead of banding together and enjoying a network of support from more experienced nurses, they often find themselves belittled, whispered about, harshly blamed even when not at fault, and subjected to openly abusive language.
Why is bullying so common among nurses? One frequently cited reason is based in oppression theory. In this theory, nurses are oppressed by their lack of empowerment within the healthcare system. Subject to being treated as inferiors by doctors, management, and even some patients, nurses often feel powerless against their oppressors and are likelier to take out their sense of oppression on members of their own group. Bystanders, meanwhile, are afraid to speak out for fear that they, too, will become the objects of bullying. In addition, nurses may have already encountered bullying in school from faculty and classmates who view one another as competitors rather than as colleagues.
Riding the Bullying Cycle
In Fast Facts on Combating Nurse Bullying, Incivility,
and Workplace Violence, author Maggie Ciocco, MS, RN, BC shows that
oppression leads to a vicious cycle, and “Not only are student nurses victims
of bullying, but they themselves become bullies as well. This impact must be
addressed, because they are our future in the health care system, and the lives
of patients depend on the student nurse becoming a just and moral citizen.”
According to Renee Thompson, RN, who frequently speaks and writes on nurse bullying, patient care suffers as a result of the bullying cycle: “If I withhold information from you and it causes you to make a mistake with a patient, or if I yell at you or criticize you in front of a patient, it’s potentially harmful to patient care,” she said. “When you’re being treated in a way that is making you feel badly, it stops the flow of information. When we’re not freely communicating with members of the healthcare team, it ultimately affects outcomes.”
Protecting Yourself from Bullying
The question is, how can a nurse avoid being drawn into a bullying situation in the first place?
An ounce of prevention: research healthcare organizations before you apply (after all, nurses are in demand; an organization is applying for your acceptance as much as you are for theirs). Do they have strong official policies governing bullying in the workplace? A caring, respectful culture? What do other nurses say about the environment there?
Bear yourself with confidence. Bullies tend to pick on easy
targets. If you have faith in yourself and take pride in your work, you will
make a much less attractive object to those seeking vulnerabilities.
Be more than just a bystander. Even if you are not the object of bullying, being around it can affect the way you feel about yourself and your work. Being a bystander—simply witnessing acts of bullying—can create feelings of guilt, depression, disillusionment, and even trauma. Calmly stand up for the dignity of other nurses who are being maltreated. You will like yourself a lot better than you would if you instead pretended to ignore the bullying or merely stood in silence. Have a sense of humor, be positive, and try not to allow your emotions to rule your response. Like a grounded self-confidence, these are traits that can prevent you from becoming a target and can contribute to your ability to defend others who are being harassed.
Counteracting a Bullying Situation
As Maggie Ciocco advises, if you do find yourself or a co-worker on the wrong end of a bully, don’t fly off the handle. Your best options are to direct collegiality and pro-social responses to the behavior you are encountering:
Ignore the behavior—If the behavior is
completely out of character for the person, you could just ask him or her a
friendly question unrelated to what he or she just said. Polite, respectful
conversation disarms a co-worker who has given way to stress and temper as much
as it does a bona fide bully.
Be calm, confident and in-control when contradicting
a bully (you don’t want to get dragged into a fight). Without being overly
defensive, simply express disagreement—such as saying “That’s not the way it
happened”—and introduce your side of the story.
You can also use what Ciocco describes as “therapeutic communication for bullies”:
Speak to how you will address the situation or help him or her to deal with the situation. “I’m going to ____. Is that okay with you?” or “Would you rather that I ______?”
If what you are saying is ignored, repeat what you will do to assist the bully, indicating that the bully needs to choose how the assistance will take place.
If the bully does not respond appropriately, this conversation at least puts him/her on notice that you will not tolerate being bullied. End the conversation by saying something like “why don’t we talk about this at/after such and such, when we have more time”—and leave the area.
Utilize Calm and Self-Respect to Gain a Position of Control
suggests, “A good trick for enhancing your effectiveness is to choose the time
and place for your confrontation with the bully. When you are attacked, calmly
ask to meet with him later to discuss the matter. That will give you time to
think through your response.” In the National Student Nurses’ Association’s study
Nurse to Nurse Horizontal Violence, Recognizing it and preventing it, J.E.
Hurley notes that “Five nurses in one study who spoke out against horizontal
violence reported positive outcomes from ‘standing up for myself’”
In the end, it is likely that one of the most important qualities that should govern your actions is respect. Showing respect for yourself and your colleagues can help you to avoid bullies, to counteract bullying against yourself and others, and help prevent you from becoming a bully yourself.
Fast Facts on Combatting Nurse Bullying, Incivility and Workplace Violence
This pocket-sized, quick-access guide gives nurses crucial information they need to know to understand, identify, and effectively counter incivility, bullying, and violence in all nursing settings.
Awarded Second Place in the 2017 AJN Book of the Year Awards, Professional Issues category!
Most NYC dwellers, including myself, do not have a car. We rely almost exclusively on public transportation. In the course of my career, I have commuted on regional trains, subways, buses, bike-sharing programs, and of course, my own two feet. Navigating public transportation in the crowds and the temperamental weather patterns of New York is a triumph and a skill.
Over the years, I have learned the written and unwritten rules of New York City travel. It goes something like this: leave early, be ready to give up your seat to someone who needs it more, ride your bike as if no one else is paying attention, ride on the left of the escalator to climb and the right to stand still, wear those snow boots twice a year (but on those two days you desperately need them), expect delays, take your backpack off on the train, never use a speakerphone in public, let others off the subway before getting on, and so on. Thankfully, today I live so close to my job in Hell’s Kitchen, my commute is nearly nonexistent.
I have noticed subtle differences in the patients we see, the procedures we do, and the teams we work with in NYC, compared to when I worked in the suburbs. It is only in the city that I have experienced proximity to fame, both in the patients and physicians. One of my first jobs as a nurse was at a well-known dermatology practice where we did Mohs procedures, as well as cosmetic dermatology. The practice saw many celebrities.
This challenged me to put certain nursing principles to work: taking an egalitarian approach to our patients, and being especially mindful to protect their privacy. I have since had many similar experiences with patients in the OR. Working with renowned surgeons, I have to remind myself that I am there for patient care, not surgeon care. My work is to care and advocate for the patient, not to placate the surgeon — although of course, I do prefer when everyone’s happy.
Clinically, in the city, we see different traumas than in the suburbs. For example, we seldom see major traumas from automobile accidents because the city congestion precludes high speeds. Also, many patients come from elsewhere because they know the names of hospitals and physicians in New York, and have experienced failed treatment elsewhere. For this reason, we see many patients with highly complex cases.
A Day in the Life
I work a 7-3 shift Monday through Friday. Because I live so close to work, I wake up at 5:55 am. That gives me enough time to have coffee, do a brief meditation, take a shower, get dressed, and get to work early enough to change into my OR scrubs. Occasionally I’ll wake up earlier and do stretching and a workout. From there, the day is like any OR: fun, fast-paced, and unpredictable. I work as a head nurse of certain specialties, which allows me the autonomy to take breaks when the workload allows, rather than relying on relief staff. Sometimes that means I’m able to go home and relax or run an errand, and sometimes it means I take smaller breaks throughout the day of five or ten minutes to have a bite or clear my head. Although my shift ends at 3 pm, I leave after most of the day staff because I need to prep for the following day, or to assist with nursing needs as they come up.
Most days I’m home by 3:45 pm. I often take a nap, food prep for the next day, then head to a dance class or meet up with a friend. I have a late dinner with my fiancé and work on one of my art projects: another way I keep my head clear and soul happy. Recently I’ve learned to sew and have started making clothing for myself and others. I’m lucky because, in NYC, I can decide I want to learn a new skill and then quickly find a resource. There is no lack of teachers and services in NYC.
The last thing I do before bed is catch up on homework. I’m in school for my MSN in informatics and my MBA. Schoolwork calms me and I get into bed with a leisure book between 10 and 11 pm. Other days I forego all these activities and allow myself to enjoy the home that I work to have. Sometimes I need to relax after being on my feet all day, rather than pound the pavement, and I give myself that time off. I’m kind to myself so I can be kind to my patients and my coworkers.
This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight the founder of the nonprofit Women of Integrity Inc.
For her full-time job, Shantay Carter, BSN, RN, works for Northwell Health Systems. But in her free time, she works for the nonprofit she founded in 2010, Women of Integrity Inc. in New York.
Carter says that she founded the organization because she
was experiencing a tough time in her life and wanted to work with youth, which
she’s always enjoyed. “I decided to channel that negative energy into something
positive,” Carter explains. “I created WOI so that it would be a resource and
support system for the women in the community. Our goal is to empower and educate
women of all ages and ethnicities.”
WOI holds a number of events throughout the year to help both
girls and women. They hold an annual prom dress drive, a prom dress giveaway, a
prom makeover project, a women in business brunch, educational workshops,
mentoring, and a Galentine’s Day celebration. Carter says that they also
partner with other local community organizations to help host girls’
“I think it’s necessary to have an organization like WOI
because our young girls and women need a safe place, they need support, they
need to know that they are loved and worthy, and that their voices are being
heard. We provide them with the tools necessary to achieve their goals and aspirations,”
says Carter. “Through WOI, we have been able to create a platform that has
helped many entrepreneurs start or grow their businesses, and we have mentored
so many young women over the years. We have also hosted numerous educational
workshops on health, etiquette, and finances. We have created a
network/sisterhood of like-minded, positive women who enjoy giving back to
their community and want to make a difference.”
Carter admits that she’s experienced some challenges. She
needed to select the right team members to help, gain the support of the
community, and raise money. “There are times when you may feel like giving up,
but then you have to remind yourself of your purpose and why you are doing this,”
If you’re a nurse and want to start a nonprofit, Carter has some advice:
Find your passion first, and then it will lead
you to your purpose.
Research your target group or area that you want
your organization to serve.
Get a lawyer when it comes time to get your 501 (C)
Learn to network strategically and
Support those who support you.
Know your competition so that you can learn how
to stand out.
Have a great team behind you.
“The vision for the organization has to be bigger than
you because it’s not about you,” Carter says. “It’s about the community and the
people you serve. Don’t try to compete with others. Just focus on what you are
doing and your end goal. You may feel like giving up and become frustrated, but
you have to keep pushing. What’s meant for you will be for you.”
Navigating holiday parties as a nurse can be tough. If you’ve been to a holiday party, cocktail party—or let’s face it—pretty much any kind of party, when someone finds out what you do for a living, the questions begin…
“Can you look at this mole?”
“This rash—do you think I should see a doctor?”
“I think I have a boil on my butt…”
Well, we hope that last one hasn’t happened! But even if it has, we’ve got some ways for you to navigate holiday parties and deal with it all properly and professionally, all while encouraging people to be proactive about their own health.
Ilene Schwartz, RN, LNC, of Pegalis Law Group, LLC, has encountered this a number of times. “Family, coworkers, even strangers at parties have started telling me about their symptoms or ailments! It’s that ‘Oh, you are a nurse! Can I ask you something…’ As soon as I hear those words, I know it is personal. They want a diagnosis, or sometimes directions on what test to get! Sometimes it’s about their medication. ‘Can you JUST look in my throat?’ or ‘Does my leg seem swollen to you?’” says Schwartz. “It’s easy to stop for a second and think – uh oh, here I am off duty, dressed up, trying to enjoy the day. But it is also an opportunity to reinforce what we know — that it is better to check than be sorry. I won’t and can’t give a medical opinion in those instances, but I am quick to offer advice on how they can and should investigate the symptom.”
Schwartz suggests that when people say these kinds of things to you, you be kind and say something like, “I don’t want to steer you wrong, and this isn’t the best place for an accurate medical discussion. But here is what I can tell you—it’s not worth guessing on anything that does not feel or look right to you. Always trust your gut!” In addition, Schwartz says, “I would suggest that they see their dermatologist, primary care physician, cardiologist, etc. as soon as they can.”
One of the reasons why people do this to nurses at holiday parties is because they can sometimes listen better at a casual event than they would do at the ER or in a medical setting, Schwartz says. “So while it is impossible to give a diagnosis at a party, it is an excellent opportunity for caring nurses to potentially save someone from medical errors. Remind them that as patients, we all need to be proactive—to not to leave things to chance, to always go to the doctor with an updated list for them of their meds and supplements, and recent symptoms and concerns. These become part of your chart/medical records. I remind them that all medical pros can make mistakes, and they need to respectfully ask questions and get second opinions. I have no problem saying that.”
encouraging people to become more active about their health care, Schwartz also
gives them practical advice: “They have to expect and accept the limits on
their time with health care professionals. To expect it means to study before
you go to the doctor, to have your questions written out, to know your
symptoms, when they started, what makes them worse or better,” says Schwartz. “It
is ideal to bring a non-emotional person with them who is a good listener to
take notes for them, when they have a serious diagnosis. Don’t just bring a
bunch of people with you for moral support. Bring one good person who can pay
attention and be your advocate when you are too upset or sick to do so.”
tells them that being proactive is crucial. Being proactive “includes really
preparing for your doctor’s appointments, asking about screening and tests, asking
for copies of lab results, keeping a health care diary and your records. Generally,
treat your health like any important project, not one you will just hand over
to someone else, but a project you will be involved closely with every step of
the way. There is no more important a project than your own health and people
have been lulled into thinking ‘other’ people will take care of the details,”
For tips on encouraging others to be proactive about their health, visit here.