Roles and Responsibilities of Health Professions: Focus on Nursing

Nurses are expected to have a core knowledge regarding health promotion, risk reduction, and disease prevention. Nurses are critical in providing health education to patients and have the power to influence the health promotion and disease prevention behaviors of their patients. Increasing the number of infants who receive human milk/breastfeed is an excellent example of health promotion and disease prevention. Yet, nurses' lack of knowledge surrounding breastfeeding has been well documented. In addition, since the lactation consultant (LC) profession was established in 1985, nurses often give away their ability to care for breastfeeding families and instead rely solely on the LC. In many institutions, the LC has become “the keeper of all breastfeeding knowledge.” In turn, breastfeeding families receive lactation care, support, and education only during any brief interactions with a LC. Few institutions have LC staff working 24 h/day and 7 days per week. This leads to extensive gaps in the provision of evidence-based lactation care, support, and education. It is of paramount importance that nurses possess the knowledge and skills to effectively care for breastfeeding families and that nurses believe it to be a vital part of their role as a health professional. Therefore, nursing programs and hospitals must make it a priority to educate both nursing students and nurses regarding evidence-based lactation/breastfeeding support, care, and advice.

All nurses, regardless of whether they plan to work with childbearing families or children, should receive basic education regarding breastfeeding and human lactation. Spatz et al. ¹ published an article describing how human milk and breastfeeding education can be incorporated into a nursing curriculum. This article emphasizes that this education can and should be integrated into all classes so that breastfeeding is not only the cultural norm but that a nurse understands that breastfeeding has an impact across the lifespan. ¹

Those students who have aspirations to work with childbearing families and children need further more intense and in-depth education regarding breastfeeding and human lactation. At the University of Pennsylvania School of Nursing in Philadelphia an innovative model for providing nursing students with in-depth research-based breastfeeding knowledge by instructing students in seminar format involving didactic, clinical, and laboratory learning experiences has been in place since 1995. ² The course entails 28 h of lecture with a broad coverage of topics in the field (history, anatomy and physiology, breastfeeding process and education, support and cultural issues, and complex breastfeeding situations, to name a few). ² The students also complete 14 h of clinical practicum in a variety of settings such as working with LCs, attending breastfeeding support groups and educational classes for expecting and new mothers, and working with community-based breastfeeding support education. ² The course also provides the students with a critical examination of research and a strong focus regarding the importance of breastfeeding advocacy. Current research articles are read and critiqued by the students on a weekly basis, ensuring the students are equipped with the newest evidence-based knowledge. Through a community-based advocacy project, students have the opportunity to change breastfeeding beliefs and practices one community at a time. ³

Almost 200 students have graduated from this course and started and continued their nursing careers as passionate advocates of breastfeeding and expert providers of evidence-based lactation care, support, and education. They span the roles of bedside nurses in maternity units, nurses in the communities, nurse midwives, and a variety of different nurse practitioners (women's health, neonatal, pediatric, family, and adult) and Ph.D. students researching lactation/breastfeeding-related issues.

Knowing that breastfeeding education is not the norm in most schools of nursing, hospitals and community-based organizations are likely to hire nurses with little to zero experience in providing expert breastfeeding care and support. Therefore, hospitals should develop and offer opportunities for nurses to receive on-the-job training. One such model has been developed at the Children's Hospital of Philadelphia (CHOP). ⁴ Breastfeeding Resource Nurses (BRNs) are staff nurses who work in various areas spanning both the inpatient and outpatient facilities of the CHOP network. These nurses take a 2-day, 16-h course on breastfeeding and human lactation and then go back to their individual units or areas to serve as resources to both families and other staff on the unit. Nurses receive continuing education credit for the course and credit for career advancement in the clinical ladder.

Every inpatient and outpatient area has a core minimum number of BRNs based on the area's exposure to breastfeeding families. For example, in the intensive care nursery, approximately 80% (217 of 270) of the nurses are BRNs, whereas in the oncology unit (a low volume unit) only a handful of nurses are BRNs. By empowering bedside nurses to embrace breastfeeding care, support, and education as a core function of their role as nurses, a tremendous change in institutional culture has been realized. Human milk rates have increased, and the visibility of breastfeeding and lactation support has become a core value that is visible across the network. BRNs have received research and program grant funding, published articles and position statements, and presented at national conferences.

In conclusion, it is imperative that all nurses possess an evidence-based core knowledge regarding breastfeeding and the use of human milk. This education should be provided by both schools of nursing and hospitals. This will ensure that the nurse can be an effective first level of intervention for all breastfeeding families.