UNC Hospitals – Chapel Hill First to Be Successfully Assessed on New Step 2 Competencies

When Debbie Gordon, MSN, RN, IBCLC, joined the UNC Hospitals in Chapel Hill as Manager of Lactation Services in September 2021, her primary mandate was to lead the UNC team through a successful Baby-Friendly redesignation process. As this was in the middle of the COVID-19 pandemic, this would not be an easy task.

“The most significant impact of COVID was on education and training,” Gordon says. “Breastfeeding training for the most part just froze for a period of time because we wanted to avoid putting team members in a room together. So, for our new hires, there hadn’t been any formal breastfeeding classroom instruction.”

This issue was compounded by significant staff turnover and staffing shortages. “It’s one thing to not be able to be together because of safety. But we also couldn’t take staffing time away from the units for training when we needed to prioritize patient care”.

“COVID forced us out of our normal approaches for doing things,” she says. “The most critical tasks got the attention, and you could only spread so far.”

Despite these challenges, UNC Hospitals’ leadership boldly began their journey toward redesignation.

“Our Baby-Friendly designation is something we take great pride in,” Gordon says. “We wanted to send a strong message to our community that we support breastfeeding and safe infant feeding practices. That’s who we are, and that’s what we want to be known for.”

Step 2 Transition

“It’s important to be held accountable to the highest standards,” says Gordon. “The Baby-Friendly designation process ensures we stay on our ‘A Game.’”

This was especially true for the UNC Hospitals team when they prepared to meet the new criteria for complying with Step 2 (“Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding”), which is for many facilities the most challenging of the Ten Steps to Successful Breastfeeding.

Just a few months before Gordon joined the UNC Hospitals staff, BFUSA had released its updated (6th edition) Guidelines and Evaluation Criteria (GEC), the document that guides facilities through the designation process by providing the specific criteria for compliance on each of the Ten Steps. For Step 2, the updated GEC shifted the emphasis from “training” to “demonstrating competence.”

“I took an honest evaluation of where we were,” recalls Gordon, “and began to make plans to close any gaps.”

In January 2022, they began to work on the new competency-based platform with support from the Carolina Global Breastfeeding Institute’s EMPower program, even though BFUSA was not planning to base assessments on the new criterion until after June 1, 2023.

“EMPower had ready-made materials to support the new Step 2 platform,” says Gordon. “We were able to load them into our LMS (learning modules for teammates), and that made the whole process so much easier.”

Everybody In

A key moment came when Gordon and her team decided all doctors, nurses, lactation consultants and staff who provide infant feeding services should go through the training. Having all providers who interact with newborns participate in the training was an additional lift.

“It was a lot of work, but it was worth it,” she says. “When we finished, providers expressed how much they had learned and how much more confident they were in their ability to support families. We began to see providers solving breastfeeding issues while they were in the room with patients instead of putting in consults to lactation. Families loved this.”

Doctors More Confident

Madison Archer, MD, a pediatric hospital medicine fellow at the hospital considers himself to be among those who improved their skills and confidence by participating in the training.

“Breastfeeding skills are not something we focus on in medical school,” says Archer. “I think my basic knowledge about breastfeeding was good, meaning I could tell mom why it was important. But if they had questions beyond that, I usually didn’t feel comfortable addressing them myself.”

Now, having gone through the online modules and in-person practice sessions, Dr. Archer takes a different approach when helping families.

“After this training, I definitely feel a lot more comfortable and confident dealing with it myself, giving more advice about positioning and latch, and spending more time with mom trying to help out in the moment than I would have before.”

First in the Nation

Because UNC Hospitals had progressed so far on the new Step 2 criteria well before the date BFUSA planned to implement them, BFUSA decided to take a special hybrid approach when assessing the facility based on the new criteria for Step 2 and the old criteria for the other nine steps.

This created the opportunity for UNC Hospitals to be the first “pilot site” for the new Step 2 platform, and for UNC Hospitals to become the first facility in the nation to be successfully assessed on the new Step 2 competencies.

“It’s very rewarding, and it was well worth the effort,” says Gordon. “We committed to giving our team the knowledge and skills to support families in evidence-based feeding practices. If we can do it here in a large facility such as ours, I’m sure anyone else can get it done too if they commit to the program and its value for staff and families.”