Abstract
A descriptive, cross-sectional study design was used to explore the relationships between the hospital work environment and implementation of the Baby-Friendly USA Ten Steps Policy in an urban hospital. Nurses reported the degree to which the Ten Steps policy was implemented, perceptions of the unit work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI), and self-efficacy related to the implementation of the policy. Results suggest that the work environment and the implementation of breastfeeding policy have separate and independent effects on nurse self-efficacy. Robust nursing leadership focused on education and skill development for clinicians, and focused on post-hospital care for patients and families are important contributory factors to successful breastfeeding policy implementation.