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Resources needed for the implementation of the Baby Friendly Hospital designation are relatively limited, due in large part to the extensive work the Brookdale Hospital has recently done to begin to implement better breastfeeding and maternal practices, as noted at the close of the Problem statement section of this work. The hospital must implement additional changes, file the proper application for assessment and designation and prove and justify implementation of the 10 steps associated with the designation over a period of five years. The resources needed for this process will include participation by existing staff including nurses, nurse managers and the hiring of a certified lactation specialist. The most costly of all the implementation strategies will be hiring of a certified lactation specialist, other costs will be further detailed in the budget section of this work and will include administrative, office supplies, additional signage and support training of nursing and support staff.

Barriers to Change

Barriers to change must begin with a clear understanding and elimination of the kinds of hospital practices that are shown in evidence-based research to be particularly contraindicative of early, long-duration and successful breastfeeding including the; use of artificial nipples (pacifiers), bottles, and even nipple shields in mainly healthy newborns (McKechnie & Eglash, 2010) supplementation that is unneeded for natal nutrition, limitations in the practice of rooming in (infant stays with mother as much as possible over the first 24 hours after birth to ensure on demand nursing opportunities), limitations in skin to skin contact of infant with both mother and father, and other institutionally practiced barriers are not only common but traditionally accepted as standards of practice in most hospitals and birthing centers ("Breastfeeding-related maternity practices…" 2008 ). The Baby-Friendly Hospital Designation, and all the steps to prepare and implement it will go far to demonstrate change in hospitals including but not limited to Brookdale Hospital in NYC.

Barriers to change, that are specific to Brookdale hospital have been briefly developed in the problem statement of this work and demonstrate mostly institutional practices that are not only accepted but supported by the hospital and L&D and neonatal staff. Rooming in, where the newborn infant spends as much time as possible with the mother during the first 24-48 hours of life, leaving the bedside of the mother only when absolutely necessary is essential to change. The existence of a highly staffed and large newborn nursery, where infants spend a good deal of time and receive a great deal of care from staff rather than the mother is one of the first institutional issues that needs to change. This reduction of reliance on the newborn nursery may offset some of the costs of implementing change, as stricter rooming in policies and practices would indicate the need for fewer staff resources in the newborn nursery. Skin-to-skin contact of mother to infant should begin at the moment of birth, as is indicated by the hospital's new policies and procedures for breastfeeding support. Newborns should be given screening tests in the presence of the mother, and if at all possible while the mother is holding and/or nursing the child during skin to skin contact. Breastfeeding education should be continuous, beginning in prenatal clinics, extending throughout the hospital stay and supported and supplemented by follow up care with a certified lactation specialist and/or nursing staff that has taken CEC courses in breastfeeding support, and the number class offerings per week should be increased to every other day to support the usual uncomplicated discharge of mother and baby at 48-72 hours post delivery and the course for mothers should be a condition for discharge. L&D and nursery nurses should continue to be encouraged to take the available course with a first year goal of 100% completion. Lastly, cultural barriers to breastfeeding in the patient population should be mitigated with culturally sensitive training and breastfeeding support, long-term breastfeeding follow up and a sensitive but essential reiteration of the many benefits of breastfeeding for both child and mother, reiteration, for those who qualify, of the benefits of the Women Infant Children program which supports breastfeeding mothers with additional food and benefits for the mother not just by supplying formula or food for the infant after birth.

Role of Nurse Executive