The American Academy of Pediatrics (AAP) safe sleep recommendations are considered best practice and are effective in preventing sudden infant death syndrome (SIDS). Yet studies have found that nurses’ practice in newborn nurseries and neonatal intensive care units is often inconsistent with safe sleep recommendations. Such inconsistencies cause confusion and hinder SIDS prevention efforts. In 2011, the AAP added significant content to its 2005 safe sleep recommendations and neonatal nurses are now being asked to endorse the recommendations from birth. This article reviews the recommendations, examines barriers and controversies and offers suggestions for how an organization might initiate change and move toward a unified endorsement of safe sleep strategies.