Enhanced Neonatal Resuscitation Provider Course for Novice ...

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CLINICAL EVALUATION & IMPROVEMENTneonatal health

ª 2020 AWHONN; doi: 10.1016/j.nwh.2020.05.009

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EnhancedNeonatalResuscitationProviderCourse forNoviceLearners
Sarah Copple
ey areas of neonatal resuscitation wasention survey on a 4-point Likert scale.

ABSTRACT

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Objective: To study the effect of an enhanced format of theNeonatal Resuscitation Program (NRP) course on new clinicians’comfort level in providing neonatal resuscitation.
Design: Pilot project based on the Plan–Do–Study–Actframework with a pretest–posttest design.

Setting/Local Problem: This course was developed in responseto an assessment of new NRP clinicians who self-reported lowcompetence and comfort with selected steps of neonatalresuscitation after participating in our system’s usual NRPprovider course.

Participants: A convenience sample of nurses, respiratorytherapists, and physicians taking the NRP course.

Intervention/Measurements: The enhanced-format coursefacilitated hands-on practice at skills stations before theintegrated skills station and simulation/debriefing component.

The level of comfort in kassessed in a postinterv

Results: After completion of this enhanced-format course,participants reported an increase in comfort level with equipmentand selected resuscitation skills.

Conclusion: An enhanced NRP provider course targeted to theunique learning needs of novice learners may increase theircomfort level and satisfaction with newborn resuscitationknowledge and skills.

doi: 10.1016/j.nwh.2020.05.009 Accepted May 2020

KEYWORDS: communication, learner, Neonatal ResuscitationProgram, newborn, novice, NRP, pilot project, resuscitation,simulation

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CLINICAL IMPLICATIONSn Failure to assess and individualize the Neonatal Resuscitation

Program (NRP) curriculum to meet all learners’ needs can lead todecreased comfort levels among learners with skills needed fornewborn resuscitation.

n As novice learners, new clinicians have unique learning needsthat need to be recognized with a curriculum and course outlinedeveloped to reflect this.

n In this project, clinicians reported an increase in comfort levelafter completion of an enhanced-format NRP class.

n Institutions could offer a special NRP class for new clinicians witha lengthened class time, instructor discussion, hands-onpractice, and videotaped debriefing to help improve learneroutcomes.

n It is important to advocate for the time and resources necessaryto ensure that intended outcomes are achieved.

Copple

added (see Table 1). The curriculum focused on three different
he Neonatal Resuscitation Program (NRP) is anevidence-based educational program that introduces
The NRP provider course is essentialtraining for clinicians who managethe care of a newborn at birth

T cognitive, technical, and behavioral skills for healthcare professionals who manage the care of newborns in thehospital setting. The program was developed as acollaborative effort between the American Academy ofPediatrics and the American Heart Association (AmericanAcademy of Pediatrics, 2019). Since its inception in 1987,more than 4 million learners have been trained in the UnitedStates (NRP, n.d.). There is a great need for this type ofeducation, because approximately 10% of newborns requiresome assistance to begin breathing at birth (Wyckoff et al.,2015).

Clinicians’ experiences can greatly affect their knowl-edge and skills related to neonatal resuscitation; this in-cludes how often they have had the opportunity toresuscitate newborns in the clinical setting and thenumber of times they have renewed their NRP providerstatus over the course of their careers (Zaichkin, 2016).In our facility, we discovered that new nurses and othermembers of the health care team were not acquiring thenecessary NRP skills at our NRP provider course becausethe course format was geared toward experienced re-suscitators. This was evident during follow-up simulationsand mock codes, when they were not able to demonstrateskills such as the initial steps of resuscitation or appro-priate use of a bag mask. In this article, I describe aproject to enhance our NRP provider course to meet newlearners’ needs.

Sarah Copple, MSN, RNC-MNN, is a clinical education specialist for MaternityServices at UnityPoint Health–Des Moines/Blank Children’s Hospital in DesMoines, IA. ORCID: 0000-0003-0091-2782. The author reports no conflicts ofinterest or relevant financial relationships. Address correspondence to:[email protected].

August 2020

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Available KnowledgeOver the past few decades, NRP instructors have used a varietyof different course formats. In the past, many NRP coursesconsisted of an 8-hour slide and lecture presentation, followedby an instructor-graded pencil-and-paper examination. Therenewal course was often a shorter course intended for expe-rienced resuscitation providers. In the fifth edition of the NRP,an instructor assessed learners’ skills by using the Megacodeformat (basic and advanced skills checklists) where thelearners could, in many cases, perform the Megacode as thesole resuscitator with the NRP instructor as the assistant andrenew their NRP provider status in less than 10 minutes. In thesixth edition, the simulation-based curriculum was introduced;this methodology ended the Megacode format and incorporatedsimulation and debriefing into the course as a method to reducemedical error by improving communication and teamwork.

In 2016, the 7th edition was implemented. The simulation-based curriculum continued; however, more components were

areas. The first was cognitive knowledge, which included self-study, eSims (simulations online that integrate lifelike scenariosinto the virtual online platform), and an online examination. Nextwas the technical skills component, which consisted of the skillsperformance/integrated skills station. The last component is thebehavioral skills assessment encompassed the simulation anddebriefing (American Academy of Pediatrics, 2019).

The NRP provides instructors with tools to facilitatelearners’ acquisition of knowledge and skills. Instructors havethe flexibility and autonomy to design their provider coursesbased on their learners’ needs and add hospital-specific in-formation to the curriculum. The American Academy of Pedi-atrics requires that certain components be included in aprovider course (shown in Table 1), but it does not require aspecific course length or format for delivery of content.

SettingOur hospital system includes two urban hospitals and onesuburban hospital with approximately 5,000 total births peryear. The neonatal services include a Level 1 nursery, twoLevel 2 nurseries, and a Level 4 NICU. The provider courseswe offer are open to clinicians at other rural or suburbanhospitals in central Iowa. We offer 24 to 30 NRP courses peryear, with approximately 12 students in each course. There isone instructor for every three to four students, with a total of15 NRP instructors within our facilities.

The NRP courses have been taught at our hospital systemfor more than 25 years. As our NRP course evolved over thelast couple of decades, participants included new and

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TABLE 1 COMPONENTS OF THE NRP, 7THEDITION

Part 1: Online Examination and eSims

� Provider examination: tests all 11 lessons of the Textbookof Neonatal Resuscitation, 7th edition (Weiner & Zaichkin,2016); first evaluation point for successful coursecompletion

� eSim cases: must complete two of four cases; passingscore not required

Part 2: Instructor-Led Hands-On Session

� Performance skills stations: optional, not required

� Integrated skills station: required and evaluates the learner’sability to demonstrate the steps in the NRP flow diagramusing the proper sequence, timing, and technique; secondand final evaluation point for successful course completion

� Simulation/debriefing: required, focuses on teamwork andcommunication

Note. eSims ¼ simulations online that integrate lifelike scenarios into thevirtual online platform; NRP ¼ Neonatal Resuscitation Program.

Neonatal Resuscitation for Novice Learners

renewing health care providers; however, the course agendawas tailored to experienced resuscitators rather than novices.

Before 2017, our course agenda required that participantsstudy independently, pass the online examination, and com-plete the eSim cases. Once completed, the participantsattended the instructor-led provider course (1–2 hours inlength) to demonstrate skills in an integrated skills stationand participate in simulation and debriefing. This includedthree scenarios that require the demonstration of positivepressure ventilation, chest compressions, and a full codeincluding medication administration. As the NRP coursedeveloped, with a combination of expert and novice learners,

TABLE 2 NRP PROVIDER POSTCOURSE SURVEY

Skill

Not Comfortable Somewhat

Using T-piece 0 50

Mask adjustment,reposition airway, suctionmouth and nose, openmouth, pressureincrease, alternativeairway (MR. SOPA)

14 57

Chest compressions 0 28

Note. MR. SOPA ¼ mask adjustment, reposition airway, suction mouth and nose, open mProgram.

258 Volume 24 Issue 4


the instructors focused on checking off the expert learnersand therefore exercised the option to skip the performanceskills stations and go straight to the evaluation portion of thecourse (integrated skills station). However, as more newnurses joined the team, educators from Maternity Servicesand NICU assessed the need to tailor the provider course tothe needs of the novice learners.

Rationale for the InterventionWe observed that after they passed the NRP provider course,new nurses were not always able to perform the steps ofresuscitation during mock newborn codes on the unit andduring our annual skills simulation day. The new nursesstated they did not feel comfortable operating the resuscita-tion devices (such as the T-piece resuscitator) and tended toforget the steps of newborn resuscitation. In 2016, afterhearing this feedback, educators from Maternity Services andthe NICU surveyed the nurses scheduled to attend the up-coming NRP provider course. We asked the seven novicenurses who were enrolled (out of the 24 total class partici-pants) to complete a postcourse survey and rate their comfortlevel in different areas on a 4-point Likert scale (see Table 2).

The results indicated that this course format failed toadequately meet the needs of novice learners, perhapsbecause there was limited instruction, practice time, andinstructor-supervised practice with feedback. The survey re-sults demonstrated that combining new clinicians with expe-rienced clinicians did not ensure that all participants achievedthe desired level of comfort with the content.

Specific AimsThe goal was to develop an enhanced NRP provider course toimprove the novice learners’ comfort level with NRP knowledgeand skills. It is important to foster novice learners’ practice andconfidence as they are gaining new knowledge and synthesizingnew concepts (Benner, 1982). This enhanced course wouldfocus on key skills, concepts, extra practice, and additional

OF NOVICE LEARNERS, FALL 2016 (N [ 7)

Comfort Level, %

Comfortable Comfortable Very Comfortable

50 0

29 0

.5 43 28.5

outh, pressure increase, and alternative airway; NRP ¼ Neonatal Resuscitation

doi: 10.1016/j.nwh.2020.05.009



TABLE 3 CURRICULUM/AGENDA FOR THE NRP FOR NEW PROVIDERS CLASS

1230 Introduction

� Introductions, plan/agenda, ground rules

1240 Communication

� Key behavioral skills (use worksheet) and ask each student to give example

� Facilitate group discussion on how key behavioral skills can be applied, narrating actions, closed loop communication

1255 Learning Stations (remind participants to follow along/take notes on worksheets)

Three groups rotating every 20 minutes.

� Face mask positive pressure ventilation led by respiratory therapist (NRP instructor)

B Blenders and oxygen concentration

B Steps of MR. SOPA: mask adjustment, reposition airway, suction mouth and nose, open mouth, pressure increase, andalternative airway, as well as signs of effective ventilation

B Peak inspiratory pressure, positive end expiratory pressure, rate of ventilation, ventilation devices, CO2 detectors

B Face mask positive pressure ventilation practice

� Laryngeal mask, intubation, and chest compressions led by nurse educator (NRP instructor)

B Preparing for intubation, assisting with intubation, confirming placement, securing endotracheal tube, assembling andchecking light, stylets, and taping endotracheal tube

B Preparing for laryngeal mask insertion, limitations of laryngeal mask, insertion, confirming placement, securing laryngealmask, removal of laryngeal mask

B Chest compressions: 2 thumb technique–head of bed, coordination with positive pressure ventilation, depth and rate,switching compressors

� Resuscitation medications, emergency umbilical venous lines led by NICU transport nurse (NRP instructor)

B Where items are located in the NICU cart

B Preparing umbilical venous catheter for use

B Assisting with placement of emergency umbilical venous catheter

B Epinephrine and normal saline—closed-loop communication, administration, epinephrine concentration, route, dose,frequency

1410–1420 Break

1420–1520 Performance Skills Stations

� Play video/show NRP instructors acting out full code and discuss expectations

� Divide into three or four groups (use three basic life support infant models and use the simulation rooms/warmers andNICU carts to make it realistic)

B Practice skills during various scenarios, coach learners as needed, progress to learners functioning independently

� Integrated Skills Station—Evaluation

B Use performance checklist from NRP, 7th edition, textbook: Lesson 6 (p. 179)

1520–1650 Simulation/Debriefing

� Two groups with a high-fidelity simulation on a radiant warmer using the NICU carts

� Rotate participants through different roles, ensuring each has the opportunity to have a key role at the bedside

� Simulation 1: apnea scenario (p. 110 in the NRP 7th edition textbook) and debriefing

(continued)

Copple

August 2020 Nursing for Women’s Health 259

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TABLE 3 CONTINUED

� Simulation 2: intubation scenario (p. 157 in the NRP 7th edition textbook) and debriefing

� Simulation 3: medication (full-code) scenario (p. 126 in the NRP 7th edition textbook); scenario will be videotaped and usedfor debriefing

� Video debriefing after each scenario: Go to classroom, review video, and debrief participants

� Repeat simulation and debriefing as needed

1650–1700 Closing

� Have participants log into NRP website to complete evaluations and obtain eCard (online copy of the resuscitation card)

Note. The NRP 7th edition textbook refers to Weiner & Zaichkin (2016). MR. SOPA ¼ mask adjustment, reposition airway, suction mouth and nose, open mouth,pressure increase, and alternative airway.


simulation and debriefing. While maintaining the NRP providercourse requirements, the course length was extended, and ourusual course agenda was restructured to address the addi-tional needs of novice NRP providers.

ContextAccording to the NRP Instructor Toolkit, the length of the providercourse is flexible and is dependent on the number of learningobjectives and the skill level/experience of the learners(Zaichkin, 2016). The role of the NRP instructor is to know thecontent and provide the information and skills by planning,coordinating, and facilitating an engaging, hands-on NRP pro-vider course. This is achieved by collaborating with other in-structors to design a high-quality interdisciplinary course(Zaichkin, 2016). It is imperative to know the background andexperience of the learners in the class to be able to meet theirlearning needs.

A multidisciplinary education team was created to workon the curriculum and class outline. This team included aclinical education specialist from the NICU, a clinical edu-cation specialist from Maternity Services, the unit-basededucator/staff nurse from Maternity Services, a respiratorytherapist, a neonatal clinical nurse specialist, and aneonatal transport nurse. This new class curriculum resultedin the need to offer two separate courses: NRP for NewProviders and NRP Renewal. We increased the class time forthe new provider course from less than 2 hours to 4.5 hours.Our renewal class is 2 hours and includes the componentsof the Part 2 instructor-led event integrated skills station andthree scenarios within the simulation and debriefingcomponent.

The education team initially met with the managers of theMaternity Centers and NICU departments and proposed a trial

It is imperative to know thebackground and experience of thelearners in the class to be able tomeet their learning needs



course for newly licensed registered nurses (NLRNs). Thesemanagers also recognized the need for an enhanced courseand fully supported the implementation of the course for newproviders.

InterventionsA new format and class outline were developed, as out-lined in Table 3. The multidisciplinary team that worked onthis curriculum facilitated practice stations before the in-tegrated skills station and simulation/debriefing. Compo-nents of the skills stations include the following: initialsteps of resuscitation, use of resuscitation equipment,use of laryngeal mask, positive pressure ventilation,ventilation corrective steps, intubation assistance, chestcompressions, resuscitation medications, umbilical veincatherization preparation, algorithm decision making, andthe NRP behavioral skills.

We developed a worksheet for participants to complete ateach station to help process this new knowledge. A sample ofthe worksheet is depicted in Figure 1. The worksheet hasfill-in-the-blank statements for key behavioral skills, medica-tion, intubation, and compressions. It also has pictures of theresuscitation devices for participants to label. These work-sheets are based on the lesson reviews at the end of eachlesson in the textbook and assist with translating new infor-mation into writing, helping learners process the informationas they learn. Ample skill practice time, as well as a full codedemonstration, is provided before the integrated skills stationto assimilate these skills. Figure 2 shows participants in abreakout session. The new provider course simulation ses-sions are videotaped and integrated into the debriefing ses-sion. The simulation scenarios are repeated as needed toprovide the opportunity for each person to participate invarious key roles. These roles include leader, ventilator,compressor, medication nurse, and recorder. If the classparticipants do not represent all medical disciplines, we havean extra instructor step in during the code to perform the skillsthat are outside the scope of the learner’s practice, such asintubation and umbilical vein catherization placement.

doi: 10.1016/j.nwh.2020.05.009



FIGURE 1 SAMPLE WORKSHEETS

NRP Skills Sta on Worksheet

Communica on

Please list an example of each of the key behavioral skills in the table below.

Key Behavioral Skills

Know your environment

Use available informa on

An cipate and plan

Clearly iden fy a team leader

Communicate effec vely

Delegate workload op mally

Allocate a en on wisely

Use available resources

Call for addi onal help when needed

Maintain professional behavior

Resuscita on Equipment 1. PEEP: ____________________________________________

PIP: ____________________________________________

2. Complete the following table:

Type of resuscita on device: ____________________

Can this device be used to give blow-by O2? Y / N

Compressed air source needed? Y / N







Use the blanks to label where the PEEP and PIP is set/ adjusted in this picture.

3. Rate of newborn breaths: _______to_______breaths per minute.

4. The most important indicator of successful PPV is __________________________ .

5. Fill in the blanks MR

SO

P

A

(Continued)

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August 2020 Nursing for Women’s Health 261


FIGURE 1 CONTINUED

LMAs and intuba�on/Chest Compressions

LMA:

ETT:

Laryngoscope Blade/ handle:

1. Chest compressions are indicated if the baby’s heart rate remains less than _______ a�er at

least _______ seconds of effec�ve PPV.

2. Thumb posi�oning should be on the _________________of the sternum, just below an

imaginary line connec�ng the baby’s nipples.

3. Compression depth is approximately ______ of the anterior/ posterior diameter of the chest.

4. The goal of coordinated compression/ ven�la�on is to give _____compressions per minute and

____ ven�la�ons per minute.

5. The person doing the _______________should count the rhythm out loud: by

saying_________________________________________________________________.

6. Once intuba�on is completed and the tube is secure the compressor should move to the

_______ of the bed, while the person opera�ng the PPV device moves to the _______ of the

bed.

7. During chest compressions, it is important not to li� the ___________ completely off the chest,

allowing adequate recoil.

Resuscita�on Medica�ons and Umbilical Lines1. The baby’s heart rate is s�ll less than 60bpm a�er the following:

•• At least 30 seconds of PPV that inflates the lungs

• Another 60 sec of chest compressions coordinated with PPV using 100% FiO2

What medica�on is indicated at this �me? _________________

2. ________or_________ are the preferred routes for epinephrine.

3. The________route for epinephrine should only be used while working to establish IV access.

4. The dose for epinephrine is:

• IV/ IO- ____to____ml/ kg

• ETT- ____to____ml/ kg

5. Administer epinephrine as quickly as possible and repeat every ___to ___ minutes if heart rate

remains less than ____ beats per minute.

6. Administra�on of a volume expander is indicated if the baby is not responding to the steps of

resuscita�on AND there are signs of __________ or history of acute __________ loss.

7. The appropriate dose for a volume expander is ____ml/kg, given over _____-_____ minutes.

Se�ng up umbilical lines:

Note. N ¼ no; PEEP ¼ positive end-expiratory pressure; PIP ¼ peak inspiratory pressure; Y ¼ yes.


262 Volume 24 Issue 4 doi: 10.1016/j.nwh.2020.05.009



FIGURE 2 NEONATAL RESUSCITATION PROGAM NEW PROVIDER COURSE PARTICIPANTS IN ABREAKOUT SESSION

Copple

Study of the InterventionSurveys were completed by participants enrolled in the newprovider NRP course. These included postclass evaluations toassess their level of comfort with the technical skills covered in

FIGURE 3 SURVEY RESULTS: SETTING UP THET-PIECE RESUSCITATION DEVICE

Note. NRP ¼ Neonatal Resuscitation Program.

August 2020


each lesson. The 11-item survey and responses weremeasured on a 4-point Likert scale ranging from not comfort-able to very comfortable. The survey measured their comfortlevel with different NRP skills, including use of the T-piece

FIGURE 4 SURVEY RESULTS: GIVINGBREATHS WITH THE T-PIECERESUSCITATION DEVICE




FIGURE 5 SURVEY RESULTS: SETTING UP THESELF-INFLATING BAG


FIGURE 7 SURVEY RESULTS: SETTING UP THEFLOW INFLATING BAG



resuscitator, flow inflating bag, self-inflating bag, chest com-pressions, problem solving for ineffective ventilation, and useof laryngeal mask, laryngoscope blade, and handle. After theclass, participants from the new provider NRP coursecompleted the same survey assessing their level of comfort onthe same core NRP skills as the novice NRP participants fromthe original 7th edition NRP course. Comparison of the surveyresults indicated that completion of the NRP for New Providerscourse was associated with an increased level of comfort inusing the T-piece resuscitator (Neo-Tee; Mercury Medical,Clearwater, FL); completing the steps of mask adjustment,reposition airway, suction mouth and nose, open mouth, pres-sure increase, and alternative airway (MR. SOPA), and per-forming chest compressions comparedwith thosewho took theoriginal course (see Figures 3–13). Qualitative feedbackreceived from course participants is included in Box 1.

FIGURE 6 SURVEY RESULTS: GIVINGBREATHS WITH THE SELF-INFLATING BAG




DiscussionAfter completion of this course, participants showed an in-crease in comfort level with the equipment and elements ofresuscitation. Participant responses on the postclass surveyindicated improvement in comfort level with the Neo-Tee, MR.SOPA steps, and chest compressions. This suggests that newNRP for New Providers class resulted in an increased comfortlevel with certain skills among course participants.

We trialed the first class with only NLRNs. After the firstclass, the survey results (level of comfort and comments) andinstructor feedback were positive. These outcomes werepresented to the Maternity, NICU, and Respiratory Therapydepartment managers. After review of the curriculum and re-sults of the surveys, the class was expanded to include allnew NRP providers (e.g., respiratory therapists, registered

FIGURE 8 SURVEY RESULTS: GIVINGBREATHS WITH THE FLOWINFLATING BAG


doi: 10.1016/j.nwh.2020.05.009



FIGURE 9 SURVEY RESULTS: CHECKINGLARYNGOSCOPE BLADE ANDLIGHT


FIGURE 11 SURVEY RESULTS: ASSESSINGCHEST RISE FOR EFFECTIVEVENTILATION


Copple

nurses, physicians) at our facility, resulting in a multidisci-plinary resuscitation team approach.

The NRP for New Providers course is now offered to all stafftaking NRP for the first time, after which they proceed to ourNRP Renewal course. Those individuals who have taken NRPbefore but are new to our institution can choose which coursethey deem appropriate. Most choose the NRP for New Pro-viders course so that they can benefit from the greater focuson skills and practice.

Because the external participants (from the outreach pro-gram) do not experience newborn resuscitation often, it wasdecided that they would be encouraged to take the NRP for NewProviders Course, not our NRP Renewal course. These courseparticipants include new respiratory therapists, maternitynurses, NICU nurses, and physicians from outlying facilities.

FIGURE 10 SURVEY RESULTS: INSERTINGSTYLET INTO ENDOTRACHEALTUBE


August 2020


Implications for PracticeThe NRP is an educational program; it does not certify anyoneto do any procedure, nor does it guarantee competence(Weiner & Zaichkin, 2016). Every learner can practice everyskill (e.g., intubation) if the instructor has the time and re-sources; however, the learners’ professional scopes of prac-tice and the facility’s policies determine what health careprofessionals are permitted to do in the actual clinical setting.It is important to advocate for the time and resourcesnecessary to ensure that intended outcomes are achieved.

The current evidence-based curriculum provided in the NRPcourse is important for those who provide care to newborns atthe time of childbirth to ensure high-quality, safe care for allnewborns. The independence and autonomy provided by the

FIGURE 12 SURVEY RESULTS: APPLYINGVENTILATION CORRECTIVE STEPS

Note. MR. SOPA ¼ mask adjustment, reposition airway, suction mouth andnose, open mouth, pressure increase, and alternative airway; NRP ¼ NeonatalResuscitation Program.



FIGURE 13 SURVEY RESULTS: CHESTCOMPRESSIONS



NRP to individualize and maximize the curriculum to meeteach learner’s needs is imperative to successful imple-mentation of this course. Evidence supports the developmentof a curriculum targeted for the unique learning needs of newNRP providers (Zaichkin, 2016).

Results of this pilot project support the belief that cliniciansneed enhanced training in neonatal resuscitation to improvetheir comfort level with their neonatal resuscitation skills. Thisenhanced course format could be offered at any institution thatoffers the NRP and may benefit all novice NRP providers.

We also offer frequent opportunities to practice resuscita-tion skills to help ensure knowledge and skills retention.There is often concern about how long the newborn resusci-tation knowledge is retained. We offer multiple simulations forour NLRNs so that they can practice their newly acquired skillsand knowledge. An NRP simulation is also repeated yearly at

BOX 1 QUALITATIVE FEEDBACK RECEIVEDFROM PARTICIPANTS IN THE NEWPROVIDER COURSE, 2017–2019

� “Great course! For someone outside the realm ofregular care of neonates, the course and theinstructors were very informative.”

� “The instructors were very gracious, patient, andtook the time to make sure I understoodeverything to apply to the emergency setting.”

� “Great hands-on course!”� “I felt like this was a really good course. The class

was very helpful.”� “I like that we had extra time with the equipment. It

allowedmetoaskquestionsandworkwitheverything.”� “I was glad to get the opportunity to really play with

the equipment and gain familiarity.”



our skills/simulation day for all learners. We provide sched-uled quarterly mock neonatal codes to practice interdisci-plinary teamwork and communication.

LimitationsThis project has several limitations worth noting. These includethe use of self-reported data, lack of postassessment ofcompetency (NRP does not guarantee competency, sothis would have been an institution-specific component),and no method to assess improvement in communicationskills. We did note anecdotal evidence of improved perfor-mance of the new nurses who took the new provider courseat unit mock codes and at actual resuscitations. Potential op-portunities, dependent on individual hospital needs and capa-bilities, may include videotaping all simulations or jointinstruction of learners at all levels of knowledge and expertise.

ConclusionThe NRP provider course is essential training for clinicianswho manage the care of newborns in the hospitalsetting. Facilities can develop and implement an enhancedcourse that facilitates discussion and hands-on practice atskills stations before the integrated skills station and simu-lation/debriefing component. An enhanced provider coursecan target the unique learning needs of novice learners andhelp increase their comfort level and satisfaction withnewborn resuscitation knowledge and skills. NWH

AcknowledgmentThank you to the following colleagues who helped develop the class:

Kaylin Sandy, BSN, RN, Nikki Ottenbacher, BSN, RN, Brenda Walker,

MSN, RNC-NIC, Kris Koenigsberg, RRT, NPS, RCP, Nancy Woestman,

BSN, RNC-NIC, C-NPT, and Jeanette Zaichkin, RN, MN, NNP-BC.

ReferencesAmerican Academy of Pediatrics. (2019). Neonatal resuscitation program.

https://www.aap.org/en-us/continuing-medical-education/life-support/NRP/Pages/About.aspx

Benner, P. (1982). From novice to expert. American Journal of Nursing,82(3), 402–407.

Neonatal Resuscitation Program. (n.d.). Home [Facebook page].Facebook. https://www.facebook.com/TheNRP

Weiner, G. M. & Zaichkin, J. (Eds.). (2016). Textbook of neonatalresuscitation (7th ed.). American Academy of Pediatrics.

Wyckoff, M., Aziz, K., Escobedo, M., Kapadia, V., Kattwinkel, J., Perlman,J., … Zaichkin, J. (2015). Part 13: Neonatal resuscitation: 2015American Heart Association guidelines update for cardiopulmonaryresuscitation and emergency cardiovascular care. Circulation, 132(18Suppl. 2), S543–S560. https://doi.org/10.1161/CIR.0000000000000267

Zaichkin, J. K. (2016). Just the facts: What instructors need to know. NRPInstructor Toolkit. https://www.aap.org/en-us/continuing-medical-education/life-support/NRP/Pages/NRP.aspx

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https://doi.org/10.1161/CIR.0000000000000267

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https://www.aap.org/en-us/continuing-medical-education/life-support/NRP/Pages/NRP.aspx


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