Simulation to Improve Confidence and Competence of the Neonatal Nurse Practitioner

Abstract

Background: Neonatal nurse practitioners must maintain competence in low-volume, high-risk procedures to provide timely, high-quality, and safe care. In institutions with multiple providers e.g. fellows, residents, and neonatal nurse practitioners, the number of procedures available per provider may be very low. Simulation education provides an opportunity to practice procedures without compromising the care of patients or competition.

Local Problem: The project institution is an academic center with a high level of procedural competition due to the presence of physicians, physician trainees, and nurse practitioners. The purpose of this quality improvement project was to implement and evaluate the impact of a needle thoracentesis simulation on the confidence and competence of neonatal nurse practitioners.

Interventions: A simulation was implemented for 15 full-time neonatal nurse practitioners in the Neonatal Intensive Care Unit. A pre-simulation survey to assess each neonatal nurse practitioner’s perception of procedural confidence and competence was conducted. Subsequently, each neonatal nurse practitioner received PowerPoint slides with an embedded video on the correct performance of a needle thoracentesis. Following the pre-survey and PowerPoint slides, each neonatal nurse practitioner participated in the needle thoracentesis simulation. Utilizing a procedural checklist adapted from the National Association of Neonatal Nurse Practitioner Competency and Orientation Toolkit for Neonatal Nurse Practitioners, the nurse practitioners needle chest thoracentesis skills were assessed. After completing the simulation, the nurse practitioners received an identical post-simulation survey to re-evaluate their perception of their procedural confidence and competence.

Results: Neonatal nurse practitioners reported an increase in confidence in their 1) ability to determine when a needle thoracentesis was necessary versus allowing spontaneous resolution (p<0.01); 2) and in their ability to perform an emergency needle thoracentesis competently without or with minimal procedural guidance (p=0.04). They also reported an increase in confidence in their ability to troubleshoot unexpected problems that might occur during the procedure (p<0.01) and an increase in confidence in their ability to incorporate patient safety measures in the event of an emergency thoracentesis (p=0.03).

Conclusions: This quality improvement project provided support for the use of simulation to increase the confidence and competence of the neonatal nurse practitioner in performing a chest needle thoracentesis and to assist neonatal nurse practitioners in maintaining competency in low volume high risk procedures.