ABSTRACT: When an emergent ventriculostomy is required for relief of increased intracranial pressure, it is critical that participating physicians and nurses work as an efficient team for optimal outcomes. From our experience, problems in ventriculostomy insertion have occurred because of delays in obtaining correct supplies and lack of skill in assembling the drainage system. The goals of this study were to (a) decrease the response time and (b) increase competency for successful insertion and setup of a ventriculostomy by using a “mock herniation” scenario. Three different nursing shifts in the pediatric intensive care unit at the University of Missouri Health Care were presented with a mock scenario of a child with increased intracranial pressure and impending herniation. Each group was timed on its ability to gather the correct supplies and scored on accuracy in setting up the drainage system. Subsequently, all pediatric intensive care unit nurses underwent skills laboratory training on correct assembly of the drainage system. After training, three different groups of nurses were tested again using the mock herniation scenario. This time, there was improvement in all areas tested, particularly in the mean time taken for accurate assembly and setup of the emergency ventriculostomy drainage system. We conclude that skills laboratory training reinforced by periodic mock herniations significantly decreases response time and increases accuracy of assembling supplies and setting up the drainage system for ventriculostomy insertion.