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Development and Validation of Simulation-Based Procedural Checklists for Evaluation of Neonatal Nurse Practitioner Performance

Jarding, Laura, MS, NNP-BC; Hogden, Laurie A., MD; Messier, Stephen E., MD, FAAP; Kozmenko, Valeriy, MD; Simanton, Edward, PhD; Bjornson, Kerri, MSN, NNP-BC; Ortman Brockmueller, Charisse, MSN, NNP-BC

Section Editor(s): Samra, Haifa A.

doi: 10.1097/ANC.0000000000000520
Professional Growth and Development

Background: Neonatal nurse practitioner (NNP) procedural competence is essential. Procedural simulation provides opportunity to practice high-risk, low-frequency procedures and helps improve skill retention. A formal procedural simulation experience was created in an attempt to provide sufficient experience for NNPs. While preparing for the simulation experience, the group recognized the lack of validated competency metrics for most neonatal intensive care unit (NICU) procedures.

Purpose: The purpose of this study was to create and validate procedural checklists measuring competence of NNPs participating in simulated performance of 9 high-risk NICU procedures.

Methods: IRB approval was obtained and NNPs agreed to data collection. A self and peer assessment tool was developed and distributed to NNPs, nurses, and neonatologists to gather a baseline perception of procedural competency. Procedural checklists were then developed to measure/assess individual skills against a standard. Benchmark videos were created to demonstrate the standard approach to procedural performance. Each procedural skill performed by the NNP participant was scored by 3 individual evaluators: once in real time and twice by video recording analysis.

Findings/Results: A Cronbach α was used to measure the reliability and validity of the procedural checklists. Comparison was made between live grading and video-based grading scores using analysis of variance. Difference between grading modalities was less than 3% and nonsignificant for 8 of 9 procedures. No significant difference was found between individual graders for any of the skills being evaluated and suggested high interrater reliability of the checklists.

Implications for Practice: Objective, standardized procedural checklists are valid tools to evaluate NNP procedural skills in simulation. Procedural simulation experiences help strengthen skills, improve performance, and possibly improve patient outcomes.

Boekelheide NICU, Sanford Children's Hospital, Sioux Falls, South Dakota (Mss Jarding, Bjornson, and Ortman Brockmueller and Drs Hogden and Messier); Division of Neonatology and Department of Pediatrics (Drs Messier and Hogden), and Department of Internal Medicine (Dr Kozmenko), University of South Dakota-Sanford School of Medicine, Vermillion, South Dakota; Parry Center for Clinical Skills and Simulation, Sioux Falls, South Dakota (Dr Kozmenko); and University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada (Dr Simanton).

Correspondence: Laura Jarding, MS, NNP-BC, Boekelheide NICU, Sanford Children's Hospital, 1305 W 18th St, Sioux Falls, SD 57105 (

Institution where the work occurred: Sanford Children's Hospital and Parry Center for Clinical Skills and Simulation.

The authors declare no conflicts of interest.

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© 2018 by The National Association of Neonatal Nurses