Setting the Stage

In 2022, one in 10 babies born in the United States was born prematurely (Centers for Disease Control and Prevention, 2024). From July 2021 to June 2022 at our hospital, there were 2,478 births, with 795 births requiring admission to the neonatal intensive care unit (NICU). NICUs range in level from I to IV, with IV being able to provide the highest level of care. Our women’s health unit (WHU) cares for high-risk maternal patients and our NICU is level IV.  Neonates admitted to the NICU require varying levels of care determined on admission and further assessments. Caring for these specialized, high-risk maternal and neonatal patient populations across hospital units requires a collaborative, multidisciplinary approach to improve care provided. The planning team initiated shared educational experiences and interunit delivery room simulations between staff from the WHU and the NICU to foster collaborative partnerships, enhance interdisciplinary communication, and identify opportunities for system workflow improvement.

Bridging the Gap in Shared Educational Experiences

While each staff member who attends deliveries is expected to maintain an active certification in Neonatal Resuscitation Program (NRP) skills, our hospital did not offer additional interunit opportunities to maintain competency beyond NRP re-certification. Resuscitations involve staff from multiple units and disciplines. Practicing scenarios together encourages familiarity with others’ roles, scopes, and workflows. Interunit NRP simulations are a hands-on, team-based practice meant to reinforce NRP skills to prevent skill loss between NRP recertification, which is every two years. Interunit NRP simulations were conducted in a delivery room scenario to support the professional development of staff responding to resuscitations. Nursing professional development (NPD) practitioners led the program’s development through active collaboration, working closely with neonatologists, NICU advanced practice providers, respiratory therapists, medical directors and nursing leaders from the WHU, NICU, and newborn nursery, as well as physicians from maternal-fetal medicine and family medicine. This collaboration involved joint planning, sharing expertise, frequent communication, and collective problem-solving to ensure the simulations reflect real-world scenarios and meet the needs of all disciplines.

Developing Robust Experiences

The initial assessment and planning of the simulations intentionally incorporated the organization’s core values—patient and family-centered care, quality and safety, and a healthy work environment. These values guided scenario design to ensure that simulations reflected real-world priorities. NPD Standard 11, collaboration, was included during planning. Standard 11 states “the nursing professional development practitioner collaborates with colleagues, academic partners, and other key stakeholders” (Harper & Maloney, 2022). A multidisciplinary approach was important because neonatal resuscitation involves multiple disciplines—WHU, NICU, newborn nursery, respiratory therapy, and physicians from maternal-fetal medicine and family medicine—each playing a critical role during delivery emergencies. The content addressed, such as communication, role clarity, and coordination during high-risk deliveries, was relevant across these disciplines since successful outcomes depend on teamwork rather than isolated expertise.

Active engagement of the multidisciplinary team contributed to the program’s success. Team members collaborated to develop scenarios using case studies and current evidence-based literature, ensuring relevance, accuracy, and alignment with best practices. Addressing this as individual disciplines would not recreate the complexity of real events, where collaboration is essential.

The Innerworkings: Educational Design to Support Adult Learners

When we began this program, our goal was to offer sessions quarterly. Initially, for each quarter we were offering two days with three sessions per day. The times were 0730-0900, 1130-1300, and 1330-1500. We noted the 0730-0900 sessions were preferred by nightshift. We struggled to have enough participants in the 1330-1500 session routinely. Currently, interunit simulations are held three times per year for both dayshift and nightshift staff. For each trimester, we offer three days of sessions with two sessions per day. The times for the sessions are 0730-0900 and 1130-1300. Since making this adjustment in offerings, all sessions have had better attendance.

The topics of the simulations change each trimester to encourage repeated participation by learners in the activity. The topics are carefully selected by the planning team with consideration to upcoming cases anticipated at the hospital in addition to high-risk, low-volume scenarios. The simulations are designed to use high-fidelity simulation manikins. The facilitators of each session include NPD practitioners from WHU and NICU, a respiratory therapist, and a NICU leadership team member.

A perceived barrier to successful implementation of the simulation experience was the concern that participation might be limited to a single practice area, reducing the intended multidisciplinary participation. The simulations were designed and conducted as interunit sessions, meaning staff from multiple departments participated together in the same sessions rather than separately. This approach was chosen because neonatal resuscitation requires collaboration, and practicing together reflects the complexity of delivery emergencies. To overcome the enrollment barrier, NPD practitioners promoted the sessions across all units and leadership teams, aiding in broad engagement. Additionally, simulation cases incorporated both maternal and neonatal concepts, making the content relevant to all participants and reinforcing shared responsibilities during high-risk deliveries.

What Do the Nurses Think?

The learning outcomes for the delivery room simulations are as follows:

• Distinguish the necessary steps needed for the resuscitation of a neonate using NRP
• Defend the importance of using effective communication during multidisciplinary collaborations including neonatal resuscitation

Post-course evaluation data, collected via learner self-evaluation, demonstrated that over 93% of participants rated the simulation activity as high or very high in terms of personal value and satisfaction, while more than 94% indicated high or very high ratings for achievement of desired learning outcomes. Nurses consistently rated their ability to articulate the importance of effective communication during multidisciplinary collaborations—particularly in neonatal resuscitation scenarios—as high or very high. Similarly, they reported strong confidence in identifying the necessary steps for neonatal resuscitation in accordance with NRP guidelines. Qualitative feedback revealed a strong desire among nurses to continue interunit collaboration and to engage in simulation experiences that more fully integrate maternal and neonatal care.

Together We Practice, Together We Excel

Our simulation experiences cover a wide variety of maternal and neonatal topics. Having all units present for the simulations allows for “full circle” learning as staff from all units learn about the roles of their counterparts, further strengthening the collaborative partnership. As staff learn more about each other through shared experiences, they are able to appreciate the work others do. Some of the simulation topics we have completed thus far include:

• Social determinants of health for a neonate with a congenital cardiac defect
• Pre-term neonate with gastroschisis
• Pre-term neonate with thermoregulation concerns
• Cyanotic cardiac defect
• Twin intrauterine pregnancy with concerns related to fluid volume replacement
• Meconium aspiration
• Uncomplicated term neonate delivery
• Umbilical cord prolapse
• Pre-term neonate resuscitation using a neonatal shuttle in the delivery room
• Fetal hydrops fetalis
• Precipitous delivery complicated by pre-term labor

Each of these scenarios highlight events where multiple disciplines must act simultaneously. These scenarios were selected because they reflect real-world emergencies that rely on collaboration. Through these shared experiences, team members were able to learn more about role clarity during events, prioritization of interventions and which interventions are shared, how to best communicate during times of high pressure and high stress, and how to integrate each other’s workflow. Learning alongside one another fostered a sense of appreciation as team members learn more about the roles of their peers. The lens shifted from viewing resuscitations as a responsibility of one unit or team to the responsibility of all disciplines.

Game Plan: Next Steps

As we continue to receive positive feedback for these simulation experiences both from formal evaluations and informal participant commentary, we reflect on ways that we can further build upon this foundation. Our learner self-evaluations suggest that learners are hopeful to have simulation experiences take place on hospital units to practice in the space of the deliveries. To address these comments, our next steps include a pilot of in-situ simulations to have the experiences that take place in the real working environment to further nurture staff relationships.

Teambuilding and bonding activities are set to be included in the agenda for the sessions to create intentional, meaningful connections between staff from all units, who must work together seamlessly when providing care in high-risk, high-stakes settings.

Acknowledgement:

We would like to express our gratitude to Director of Nursing Research Eric Messner, PhD, FNP-BC, for his invaluable support in the refinement and scholarly contribution of our submission. His expertise, thoughtful guidance, and commitment to nursing scholarship significantly enhanced the clarity and impact of this work.

We also extend our appreciation to Sue Pazuchanics, MSN, RN, CCRN-K, NPD-BC, for her continued leadership and support of nursing professional development initiatives. Her dedication to fostering a culture of learning and excellence is deeply appreciated.

References

Centers for Disease Control and Prevention. (2024). Preterm birth. https://www.cdc.gov/maternal-infant-health/preterm-birth/index.html

Chuang, S. (2021). The applications of constructivist learning theory and social learning theory on adult continuous development. Performance Improvement, 60(3), 6-14. https://doi.org/10.1002/pfi.21963

Garvey, A. A., & Dempsey, E. M. (2020). Simulation in neonatal resuscitation. Frontiers in Pediatrics, 8. https://doi.org/10.3389/fped.2020.00059

Harper, M. G., & Maloney, P. (2022). Nursing professional development: Scope and standards of practice (4th ed.). Association for Nursing Professional Development.

McEwen, M., & Wills, W. (2023). Theoretical basis for nursing (6^th ed.). Wolters Kluwer.

Palmer, E., Labant, A. L., Edwards, T. F., & Boothby, J. (2019). A collaborative partnership for improving newborn safety: Using simulation for neonatal resuscitation training. The Journal of Continuing Education in Nursing, 50(7), 319-324. https://doi.org/10.3928/00220124-20190612-07

Sondergaard Lindhard, M., Thim, S., Sehested Laursen, H., Wester Schram, A., Paltved, C., & Brink Henriksen, T. (2021). Simulation-based neonatal resuscitation team training: A systematic review. Pediatrics, 147(4). https://doi.org/10.1542/peds.2020-042010