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A major factor that supported the development and evolution of the Nurse Practitioner role in the 1960s was lack of access to health services. The American public’s struggles to gain access to primary care and preventive services are certainly nothing new, and this need crosses socioeconomic lines.

Certification programs that focused on training the practitioner to work in a specific field followed specialization, and were sometimes tied to state licensure requirements.

By the early 1980s, nurse practitioner education moved into graduate programs and by 1981, most states required graduate degrees for nurse practitioner practice.  In response to the scientific knowledge explosion, programs kept adding new courses, expanding their length and their credit loads. By the turn of the 21st century, most nurse practitioner programs credit hours far exceeded those in other graduate programs. At the same time there was a growing movement towards practice doctorates in other professions and this led educators to think about new types of nurse practitioner programs. By 2005, the Doctorate of Nursing Practice (DNP) became the newest level of practitioner training, giving credit for the breadth of content in the nurse practitioner programs.

Neonatal nurse practitioners from novice to expert attend a didactic review of high-risk, low volume occurrences (such as recognition and treatment of various cardiac arrhythmias and utilization of a defibrillator in an emergency situation), followed by a procedure lab where participants can demonstrate mastery of all technical skills

practitioners are then placed in multidisciplinary teams and undergo several advanced level simulations followed by video-debriefing sessions which allow for further evaluation of their knowledge base, critical thinking, leadership and communication abilities, team performance, and technical skills performance in critical situations.

This article will review the evidence supporting simulation, define the core elements of health care simulation, describe the bodies that regulate advanced practice nursing, identify the principle areas in which neonatal nurse practitioners (NNPs) must maintain proficiency and expertise, and illustrate how simulation is utilized in acquisition, maintenance and competency evaluation for NNPs