DO I TAKE NRP ESSENTIALS OR NRP ADVANCED?

The Curriculum: NRP Essentials and NRP Advanced

  • “The NRP Steering Committee made the decision to offer two course options so that NRP providers could excel in the course material most relevant to their role and personnel resources.”

NRP Essentials: For anyone involved in the care of a newborn. Read more.

NRP Advanced: For anyone expected to participate in resuscitation beyond PPV. Read more.

As of March 1, 2023 all CPM’s and CNM’s are required to take the Advanced NRP Provider course.

If you work at a CABC accredited birth center you are required to have the Advanced NRP Provider course

As of December 20, 2022 NARM wrote:

”NRP Advanced Requirement:

With the NRP 8th edition update in 2021, the AAP has created two course pathways for providers (see details highlighted below). NARM acknowledges that some of the advanced skills such as IO administration of newborn medications and Umbilical Vein Catheterization are not essential for CPMs who attend Community based births, however we recognize that completion of the NRP Advanced course is important to have a basic understanding of the full AAP NRP algorithm.

  • NRP Advanced is required effective March 1, 2023 for certification or recertification.

NARM will continue to accept unexpired NRP Essentials (plus BLS for Health Care Providers) as meeting the NRP Requirement for certification and recertification applications after March 1, 2023. However, NARM encourages taking NRP Advanced, if available prior to March 1, 2023”.

NARM Statement

PLEASE NOTE:
I'm unable to advise you on which (Essentials or Advanced) to take. It's your responsibility to choose the course most appropriate for you. Please contact your employer before choosing. No refunds will be issued for taking the wrong course and needing the other.

Which option is right for you?

The new 8th Edition process and choosing Essentials or Advanced has brought up even more questions. So here’s a couple questions to consider:

  • Do you work in a hospital? 

  • Do you work at a birth center that is CABC accredited?

  • Are you a CNM student preparing for clinicals?

  • Does your facility require Advanced?

  • Are you a CPM or CNM?

If you answered yes, you will need the Advanced. Contact your facility before choosing this option.

Or,

  • Are you a midwife who works out-of-the-hospital?

  • Are you a student, birth assistant?

  • Are you a doula?

  • Are you a parent

If you answered yes, you may want to consider Essentials.  And most midwives that work in the out of hospital setting as either a CNM, CM, CPM, NP or other title are required to take the Advanced NRP Provider course.

Karen covers chest compressions in her online Teachable course and she practices chest compressions in the Live Skills session but in order to have chest compressions on your NRP card you must take the NRP Advanced Learning Platform as it is not covered in the Essentials Learning Platform.

Consider:

Here’s what we’ve considered:

  • State

    • States with laws about midwifery practice

    • States without laws about midwifery

    • States where practicing midwifery is illegal 

  • Scope of Practice

    • MANA

    • ACNM

    • Other practitioners that don’t fall under NARM (i.e. Nurse Practitioner, Licensed Midwife, etc.)

  • Facility Requirements

    • CABC requirements

    • State licensing requirements for freestanding birth centers (vary from state to state)

    • Hospital requirements (vary according to each hospital)

  • Desire for Competency, Training and Proficiency

    • Competency: intellectually understanding a subject matter

    • Training: learning and practicing under adequate supervision, over time

    • Proficiency: mastery of advanced skills requires continued regular practice

  • Liability & Malpractice

    • It is nearly impossible for most NRP providers to have adequate training and experience in advanced skills. Does this expose those providers to additional liability if their performance of those skills is not adequate when needed?

    • If an NRP provider is performing skills outside of their scope of practice, will malpractice insurance cover lawsuits requiring you to use those skills?

    • If your malpractice carrier will not cover you, will you then be personally liable?

    • If you choose not to perform advanced skills, yet have completed the advanced skills NRP, will you be liable due to your decision not to use those skills during a resuscitation?

Points to Consider

  1. In floods of adrenaline, everyone gets tunnel vision, its human physiology. Some providers become hyper-focused, while most experience panic, and it takes time to respond appropriately. This is not often talked about, what happens inside many providers when confronted with a severely compromised baby. It can be shattering/ disorganizing.

    Scenario: You have a severely compromised baby. You start with PPV, it’s difficult so you do the corrective steps. After 30sec, your partner begins chest compressions. If you stop ventilating, the HR immediately goes down. Do you have enough providers to either: prepare UVC, meds and equipment, intubate with a laryngoscope and equipment, or drill, insert an I/O line and prepare meds and other equipment (WHILE ventilating and compressing) ??

  2. If you have a bad outcome, and you use a skill (without extensive training and supervision), you may be liable. NRP, NARM, MANA, ACNM will not vouch for you.

  3. “If nurses [or midwives] become intubators, the scope of their practice should be incorporated into their job description. Consequently, a nurse’s professional experience should reflect the ability to perform this role. Nurses must also be willing to assume the additional professional liability in extending their practices to high-risk care. When planning this type of extended nurse practice role, anticipate the questions a plaintiff’s attorney would ask the nurse at a deposition:

  • What type of education prepared you to care for this newborn?

  • What type of training did you receive in neonatal intubation?

  • Who taught and supervised you?

  • What qualified that person to train you?

  • How was your skill measured?

  • How many intubations did you perform before you were considered proficient? In what time period?

  • How many babies have you intubated in the past six months? In the past year?

  • Did you successfully intubate each of those babies on your first or second attempt or did you require some kind of assistance from another provider?

  • Show me the documentation to prove the answers to these questions.”
    - From an archived NRP Instructor Update

    “Nurses should not become intubators by default...However, the staff nurse who adds neonatal intubation to his/her repertoire of resuscitation skills does not replace a physician or NNP whose scope of practice covers complete resuscitation skills, including placing an emergency umbilical venous catheter and/or ordering medications.” -From an archived NRP Instructor Update

“NRP Essentials is most appropriate for those assigned responsibility for the newborn at birth when there are no apparent perinatal/neonatal risk factors and for those who care for healthy newborns after birth.” - NRP 8th Edition Busy People Update #1

We want you to have the best, most appropriate newborn resuscitation training available. If you have any questions or need to update your registration, please contact us. 

Bottom Line

NRP is written for the in hospital setting, so neither route is a perfect option. 

For most midwives, the material taught in Essentials will fit the majority of their needs, however it does lack chest compressions. The material taught in Advanced may be inappropriate for the out-of-hospital setting. The most important aspects of newborn resuscitation are thermal management, ventilation and preparing for transfer. 

In the Integrative Resuscitation of the Newborn course, chest compressions are covered in both the Teachable online course and the Live Skills Sessions.

NRP Scope of Practice Statement:

Every out-of-hospital provider who anticipates managing a newborn at birth needs to know how to initiate positive-pressure ventilation and use the MR. SOPA ventilation corrective steps to achieve lung inflation.
For many out-of-hospital providers, laryngeal mask insertion is part of their legal and professional scope of practice; however, intubation and vascular access are not within the scope of many out-of-hospital providers.

NARM Scope of Practice Statement:

The scope of practice of the CPM is derived from the NARM Job Analysis, state laws and regulations, and individual practice guidelines developed by each midwife according to her skills and knowledge. NARM POLICY UPDATE