1. The role of human error is prominent in healthcare; thus, competence is required to protect and promote the health of our most vulnerable population, preterm and critically ill neonates. Lack of instrumentation for documenting, mapping, tracking, and retrieving a Neonatal Nurse Practitioner’s (NNP’s) cognitive, technical, and behavioral competency impedes the advancement toward competency-based assessment for the profession. The long-term goal is to design a valid and reliable competency-based assessment instrument (C.A.T.E.S.) that utilizes technology to document, map, track, and retrieve documentation of a NNPs’ multidimensional competency while being observed in simulation. The objective here is to produce the first draft of C.A.T.E.S. The central hypothesis is that with C.A.T.E.S., multidimensional competency can be accurately assessed; thus increasing quality improvement and patient safety while ensuring competency. The rationale is that the medical error rates of NNPs, as well as patient safety and outcomes for those patients managed by NNPs, will be improved through the utilization of C.A.T.E.S. The proposed study will test the central hypothesis by pursing the following four specific aims: • Identify which cognitive, technical, and behavioral dimension of NNP competency accurately reflects each of the global items. • Indicate whether each of the global statements is correctly mapped into the following NANNP Core Competency domains. • Determine if the operational definitions are accurate reflections of NNP performance while being observed in simulation. • Choose the essential scenarios to evaluate multidimensional NNP competency. • The approach utilized is a Real Time Delphi (RTD) Method, created by Gordon and Pease (2006), a technologically based uninterrupted round-less process with 24 hour a day simultaneous computation and delivery of the participant’s responses through which content validity can be ascertained. C.A.T.E.S. will be a significant contribution because it will enable NNPs to be evaluated in simulated clinical situations reflective of the multidimensional competencies required to be reliable and safe providers. Furthermore, C.A.T.E.S. can then be applied to other nursing specialties, paramedical and medical disciplines. • This proposed research is innovative on numerous levels because C.A.T.E.S. will be the first instrument designed to assess NNP cognitive, technical, and behavioral competency during simulation that will simultaneously utilize technology to: 1) Gather demographic information; 2) Assess physical demonstration of multidimensional competency; 3) Score subjects on a global novice to expert scale; 4) Map core competencies for the studied subject, and 5) Track performance of high-stakes procedures. Over the long-term, a national database might then be formed as a repository for this information that could be used for student evaluations, medical staff credentialing, acquisition and/or maintenance of certification, as well as quality and safety research. Finally, C.A.T.E.S. will create greater accountability and transparency to the competency assessment process of NNPs while providing facilities and the public a valid measurement of NNPs ongoing competency.

2. The role of human error is prominent in healthcare; thus, competence is required to protect and promote the health of our most vulnerable population, preterm and critically ill neonates. Lack of instrumentation for documenting, mapping, tracking, and retrieving a Neonatal Nurse Practitioner’s (NNP’s) cognitive, technical, and behavioral competency impedes the advancement toward competency-based assessment for the profession. The long-term goal is to design a valid and reliable competency-based assessment instrument (C.A.T.E.S.) that utilizes technology to document, map, track, and retrieve documentation of a NNPs’ multidimensional competency while being observed in simulation. The objective here is to produce the first draft of C.A.T.E.S. The central hypothesis is that with C.A.T.E.S., multidimensional competency can be accurately assessed; thus increasing quality improvement and patient safety while ensuring competency. The rationale is that the medical error rates of NNPs, as well as patient safety and outcomes for those patients managed by NNPs, will be improved through the utilization of C.A.T.E.S. The proposed study will test the central hypothesis by pursing the following four specific aims: 1. Identify which cognitive, technical, and behavioral dimension of NNP competency accurately reflects each of the global items. 2. Indicate whether each of the global statements is correctly mapped into the following NANNP Core Competency domains. 3. Determine if the operational definitions are accurate reflections of NNP performance while being observed in simulation. 4. Choose the essential scenarios to evaluate multidimensional NNP competency. The approach utilized is a Real Time Delphi (RTD) Method, created by Gordon and Pease (2006), a technologically based interrupted round-less process with 24 hour a day simultaneous computation and delivery of the participant’s responses through which content validity can be ascertained. C.A.T.E.S. will be a significant contribution because it will enable NNPs to be evaluated in simulated clinical situations reflective of the multidimensional competencies required to be reliable and safe providers. Furthermore, C.A.T.E.S. can then be applied to other nursing specialties, paramedical and medical disciplines. This proposed research is innovative on numerous levels because C.A.T.E.S. will be the first instrument designed to assess NNP cognitive, technical, and behavioral competency during simulation that will simultaneously utilize technology to: 1) Gather demographic information; 2) Assess physical demonstration of multidimensional competency; 3) Score subjects on a global novice to expert scale; 4)Map core competencies for the studied subject, and 5) Track performance of high-stakes procedures. Over the long-term, a national database might then be formed as a repository for this information that could be used for student evaluations, medical staff credentialing, acquisition and/or maintenance of certification, as well as quality and safety research. Finally, C.A.T.E.S. will create greater accountability and transparency to the competency assessment process of NNPs while providing facilities and the public a valid measurement of NNPs ongoing competency.