Effect of a Neonatal Abstinence Syndrome Training Program on Nurses’ Confidence and Ability to Use the Finnegan Scoring Tool

Objective: To study the impact of an educational training program about neonatal abstinence syndrome (NAS) on the accuracy and reliability of NAS scoring by neonatal nurses when using the Finnegan Scoring Tool (FST), as well as the impact of training on nurses’ confidence when using the FST. Design: Pilot project based on the Plan–Do–Study–Act framework with a pretest–posttest design. Setting/Local Problem: Although nurses at this agency receive training on the FST as part of their unit orientation education, there is not currently a program for assessing their confidence and accuracy when using this tool over time. Participants: A convenience sample of registered nurses from the mother–baby (n = 11), NICU (n = 5), and pediatrics (n = 1) units. Intervention/Measurements: Nurses watched a video of a neonate, used the FST to score the neonate's withdrawal symptoms, and completed a rating of their self-confidence when using the tool before and after an educational training session and at a 2- to 4-week follow-up session. Results: Participants improved to at least 90% interobserver reliability from the pretraining (64.7%) to posttraining (94.1%) assessments. No participants maintained 90% at follow-up. There appears to be a correlation between years of neonatal experience with tool confidence at pretraining (r = 0.52, N = 17, p < .04), posttraining (r = 0.52, N = 17, p < .03), and follow-up (r = 0.56, N = 17, p < .02) assessments. Pretraining reliability had a positive correlation to follow-up reliability (r = 0.51, p < .04). There was a statistically significant increase in confidence from before the training (mean = 2.06, standard deviation = 0.56) to after (mean = 2.47, standard deviation = .51; t[16] = –3.3, p < .004 [two-tailed]). Although participants reported feeling confident when using the scoring tool, they did not always accurately score symptoms. Participants reported positive buy-in and the need for additional training. Conclusion: Advanced training in NAS and the FST may help nurses improve NAS symptom detection and contribute to better neonatal health outcomes. Accurate use of the Finnegan Scoring Tool can enable early identification of newborns with neonatal abstinence syndrome, which may reduce newborn length of stay, pharmacologic treatments, and negative health outcomes.