Objectives To determine whether there is a significant stress response to the neonatal life support airway test (NLSAT) amongst nurses, midwives, doctors and other professionals; to compare level of experience with the stress response measured in each participant and identify whether high stress levels correlate with difficulty passing the NLSAT.

Design Quantitative observational study measuring stress levels of candidates on the NLS course using salivettes to measure salivary cortisol levels and a validated anxiety questionnaire (State Trait Anxiety Inventory).

Setting NLS course centres in the UK in 2013

Participants: 80 healthcare professionals (nurses, doctors and midwives) enrolled on the NLS course.

Interventions: Stress levels measured at baseline (10am), immediately before and then 20 min after the initiation of the NLSAT. Demographic data including professional experience and prior exposure to the NLS course was collected.

Results Cortisol measurements failed to detect any significant rise in stress levels. Significant stress levels were induced by the NLSAT when measuring anxiety scores with baseline mean scores of 39.63 (11.75), mean pre-NLSAT scores of 48.38 (SD 12.89, p-value <0.001) and mean post-NLSAT scores of 42.82 (SD 13.65, p-value 0.03). STAI scores significantly rose in all professionals from baseline to post-NLSAT (p < 0.001) with greatest change detected for midwives (+11.82 (SD 7.64, p-value <0.001) compared to nurses (+8.86 (SD 12.1, p-value <0.001) and doctors (+7.96 (SD 2.9.69, p-value <0.001). There was no impact of experience on stress levels. It was not possible to determine if stress levels impacted on performance due to the low re-sit rate (7.5%).

Conclusions Stress levels induced by the NLSAT are significant and need to be considered when instructing and developing the NLS course with variation amongst different healthcare professionals.