Are the providers feeling like they are coming ill prepared and are anxious about the integrated skills or do they feel that way because of the environment once they get there i.e. instructor intimidation? I would ask questions to the providers on why they are not feeling comfortable. Having the skills stations really helps with the providers feeling more comfortable and we set up our program so that they can practice every lesson. We also have seen a big increase in the skill level by having bi-annual NRP scenarios instead of our staff meeting that month.