At a large expanding academic medical center with over 80 clinics, adult ambulatory care nurses are being expected to care for pediatric patients due to outpatient rapid expansion. These nurses did not have the pediatric emergency training needed for the ambulatory care setting. While the American Heart Association (AHA) pediatric advanced life support (PALS) and pediatric emergency assessment, recognition, and stabilization (PEARS) are options for training, they are costly, not specific to ambulatory care, and take time away from the nurse’s clinical role. With these needs discussed, the clinical education and professional development (CEPD) department created recognition of pediatric emergencies plus stabilization (ROPE+S). This course was implemented to develop pediatric emergency recognition and response training for ambulatory care nurses and is also a substantial cost saving initiative for the institution. This curriculum is online-based learning, with no current in-person didactic training required. The course takes an average of eight hours to complete. It includes pre-existing and institutional created evidence-based learning modules and associated skills with quizzes to assess knowledge, and it offers NCPD upon completion of all course requirements. The elements of ROPE+S include emergency primary and secondary assessment for pediatric patients, asthma, assessment of respirations, seizure precautions, recognition of various types of shock, and use of an AED in the pediatric population. The CEPD targeted members of the ambulatory care rapid response teams as well as nurses who might be assigned to care for pediatric patients in the clinic. This course has been assigned to over 150 nurses so far. With the development of ROPE+S, the need for pediatric training for the ambulatory care nurses is being met. The institution is also saving money. The average PALS class from the AHA costs $150 per learner, and a PEARS course cost $125. Currently, over 150 nurses have been assigned ROPE+S in lieu of an AHA course, saving the institution $18,750. The average daily rate for an ambulatory care nurse is $316. Additionally, the medical center would also need to pay a float pool nurse to cover the shift, equaling $94,800 per year. Added together, the ROPE+S course is saving the medical center approximately $113,550 annually. Since clinics can’t afford to allow their nurses to be away from patient care, scheduling and staffing were also a concern when registering employees for AHA classes. This can lead to a delay in the staff attending these courses, which could in turn cause safety concerns if the staff are not appropriately trained to care for the patients. A post-ROPE+S survey also showed that 77% of respondents would recommend this training to a co-worker. ROPE+S will be assigned to an estimated 150 nurses annually to reinforce the training. It will be adapted based on clinic needs and participant survey results. The goal is for continued cost savings and more efficient training for the staff, which will ultimately lead to safer patient care and better outcomes.