Why are preceptors not provided in MSN programs?

llg, PhD, RN · Feb 4, 2014

I had to find my own preceptors for my BSN, MSN and APN. It wasn't that difficult and I was able to secure preceptors that gave me a great learning experience.

Yes ... But were those preceptors ever compensated for the teaching they teaching they did ... the education you paid the school for?

I am happy that it worked out for you. Really I am. But "the system" is ripping off the preceptors.

allnurses Guide · Feb 4, 2014

Yes ... But were those preceptors ever compensated for the teaching they teaching they did ... the education you paid the school for? I am happy that it worked out for you. Really I am. But "the system" is ripping off the preceptors.

MDs that take PAs get $3500 per 6 weeks AFIK, which is exactly $3500 more than I get, though most of my DNP is paid for in the credits I earn.

Advanced Practice Columnist / Guide · Feb 4, 2014

My own research on the matter boils down to lack of true accreditation standards.

All North American MD programs (including Canada) are accredited and tightly regulated by the LCME. Physicians who teach medical students belong to an academic practice housed within the medical school with strong affiliations to community health and hospital networks. Well-established schools have their own facilities that provide teaching in a seamless fashion transitioning from community medicine to tertiary care.

Physician Assistant programs are regulated and accredited by ARC-PA. They are very much modeled along the same vein as LCME.

CRNA programs are accredited and regulated by COA. Not only are the number of CRNA programs kept small by tight regulation, student admission into individual programs are kept at a quota.

CNM programs are accredited and regulated by ACME an arm of ACNM.

Students in all the above programs do NOT beg for preceptors.

NP programs do not have a specific accreditation body and are loosely regulated by CCNE. CCNE accredits Bachelor's, Master's, and DNP programs. You an I know that not all Master's and DNP programs lead to NP specialization. In short, as NP's, we don't have a specific body charged with safeguarding the integrity and quality of our training programs. Per CCNE's Accreditation Standards (on page 11):

Preceptors, when used by the program as an extension of faculty, are academically

and experientially qualified for their role in assisting in the achievement of the mission, goals, and expected student outcomes.

Elaboration: The roles of preceptors with respect to teaching, supervision, and student evaluation are:

* clearly defined;

* congruent with the mission, goals, and expected student outcomes; and

* congruent with relevant professional nursing standards and guidelines.

Preceptors have the expertise to support student achievement of expected outcomes. Preceptor

performance expectations are clearly communicated to preceptors and are reviewed periodically.

The program ensures preceptor performance meets expectations.

I, for one, view the above as very generalized statements and subject to loose interpretation. These are not standards, these are merely stating obvious requirements any program should have without careful attention to how it should be implemented. It is lacking in elaboration and enforcement details. I also found out that there is a certain former CCNE director who is now involved in administering a for-profit FNP/ANP program that has no physical campus, offers all didactics online, does not assist with preceptors, and admits students with minimal standards.

futureeastcoastNP · Feb 4, 2014

My own research on the matter boils down to lack of true accreditation standards.
All North American MD programs (including Canada) are accredited and tightly regulated by the LCME. Physicians who teach medical students belong to an academic practice housed within the medical school with strong affiliations to community health and hospital networks. Well-established schools have their own facilities that provide teaching in a seamless fashion transitioning from community medicine to tertiary care.
Physician Assistant programs are regulated and accredited by ARC-PA. They are very much modeled along the same vein as LCME.
CRNA programs are accredited and regulated by COA. Not only are the number of CRNA programs kept small by tight regulation, student admission into individual programs are kept at a quota.
CNM programs are accredited and regulated by ACME an arm of ACNM.
Students in all the above programs do NOT beg for preceptors.
NP programs do not have a specific accreditation body and are loosely regulated by CCNE. CCNE accredits Bachelor's, Master's, and DNP programs. You an I know that not all Master's and DNP programs lead to NP specialization. In short, as NP's, we don't have a specific body charged with safeguarding the integrity and quality of our training programs. Per CCNE's Accreditation Standards (on page 11):
Preceptors, when used by the program as an extension of faculty, are academically
and experientially qualified for their role in assisting in the achievement of the mission, goals, and expected student outcomes.

Elaboration: The roles of preceptors with respect to teaching, supervision, and student evaluation are:
• clearly defined;
• congruent with the mission, goals, and expected student outcomes; and
• congruent with relevant professional nursing standards and guidelines.
Preceptors have the expertise to support student achievement of expected outcomes. Preceptor
performance expectations are clearly communicated to preceptors and are reviewed periodically.
The program ensures preceptor performance meets expectations.
I, for one, view the above as very generalized statements and subject to loose interpretation. These are not standards, these are merely stating obvious requirements any program should have without careful attention to how it should be implemented. It is lacking in elaboration and enforcement details. I also found out that there is a certain former CCNE director who is now involved in administering a for-profit FNP/ANP program that has no physical campus, offers all didactics online, does not assist with preceptors, and admits students with minimal standards.

This is so sad and pathetic. Can we please, as a group, DO something to change this?? Can we not organize a letter writing campaign or SOMETHING to force there to be actual standardization of NP curriculums, exams, etc. I mean it's downright embarrassing, and I think the most embarrassing thing of all is the high number of NPs and NP students who come on here defending the current standards and saying that since everyone passes the same exam everyone is equally competent. Not one other health profession would allow this, nor would their members DEFEND such actions. Go to the PA or MD forums and see what they say about offering a program online with no standardization, no provided preceptors, no entrance requirements...I mean, really??

llg, PhD, RN · Feb 4, 2014

MDs that take PAs get $3500 per 6 weeks AFIK, which is exactly $3500 more than I get, though most of my DNP is paid for in the credits I earn.

None of the NP preceptors in my institution get compensated in any way for serving as preceptors. We get a steady stream of students looking for preceptors ... offering nothing in return. People in general and nice and willing to help out a bit, but they get tired of "giving" all the time and getting nothing back -- especially when they know that the student is paying the school for the course.

... and there is usually minimal guidance or supervision from the school. The written objectives given to the student and preceptor are, as Juan says, usually just vague statements of general goals that leave miles of room for interpretation.

I've been saying for years, it is one of the big "shameful" practices of nursing education and shows our profession at its worst.

Advanced Practice Columnist / Guide · Feb 4, 2014

Can we please, as a group, DO something to change this?? Can we not organize a letter writing campaign or SOMETHING to force there to be actual standardization of NP curriculums, exams, etc. I mean it's downright embarrassing, and I think the most embarrassing thing of all is the high number of NPs and NP students who come on here defending the current standards and saying that since everyone passes the same exam everyone is equally competent.

You're absolutely right. I won't claim that the subscribers of allnurses.com are highly representative of the entire NP and NP student population but how many times do you see statements that say:

- it doesn't matter where you went to school

- I had all my preceptors lined up anyway so the ones who are complaining are the ones who didn't

- I had a job guaranteed after graduation so it doesn't matter what school I'm going to

- you don't need to learn everything in NP school because your job will train you

The fact is, many individuals are happy with this status quo. Their numbers are just as many as those who ask "where can I get the best NP education?". It seems to me that everyone has their own preconceived notion of what NP education should be and in the meantime our colleagues in the other health related professions have moved past standardization.

If you or anyone else are concerned, yes, write the ones who have the power to change things. Problem is I think the students of these programs would not report their schools anyway for fear of a backlash. It's such a bad situation and I'm sad for our profession just as you are and you haven't even started. I love the NP role and am very proud of our contributions to health care. But we can not sit on these laurels and not strive to be better.

Here are organizations involved in one way or another in NP training and certification that should be pressured to make or propose changes in our education:

zmansc, ASN, RN · Feb 4, 2014

Juan's comments above, shed some interesting light on the subject for me. I did not realize that the accreditation of NP programs was so weak. As long as there is no strong oversight many schools will offer programs that are substandard, that goes for B&M, preceptors provided as well as online, student finds preceptor schools and anything in between. Are you more likely to find "shoddy" programs from schools that have bad reputations in other fields? Absolutely. Are those programs more likely to be online, to require the students to find their own preceptors? Yes, again. Are those the only programs that will go astray of strict institutional controls if not being monitored? No.

My own school is an online school, and I have to provide my own preceptors. I choose this path because it was the only way I could attend a FNP program. I'm the step-dad to my teenage sons, I don't have an option of relocation without missing out on my children's teen years. There are no local schools, nor are there any schools that would be able to provide preceptors in such a remote location. So for me, it boils down to online school, or no school.

There is significant evidence that shows if people in rural communities are able to obtain the education in their communities they are far more likely to stay in those communities after they get that education and use it there (in this case practice in those rural underserved towns). I think any solution, must maintain access to this education for the rural student who stays in their hometown while obtaining their training.

I also noticed in Juan's post, that he mentioned that CNM have a stronger accreditation agency. My preceptor is affiliated with three programs. One is all (mostly - 3 campus visits during program) online from a school that is all online. The second is from an SEC school, but the program is online and the students find their own preceptors. The third is the main state school in our state, again most of program is online with infrequent campus visits and students find their own preceptors. All three of the schools offer both NP and CNM programs, and I'm wondering if it isn't because they offer CNM programs that they seem to have significant oversight on the students and preceptors during the clinical portion of the program.

Let me reiterate, I'm all for improving the oversight of programs, and tightening the standards that all programs must adhere to. I just think sometimes the solutions posted sound like people forget that there are students and needs out there that are not served by a traditional program (B&M, preceptors provided).

Advanced Practice Columnist / Guide · Feb 4, 2014

I'm not against online programs in general. I think if we are to accept online education as part of the solution in making sure Nurse Practitioner education reaches every qualified candidate to the profession in all of the 50 states, a higher degree of regulation and educational structure should be in place before a program is even established. I am aware that there are students in rural areas where the closest institution offering campus-based NP programs are many miles away.

If these are public universities, there ought to be funding to establish distance programs that students can avail of with a guarantee that there are affiliated training sites within these rural areas. This is not a new concept. I used to live in Michigan where the campus of Michigan State University's medical schools (they have both MD and DO) are physically based in East Lansing, MI. However, they have students and residents all over the state (many in rural Michigan) through partnerships with community health entities. Their medical schools are rated highly in terms of excellence in Primary Care.

Why can't NP programs follow this model? Why resort to giant national corporations, err schools, who admit students from across the US in large volumes and leave them to fend for themselves in terms of clinical training? And by the way, going back to my original post about CRNA and CNM programs having their own accrediting body, you all must know that CRNA and CNM programs housed in schools and colleges of nursing are also CCNE accredited. This only goes to show how much of a badge of honor that CCNE accreditation is to our CRNA and CNM colleagues.

zmansc, ASN, RN · Feb 4, 2014

Several years ago, I started talking to my State BON president about the ADN/BSN entry level requirement. I posed the question, if we want to migrate to a BSN for entry level, why are there 13 ADN programs in our state and only two BSN programs?

The answer that I was given, was that there are a lot of rural community colleges that can train ADN nurses and those people will then stay in the state and generate tax revenue. That is something a legislator will fund, but having a student move to the big city, then get their BSN at the big university will often result in that person leaving the state and no return on that investment.

Our state is now adopting a model where the student can be enrolled in a community college based RN program and remotely in the state university's BSN program concurrently. The two programs curriculum have been synced up, so that irregardless of where you take the course, it is the same offering. This is allowing all students in all of the ADN and BSN programs (all of them have agreed to this standard curriculum) to be able to get BSN degrees irregardless of where they live. They take certain courses at the local school because these courses require local, hands on content. Other courses, are offered remotely by one of the four (I think) universities that are able to offer BSN degrees. Some schools will still allow their students to opt out and get an ADN, but most are expected to obtain their BSN degree instead.

I'm not suggesting that I actually caused this to happen. But I think it is a solution that is a long time coming. I only relay this story, because I think that it would benefit all of us to try to think outside the box and come up with a way to move our profession's educational offerings forward in a more innovative way than writing letters to people who are already invested in this model and see any other model as a threat to their very existence.

I'm not suggesting a solution, I don't have one. I am open to hearing options that would help. I have a strong desire to make sure that the rural student is still served by whatever solution is advocated, but I also feel that the quality checks need to be there to make sure the education obtained is sufficient to move our profession forward.

Advanced Practice Columnist / Guide · Feb 4, 2014

Off topic but I found this interesting as an accreditation standard from LCME. To me, it translates as: Medical students, be prepared to work with NP's, PA's, etc when you start your clinicals, LOL.

New Standard ED-19-A Approved

At its February 2013 meeting, the LCME approved the following new accreditation standard:

ED-19-A: The core curriculum of a medical education program must prepare medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These curricular experiences include practitioners and/or students from the other health professions.

This new standard became effective July 1, 2013, and appears in the medical education database for schools with a full accreditation survey in the 2014-2015 academic year.

allnurses Guide · Feb 4, 2014

I don't have a specific problem with online programs provided they are offers by schools with a well-established track record for producing quality NPs. Other than hands-on skills and direct patient care, there is no reason why lectures can't happen via an online format with today's technology, but it does place added importance on assuring appropriate clinical education.

I shudder when I see the "what's the quickest, fastest, cheapest online program". There are equally bad brick and mortar programs though. I remember sitting next to a graduated NP candidate at a board review course that raised her hand to ask what an A1C was.

I also believe that step-based exams would be beneficial to NP education. Our national certifying exams are basic entry to practice exams that could (and perhaps should) be more challenging.

As an aside, I have two good friends in medical school right now and they both do the majority of their lecture-based education remotely.

futureeastcoastNP · Feb 4, 2014

I too think distance based lectures are perfectly fine.

My main three issues with NP education is:

1. Allowing for-profit schools to open programs. It is frowned upon in both the MD and PA professions, but celebrated in nursing (the "colleges" tab even has dedicated boards for Excelsior and Walden - *****)

2. Allowing someone to choose anyone with an NP license and a pulse to be their preceptor.

3. As BostonFNP said, I believe the licensing exam could use some beefing up. Obviously I've never taken it so I do not speak from experience, but from what I've heard and seen in review books it isn't that in depth. I plan to take the AANP exam upon graduation because it's more clinical based, but still..