Advance Practice Preceptorships - Should students find their own preceptors?

Excerpt from letter written to nursing administrators...

Advance Practice Preceptorships - Should students find their own preceptors?

There are several additional points that I would like to make at this time. The concept of students finding and arranging their own preceptorships in advance nursing is an unsustainable and unethical one. For one thing, there is an unequal playing field in the process. Students that have greater access to medical professionals due to their previous experience or background will have a tremendous advantage in securing preceptorships. For instance, the son of an ICU physician would undoubtedly have almost no problems finding all his preceptors due to his father's connections. However, a first generation, aspiring nurse from a disadvantaged inner city that is pursuing an advanced degree will face significant difficulty securing preceptors.

Furthermore, students, in general, have almost no leverage when trying to secure a preceptor. An advance practice student, being one of the lowest in the medical hierarchy, is in essence trying to get a highly paid medical professional (Physician, PA, NP) to teach him/her a skill or profession without any type of compensation whatsoever. The natural question is of course "Why would anybody want to do that?" And the answer to that question is that "hardly anybody" and understandably so. In addition, medicine is practiced in a highly regulated and litigious environment. Even if a student secures a preceptor (most likely due to personal connections), there are nowadays a myriad of institutional regulations by hospitals and clinics that provide significant hurdles. What kind of incentive does a hospital or medical clinic have to allow just anybody to walk through its door and provide that person with the opportunity of becoming a highly skilled professional? In the case of advance practice nursing, they have none. With the increased concentration and buyouts in medicine, many more practice environments are now regulated by big corporations. Mostly gone are the days, when a nurse could walk into the office of the local town doctor and ask him to train her. Now even the local office might be owned by XYZ Inc. which has regulations, and a lot of them.

Certainly, the leaders of physician and PA programs understand this and that is why they arrange clinical experiences for their students. As nurses, we expect the same of our leaders. Unfortunately, our nursing leaders and schools have shortchanged us as students in the past, but this got to change. Most physicians and physician assistants express general satisfaction with their education. I haven't met many nurse practitioners yet that came to the same conclusion.

As NP students we pay the university to provide a service to us - education. One of the most important parts of this education is the clinical experience. It is not sufficient for the university to charge tuition, write a plethora of rules about the clinical experience and to abandon students to find their own preceptors, knowing well that many will not succeed.

Key Element III E of the CCNE Standards for Accreditation of Baccalaureate and Graduate Nursing Programs (2013) states, "To prepare students for a practice profession, each track in each degree program and post-graduate APRN certificate program affords students the opportunity to develop professional competencies in practice settings aligned to the educational preparation. Clinical practice experiences are provided for students in all programs, including those with distance education offerings."

It states, "clinical practice experiences are provided for students in all programs..." It does not say that students shall provide their own clinical practice experience.

I believe that the CCNE should start enforcing this rule. Schools that are not willing or able to provide this most important aspect of NP education should not be accredited by CCNE. Obviously, this accreditation agency has lacked in enforcing its own standard in past times. However, I believe as an officially recognized national accreditation agency by the U.S. secretary of Education, it needs to step up to the plate and do its job. It is unfair towards the schools that follow the rules and provide clinical experiences when other schools skirt their responsibility, getting by with it. Our physician and PA colleagues have shown us that providing clinical experiences for their students is not that difficult and results in a superior educational experience.

I thank you for your time and appreciate any constructive feedback.

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husky171

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It's all true and a well written letter but speak with your wallet. Not your words. If the program sucks don't go. If you can't get into a good program stay a nurse for your own benefit.

"McDonald's food sucks and it is unethical to put such low quality meat it your food please put better meat in"

two days later

"I'll take a Big Mac and fries please"

Sigh

wallet> words.

Wallets have power in a capitalistic economy, more than words

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I can't imagine why anyone is willing to attend a school that charges you full tuition but only provides half your education (the didactics) and leaves you responsible for finding people willing to provide you with the other half for free. If people would stop applying to schools that do this, they would have to either change their practices or close down. But each time this topic comes up, lots of people post here that they want to attend programs in which they have the convenience of finding their own preceptors close to home. Boggles my mind.

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If a product is continually bought, the seller has no reason to change the product. Students are purchasing degrees from said colleges on a regular basis, even though they are dissatisfied with the product.

it is a little bit different in the education sector, because some people would otherwise not be able to pursue a master's degree though, but it still must be taken into account. Degrees and products, even though we have to work for them also.

As time goes on degrees from said schools will not be worth as much as they are now, and if one is not willing or able to get into a program that is sufficient it is most likely better that they stay a nurse.

The advanced practice field is not for most people, even though 10 years from now we will probably have 2-3 times the number of the nurse pracitioners we do now. Just because they want another degree basically.

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My MSN-CNS program has a list of preceptors that have agreed to assist students in the past, but the student is responsible for seeking his or her own mentors in the fields they desire (within their specialty focus of choice). In the FNP program at my institution, this causes some students to have to stay out for a semester due to inability to find preceptors, even within several hours' driving radius.

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I think unethical schools prey on students who either want to be an APRN SO BAD that they are willing to take a sub-standard education or students who simply don't know any better. CCNE not accrediting them would go a long way towards fixing this problem. Thank you for this letter.

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I think unethical schools prey on students who either want to be an APRN SO BAD that they are willing to take a sub-standard education or students who simply don't know any better. CCNE not accrediting them would go a long way towards fixing this problem. Thank you for this letter.

My program was ranked one of the highest in the nation among nursing programs, and we are CCNE accredited :) Our faculty make site visits and discuss our progress with our preceptors.

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My program was ranked one of the highest in the nation among nursing programs, and we are CCNE accredited :) Our faculty make site visits and discuss our progress with our preceptors.

That's great! I don't see what that has to do with this topic, which is about programs forcing students to find their own preceptors and the inequities and problems inherent in that.

EDIT: Sorry I didn't read your other post in this thread. I think CCNE-accredited programs asking students to find their own preceptors is a problem, regardless of school rankings or site visits (are there actually schools out there that DON'T do site visits??)

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But it doesn't provide preceptors. Which is the topic. Being so highly ranked and still not providing preceptors is even more worrisome in nursing education as a whole.

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Specializes in allergy and asthma, urgent care.

I agree with those above. One of the reasons I chose my school was because it matched us with preceptors for our NP clinicals. I would not give my money to a school that left me hanging out int he cold to find my own.. I have also heard of students whose graduation was delayed due to a lack of preceptors. That is completely unacceptable.

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I can't imagine why anyone is willing to attend a school that charges you full tuition but only provides half your education (the didactics) and leaves you responsible for finding people willing to provide you with the other half for free. If people would stop applying to schools that do this, they would have to either change their practices or close down. But each time this topic comes up, lots of people post here that they want to attend programs in which they have the convenience of finding their own preceptors close to home. Boggles my mind.

I guess I will be one of those mind boggling people when it's time!

I already know where I want to attend for my CNM. It's a school with deep heritage and very well known for midwifery. And you have to find your own preceptor. They have a list of previously used preceptor and will assist you with finding one if you have having issues. But it's where I want to go so I will deal with it.

It is however, one of THE most affordable options for midwifery as well, so I feel like it balances it out. I will end up paying almost half compared to some other CNM programs.

So the previous posters are right, people keep buying their services, so they have no incentive to change. I'm sure as heck not changing where my money is going based just on preceptorship process. Sorry for contributing to the problem!

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Specializes in Psychiatric and Substance Abuse Nursing.
It's all true and a well written letter but speak with your wallet. Not your words. If the program sucks don't go. If you can't get into a good program stay a nurse for your own benefit.

"McDonald's food sucks and it is unethical to put such low quality meat it your food please put better meat in"

two days later

"I'll take a Big Mac and fries please"

Sigh

wallet> words.

Wallets have power in a capitalistic economy, more than words

That's where the appropriate role of government enters the picture, to save consumer and multinational corporations from themselves. Consumers might become addicted to Big Macs, cigarettes, opiates, etc, and the companies will be whistling dixy while gladly providing the product for a profit to consumers. Very hard to separate logic and emotion. Unchecked, big biz will milk profits until it even affects the family of their executives. The hard part is upholding government that is free from influence of big biz, and their sweet money strokes. I always wondered why when the FDA finds a bad batch of medication that they immediately pull it from shelves because it can *potentially* kill people, but with cigarettes, that has been *actually* shown to kill people, it settles on slapping warning labels on it and continue to allow it to be sold.

Can u imagine going to a car dealership..."hey, this car's wheels can fall off while driving, but you know what, we're just gonna slap a big label on it in a huge font and let it be your decision, ok?"

Same phenomenon with NP programs...prospective students are addicted to potential/perceived prestige and or increased earning potential with their degrees that they are willing to pay for the for profit ACME NP school. It has to be reined in at some point.

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