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.
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.
From the research that I have done so far, this doesn't seem to be a problem only at for-profit/private schools. Even many established, seemingly well-respected public university programs are having their NP students find preceptors.
Also (not in direct response to xenogenetic's comment):
For many NP students that I know, the decision to go to a school that requires them to find their own preceptor was a balance of logistics. There are only so many programs, public or private, that are within a reasonable distance of their current home. With spouses who can't easily relocate (due to their employment) for the NP student to attend grad school, to not wanting to uproot kids from schools (or move them away from family support systems that are needed even more when a parent is in grad school), these students had to choose between the many problems caused by relocating to attend a school that provides preceptors and the cost/benefit of going to a local school that doesn't provide preceptors (but doesn't require them to sell their home or move away from other resources - employment, family, etc.) . If family logistics can't support the NP student moving for a school that provides preceptors, then the only choices for that student were to skip school altogether, or accept the less desirable option of finding their own preceptors, even if there are problems with this system.
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.
Really? You're not aware that this is because Congress has, for decades, danced to the tune of the tobacco lobby and, in the face of all logic, prevented the FDA from regulating tobacco in any meaningful way?
I'm in one of those where you have to find one of your own preceptors. We are accredited and one of the highest ranked in the nation. I happen to live in a very saturated area where there are other well known universities. Many sites said that they would only take students from local universities.
I am currently sitting out a semester because my preceptors practice (MD side) all of a sudden decided they would not take NP students. My institution is trying as much as they can to help, but it may mean going out of state. (!) I do not think it's horrible having to find your own, as long as you are given some resources, which I was (past preceptors, emergency contacts)...
A huge issue is NPs not wanting to take students. I agree with other posters that if they're not getting paid to, why should they? Those offices I call that do have student friendly NPs seem inundated with requests, and I kind of get that "Siiiiiiigh, I would like to help you, but I've had students with me for a year and I really need a break." We are only allowed to do a certain number of hours with specialty/MD and I was hoping to save these in case I had a specialty NP that I could follow for a bit. Also, some are in positions where NPs state "we only get the walk-ins, and the MDs aren't NP student friendly." Frustrating.
I'm all for having it set up for me, as then I wouldn't be twiddling my thumbs while all my classmates spring ahead. Unfortunately, even brick and mortar schools are starting to follow this standard. A friend at a very well known NP program has been working on her degree for 4 years because of schedule changes, school being unable to set up a reliable preceptor, etc. I believe it is the new norm...
I think the answer lies more in a nationwide requirement for an established NP residency than putting all the burden on the school. Some programs I know of blend some of the MD components with NP components (didactic and clinical). I would have loved to do a program like that!
Everybody is defending their school with "but it's the highest ranked in the nation"
a year from now they will be like "omg need women's health preceptor help me plzzzz"
nobody cares if your school is the highest rank. If you have to sit out a semester because the school isn't providing the full experience it is obviously not a good school. You can't blame the preceptors. Maybe the school should offer them benefit for taking students? I mean we pay enough tuition.
why shouldn't the burden be on the school? What do we pay them for then!? Jeez people are awful consumers and bend over to take it deep. If you want to take it deep that's fine by me but that makes it harder on the rest of the students who actually have some common sense when it comes to money. If you want to just hand out tuition dollars with no return I'll take some. I need to get my wife a 4wd SUV so she can drive in the snow to and from her medical school clinicals that her school actually set up for her.
Specializes in Psychiatric and Substance Abuse Nursing.
Really? You're not aware that this is because Congress has, for decades, danced to the tune of the tobacco lobby and, in the face of all logic, prevented the FDA from regulating tobacco in any meaningful way?
Yes, am aware. Just virtually verbalizing my wonder. :-)
I precepted students when I worked in primary care. I felt that I should give back and I really enjoyed it. Now I'm in a specialty that many students aren't interested in. Precepting is challenging. It slows you down, and that's difficult if you work in a practice that is numbers driven and your pay depends on productivity. More providers might be interested if there was some sort of incentive.
With a state university / medical school, I had to find my own preceptors. This is no easty task. As the OP noted, the preceptor and host institution get nothing for this. I am still angry about having had to do this. I feel it is unright on so many levels. There is also no iota of uniformity in what the student will receive from a preceptor. I had utterly useless ones and utterly fabulous ones.
West they had a button where I could auto like all of psychguys posts. It gets tiresome having to do it manually. If we and a few other were in charge of the BON we would get stuff done baby.
I'm currently in an online NP program in a well known state program (the school is discussed on allnurses frequently). We have to find our own preceptors. The school provides a list of past sites, but it is largely outdated. I have called all the sites on the list in my area and either they say they are not taking students or they don't respond at all.
It has been one of the worst experiences ever to try to find preceptors. It added so much stress. I have a preceptor who is good and she allows me see most of your patients. I have two other preceptors who will only allow me to observe and they make it clear they are too busy to answer many questions. But I took what preceptors I could find, because 'beggars can't be choosers', which is a terrible sentiment when you are talking about an advanced education for an advanced career.
And my school does not do site visits. How can they? My clinical instructor oversees students in 3 states.
I was going to apply to a program 2 hours away from my house that DOES find preceptors and has a residency program. The cost was 3 times the tuition of my current program. I choose my current program because I could pay out of pocket for it. Now I really, really, really regret that decision.
I do not feel I am getting a good education. This school is a disorganized mess even with their didactic classes. They are charging tuition for doing next to nothing.
With the state of NP education, no wonder nurses are not valued.
Specializes in Psychiatric and Substance Abuse Nursing.
I like psychguy's posts too!
I'm currently in an online NP program in a well known state program (the school is discussed on allnurses frequently). We have to find our own preceptors. The school provides a list of past sites, but it is largely outdated. I have called all the sites on the list in my area and either they say they are not taking students or they don't respond at all.
It has been one of the worst experiences ever to try to find preceptors. It added so much stress. I have a preceptor who is good and she allows me see most of your patients. I have two other preceptors who will only allow me to observe and they make it clear they are too busy to answer many questions. But I took what preceptors I could find, because 'beggars can't be choosers', which is a terrible sentiment when you are talking about an advanced education for an advanced career.
And my school does not do site visits. How can they? My clinical instructor oversees students in 3 states.
I was going to apply to a program 2 hours away from my house that DOES find preceptors and has a residency program. The cost was 3 times the tuition of my current program. I choose my current program because I could pay out of pocket for it. Now I really, really, really regret that decision.
I do not feel I am getting a good education. This school is a disorganized mess even with their didactic classes. They are charging tuition for doing next to nothing.
With the state of NP education, no wonder nurses are not valued.
I hear you on the cost front...only one of the 3 psych NP programs physically located within my state offers providing you preceptors. That school is Yale and its a bit pricey...costs $18,400.00 per term.
That's a lot wow. Mine cost 20k and provided them. But they probably cost more now. Education is a big scam. Hopefully students will revolt one day. I would if I was still in school.
SarahRN2013
32 Posts
From the research that I have done so far, this doesn't seem to be a problem only at for-profit/private schools. Even many established, seemingly well-respected public university programs are having their NP students find preceptors.
Also (not in direct response to xenogenetic's comment):
For many NP students that I know, the decision to go to a school that requires them to find their own preceptor was a balance of logistics. There are only so many programs, public or private, that are within a reasonable distance of their current home. With spouses who can't easily relocate (due to their employment) for the NP student to attend grad school, to not wanting to uproot kids from schools (or move them away from family support systems that are needed even more when a parent is in grad school), these students had to choose between the many problems caused by relocating to attend a school that provides preceptors and the cost/benefit of going to a local school that doesn't provide preceptors (but doesn't require them to sell their home or move away from other resources - employment, family, etc.) . If family logistics can't support the NP student moving for a school that provides preceptors, then the only choices for that student were to skip school altogether, or accept the less desirable option of finding their own preceptors, even if there are problems with this system.