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.
