For-Profit, Nonselective NP Schools are Hurting Our Reputation and Credibility

For-profit, nonselective NP programs are becoming more and more popular, and I wanted to share my thoughts and what I have learned from my experience and the experience of others.

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For-Profit, Nonselective NP Schools are Hurting Our Reputation and Credibility

The difference between nurse practitioner (NP) programs has become a topic of interest, and for good reason.  I am going to highlight some of the significant differences between the NP Program that I attended and the program attended by three friends. To provide some background information, the program I completed is a highly rated NP Program from a nonprofit, selective university. My NP Program holds a high ranking on US News & World Report and is considered one of the best in the state. Three of my friends attended one of the largest, for-profit, nonselective nursing universities in the United States.

Within the first year of each of us starting our NP Program, it became apparent that the grading standards and effort required of each of us varied significantly. These variations and inconsistencies grew as we navigated towards graduation. During the more difficult semesters in my own DNP program, I was putting in 100 or more hours for each proctored exam to earn the 85% minimum passing grade. I became frustrated with how easily my friends seemed to pass the classes in their programs, while my program seemed to require endless hours of nonstop studying, isolation, and sacrifice.

My friends and I frequently shared advice on studying methods, time management, and textbook resources. It wasn't until I was asked to read over a friend's research paper for a health policy course that I had to question the integrity of these for-profit, nonselective NP programs. My friend's paper was written at a remedial level of English, with multiple grammatical and punctuation errors. I was stunned. This was the work of a second-year GRADUATE nursing student. I returned my friend's paper with a list of recommended edits and revisions. She thanked me but dismissed my comments, stating that her school did not require "any of those things" and that she had received near-perfect scores on her previous papers. The edits I recommended included the proper use of 'their' and 'there,’ corrections for run-on and fragmented sentences, comma placement, misspelled words, and APA citations. She ultimately decided not to apply my corrections and submitted her paper as it was. I was shocked when she received yet another 'A' to add to her academic repertoire. Meanwhile, my professors returned papers ungraded if there was an extra space at the end of a paragraph. What was happening?

For-profit, nonselective NP programs have become popular, albeit expensive, avenues to obtain a nurse practitioner degree. Admission requirements are minimal. There are no admissions essays. No letters of recommendation are needed. The minimum GPA requirement is lower than that of a selective program, and there are exceptions available if a student does not meet the minimum GPA.

The coursework in for-profit, nonselective NP programs is also different. While turning in a poorly written paper in a nonprofit, selective NP course will get the student a quick referral to the writing lab with a mandatory re-write, the same poorly written paper in a nonselective NP course may earn the student an 'A.’ This would be less concerning if the instructors provided detailed feedback about the mistakes made and how to correct them. From what I have witnessed, these students either continue to make the same writing errors or rely on the 'copy' and 'paste' functions to complete their notes after they transition to clinical practice.

The exams in a for-profit, nonselective NP Program do not carry the same weighted grades as they do in selective NP programs. For example, a student can fail every proctored exam with a score as low as zero in a nonselective program and still pass the class with an 80%. In contrast, courses in a selective NP Program consist of exam scores only. NP courses in for-profit, nonselective programs are graded using an 80/20 ratio of assignments and exams, with exams making up only 20% of the total grade. It is not uncommon for students in these nonselective NP programs to fail (receive a score less than 80%) half or more of their exams and still go on to graduate.

What is surprising to me is that many intelligent and competent nurses intentionally choose for-profit, nonselective NP programs from a pool of higher quality, lower-cost programs. What is the appeal? Is it the simplicity of the admissions process? Are they intimidated by the competitive programs? Do they think the program will be too difficult?

An internet search for NP programs will produce several heavily advertised for-profit, nonselective programs. These schools allocate more money to marketing and recruitment efforts than they do to hiring and retaining well-qualified, experienced faculty. I find this highly concerning. The quality of the faculty may be the reason that some students are graduating from NP programs with subpar writing skills and enough clinical knowledge to pass the board exam but not much else. It is no wonder why most for-profit, nonselective schools provide high-priced, intense board review prep courses to all their NP students after graduation. Passing rates would surely decline without this provision.

Recruiters and employers seldomly know the difference in quality between NP programs, which I found highly frustrating. This could be good or bad, depending on the individual's education, skills, and abilities. This idea that all nurse practitioners are held to the same standard is both inaccurate and harmful. What that standard IS remains the concern. It is especially disappointing to share my degree - a degree that I hold in high esteem - with others who have poor reading and writing abilities.

Several articles have been published in the last two years questioning the quality of NP education. The perceived level of difficulty in nurse practitioner programs has been under fire, as physicians have been skeptical of the NP student's ability to be employed full-time while attending a full-time program. This criticism hurts us all, as it implies that NP programs have become too easy. While I take offense to this, I cannot say that this is entirely off-base. I attended a nonprofit, selective NP Program. My program was not easy in any aspect. No students were permitted to fail an exam without failing the class. My professors rarely awarded grades of 100% to ANY student on ANY assignment. Papers with grammar and punctuation errors were not accepted, let alone graded. There were approximately 36 students in my graduating class. In contrast, my friends were among a graduating class of more than 600.

I understand that nurse practitioners do not have to be high-performing academic scholars to be good providers. However, for-profit, nonselective schools may negatively impact our profession in the future. The reality is that nonselective NP programs are graduating far more nurse practitioners than selective programs. That is not surprising when you consider that nonprofit NP programs are competitive and have a low acceptance rate, while most for-profit NP programs have 90-100% acceptance rates. The for-profit, nonselective NP programs are not just attracting nurses with lower GPAs. Despite the comparatively higher cost of attendance, these programs attract nurses with high GPAs, as well. When the entry-level pay for nurse practitioners does not factor in the student's program, there is little incentive to attend a selective school that is historically more difficult and will require more effort. This negates the work of those of us graduating from reputable programs. This can and does affect NP entry-level salaries and negotiating power. This can damage the credibility of new nurse practitioners. This directly affects our campaign to obtain full practice authority in all states. This trend is something we need to put to an end.

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DNPgrad2022

About DNPgrad2022, ASN, BSN, DNP

DNPgrad2022 has 6 years experience as an ASN, BSN, DNP.

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My hospital refuses to hire NPs unless they come from their organic fellowship program (1 year) or have SERIOUS experience.

My manager (not a provider) told me flat out that the quality of NPs varies so heavily that they are leery of hiring any. Finding candidates has been so hard they just stopped looking. My job requires a high level of independence, the preparation these schools give to new grads would kill someone.

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Specializes in Former NP now Internal medicine PGY-3.

The odd thing is that writing seems to be the core competency that many programs use to see if someone is an adequate provider. I mean it is helpful for writing notes but does not really evaluate if someone actually “knows things” and can put those things to clinical use. 

Most of the above paragraph is describing the difference in paper writing. I would say that is not an adequate way to determine if someone is ready to practice medicine. 

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22 minutes ago, Tegridy said:

The odd thing is that writing seems to be the core competency that many programs use to see if someone is an adequate provider. I mean it is helpful for writing notes but does not really evaluate if someone actually “knows things” and can put those things to clinical use. 

 

Most of the above paragraph is describing the difference in paper writing. I would say that is not an adequate way to determine if someone is ready to practice medicine. 

I don't think nursing knows what to focus on academics wise for NPs. Traditionally yes, grad school is research and paper-heavy, but NP school should be focused on competency in a clinical sense and determining which research is useful/viable for practice. I am a big fan of stats/biostats classes, I feel they have value. NP school just tries to do too much without doing anything well.

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Specializes in Former NP now Internal medicine PGY-3.
43 minutes ago, Numenor said:

I don't think nursing knows what to focus on academics wise for NPs. Traditionally yes, grad school is research and paper-heavy, but NP school should be focused on competency in a clinical sense and determining which research is useful/viable for practice. I am a big fan of stats/biostats classes, I feel they have value. NP school just tries to do too much without doing anything well.

Yeah pretty much. Not sure how one can do all of the clinic stuff plus research plus policy plus all the other random things combined into a two year program ?

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Specializes in Psychiatry.
10 hours ago, Numenor said:

I don't think nursing knows what to focus on academics wise for NPs. Traditionally yes, grad school is research and paper-heavy, but NP school should be focused on competency in a clinical sense and determining which research is useful/viable for practice. I am a big fan of stats/biostats classes, I feel they have value. NP school just tries to do too much without doing anything well.

My unpopular opinion: NP school is "soft" on hard sciences because half of nurse practitioner students would fail out, nursing schools would have to be more selective, and their cash cow funds would dry up. The for-profit programs, if they required students to take hard science before/during the program would have almost no students.

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Specializes in Cardiology.

Im guessing it's because they aren't as selective as traditional NP schools. The sole purpose of them is to make money, not churn out quality NPs.

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On 9/27/2022 at 7:12 PM, MentalKlarity said:

My unpopular opinion: NP school is "soft" on hard sciences because half of nurse practitioner students would fail out, nursing schools would have to be more selective, and their cash cow funds would dry up. The for-profit programs, if they required students to take hard science before/during the program would have almost no students.

100% they would fail out. I even have seen people complain that simple patho and pharm were too intense on this forum. It's crazy. People want dumbed down convenience, not actual competency.

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Specializes in Clinical Research, Outpt Women's Health.

Totally agree with the last 3 posters. Money. I have worked with so many NP's over the last 3 decades and what a difference. Still some good ones, but much fewer and rarer.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
On 9/27/2022 at 2:59 PM, Numenor said:

but NP school should be focused on competency in a clinical sense and determining which research is useful/viable for practice

I totally agree!! I graduated from the distance program at a brick and mortar school that was also in the US News and World report rankings for NP school. I did research, thought I found a well respected program and was prepared to put in the work. What I got was crap.  In one semester I had a professor who started the class by telling us she was teaching four sections of the course, in addition to working full time AND working towards her DNP. I figure she had about 12 minutes a week for me. Her "feedback" on my care plans and patient write ups included not one bit of constructive criticism on the content, but she did take off a point because I wrote paragraphs instead of bullet points.

And the group work, the multiple freaking group projects every semester among nurses across the country working all different schedules. Some of them couldn't put together a cohesive argument to save their lives. It was a total joke. And the exams were 40 multiple choice questions that I think did nothing to give me any level of competence. The "lectures" were pre-recorded at least a few years ago and just replayed with the same modules every semester. 

I was fortunate that my clinical rotations were outstanding. My preceptors were challenging and interactive and I got their complete focus during my time with them. That's what made my education worth anything to me. I have friends at a local brick and mortar program and one of them was assigned a preceptor with THREE students at the same time. Limited personal interactions or actual teaching in that scenario. I have another friend who is paying $900 per semester for a preceptor. So many programs have drawbacks these days, even for people that are trying to get the best education they can at respected programs.

I made it through and now I am working in a critical care unit. They didn't ask about my school specifically. I had strong clinical references and I'm in a well structured orientation program that has been successful for years and involves more classwork with my training. I've also spent thousands of dollars on additional course materials, and hours tracking down relevant Youtube channels and references.

I will be successful despite my education, not because of it. 

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Specializes in Community health.

Yes yes yes. And ultimately the poorly-prepared NPs are going to accept starting salaries at less than RN wage (which is probably what they deserve) which is driving pay down for everyone, including the well-prepared! 

l am in a well-regarded B+M nonprofit school. My education has been lacking to some extent, but overall, my fellow students are extremely high quality and our professors are some of the best in the field. I cringe when I realize that a lot of employees are going to lump all NPs together, and will assume none of us know the first thing about practicing. 
 

It’s terrible that people who can’t write a sentence are getting As. That being said, I agree with another poster that writing isn’t a critical skill for an NP. I have some classmates who have English as a second language, so their papers aren’t at the same level as a native speaker. And I think that’s fine; it’s an MSN program, not a PHD. However, in your example, it’s obvious that poor writing skills are the tip of the iceberg. 

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Specializes in CRNA, Finally retired.
On 9/27/2022 at 2:49 PM, Tegridy said:

The odd thing is that writing seems to be the core competency that many programs use to see if someone is an adequate provider. I mean it is helpful for writing notes but does not really evaluate if someone actually “knows things” and can put those things to clinical use. 

Most of the above paragraph is describing the difference in paper writing. I would say that is not an adequate way to determine if someone is ready to practice medicine. 

Sloppy writing is reflective of a sloppy mind and a lack of attention to detail.  If you don't want to learn basic grammar and spelling, do something else that doesn't require reading.  It's grad school, not third grade.

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