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.
