Oversupply of Nurse Practitioners

[guest416560]

I recently received a published form from the State of Florida showing that ARNPs increased 22% over the past two years. RNs only increased by 7.4% If you are a new grad wondering why you can't find a position here is your answer. Our NP mills have pumped out too many graduates for the demand of society. I don't have the data to back it up but if this is happening in Florida I would assume it is happening around the nation.

I'm licensed in Florida but moved to California years ago because I could see the tsunami of new graduates slowly starting to erode the wages of established NPs. It's now happening here in California and I have been directly affected. I can count at least another dozen of my NP colleagues around the nation who are complaining of wage deflation happening because new grads will accept a position at almost any wage. Starting wages are below those for RNs in some cases.

For those of you thinking of becoming a NP think and long and hard before you commit your money and your time. The job is enjoyable but the return on investment is declining year after the year with the flooding of the markets. Maybe one day the leaders of our nursing schools will open a book on economics and understand the relationship between supply and demand rather than stuff another useless nursing theory down our throats.

[ThePTNurseGuy, DNP, NP]

@FullGlass: I appreciated the points you made. There were was a lot to dissect in your post, but I'd like to clarify the following:

1. I am not suggesting that we add more classes on TOP of the curriculum. I am proposing an updated curriculum that meets the demands of being a provider. If you have a BSN and an MSN, then you know that there are a number of classes that are considered fluff. You could have easily removed some of those classes with more substantial topics like the ones I mentioned. No extra cost. Frankly, I am thankful that I received my doctorate in physical therapy, because it was very medical science-heavy and it provided an excellent framework for nursing school later on. Are you already practicing or are you currently in Hopkins for NP school?

2. I am all for residencies; I did a full time orthopedic residency at the University of Chicago for PT. I think these types of programs are great for the profession. PT, Pharm, PA, OD, DPM, MD/DO, etc. all do it. There's no reason why NPs shouldn't have more programs like this. There are some fellowships programs but there aren't that many of them.

3. While I agree with your 'survival of the fittest' mentality, I don't think it changes the fact that opening more mediocre schools is healthy for the profession or beneficial for the population that we serve. Healthcare education isn't a field where we should settle for mediocrity. I went to George Washington University in D.C. You went to Yale. I went to University of Chicago for residency. You went to UCLA for management. We both went/go to good schools, but I still think it's a terrible idea to open more schools. Are you arguing for unchecked exponential NP growth? Where's the ceiling? Do you consider no limit most optimal? I don't. The number of new grads has never decreased from one forward year to the next. It is increasing quite steadily (and will continue to do so with more schools opening). It waters the profession down. What good is 500,000 NPs when there are already close to 300,000 vying for limited positions? There's a reason why most physicians can get a job almost anywhere; moreover, they can leverage higher salaries. Why? They've received more training and there is substantially less of them. If you made medical school easy to get into (like NP school), there would be a lot more physicians and salaries would go down. NPs are already having a hard time finding jobs, which is a huge problem. Why? Because when they finally come across a low-paying job that will take them, they seize the opportunity. They take a lower salary, and that has substantial implications for the next wave of NPs that are desperately looking for jobs. It's a domino effect and it isn't easy to fix once the pieces are in motion. These NPs who take a low paying jobs not only screw themselves over, they also screw their colleagues over down the line. You might argue it's their own personal fault. I would partially agree with that. But I would also argue that part of the problem is the plethora of NPs.

[Oldmahubbard]

I was told there was a glut of NP's in the area when I graduated in 2003. A few months later, I took a job at RN pay.

Since that time 3 more NP programs have been opened within 50 miles of my house.

[myoglobin, ASN, BSN, MSN]

One possibility would be becoming an NP instructor.

[ZenLover, MSN, RN, NP]

While I agree with making standards tough, standardized testing isn’t it. This is why top programs want to see a “well rounded” candidate. A psychopath can pass a GRE with flying colors. Do you want a psychopath treating you? It is one piece of a very complicated puzzle.

I grew up very poor, no parents. I will be starting a BSN-DNP program at a very reputable brick and mortar institution. Name does matter. The name attracts the best teachers, the most funding for scholarships and the best job opportunities.

Online and for profit institutions can just churn out graduates. Some of these graduates are in need of easy access for all kinds of reasons, but they will have to work harder to network and find preceptors.

It has a been a long road for me, but one thing is clear. No one bypasses the work of making rubber meet road. You either do that to get into a well known name brick and mortar or you do it after going to a for profit on-line to prove to everyone you can do it even though you went the “easy” way.

Starting with grade school however....standardized testing doesn’t tell you jack. I took the GRE and had the scores available if needed, but my “public Ivy League” didn’t ask for them and I was able to meet the other standards.

At the end of the day there is a nurse and provider shortage because so many people can do the academic work, but they can’t do the real life work. The burn out, leave, try for higher education and find out the problems only get more complicated to solve as you climb....academics isn’t where the litmus test is applied. Real life is, always. In any case, if anyone thinks they can help and are smart enough to try we need to help them do it because we all know that all the help in the world is needed right now....

[myoglobin, ASN, BSN, MSN]

Even very highly acclaimed Universities like Duke do not guarantee that they will find you a preceptor locally (I know because I asked them when I was thinking about applying there). The reality is that most working adults who have families will need to "stay some what local" for most of their graduate education and that means finding their own preceptor. Also when you find your own preceptor you have more opportunity to control the hours that you are have to be in clinical. How many of you during your ASN or BSN degrees (when preceptors are often provided) had the ability to control your own hours? You also have greater opportunity to find "the right" preceptor for your unique personality. There is also something to be said for the social business skills along with motivation involved in finding a preceptor. I have no problem with those who choose to attend schools that provide preceptors, but do not denigrate those of us who choose (or must) go a different route.

[ThePTNurseGuy, DNP, NP]

@ZenLover thanks for sharing your thoughts on the subject.

I agree that standardized testing, in of itself, does not paint the whole picture by any means. There is so much more to an ideal candidate than a GRE score. Though, I do find it interesting that it is essentially the only healthcare profession that does NOT require testing of any kind. I take issue with that, because that automatically opens up another layer of candidates that may not be academically qualified. I’ve talked to with my wife who is a pharmacist about this, but we’re both amazed at how bad some nurses are with critical thinking skills. Some even have a hard time doing basic medication calculation: that’s pretty embarrassing when lives are at stake. I understand that there are bad apples in every bunch, but you inherently have more bad apples with lower standards. There’s no absolutely no way to argue against that: no GRE/standardized test, a 3.0 gpa, lower requirements for admission etc all lead to increased variance in the profession. I do believe emotional IQ and communication skills are JUST AS (if not more) important; however, to say these other objectives measures don’t matter is simply not true.

[ThePTNurseGuy, DNP, NP]

23 minutes ago, myoglobin said:

Even very highly acclaimed Universities like Duke do not guarantee that they will find you a preceptor locally (I know because I asked them when I was thinking about applying there). The reality is that most working adults who have families will need to "stay some what local" for most of their graduate education and that means finding their own preceptor. Also when you find your own preceptor you have more opportunity to control the hours that you are have to be in clinical. How many of you during your ASN or BSN degrees (when preceptors are often provided) had the ability to control your own hours? You also have greater opportunity to find "the right" preceptor for your unique personality. There is also something to be said for the social business skills along with motivation involved in finding a preceptor. I have no problem with those who choose to attend schools that provide preceptors, but do not denigrate those of us who choose (or must) go a different route.

You’re not choosing anything: they’re forcing your hand (and others) by making you find preceptors. That should be built in the tuition. I can’t tell you how many people have had to delay graduation (or simply not graduate) because they couldn’t find any preceptors. There is no profession in all of healthcare that does this. They’re not doing this as a favor to you. You’re trying to see the good in the situation, which is noble, but that is not the rationale for why they do this. It is simply laziness, and with no checks and balances, there is no reason for them to try harder. In PT, there were multiple clinics and locations that you could pick from and research which you believed would be the best fit. It is HARD to find preceptors, but the clinical education coordinator does everything in their power to lock down clinical rotations.

What you’re asking for is not mutually exclusive to what should be expected of them. Don’t give them the benefit of the doubt. You are right that higher institutions do not guarantee preceptors. However, a lot of the prestigious universities have 5-10 year contracts with clinics/hospitals across the country. That makes it easy for students to lock down older preceptors that were used and mitigates any delay with contracts.

[myoglobin, ASN, BSN, MSN]

5 minutes ago, ThePTNurseGuy said:

@ZenLover thanks for sharing your thoughts on the subject.

I agree that standardized testing, in of itself, does not paint the whole picture by any means. There is so much more to an ideal candidate than a GRE score. Though, I do find it interesting that it is essentially the only healthcare profession that does NOT require testing of any kind. I take issue with that, because that automatically opens up another layer of candidates that may not be academically qualified. I’ve talked to with my wife who is a pharmacist about this, but we’re both amazed at how bad some nurses are with critical thinking skills. Some even have a hard time doing basic medication calculation: that’s pretty embarrassing when lives are at stake. I understand that there are bad apples in every bunch, but you inherently have more bad apples with lower standards. There’s no absolutely no way to argue against that: no GRE/standardized test, a 3.0 gpa, lower requirements for admission etc all lead to increased variance in the profession. I do believe emotional IQ and communication skills are JUST AS (if not more) important; however, to say these other objectives measures don’t matter is simply not true.

I disagree that becoming an NP "does not require standardized testing of "any" kind:

a. Most nurses took the ACT or SAT to get into their primary programs. Many also took the TEAS test.

b. All RN's must also take the NCLEX, all NP's must also pass the board exams.

c. Many NP programs do require the GRE, and many do not.

d. Almost all RN programs involve extensive dosage calculation quizzes in the program.

[ZenLover, MSN, RN, NP]

10 minutes ago, ThePTNurseGuy said:

@ZenLover thanks for sharing your thoughts on the subject.

I agree that standardized testing, in of itself, does not paint the whole picture by any means. There is so much more to an ideal candidate than a GRE score. Though, I do find it interesting that it is essentially the only healthcare profession that does NOT require testing of any kind. I take issue with that, because that automatically opens up another layer of candidates that may not be academically qualified. I’ve talked to with my wife who is a pharmacist about this, but we’re both amazed at how bad some nurses are with critical thinking skills. Some even have a hard time doing basic medication calculation: that’s pretty embarrassing when lives are at stake. I understand that there are bad apples in every bunch, but you inherently have more bad apples with lower standards. There’s no absolutely no way to argue against that: no GRE/standardized test, a 3.0 gpa, lower requirements for admission etc all lead to increased variance in the profession. I do believe emotional IQ and communication skills are JUST AS (if not more) important; however, to say these other objectives measures don’t matter is simply not true.

I understand your concerns and agree. I took the GRE. The GRE doesn’t test critical thinking under pressure like actual critical care nursing does. You can have a 4.0 and completely lack common sense and critical thinking. If you can memorize you are golden with most tests. Or you learn the test, practice and practice, and there you have your high score. Your resume, your references and your essays should speak volumes. I have seen the same thing at the bedside you have, and I have to wonder who wrote their essays for them....but we have idiots sitting behind benches that went to Harvard, so....I don’t know what the fix is.

[myoglobin, ASN, BSN, MSN]

15 minutes ago, ThePTNurseGuy said:

You’re not choosing anything: they’re forcing your hand (and others) by making you find preceptors. That should be built in the tuition. I can’t tell you how many people have had to delay graduation (or simply not graduate) because they couldn’t find any preceptors. There is no profession in all of healthcare that does this. They’re not doing this as a favor to you. You’re trying to see the good in the situation, which is noble, but that is not the rationale for why they do this. It is simply laziness, and with no checks and balances, there is no reason for them to try harder. In PT, there were multiple clinics and locations that you could pick from and research which you believed would be the best fit. It is HARD to find preceptors, but the clinical education coordinator does everything in their power to lock down clinical rotations.

What you’re asking for is not mutually exclusive to what should be expected of them. Don’t give them the benefit of the doubt. You are right that higher institutions do not guarantee preceptors. However, a lot of the prestigious universities have 5-10 year contracts with clinics/hospitals across the country. That makes it easy for students to lock down older preceptors that were used and mitigates any delay with contracts.

How would they (my school) accomplish this? There are only about 5 psychiatrists (practices) within 60 miles of me and only two even take students. The chances of my school in Indiana being able to convince one of those five to take students is virtually zero (even we extended the radius out to 100 miles the odds are very low). Indeed, where I am currently doing clinical only took me because I both wroth and visited their office (I was persistent, a bit like a pharmaceutical rep). It is even harder for those students who must find a PMHNP to do a portion of their clinical hours with since there seems to only be about 20 in the state of Florida (and all of these must work with a psychiatrist from whom they would have to obtain permission to precept a student lowering the odds further). If finding preceptors was a requirement for school many adult/working learners would be de facto excluded.

[ZenLover, MSN, RN, NP]

You bring up good points about why more educators in certain specialties are needed and what happens when you have a lack of providers in certain specialties to provide preceptorship and mentor ship. Mental health providers are needed everywhere. A school can’t magically make providers appear or make them become preceptors. The other option is not to offer the program...but mental health is so badly needed in every community. It does make you wonder what the answer is and thankfully you are finding a way through it so perhaps you can also help others.....

[myoglobin, ASN, BSN, MSN]

2 minutes ago, ZenLover said:

You bring up good points about why more educators in certain specialties are needed and what happens when you have a lack of providers in certain specialties to provide preceptorship and mentor ship. Mental health providers are needed everywhere. A school can’t magically make providers appear or make them become preceptors. The other option is not to offer the program...but mental health is so badly needed in every community. It does make you wonder what the answer is and thankfully you are finding a way through it so perhaps you can also help others.....

I believe my school (University of Southern Indiana) is a blessing in that they only charge around $400.00 per credit hour, and they do not "up charge" for out of state residents. Also, unlike many programs they do not show an overt preference in admissions for students who did their undergraduate course work at USI. Most schools that offer distance education will be hard pressed to find preceptors. If this becomes a regulation it may actually favor "for profit schools" since they will be well positioned to "pay" practices for student placement much like St George's in Grenada does for medical residencies (in the United States). Indeed, you probably have a better chance at securing a residency if you graduate from St. George's than you do if you graduate from a mid tier United States medical school despite St. George's being considered "lower tier" in terms of academic competition. The lower cost, non profit state schools will likely find themselves "priced out" from clinical spots while the for profits "lock" up the market (then they will raise fees even higher).