DNPgrad2022

AANP and ANCC recently published their certification statistics for 2022. The AANP FNP pass rate dropped from 85% in 2021 to 75% in 2022. https://www.aanpcert.org/resource/documents/AANPCB 2022 Statistics.pdf The ANCC FNP pass rate remained steady with a pass rate of 85.9%, down slightly from 86.6% in 2021. https://www.nursingworld.org/~498ced/globalassets/docs/ancc/ancc-cert-data-website.pdf What happened? Did the ANCC's FNP board certification just become the easier exam? These passing rates are for INITIAL EXAMINATIONS (first-time test takers). Did you take the FNP board exam in 2022? All comments are welcome.

For a college that graduates a substantial majority of the RN and NP workforce and has a marketing budget that could support a small country, why is Chamberlain University not submitting their data for state or national ranking on US News Best Colleges and Graduate Schools? It would be more respectable if they allowed themselves to be evaluated and ranked at the bottom 5% than it is to continue to evade any reputable attempts to analyze the quality of their programs and student outcomes. Their BSN program holds a ranking of #661-681 out of 681 programs. In other words, dead last. https://www.usnews.com/best-colleges/rankings/nursing-overall?schoolName=chamberlain&_sort=rank&_sortDirection=asc I can only imagine that if they participated in the graduate school rankings that the result would also place them somewhere close to dead last. To be included in the ranking, they would have to submit REAL student data, acceptance and retention rates, faculty qualifications (education, experience, active status in practice), and first-attempt board exam passing rates. A quick Google search will show you how aggressive their multi-million-dollar marketing campaign is at redirecting negative publicity and statistics. The top 20-30 search results will directly link back to their Chamberlain website, even if you search for something mildly inflammatory like “Chamberlain University under investigation” or “Chamberlain nursing loses accreditation.” I’ll save you some time- I found nothing. This is not to say that US News Best Colleges is the best source of information for college rankings, but a revenue-generating school of this size should be willing to submit its data for review in a formal process that allows consumers to make an informed decision. https://www.usnews.com/best-colleges/chamberlain-university-6385/overall-rankings https://www.usnews.com/best-graduate-schools/top-nursing-schools/chamberlain-university-33617 If you want to review Chamberlain’s financial report from 2020, click the link below. It is a very lengthy read but quite interesting. While most college enrollments declined during the pandemic, Chamberlain’s enrollment soared! Make sure you check out their marketing, advertising, and recruitment expenditures. Good grief. https://sec.report/Document/0001558370-20-010728/

I find this statement from Chamberlain's website to be incredibly (and intentionally) misleading: NP Pass Rates The Overall Pass Rate for the FNP Exam for the 2019-2021 Calendar Years is 90.5% for all Chamberlain FNP programs and tracks. Instead of reporting the pass rate of a single year, as they have in previous years, they chose to report an "overall" pass rate for 3 consecutive years. I could be interpreting this incorrectly, but I think they are only counting those who passed eventually (second or third attempt) and intentionally omitted the statistics for those who passed on their first try. Why would they do this? Perhaps because the pass rate for first-time attempts is much lower, like 80% or less, and that would not be as marketable. If they group three years together, they can count everyone who failed their first attempt as a successful passer, assuming they passed the second or third time within the three-year period. Just an observation...

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.

#1. What do you want to do? I would like to do the job that I applied for, sir. What kind of question is this? I applied for a primary care nurse practitioner job. Why else would I be here? I could have applied for a job in housekeeping or neurosurgery, but I chose THIS job. What do I want to do? My job! Should I have recited the duties listed on the job listing? #2. What else do you want to do? Que creepy response from the twins in The Shining… I would like to work for you… forever…and ever…and ever. What does this mean? I want to go skydiving. I want to learn how to mold clay. Is it not good enough that I only want to do THIS job? I just graduated! Shouldn’t I get acclimated to this job before I start multitasking and pursuing other endeavors? Is this really the time to mention my bucket list of goals that include opening my own practice and not working under a physician? Seriously, what answer are they looking for? #3. What experience outside of nursing and clinicals do you have in Internal Medicine? This was a real question asked by a physician during an interview. What experience in Internal Medicine do I have outside of nursing and clinicals? Was he asking if I practiced medicine outside of nursing? Was he asking if I used recreational drugs? Did he think I was a drug dealer? I have supplied ibuprofen to my coworkers multiple times. Was he asking for my personal medical history? Should I have fabricated a story about an illness that required medical treatment and summarized my thoughts about the care that I received? My CV and resume did not mention any previous employment history involving administrative work for a clinic and I doubt he wanted to hear about my adventures in diagnosing mental illness in my customers while bartending in my twenties.

I recently graduated from a nurse practitioner (NP) program and experienced the infamous preceptor struggle that many students complain about. Like many NP schools, my school does not provide their students any assistance with finding preceptors. Students are expected to find practicing nurse practitioners or physicians willing to precept them for each of their required rotations. I expected the process to be more formal and not as desperate or pathetic as my predecessors described. I was wrong. Self-Directed Process To my disappointment, there was no magical database of potential preceptors to tap into when I started my search. There was no list of potential or confirmed preceptor "leads" provided by my school. The process was a self-directed solo mission and was eerily similar to how I perceive a telemarketing sales job would be. The reality is that most nurse practitioners and physicians do not want to precept a student. It takes time away from their workday tasks and all students are not receptive to teaching, nor are they motivated to work. My search to find a preceptor willing and available to precept me quickly became a full-time job of tedious administrative tasks. In the end, securing preceptors required an exhausting combination of sending emails and faxes with my resume and CV to various human resources departments, cold calling clinics and leaving messages with secretaries, and repeatedly asking (bothering) my healthcare colleagues for any potential connections. It was awkward, embarrassing, time-consuming, and often unsuccessful. Why is This MY Problem? I have to question how this practice of students finding their own preceptors is considered appropriate or normal. From a student's perspective, it is a menial task of imploring strangers to take an unpaid preceptorship to train you. From an institution's perspective, clinical education should be structured and consistent for all NP students, with required learning objectives that are supervised by educators employed with the school. In other words, how did this ever become the student's problem? The process of finding preceptors has become so difficult that some students are forced to delay their graduation date while others have had to pay up to $20 per clinical hour for preceptor-matching services to complete their residency. When students are solely responsible for finding their own preceptors, a culture of desperation is created, and the option to be selective is removed. Instead of electing preceptors by their qualifications or student reviews (few reviewing systems exist), students settle for any provider that is willing and available. The NP Program's only qualifying prerequisite for most preceptors is that they have acquired at least one to two years of clinical work experience. It is not uncommon for students to choose their friends or people they work with to precept them. Potential conflicts of interest did not appear to be a concern, as most NP programs prefer not to have any involvement in the student's search. This is not to say that all friend-turned-preceptor arrangements are bad, but are they appropriate? What's the Incentive? In student-arranged preceptor agreements, preceptors are not asked to follow any format when teaching an NP student. The preceptor provides background information and credentials to enter into a legal contract approved by the school, yet the direction and structure (if any) of the student's clinical time are up to the preceptor. There are no checklists of clinical skills that must be demonstrated during the student's residency. There are no student-specific protocols provided to the preceptor outside of general safety guidelines. The most well-intentioned preceptors may have heavy patient loads that prevent them from providing an adequate clinical experience for the student. The preceptor can give you as much or as little instruction and guidance as they choose. They are doing the student an unpaid favor, after all. Healthcare employers do not give preceptors additional time or smaller patient loads when they are training a student. Precepting is considered a volunteer-based commitment. There is no incentive for the preceptor's employer when permitting them to train a student. On the contrary, precepting may be seen as a hindrance to the employer, as the student's presence may be a distraction and impact the preceptor's productivity. My Experience I was fortunate enough to work with some outstanding preceptors during my residency, however, the clinical settings were less than ideal. My participation in residency ranged from strictly observing patient-provider interactions to taking patients independently and reporting my diagnoses and treatment plan to the preceptor. I did not have access to electronic medical records (EMR) in any clinical rotation. I was not given a login ID or a computer to use. No workspace was provided. Some of my preceptors shared their desks with me. In one 4–week rotation, I sat in a single chair, writing in a notebook on my lap in between patient appointments. My only method of documenting patient information was to jot down as many notes as possible on a notepad, which was a practice that seemed to make patients uncomfortable. I would then use what little information I had written to complete full-length, SOAP-style clinical notes when I returned home. My school required these full-length SOAP notes on every patient seen in clinical, including the patients I only observed. My preceptors did not have time to share vital signs and CPT codes, explain rationales and treatment plans, or give me more than a 10–20-second verbal report before we entered a patient's room. With an average of 15–20 patients per 8-hour clinical day, there was little opportunity for notetaking if I wanted to practice any hands-on skills. While I am grateful to have gained the writing skills to complete clinical notes without EMR, I am concerned that NP students learning under this precepting method will have little to no training when it comes to researching or incorporating past medical history when they get into practice. Access to EMR is essential to clinical learning and understanding. Unfortunately, I was not in a position to be demanding amenities like desk space and computer access. My residency experience is more common than not. The quality of the clinical experience is neither a priority nor a consideration in most programs. While my program required comprehensive clinical notes on every clinical patient, most programs have minimal writing requirements. Residency faculty are not concerned with the details of the student's clinical learning experience or the student's struggle to find and secure preceptors. I find this disconcerting given the high cost of tuition and program fees. Are program administrators not responsible for the quality of the clinical experience because they refuse to participate in or assist the student with the preceptor search? With other aspects of the NP curriculum being so rigorous, intense, and micromanaged, why is the clinical experience not held to the same standard? The clinical residency is just as important to a nurse practitioner's education as the coursework. The practice of precepting should be standardized to meet the objectives of the student's clinical residency experience. It makes little sense why some NP programs are not directly involved in and oversee this practice. Is it at all surprising that new NP graduates are entering the field unprepared? Precepting nurse practitioner students should be a PAID role and candidates should be screened for qualifications and interviewed in the same process used to hire other educators. Preceptors ARE educators. They educate students in clinical practice. They prepare students for the clinical setting in an environment with real patient interactions. Preceptors teach skills in residency that cannot be acquired from a textbook or a simulation lab. Precepting is a job, and it is an IMPORTANT job. All nurse practitioners do not possess the skills to be good preceptors. All clinical sites and settings are not ideal for teaching NP students. FACT: It is time that NP programs recognize the importance of the preceptor's role and provide their students with PAID preceptors who are invested in the student's clinical experience and held to the same performance standards as other course instructors.

Realistic timeline from NP graduation to employment? I wanted to share my experience with the current process of graduating from NP school. I recently finished a BSN-DNP program in the Summer 2022 semester. The four-year, part-time track for my program was structured so that the didactic courses and clinical hours were completed by year three and the last three semesters were dedicated to Capstone-specific courses. This structure allowed me to apply for and take the AANP board exam a bit sooner, as my core courses and residency hours were finished and graded before my actual graduation date. I applied for the AANP board exam in late May. I received permission to schedule my exam on 7/1/22. July was an insanely busy month for my DNP-FNP cohort, as anyone who has ever completed a major Capstone project and presentation will tell you. While other students were focusing solely on Capstone activities, the overachiever (and often irrational) side of me decided that I could complete my program and pass my board exam in the same week. I ignorantly thought that passing the board exam early would expedite the process of getting certified, licensed, and employed as a nurse practitioner after graduating. With little sleep or sanity, I passed my board exam on the first try on 7/11/22. Fast forward to today, 9/10/22. I STILL do not have my certification from AANP. Why? Well, allow me to explain the painfully slow process of how this works. Even though my DNP cohort finished in mid-July, my school does not award degrees until the end of the semester. My “official” graduation date, AKA the “degree conferred” date, was 8/6/22. Does that mean that my school automatically awarded my degree and transcripts on 8/6/22? No. It takes 4-6 weeks AFTER the graduation date to receive an official transcript that can be electronically sent. After 3 weeks of impatiently waiting, I was able to get the registrar to release my official transcripts so that they could be electronically sent to AANP. Another week later, I received confirmation that AANP finally received my official transcript, however, it would take another 15-20 business days for the official transcript to be processed. That takes me to 9/20/22 IF my transcript is processed by the 20th business day. Talk about frustrating! What happens after the AANP certifies you? Is that the end? Nope. Once you have your certification from AANP or ANCC, you can apply for your license. Depending on the state, this could take anywhere from 2-8 weeks. I hope patience is one of your virtues, otherwise, you may need some meditation and yoga to get through this! Let’s assume that you finally have your license and that everything I have described thus far is complete. Are you finished and ready to receive your first paycheck as a new nurse practitioner? Nope. There is still the process of CREDENTIALING. All healthcare organizations have a credentialing and/or “onboarding” process. How long does that take? Anywhere from 1 to 3 MONTHS. I wish I were kidding. You may be able to get paid before you are credentialed with your new employer, but you may also be forced to wait until you are fully credentialed to start earning an actual paycheck. Some of you may not think that 3 to 4 months is a long time to transition from an RN position to an NP position after graduating. I have heard stories from some of my NP friends that it took 6 months to almost 2 years to find an NP job. Personally, I have had the opposite experience. I have received a job offer from 11 out of 12 employers that I have interviewed with and lost out on three of the opportunities because they needed someone available to start immediately. At this time, I cannot say with certainty when I would be available to start anywhere. These estimated time frames that I have been given are just that- estimated. If the pandemic has taught us anything, all things labeled “estimated” are subject to change and be delayed. I will be posting an update when I have one. If you have had a different experience or if you have any advice on how to speed up this process, please share your thoughts in the comments!