Schools that require you to find a preceptor (rant)

Jules A, MSN · May 11, 2018

Add to your rant and consideration of what is presently being seen in many areas and has been predicted to be an upcoming saturation of the NP market.

"In 2025, no state is projected to have a shortage of primary care NPs. Projected surpluses

range from less than 100 FTE NPs (4 states and the District of Columbia) to 5,350 FTE

NPs (Texas). Thirteen states are projected to have a primary care NP surplus in excess of

1,000 FTEs in 2025."

https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf

djmatte, ADN, MSN, RN, NP · May 11, 2018

The only thing I disagree is the idea that finding your own preceptor translates to "low standards". In an online environment having minimal requirements for clinical quality is what translates to good standards... Not who finds the site. They need to be conducting site visits both before and during the students stay and have sound experience requirements. I knew Georgetown students who had complaints about one or two of their clinical site qualities. I remember sharing a site with one who never had someone show up to evaluate the site while I had someone come out twice. Quality resides in the standards the school sets. I liked Georgetowns in class requirements. It's similar to my schools and while we don't have to show up for exams we absolutely had a camera based exam proctor and needed to show up for clinical skills exams before we could start clinicals. But as stated, just because you had to find the site doesn't make the program bad.

ImmaNP · May 11, 2018

Thank you for sharing that 2025 projection Jules. So analyzing that data, I don't know if any nurse would venture into becoming a nurse practitioner (primary care at least). In 2025 all, states are expected to have a surplus along with most states having a PA surplus as well. Obviously, we don't know what changes can occur by 2025 but the continued supply of primary care nurse practitioners at this rate will drastically change the job landscape. Instead of retaining quality NPs, who is to stop employers from just having a warm body and pay minimally. The cream always rises to the top, but what happens to the average NP when their salary is less than RN but with more responsibility. I know this is happening already, and I remember someone mentioning our profession going down the same road as lawyers in the past, with a vast oversupply. The data really scares me being a FNP, but I challenge all prospective NPs to research and make an informed decision instead of defaulting to "I might as well become a NP."

Jules A, MSN · May 11, 2018

Obviously, we don't know what changes can occur by 2025 but the continued supply of primary care nurse practitioners at this rate will drastically change the job landscape. Instead of retaining quality NPs, who is to stop employers from just having a warm body and pay minimally.

This is already the case in with regard to employers. They are covered by hiring someone licensed with the expectation they are competent due to said licencure which as we all know isn't always the case. Employers however really could care less in my experience.

lwsoccjs · May 11, 2018

I'm currently applying for NP school and I need to vent about a few things.....
1. It's unacceptable that a school requires students to find their own preceptors. Ridiculous, unacceptable, they should not even be in business (traditional or for profit). If I'm going to pay over 30,000 (on the low end) for an education and have to find my preceptors, what is it i'm paying for exactly? For the love of god, stop applying to these schools. I know someone personally who literally cannot find a preceptor in his area and is about to quit the program due to this. His school offers very little if any support.
2. I hear nurses gloat about programs that don't require any campus visits and have no mandatory login times. You are training to do the same job as a physician. Literally. I would never attend a program that required as little as possible from it's students. You are training to operate in a similar fashion to a physician, but are excited about doing a fifth of the work.... I have only applied to schools with live class rooms and login times for actual classes. I don't understand the appeal of a school advertising that they expect almost nothing from you. Georgetown (despite it's outrageous cost) is an example of an online program I would deem acceptable (I also know a few of their grads that are working and very competent NPs) because of it's login times, finding clinical placement and campus visits.
3. For the love of god, get some experience. Stop filling up schools with new grad RNs with less than 1 year of irrelevant experience. I've been a nurse for nearly 8 years, and I still considering waiting until the 10 year mark. It's just so crazy that people with no experience go to NP school. I'm sure there are some great ones out there, but I haven't met any that weren't RNs for years.
I know this post comes across as "angry" but i'm just frustrated with the low standards that the NP profession has adapted. I was so excited to apply. I did my time on the floor, worked really hard in my specialty and I believe i'm a qualified candidate. When I started researching and seeing what the standards are, it just aggravates me. I know some wonderful NPs out there who are very capable providers. I feel that the low standards are ruining it for the future of the profession. It just seems like these programs care about the money rather than graduating competent NPs. This whole experience has had me considering re-taking my science classes and applying for PA school.
Anyways, any open discussion is appreciated.

I am on my iPad so I'll come back to write full response. But in short if you want a better education go the PA route. Especially if you want to do primary care. The consensus on specialty practice being better trained in the Np realm has it's merits but PA's are definitely better trained as a generalist which essentially is what a primary care provider is. Do not make the mistake of thinking it will get better. Being an RN it is quicker to do the NP, and with the experience you probably have the ability to fill in the gaps that NP school lacks. But, make no mistake PA school prepares you and challenges you more. Of course there are poor apples in both corners but one grossly overshadows the other. With the future over flood of NP that now double PA numbers just consider last year 23,000 NP graduated, compared to mid 6,000 PA each year. It's scary times to be a future NP.

guest416560 · May 11, 2018

The oversupply is here. Even where I work in an extremely rural area wages are starting to decrease because of "warm bodies" who will accept any job. It's just a matter of time when NP wages will be equal to or less than RN wages as an average. That time is in matter of less than a decade. Hold on, it's going to be a bumpy ride.

Dranger · May 11, 2018

Preaching to the choir. This what happens when profit is worth more than quality and there are NO barriers to entry. Just going to get worse.

The dagger needs to be held at the throat of the schools who overemphasize degrees inflation to young BSNs (they pretty much expect you to at least get MSN and now have an obsession with the DNP) and have 0 pre-req standards. My program at least required a year of ICU experience. Thank goodness.

bryanleo9 · May 11, 2018

I agree, it is outrageous to charge $40k and except your students to have to cold call all over town begging for a preceptor. It gets worse for male students during the OB/maternity course. There chances of getting placement are near 1%. All the stress of class and worrying you won't find a preceptor is too much. I have read too many stories of how people could not proceed because of this issue.

mmutk, BSN, RN, EMT-I · May 12, 2018

I understand what you are saying. However since I go to a school in alabama online and practice in Nashville, I don't really expect them to find preceptors for me up in Nashville...

Rathyen · May 12, 2018

You are training to do the same job as a physician. Literally.

This quote is exactly why the AMA and physicians look down on nurse practitioners so much. We do not do the same job as a physician. We are nurse practitioners, nurses with advanced training to use the nursing process to provide primary care for our patients. Please do not add fuel to the fire and give physicians and the medical association more reason to hate NPs, they spend enough money on lobbyists to prevent us from working to our full potential as it is.

FullGlass, BSN, MSN, NP · May 13, 2018

Add to your rant and consideration of what is presently being seen in many areas and has been predicted to be an upcoming saturation of the NP market.
"In 2025, no state is projected to have a shortage of primary care NPs. Projected surpluses
range from less than 100 FTE NPs (4 states and the District of Columbia) to 5,350 FTE
NPs (Texas). Thirteen states are projected to have a primary care NP surplus in excess of
1,000 FTEs in 2025."
https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/primary-care-state-projections2013-2025.pdf

Not necessarily true. Some states have done their own projections, like California, and they will have an NP shortage at least until 2030. In addition, there is acute distribution problem. Most of California outside of San Francisco, Los Angeles, and San Diego has a severe provider shortage of all types (MD, NP, PA). There are low cost of living areas that will pay as much or more than the expensive coastal cities. I would advise potential NPs to carefully research job opportunities and pay and consider moving if necessary, especially for their first NP job.