Schools that require you to find a preceptor (rant)

[Telenurse1990]

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.

[Telenurse1990]

I'm aware that NPs are not physicians, but the lines do cross....I mean, when i get surgery I dont really care who's administering my anesthesia. I want a provider (MD, CRNA, DO, AA) thats competent and well educated, regardless of their official title. Thats my point. We're not held to a lesser standard when we are actually in practice, so why should our schooling be that much less rigorous? I mean, there's literally barely any standards for some of these programs.....

[Telenurse1990]

Which is why I personally don't think they should operate in Nashville. It's an absolute slap in the face to students to make them cold call like a telemarketer to find some place to allow them to complete their clinical. It's a money making scheme for schools to operate like that. What exactly is the school doing for you if their not monitoring the quality of your clinical (which is basically the meat of your program)and making YOU do all the work?

[Telenurse1990]

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.

There will always be a shortage of providers in smaller more rural towns. I have yet to meet a nurse practitioner that went unemployed for longer than a few months.

[djmatte, ADN, MSN, RN, NP]

Which is why I personally don't think they should operate in Nashville. It's an absolute slap in the face to students to make them cold call like a telemarketer to find some place to allow them to complete their clinical. It's a money making scheme for schools to operate like that. What exactly is the school doing for you if their not monitoring the quality of your clinical (which is basically the meat of your program)and making YOU do all the work?

There's different degrees of "setting up your own clinical". My school required uggs to find a preceptor. Once we made contact and they agreed, the school handled everything from there including contacts, site inspections, etc. They checked the site before we showed and while we were there. They also maintained contacts with some preceptors and provided these lists, but it was still up to us to make the calls and hope someone had an opening. I can't speak for other schools, but while reaching out was a hassle, it certainly didn't negatively impact the quality of clinical sites.

[Telenurse1990]

There are services out there that charge students to find clinical sites. It's insanity. One of them charges 12.50 hour....if you times that by 650 hours, you're well over an additional 12,000 on top of your tuition. Idk. I just didn't realize all this before I had started to apply. I always knew there were online components to these schools but I didn't realize how lackluster the programs were.

[BostonFNP, APRN]

I agree with you that there are several failures in NP education right now, and that those are affecting both students and practicing NPs.

Re: preceptorships. I don't know of a single NP program that would tell students that perceptorships are not vitally important to their preparation, yet many programs (good programs included) have moved away from securing quality preceptorships. There is only one explanation for this and it is money. Perceptorships have become the largest bottleneck for NP programs and rather than admitting less students or hiring more clinical placement laisons, programs have decided that they have plenty of students applying so they can just transfer that responsibility on to students. There is no way to argue that this is good practice, but even quality programs have gone this route. You can not judge quality of program by this factor alone, though I would argue that if a program does secure preceptorships than it is more likely than not to be a quality program (and probably also more expensive of a program).

Re: B&M vs online vs hybrid programs. Again, quality of a program can't be judged on this alone. The didactic learning can take place online and there is some research to prove this. Synchronous vs asynchronous is another debate and it does seem most quality program use synchronous, or at least a mix of the two. I believe (having taught both in traditional B&M and in a hybrid/online model) that there are intangibles to B&M learning which are important to the overall preparedness of novice NPs, but I don't have any hard data on that. Site visits can be more (skills workshops, H&P demos, simulations, etc) or less (administrative, orientation, social) useful for students. I do believe that technical skills can be learned post-graduate.

Re: experience. This we disagree on, at least as something mandatory. Working as an RN shouldn't be a "holding pattern" for those wanting to move to the APRN role (like post-docs in academia). There is also a misconception that there is a progression of expertise from novice RN to expert RN to novice NP to expert NP; RN expertise is independent of NP education/experience/expertise. In my professional experience there have been students without RN experience that definitely need to get some before graduating as an NP (though to be fully honest they were probably not going to be great RNs either) and some expert and experienced RNs that no amount of experience/expertise was going to make them a good NP. Having taught students and hired/trained novice NPs I have never felt I could accurate predict their successful role transition based on their prior RN experience (or lack of). I admit I likely have some bias on this issue because I only work with a single high-quality NP program that has very strict/competitive admissions criteria for their direct-entry students.

In the end, there are lots of crappy programs out there that should be shut down to make room for the quality programs. I am willing to wager if we dropped the bottom 1/3rd of NP programs, the quality programs would go back to controlling preceptorships and students would get a better education. It['s hard to shut these programs down when they are making lots of money and have plenty of students to fill the coffers. It needs to come either from regulatory side with pressure from practicing NPs or by increasing the difficulty of the board cert exams.

[FullGlass, BSN, MSN, NP]

I'm sorry for your frustration. However, there are plenty of high quality NP programs that do provide preceptors. There is nothing stopping you, or anyone else, from applying to those programs. With regard to RN experience: RN experience is indeed required for acute care and oncology NPs. Some NP schools do not require RN experience for primary care NP programs because the existing evidence indicates it does not impact academic or clinical performance. However, admissions standards for NP students w/o RN experience is generally more stringent for high quality NP programs.

[elkpark]

It needs to come either from regulatory side with pressure from practicing NPs or by increasing the difficulty of the board cert exams.

Or from students choosing to avoid low-quality programs, but apparently that's just too much to hope for.

[Jules A, MSN]

Interesting to see the change in nursing faculty opinions of NP programs in recent years.

[lwsoccjs]

Or from students choosing to avoid low-quality programs, but apparently that's just too much to hope for.

It's never going to be students avoiding low-quality programs. The boards are a very low barrier to entry allowing most to graduate/pass/ & get placed into the job market. People will continue to want what they want with as little work as they can get away with. Students will go anywhere they are accepted, and as we have seen with the proliferation of schools, the establishments are more than willing to oblige. So without either A) Better education to corporations of the difference in rigors of different schools B) legal C) accreditation D) or changes in barrier to entry (exam, etc) it will continue to stay the same or get worse.

[BostonFNP, APRN]

Interesting to see the change in nursing faculty opinions of NP programs in recent years.

Even good programs really struggle with maintaining faculty. Quality programs know that they need their faculty to be practicing providers but most NPs can make (far) more in clinical practice than teaching and very few practicing providers have an "extra" 30-40+ hours a week to be a full time faculty.

[BostonFNP, APRN]

It's never going to be students avoiding low-quality programs. The boards are a very low barrier to entry allowing most to graduate/pass/ & get placed into the job market. People will continue to want what they want with as little work as they can get away with. Students will go anywhere they are accepted, and as we have seen with the proliferation of schools, the establishments are more than willing to oblige. So without either A) Better education to corporations of the difference in rigors of different schools B) legal C) accreditation D) or changes in barrier to entry (exam, etc) it will continue to stay the same or get worse.

Which boards did you take, out of curiosity?

The AANP and ANCC FNP pass rates are in the 75-85% pass rate historically. In comparison the USMLE step 1 is low-90%, step 2 is 98%, step 3 is 91-98%, but there is a much more competitive and rigorous admission criteria. I often worry (having taken both the AANP and ANCC exams) that the 20+% failure rate is indicative of a problem with grossly incompetent people qualifying to take the boards rather that rigorous examination.

There is another solution: practicing NPs start refusing to precept subpar program students. I sent one student away his first day and tbh it wasn't his fault (I had agreed to take a student from the program because the program paid $1500/semester): he showed up ad had never had a single graduate class on how to do a proper H&P. He couldn't do a physical exam or elicit a history. I don't have time in practice to teach that and see patients.