Shortage of Nurse Practitioner Preceptors

[ashonman]

Is there a national shortage of Nurse Practitioners who are willing to precept? I am finding it very difficult to find a preceptor, MD's are very quick to offer what they have, unfortunately as a NP student I have to have a FNP/NP for at least 50% of my 704 hrs. As Nurses/NPs we are asking and fighting for autonomy but not willing to help train more NPs to fight this cause. It is so easy for PA's to have their rotations lined up for them but can not do that for nursing? I am seeing more and more schools (Not just online schools) shifting that responsibility onto students. I love my school, great state school; but this issue of finding preceptors on our own bothers me, and they tell you today, when school starts in 10 days. However, if we are unable to find one, then "the school will step in". I just don't get it! I taught undergrad was difficult with unreasonable demands, but graduate school too? Are nurses in a way still eating their young? or now they are just putting hot sauce on it!

[mystory, BSN, RN]

What on earth does a shortage of preceptors have to do with "nurses eating their young"? I don't see the connection there, but I do have a few thoughts on the shortage of advanced practice nurse preceptors.

1) APNs need to be incentivized to precept students. Our colleagues in medicine are paid to precept and train students, why are NPs expected to volunteer their time and expertise? Many are paid according to how many patients they see, and stopping to teach a student and answer questions directly cuts their pay.

2) Schools that do not place students clinically should have their accreditation suspended. I have seen their students' pleas on allnurses for preceptors and how their futile search has delayed their graduation, led to failed courses, loss of money, etc... it is quite heartbreaking. And I don't know if the schools are shameful or shameless, but I do know they are scams.

[myelin]

I agree that schools that don't provide their students with clinical placements are scams. But it goes both ways. As long as students keep choosing to attend these programs, they will continue to exist and be a huge problem.

[Corey Narry, MSN, RN, NP]

As I said before, it boils down to loose standards that nursing seems to think is good enough. CCNE accredits all baccaleaureate and graduate programs in nursing including master's and DNP with nurse practitioner foci. Per CCNE's accreditation standards, a short blurb that addresses preceptors states:

When used by the program, preceptors, as an extension of faculty, are academically and experientially qualified for their role in assisting in the achievement of the mission, goals, and expected student outcomes.

Elaboration: The roles of preceptors with respect to teaching, supervision, and student evaluation are clearly defined; congruent with the mission, goals, and expected student outcomes; and congruent with relevant professional nursing standards and guidelines. Preceptors have the expertise to support student achievement of expected learning outcomes. Preceptor performance expectations are clearly communicated to preceptors.

Who wrote these things? I mean, how general can that statement be? any school will easily pass accreditation with no resources whatsoever in finding preceptors for their students if all CCNE asks for is the above.

Now, contrast that with the accreditation standards set forth by the Liaison Committee on Medical Education (accredits all allopathic medical schools) which details the following:

C. Clinical Teaching Facilities

ER-6 The medical school must have, or be assured use of, appropriate resources for the clinical instruction of its medical students. Clinical resources should be sufficient to ensure breadth and quality of ambulatory and bedside teaching. They include adequate numbers and types of patients (acuity, case mix, age, gender, etc.) as well as physical resources.

ER-7 A hospital or other clinical facility that serves as a major site for medical student education must have appropriate instructional facilities and information resources. Appropriate instructional facilities include areas for individual student study, for conferences, and for large group presentations (lectures). Sufficient information resources, including library holdings and access to other library systems, must either be present in the facility or readily available in the immediate vicinity. A sufficient number of computers are needed that allow access to the Internet and to other educational software. Call rooms and lockers, or other secure space to store personal belongings, should be available for student use.

ER-8 Required clerkships should be conducted in health care settings where resident physicians in accredited programs of graduate medical education, under faculty guidance, participate in teaching the students. It is understood that there may not be resident physicians at some community hospitals, community clinics, and the offices of community-based physicians. In that case, medical students must be adequately supervised by attending physicians.

ER-9 There must be written and signed affiliation agreements between the medical school and its clinical affiliates that define, at a minimum, the responsibilities of each party related to the educational program for medical students. Written agreements are necessary with hospitals that are used regularly as inpatient sites for core clinical clerkships. Additionally, affiliation agreements may be warranted with other clinical sites that have a significant role in the clinical education program. Affiliation agreements should address, at a minimum, the following topics:

• The assurance of student and faculty access to appropriate resources for medical student education.

• The primacy of the medical school over academic affairs and the education/evaluation of students.

• The role of the medical school in appointment/assignment of faculty members with responsibility for medical student teaching.

• Specification of the responsibility for treatment and follow-up when students are exposed to infectious or environmental hazards or other occupational injuries.

If department heads of the school are not also the clinical service chiefs at affiliated institutions, the affiliation agreement must confirm the authority of the department head to assure faculty and student access to appropriate resources for medical student education. The LCME should be advised of anticipated changes in affiliation status of a program’s clinical facilities.

ER-10 In the relationship between the medical school and its clinical affiliates, the educational program for medical students must remain under the control of the school’s faculty. Regardless of the location where clinical instruction occurs, department heads and faculty must have authority consistent with their responsibility for the instruction and evaluation of medical students. The responsibility of the clinical facility for patient care should not diminish or preclude opportunities for medical students to undertake patient care duties under the appropriate supervision of medical school faculty and residents.

It's time for nurse practitioner programs to be accredited by a committee that knows the issues surrounding our clinical education and enforces strict requirements not only in terms of existing program accreditation but also the establishment of new nurse practitioner programs around the US. It's time to fire CCNE.

[LHendon]

I am a new graduate of an FNP program and we had to find our own preceptors. This was definetly a challenge. I too had a practice that only precepted MD or PA students even though much of their staff was NP's. This is very frustrating. I cannot wait to be approached to be a preceptor!

[Pug RN]

I have to disagree on all programs that make you find your own preceptors being a scam. Despite the fact that I have not started a program yet, I know people that are going to many extremely reputable schools that have to locate their own preceptors as well. I know UTHSC requires this, as does LSU and they are some of the best. I also know that Frontier, one of the best midwife programs in the country requires the same thing.

[DuckFan23]

I had such a hard time finding a willing/able preceptor it delayed my completion of my program by 6 mos. Very, very frustrating. The school does nothing to help. Which was odd to me. (I'm paying for what?) And even if you found one, sometimes it just doesn't work out. Then you were back to finding another one. keep at it. Be diligent. And be well-rounded. I started doing smaller shorter rotations to get some exposure to specialty areas-GYN, optho, derm, ortho. Things you see a lot of but they don't focus a lot in in class. Of course you'd send these to a specialist, but being more comfortable in IDing those things that need a specialist-this helped-and it got me the precepted time. Get creative. And BE SURE to check with you BON to make sure you fill out paperwork with them. I ran into a huge hot mess with that as well.......

[Pug RN]

Thanks for the advice. You are the second person that has recommended multiple preceptors for shorter time periods.

What paperwork are you referring to for the BON?

[AtomicWoman]

I agree with mystory completely. Why should we expect NP preceptors to precept for free? I am extremely grateful that my preceptors have been so gracious, but we are relying on preceptors' altruism. And this business of schools telling students to go out and find their own preceptors is nonsense. How is the student supposed to judge how appropriate a clinical site is?

[Tiny_Toes_RN]

I am finding it difficult to find a NNP preceptor in Tulsa, OK. Classes start next month and I am out of options within Tulsa and out of the city. If I can't find a site, I will be delayed a year and going out of state is not an option due to school, work, and family obligations. If any NNP's in the Tulsa/Oklahoma City area want to precept me...I would forever be grateful!!!

[HollyBerryRN]

Could be an issue of nurses still eating their young, but I suspect it is a legal issue. I finished my BSN via on online university and had completed all but my last clinical class for graduation that required a NP or Masters Prepared Nurse preceptor. I had to sit on that unfinished degree for two years because of being unable to locate such a preceptor. Apparently not only must he or she agree to this, but the facility and the NPs boss must also agree and there is the very important and legal paperwork of the Memorandum of Understanding that must take place between the facility and the school's legal dept. Good grief what a huge pile of red tape. I am now about to begin my first semester in Family Nurse Practitioner/Nurse Educator duel degree option this fall and I've chosen a school that supplies my preceptors/clinical rotations FOR ME for this reason.

[charlie1234]

Hi,

Just curious about paying preceptors. My school does not pay preceptors and we have to find our own. How much do they get paid and do you have to pay that fee in addition to your tuition? I think I'll offer to pay and that might entice someone to do it, I just wasn't sure what the standard rate was. THanks,

Amanda

[tyscott1286]

I am a Family Nurse Practitioner working in NC and recently responded to a survey (?) or a poll (?) from one of the professional advanced NP organizations (ancc) or (acnp) or (ana-np specific)...well anyway, I responded that I'd be happy to precept-any student that needed my time or guidance. THE REASON: Because I remember how difficult it was (12 years ago) to find willing preceptors...or even to approach a colleague to mention that I needed a preceptor. Reviewing these posts, makes me feel that some of us "older birds" have forgotten how difficult it was to build that first nest. If any of us more experienced "older birds" are reading this and would like to search our memory banks for what it was like to acquie preceptors when "we were back in time", please feel free to respond or post somewhere on this forum that you'd be glad to precept or you know a fellow NP who'd be willing to precept.

I'd love to precept....please respond. I am in NC in the Triad region-working in ED. Have no fear-I do not bark-I have not eaten anything young in years...well except my morning eggs!

I would like to use you for a preceptor. I am also in the triad area looking for a preceptor from Jan 2013 until April 2013. I am a student at the University of Cincinnati, completing a degree in Adult Nurse Practitioner.