Why is it so hard to find a preceptor?

studentdrtobe · Jul 19, 2012

@IrishizRN. you are onto something!! When I did my practicuum psychologists were given a stipend , residents were paid minimal amounts, and Psych CNS students weren't paid. We
Were all seeing patients. And I think they were billing for my time--and why shouldn't they??
If students could approach sites and be able to bill based on our BSN, it would make us more attractive..

Are you sure about that? Admittedly, I don't know as much about billing (since we don't really get any formal education on that issue), but I was under the impression that it's illegal to bill for something a student did. The practitioner has to see the patient himself/herself in order to bill something.

studentdrtobe · Jul 19, 2012

A Nurse Practitioner student IS a student. The RN license does not cover the scope that NP's do, hence, all the actions as an NP student fall done under the NP preceptor's license. A resident and a fellow have MD's or DO's on their names. They are able to function under that license (albeit a medical educational limited license as it is called in some states). NP fellowships are open to certified NP's, that's where a stipend can be arranged and is typically available.
We can debate ad nauseam about how many NP students have extensive experience at the bedside. I went to NP school with 10 years of RN experience. But you and I know that that's not the only route to NP now that we have direct entry programs. Personally, I don't care how long an NP student have been a nurse. They're still learning stuff they never did as an RN. I have not seen a positive correlation between length of RN experience and performance in NP school. I only agree that having that RN experience can be helpful in many cases.
I still uphold my belief that NP education has gotten way out of hand by sacrificing quality to favor widespread availability and ease of admission. I've never heard of a huge NP shortage either and I don't see it happening if we continue with the direction we're heading.

Very eloquently put!

The last sentence seems especially true. With this in mind, it would be a better idea to focus on improving the curriculum rather than opening more schools and looking to primarily produce more graduates.

Advanced Practice Columnist / Guide · Jul 19, 2012

Were all seeing patients. And I think they were billing for my time--and why shouldn't they??
If students could approach sites and be able to bill based on our BSN, it would make us more attractive..

You can't bill for work students do. NP's who precept have to write their own notes in order to bill. The only element of the student NP note that can be referred to by the NP are ROS, PMHx, PSHx, and Social Hx. NP's have to write their own HPI, Physical Exam, and Assessment and Plan. Resident's Notes (House Officers who are physicians) can be attested by attendings and billed.

myelin · Jul 20, 2012

Having students find their own preceptors is pretty common. I'm going to a top university in a major city....I hang to get my own preceptor. It's something bring done in top schools.

Eh, I'm at a top school and was accepted to several other top schools. None of them do this.

IrishIzCPNP, MSN, RN, APRN, NP · Jul 20, 2012

Eh, I'm at a top school and was accepted to several other top schools. None of them do this.

I never said they all do it. I simply said that it's pretty common...and not just at less competitive schools.

core0 · Jul 20, 2012

A Nurse Practitioner student IS a student. The RN license does not cover the scope that NP's do, hence, all the actions as an NP student fall done under the NP preceptor's license. A resident and a fellow have MD's or DO's on their names. They are able to function under that license (albeit a medical educational limited license as it is called in some states). NP fellowships are open to certified NP's, that's where a stipend can be arranged and is typically available.
We can debate ad nauseam about how many NP students have extensive experience at the bedside. I went to NP school with 10 years of RN experience. But you and I know that that's not the only route to NP now that we have direct entry programs. Personally, I don't care how long an NP student have been a nurse. They're still learning stuff they never did as an RN. I have not seen a positive correlation between length of RN experience and performance in NP school. I only agree that having that RN experience can be helpful in many cases.
I still uphold my belief that NP education has gotten way out of hand by sacrificing quality to favor widespread availability and ease of admission. I've never heard of a huge NP shortage either and I don't see it happening if we continue with the direction we're heading.

Fundamentally its an accreditation problem. Accreditation exists for two reasons. To protect the public from inept programs and to protect students from programs that do not educationally prepare them. The analagous situation would be nursing 30 or so years ago. There were no national standards. Nursing tests were administered by the states. Schools were approved by the states. This led to students moving to other states and finding their education was deemed insufficient. The National Boards of Nursing got together and formed the NCLEX to have a single universal test for all nurses that was useable in any state. To sit for the test they mandated that the two accreditation agencies use the same competencies and ensure that programs have sufficient didactic and clinical resources for their students.

Think about it. Would a nursing program be accepted if it told their students that they had to find their own preceptors. Would any hospital take nursing students from a program that didn't provide clinical resources to the hospital? This would directly contravene the regulations passed by the accreditation agencies.

If you look at both the CNM and the CRNA both have separate accrediting bodies. They mandate the program must have sufficient clinical and academic resources for their students. They ensure that the student meets core guidelines. It ensures the student has access to due process.

http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000721/ACME.Programmatic.Criteria.final.Nov.2010.pdf

Now find similar standards for any NP program. The lack of an accreditation body allows program to provide substandard clinical experience without and recompense by the student. If a program does not provide all the resources for a student to graduate what does the student pay for. And if the program does not ensure that the student is in a clinical environment where they can learn again what is the student paying for. Students do not necessarily understand what the competencies are for the profession. It should be up to professional paid instructors to make sure these competencies are met.

If a PA, allopathic or osteopathic program required their students to find their own rotations then their accredidation would go on probation pretty much immediately. I think that a student finding their own rotation is acceptable as long as the program has resources in place to ensure that the student is getting adequate clinical experience.

I precept for two ACNP programs. One local and one remote. The local program visits at least once during the rotation and has clear objectives for the student and what is expected. We communicate by email every 2-3 weeks. The remote program visits once a year and communicates by email weekly. I get calls all the time from students wanting to set up a rotation. I ask them to have their clinical coordinator call me and send the competencies and have yet to hear back from anyone.

IrishIzCPNP, MSN, RN, APRN, NP · Jul 20, 2012

If you look at both the CNM and the CRNA both have separate accrediting bodies. They mandate the program must have sufficient clinical and academic resources for their students. They ensure that the student meets core guidelines. It ensures the student has access to due process.
http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000721/ACME.Programmatic.Criteria.final.Nov.2010.pdf
Now find similar standards for any NP program. The lack of an accreditation body allows program to provide substandard clinical experience without and recompense by the student. If a program does not provide all the resources for a student to graduate what does the student pay for. And if the program does not ensure that the student is in a clinical environment where they can learn again what is the student paying for. Students do not necessarily understand what the competencies are for the profession. It should be up to professional paid instructors to make sure these competencies are met.
If a PA, allopathic or osteopathic program required their students to find their own rotations then their accredidation would go on probation pretty much immediately. I think that a student finding their own rotation is acceptable as long as the program has resources in place to ensure that the student is getting adequate clinical experience.

Actually, there are CNM programs that require the student to find their own preceptors. I was about to start one this past year. The same school is where my mother went many years ago and she found her own clinical sites/preceptors. So CNM programs don't set up preceptors in all cases.

IrishIzCPNP, MSN, RN, APRN, NP · Jul 20, 2012

I never said student NPs were equal to residents across the board. I do believe that a well educated and experienced nurse who is now an NP student is pretty equal. I work with resident every single day. The day the first years start...oh my! We, the nurses, do so much teaching, correcting and instructing of these residents. They are still students. MDs don't have different levels. The med student gets the MD and then they go on for more training...aka they are again a student only now they get paid. They are still learning and many times learning from the nurses.

I do believe in some cases it's reasonable to make a comparison between an NP student and a resident.

I also will admit that I don't know that I agree with direct entry NP programs. I think the beauty of nursing is the art that it is. I also believe that one should have some nursing experience before going on for an advanced degree.

I have yet to meet a physician who is pro-PA and anti-NP. I do know PLENTY of individuals who will not accept treatment from a PA. I won't. I had one walk into my room in the ED a few months ago and I sent them away. I would not accept treatment from the PA. Want to send an NP in? Sure. I know too many PAs will very little education and it is frightening that they are out there treating patients.

Yea, that was the point I was getting at.
LOL! No. Just because you have an RN background and are an NP student absolutely DOES NOT make you equivalent to a resident or fellow! Extensive bedside experience as a nurse =/= extensive experience formulating differentials and treatment plans nor does it mean a sound theoretical basic science/clinical science foundation. Yikes, that's insulting to all the effort and training med students and residents and fellows go through! Not only that, how many people are entering through direct-entry programs these days? Please don't tell me that a few classes + a couple hundred clinical hours means you're equivalent to a fellow. As med students alone, we get several thousands of hours of clinical training. Even before starting the clinical years (ie. M1 and M2), we get several hundreds of hours of clinical training with our physician preceptors.
Also, didn't someone link in a prior thread a study that suggested prior nursing experience isn't as useful for NP/DNP training as people have assumed it would be? That also pretty much negates your bolded statement. So, no, you will not be treated, nor should you expect to be treated, as a resident or a fellow when you're an NP student. In the hospital systems where I'm training (and in the systems where I was a med student), our experienced NPs and PAs have the same level of responsibility as our PGY-2s do (our second-year residents). So, if they're held to a resident standard after years of experience practicing as NPs and PAs, why would students be elevated to residents or fellows? I would avoid making such claims on the wards if I were you; the only thing that would accomplish is souring relationships between physicians and nurses, which is really that last thing we want to encourage.
I agree with pretty much everything Juan has mentioned so far. I urge you guys to push for a national standardized education. IMHO, the lack of standardization is hurting you guys a lot more than it is helping. There's a reason a lot of physicians these days are preferring PAs to NPs: we know what they're training is like and can reasonably expect PAs graduating from various schools to have similar levels of training. With NPs, it's more of a lottery because of the wide variation in the education they receive. If this is fixed with better standardization, I can only imagine that the job market for NPs would improve.

myelin · Jul 20, 2012

People all have their own biases, and you will see that they reflect their own experiences. For example, I have noticed that NPs who attend online programs and/or who had plenty of RN experience seem to feel there is no problem whatsoever with online programs and that one must have RN experience in order to practice competently. Or at the least they tend to overestimate the importance of RN experience. I admit that I can be biased myself, since I am at an "elite" institution that is also direct entry. My program was very hard to get into (unlike many NP programs), and my classmates are all impressive, bright, and passionate about nursing. Also, most have extensive clinical and research experience in their field of choice, it just isn't RN experience. I can't help but believe that it helps make up for the lack of RN experience, although many of us will have 1-2 years of RN experience by the time we graduate, anyway. My point is that it can be hard to separate our opinions from our personal experiences.

That's why it's nice to have data. One study has been done comparing RN experience with NP competency, as determined by physicians and NPs themselves. The finding was that RN experience does not contribute to NP competency. This makes sense if you think about it, because RN experience varies a hell of a lot, as does NP work. I think if you broke it down by specialty, you might get more telling data. For example, I bet that a seasoned ER or ICU nurse would run circles around a direct entry grad in a ACNP program. But when it comes to FNP, I'm less convinced.

Advanced Practice Columnist / Guide · Jul 20, 2012

Fundamentally its an accreditation problem. Accreditation exists for two reasons. To protect the public from inept programs and to protect students from programs that do not educationally prepare them. The analagous situation would be nursing 30 or so years ago. There were no national standards. Nursing tests were administered by the states. Schools were approved by the states. This led to students moving to other states and finding their education was deemed insufficient. The National Boards of Nursing got together and formed the NCLEX to have a single universal test for all nurses that was useable in any state. To sit for the test they mandated that the two accreditation agencies use the same competencies and ensure that programs have sufficient didactic and clinical resources for their students.
Think about it. Would a nursing program be accepted if it told their students that they had to find their own preceptors. Would any hospital take nursing students from a program that didn't provide clinical resources to the hospital? This would directly contravene the regulations passed by the accreditation agencies.
Now find similar standards for any NP program. The lack of an accreditation body allows program to provide substandard clinical experience without and recompense by the student. If a program does not provide all the resources for a student to graduate what does the student pay for. And if the program does not ensure that the student is in a clinical environment where they can learn again what is the student paying for. Students do not necessarily understand what the competencies are for the profession. It should be up to professional paid instructors to make sure these competencies are met.
If a PA, allopathic or osteopathic program required their students to find their own rotations then their accredidation would go on probation pretty much immediately. I think that a student finding their own rotation is acceptable as long as the program has resources in place to ensure that the student is getting adequate clinical experience.

As I've mentioned in other posts, my opinion has been that NP programs need to be accredited by a single agency whose sole responsibility is to enforce high standards in NP education. As it stands, most certification boards (with the exception of PNCB) require candidates to have graduated from a CCNE or NLNAC accredited NP program. I have strong feelings against this as I expressed on the post below:

https://allnurses.com/advanced-practice-nursing/shortage-nurse-practitioner-658511-page3.html#post6478792

I precept for two ACNP programs. One local and one remote. The local program visits at least once during the rotation and has clear objectives for the student and what is expected. We communicate by email every 2-3 weeks. The remote program visits once a year and communicates by email weekly. I get calls all the time from students wanting to set up a rotation. I ask them to have their clinical coordinator call me and send the competencies and have yet to hear back from anyone.

I also precept ACNP students as part of a critical care NP group in a medical center affiliated with a university that only offers programs in medicine, nursing, dentistry, biomedical sciences, rehabilitation sciences, and pharmacy. Our ACNP students function as sub-interns similar to medical students. We round as an interdisciplinary group: attending, fellow, NP's , residents, med student, NP student, pharmacist, pharmacy resident and/or student. The NP students learn from every member of this entire team and gets to be pimped on rounds just as much as the residents and medical students. I'd say the rigor for NP education is there if you pick the right school.

HumptyDumpty · Jul 21, 2012

Are you serious? A majority of NP students aren't even on par with medical residents in knowledge. So you think we should get paid for it? You are the one that gives us a bad name.

IrishIzCPNP, MSN, RN, APRN, NP · Jul 21, 2012

Are you serious? A majority of NP students aren't even on par with medical residents in knowledge. So you think we should get paid for it? You are the one that gives us a bad name.

I believe that NP students are on par for what they do compared to what residents do. Yes, I believe that. Do I think they are equal to each other? No, and I never said that either. So, I'm not the one giving us a bad name. I would suggest that those who take words and twist them create a bad name when there isn't one.

I know that the residents who walk onto the floor I work on are students. They start knowing very little and rely on the NURSES to help them. It is ridiculous to suggest that a resident isn't a student. A student NP who has a nursing background is very similar to a resident in the ladder of learning. I never said they are equal but they can be compared side by side based on where they stand within their own area.

So how about you read what I wrote and not put words in my mouth? Oh that's right...it's nursing and we like to fight with each other and then question why we never can move forward.