My Two Cents: Thoughts About The Direction of Our Great Profession and the Preceptor Problem... Part I: A Message to Nurse Practitioner Schools:

I love being a Nurse Practitioner and am a huge advocate for Advanced Practitioners in general, but there are things that concern me about the direction we are going as Nurse Practitioners (NPs). In my current roles, I’m in a unique position to really see the issues from many different angles. In this first blog, I’m directing my thoughts to NP schools.  These are the places where it all begins: our alma maters. Are there some things the schools could do to help with this problem?  These are my thoughts on a subject of which I have become quite versed. Follow up blogs will address the same issue in regards to the student, the preceptor and the practice sites.  I believe there are things we can do in all of these areas to address the problem of the Preceptor Shortage. 
 
We all see schools pouring out students but then see countless students struggling to find preceptors. This is not news to anyone in our profession and the situation is getting worse.  This problem affects all of us in the field! The balance is just too far off and, if this continues, I am concerned it will damage our profession.  Current research studies demonstrate positive outcomes for nurse practitioners (NPs), but if we can’t train quality NPs this trend is not likely to continue. I’m concerned that we are setting ourselves up for trouble.
 
I frequently hear practice sites saying things like, “We only train med students, so we don’t take NP students; We don’t take students from XXX University; We are too busy to take students; It is too much work to take students,” or just plain, “We don’t precept.”  The current system is unsustainable.  Something has to change before it’s too late.
 
Here are my thoughts on the challenges we face in this growing profession and some ideas on how we might change them:
 
To the Nurse Practitioner Schools:

1. First of all, I understand that there are requirements for the various NP degrees, but perhaps it's time we revisited these requirements.  Just because we've always done it that way doesn't mean it is the only way or even the best way.  I don't pretend to know the ins and outs of running an Nurse Practitioner program, but based on my unique perspective, I do have some ideas that might help the situation. At least consider these thoughts...
2. There are so many students looking for the same thing: Family Practice; OB/Gynecology; Pediatrics.  As everyone knows, there is a shortage of family practice providers, so how can we pour out more students and expect them all to find family practice sites?  Yes, Family Nurse Practitioner (FNP) students need to see family practice sites, but to have time in endocrine, cardiology, dermatology, orthopedics, wound care, occupational health, urgent care, emergency room, nursing homes…so many other sites would be beneficial too! Many of those sites will take students but don’t get asked. Please consider looking outside the very limited boxes of Family Practice, Pediatrics and OB/Gyn. Physician Assistants (PAs) do varied rotations and many end up working successfully in primary care.  Those specialty areas are all things we see in primary care. Students would still need some time in Family Practice (FP), but please allow students more hours in specialty practices. That will help unload the multitude of students all looking for family practice sites. The same is true in Pediatrics. Pediatrics preceptors are VERY hard to find, especially for the FNP student. There just are not enough available/willing sites for the number of students.  Please allow students in Pediatric rotations to do some specialty Pediatrics practice.  And allow them to do their Pediatrics rotations in a Family Practice that sees a fair number of children.  
3. Consider allowing students more flexibility with whom they can use as preceptors.  It is very helpful when schools allow NPs, M.D.s, D.O.s, Physicians Assistants (PAs), Certified Nurse Midwifes (CNMs) and other Masters-prepared and higher preceptors. Please don’t make requirements so narrow: “FNP students have to work with an FNP for pediatrics and not a Pediatric NP.”  That makes it nearly impossible!  “Must be a primary care Internal Medicine practice.” Those are a dying breed these days and very hard to find!  “Can’t work with the same preceptor for more than one term.”  If the student finds a good and willing preceptor, please allow them to continue!  Finding preceptors is HARD!! Please don’t make it even harder.
4. If possible, be flexible with the order of rotations.  It’s not always doable, but that would help this situation.  If they find an OB/Gyn preceptor willing to take them for a rotation, allow them to do that rotation at that time.  I know some schools do the didactic portion followed by the clinical rotation, so this might not work in that case. 
5. Consider adding Nurse Practitioner-run clinics.  It works for medical schools and it works for NPs.  One of our local schools does it, and it is a great solution. It’s a lot of work, but it benefits the community and students: http://www.csusm.edu/nursing/studenthealthproject/
6. Please, please, take only quality students and give them a quality education.  The profession is counting on you for this.  Train them how to do the things they need to do to be competent (preferably excellent) practicing NPs.  If you can’t provide hands on (online schools), consider sending them to trainings where they can do hands on.  It is very hard to teach a student to do a pelvic or rectal for the first time on a patient in clinic.  Who would want to be that patient?  A paid pelvic model is much better for learning.  It just makes our profession look like we don’t train our students well enough.  We are under the scrutinizing eye of the public and medicine as we push forward to get full practice authority for NPs nationwide. We need to make sure we are putting out quality practitioners.
7. Thank you, NP programs for helping train the next generation!  We are a great profession and we want to stay that way. 

Next blog will continue the discussion and be directed towards Students.