We have all seen it. The symptoms are undeniable and can be very distressing for family, friends, and especially the patient him or herself: Depression, anxiety, G.I. disturbance, increased occurrence of unrelated medical problems… Patients are often seen crying, complaining, yelling out expletives, despondent and doubting their future and past choices. They are very difficult patients to help because, quite frankly, as things stand today there is no good cure. Preceptor Shortage Traumatic Stress Disorder (PSTSD) is undeniably an increasing challenge for the medical profession today.
So I jest, but not really. There is nothing funny about the current situation and The Preceptor Problem. (Yes, I am capitalizing that on purpose.) It is absolutely tragic that students have to struggle so much to find mentors. Sadly, from what I see, the problem seems to be getting worse. Perhaps it’s my slanted and unique perspective, but I see it everywhere and most of the people who are complaining/begging/angry/crying are not clients. I see it on Facebook, LinkedIn, at every nurse practitioner meeting I attend, and I hear it from every practice, student and medical provider. I know this is a huge, nationwide problem and not just something seen in a small population of students. In this post, I’d like to bring up some issues that I would like our profession to consider. Be kind in your remarks! Let’s work together for some positive changes to The Preceptor Problem and find a cure for PSTSD!
It was hard before, but some schools are making it even harder for students. In a perfect world, nurse practitioners would predominately precept nurse practitioner students. However, we are far from a perfect world. Due to many factors, there is an undeniable preceptor shortage. Yet some schools are requiring more time with a nurse practitioner and allowing less or no time with physicians, physician assistants (PAs), Certified Nurse Midwives (CNMs) or other qualified providers. Let’s face reality: First of all, there are more physicians than nurse practitioners practicing. Additionally, more often physicians own the practice, and they can make a decision about whether to take student or not, so it’s easier to find physician preceptor. On the other, most often nurse practitioners have to ask permission of administration, and, due to many factors, they are often declined even if they’re willing to precept. There’re many other reasons it’s easier to find a physician preceptor but those are the major ones.
Then there are the schools that have increased the requirement for family practice rotations. They are denying wonderful sites that provide geriatric, urgent care, home health, adult, and even pediatric populations because they are not “Birth to Death Family Practices.” Family practices are inundated with requests for preceptors. As medicine has changed, “birth to death family practices” are becoming less common. Often there are other sites available and willing, but because they don’t fall into a narrow definition mandated by the school they are denied. Since we work with so many different schools we know that there are requirements for students but the requirements seem to vary drastically from school to school. Why is it fine for some and not others?
Fortunately, not all schools have such restrictive requirements. Some allow some specialty hours as long as a majority of general hours are completed. And, of course, some schools help students find preceptors. Power to these schools! The reality is, however, even if every school helped find preceptors there would still be a shortage of preceptors. I just think we have to look at different alternatives to our current system. We must be open to these alternatives and stop trying to do things the way we used to do them.
Another way schools could help students is to be less restrictive with dates for clinical rotations. Some schools are flexible and even allow students to start early. Bravo! But other schools do not allow that flexibility and some will not even allow a student to complete hours over a short period of time, instead mandating that the rotation be spread out over several months. This is a huge problem for students who are willing to move to other areas in order to complete his/her rotation. If the student can get his/her hours done over a shorter period of time and then return home it reduces travel costs substantially. Why is it that some schools allow this and others do not? No, it is not ideal to get the hours done over a short period, but it seems we need to make some concessions given this challenging situation.
We have a wonderful, respected and growing profession. Many methods we use to train our students are still valid and effective, but we must be willing to change with the times. There are things our profession can do to make it better and not harder for students. Let’s be open to these ideas and changes. Let’s not make requirements so strict and narrow that it makes it nearly impossible to find what students need in order to graduate. I don’t know if changes are being made because students are not passing the Boards or because schools feel philosophically it’s the way it should be done…I just don’t know. What I do know is that, as we speak across the nation there are countless students suffering from the cruel and devastating consequences of PSTSD- Preceptor Shortage Traumatic Stress Disorder. Let’s work together to stop this devastating problem!
PreceptorLink (formerly Advanced Practice Link) is in the ridiculously difficult and often thankless business of matching students to preceptors. We have a team of people working 24-7 to help find preceptors because we know how difficult it is for a student who works part/full time and has a family at home to find time to search for a suitable and willing preceptor. We are dedicated to finding solutions to The Preceptor Problem and will continue to work on this issue.
As a longtime NP with a desire to help and make positive changes to her beloved profession, Lynn often writes opinion pieces about the NP profession.
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