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Gwinnett Forsyth Chapter United Advanced Practice Registered Nurses

The Answer to the Preceptor Problem depends on Students!

Posted almost 4 years ago by Julie Hannah

After hearing so many APRN students complain about how difficult it is to find a preceptor, I formed a coalition to address the issue.  Very few members weighed in at all - participation was poor.  I can tell you what answer I was given from many NPs who receive a paycheck from our Georgia nursing schools: practicing NPs should take on students every year, for free, including all the tedious paperwork involved, because it is their professional DUTY.

Well guess what, that philosophy has failed completely.  The reality is that many NPs work only part-time or in settings such as specialty clinics, instead of family practice, women's health or pediatrics.  The NPs with full-time positions in those areas want to protect their jobs.  Their employers (usually physicians) could care less about educating the next generation of NPs - their goal is to have their current provider see as many patients per day as possible, and taking on a student will just slow them down, i.e., cost the practice money.  Also, many patients feel uncomfortable being the "guinea pig" for a student, and employers in a competitive healthcare market want their patients to feel they are seeing the most experienced clinicians.  In practices where NPs are often "ghost providers" - unrecognized on websites or on the door alongside the physician's names - we can not expect them to want to handle the endless phone calls and faxes from desperate students, or open their crowded offices to freeloading strangers every semester (I am quoting an office manager here).

Of course there are exceptions to this rule, and some (particularly rural or low-income) clinics will take students, but they are too few to handle the hundreds of APRN students the graduate schools admit every semester.  Many mentors become exhausted by the number of students they are begged to take on, and drop out of precepting completely.  The clinical sites that will take students seldom offer the practice in procedures - such as suturing, x-ray interpretation, digital blocks, etc. that good-paying employers are seeking.  In addition, the graduate nursing programs do not warn potential incoming MSN students of the extreme difficulties they will face in finding decent clinical sites.  Instead, it often comes as an unpleasant surprise, long after the student has invested too much time and money in their degrees to turn back.

Some suggestions were made about honoring preceptors with a plaque or a dinner, which is nice, but does not address the underlying problem that qualified NPs face: convincing the physicians (or corporations) that they work for to allow a steady stream of inexperienced clinicians to have access to their facilities and their patients, and to provide this highly-valuable service for free.  Any decent preceptor will lose some productivity when teaching, and they often have to make up for it by staying late after hours.  It is not fair to ask them to sacrifice personal time year after year without compensation.  Also, some preceptors in the discussion group expressed concerns that students from certain (especially online) programs were intellectually unprepared for their clinicals, putting a larger teaching burden on the preceptor.

My physician assistant colleagues speak of qualified mentors that gave them valuable, hands-on experience - all arranged by a person in their school whose sole responsibility is to set up (and pay for) clinical sites.  The PA students even rate their preceptors, so that poor performers are dropped from the program!  Many NP students who have become tired of searching have turned to websites that pay preceptors for their services, and handle all the credentialing and paperwork.  Yes, the student has to pay for it, but it costs less than delaying their graduation (and employability).  It also alleviates the time commitment and stress of trying to do it themselves.  Please note I have no financial interest in any of these websites - I just recognize the need for them that the nursing programs have created.  Unfortunately, it still leaves students who are on a tight budget with no recourse but to wait and beg, wait and beg...

Now I come to my point.  GRADUATE STUDENTS, if you are 1) forced to use such websites out of desperation, 2) losing valuable study time searching fruitlessly for preceptors, 3) delaying your classes because of failure to find one, or 4) have ended up with a sub-standard clinical locations or mentors that did not meet your needs, then take action!  You need to write a letter to the Dean of your school and the University President (who is not part of the nursing program) demanding that they stop making graduate students solicit their own preceptors!  The colleges of nursing should be using the ever-increasing amount of money they charge MSN students for tuition and fees ($35,000-45,000 on average) to compensate preceptors and quality clinical sites, and fund staff to handle the legwork involved, just like physician assistant programs do!  This would allow the schools to find the most qualified mentors who will be willing and happy to help you, instead of reluctantly agreeing to it out of guilt, or ignoring you because they are not in a position to work without compensation (to themselves or their employers).  Paying for clinical sites also means you will get the valued experiences you need, before you are thrown out into practice on your own! 

Only a barrage of complaints from disgruntled students will stop this policy of making NP students "fend for themselves" to find preceptors that meet the stringent school requirements.  If incoming students knew what they were in for, they would avoid programs that do not provide guaranteed clinical placement.  This would drive enrollment in programs that provide clinical sites, and decrease enrollment in programs that do not.  Speak up for yourselves, or you have no right to complain.  As practicing NPs we have no power to change the status quo in nursing schools; as tuition-paying students, you do!  Most of us NPs (myself included) would continue to mentor without compensation, but the payment given to our employers would ease any fears we have about possible decreased productivity, and imposing on a clinic that we do not own.

As always, UAPRN is here to support you, and we will continue to push for passage of a bill in the State legislature that will allow preceptors to obtain a deduction from their State income tax.  Students and preceptors alike can help by contacting their State representatives to ask them to support such a law.  Still, that alone will not be enough to alleviate the shortage.  The nursing graduate programs need to recognize that their model of not paying for and arranging clinical sites does not work; and the model of PA programs and medical schools does.

I am going to enable comments, as I know this will be controversial.  I want to hear less from the faculty, who have a vested financial interest, and more from the students and new graduates.  Have I accurately described your predicament?  Can you give testimonials about what your clinical experiences were like?  Did they adequately prepare you for practice?  What did you have to do, how long did you have to wait to find preceptors?  If you are sending letters to the Dean, President, and/or legislators, let us know about it!

Best wishes,

Julie Hannah, FNP-C


Amy Warner almost 4 years ago

Unless things have changed, since 1998, Emory University provided my preceptorships. Perhaps this varies by the program and cost. It was an expensive program.

Karen Melde almost 4 years ago

You have addressed all the reasons my practice is no longer precepting students. We have had two students this past fall and winter. One was the sister of one of the docs, the other, somehow, was told she could come, but no one knew who told her we would work with her, so we were 'stuck'.

I took a precepting course at Emory about a year ago. I've been a PNP for almost 20 yrs, and now that I'm back in primary care, thought I could give back. Nope. My daily schedule was not adjusted for spending time with students, patients were, for the most part ok with seeing the student before either myself or one of the docs came in. This really slowed me down, as I only have two rooms to begin with.

Just this week I received an email asking me to be a paid preceptor with a company that would take care of my credentials get, etc. it still wouldn't ease the problems I've outlined above.
I agree with Julie, STUDENTS need to complain long and loud. Conversely, perhaps the schools should dial back on the numbers they admit, and only admit students that they (the schools) can place.
Tough dilemma without an easy answer.

Elizabeth Parsons almost 4 years ago

I am one of those students who is currently paying for my preceptorship. Finding a clinical site on my own was a nighmare. The cost depends on how many hours you need. I plan on doing it again for the next two clinicals because I currently do not have the contacts in women's health yet.

When I informed my teacher that I was paying she was shocked.told me to try planned parenthood. But the same contacts we have are the same ones other schools have.

I wish I was told before applying what the real deal is.

Janet Ross almost 4 years ago

Dear Julie Hannah, FNP-C and UAPRN:

I read the article “ The Answer to the preceptor problem depends on students” with interest. It was apparent that you have limited knowledge of the accreditation standards for APRN programs. SO, allow me to offer you some insight:

In order to maintain accreditation of a program, faculty have to demonstrate their involvement in clinical site identification and vetting; So, if this is a problem for students, they should contact their accreditation body for the program they are enrolled in, not the state government or the Dean or the university… the accreditation boards are the ones with the power in nursing education. You are correct in stating that it is the programs’ responsibility to procure the clinical experiences for their students. And it is an absolute shame when that doesn’t happen… but students should vote with their feet- and leave a program that does not offer this to them- or better yet, don’t enroll there. There are other alternatives, which brings me to my second point:

There are some outstanding programs in Georgia that take care of preceptors and clinical site negotiations and do NOT expect nor allow their students to undertake this. I would caution you NOT to lump all programs together.

Lastly, let me give you some accurate information about HB 463, known as the PTIP bill… this bill was introduced by Rep Harbin (Augusta) and it would have allowed NP and PA preceptors to receive the tax incentives for precepting students enrolled in a Georgia program. The Georgia AHEC Network, made up of PA, MD and APRN representative groups all supported this bill and we assured Rep Harbin that we were all in agreement with it moving forward. The bill got pulled on March 4th, because an “APRN group” went to him and asked for a language change…. And I can guarantee that it was not Georgia Nurses Association who asked for that change, since we were part of the support base for the bill. So, before you get students mobilized to contact their senators and representatives, maybe we should get the “APRN group” house in order first so that we are not under-cutting ourselves.

Suzanne Staebler, DNP, NNP-BC, FAANP

Georgia Nurses Association APRN Director

Julie Hannah almost 4 years ago

Thank you all for you honest responses. I would like to respond to Janet Ross. Yes, I knew about HB 463, and everything else you mentioned, for that matter. It was a CAPRN lobbyist who got nurse practitioners added to the original bill in the first place. It was originally drafted by a medical association, and was geared only towards giving physicians the State income tax break. The bill passed only as a pilot program for two years, to prove to the State that it could "afford" to give such a tax break. You need to find out which "APRN group" it was that you think sabotaged your efforts and deal with them directly, instead of complaining to me. I agree there is far too much fragmentation amongst the APRN groups in Georgia, which is why CAPRN was created - an attempt to unify them and their efforts. I did say in my article that the students should only join programs that guarantee preceptor placement. I also said that many programs are not up front about this, and do not warn students of the difficulties they will face. Therefore, unsuspecting prospective students don't know what they are in for until it is too late. They programs need to let every prospective student know either a) we will guarantee quality clinical placements for you or b) you will be on your own, and will likely find difficulty finding a preceptor. Instead they just cash the tuition check and let it be an unpleasant surprise.

Julie Hannah almost 3 years ago

I also discovered that the language change that Laura Searcy (lobbyist) asked for on HB 463 was merely the inclusion of certified nurse midwives, since the original language was only NPs. That was perfectly appropriate and would only have added 500 people to the list of eligible preceptors. I seriously doubt that request was why the bill did not pass - it was just an excuse for opponents who already wanted to kill it to do so. One APRN group "blaming" another for such an incident is highly unprofessional and shows our opponents how easily we can be divided.

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