The Answer to the Preceptor Problem depends on Students!

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