2026: A Time for Reflection, and Resolutions

Nurse practitioners are a vital part of our healthcare system. We are compassionate and capable clinicians who help to improve access to care in almost every setting and specialty. Behind the essential role we play lies a growing reality that is raising concern in the healthcare community: the path to becoming an NP in the United States lacks consistent standards, especially compared to the highly standardized, regulated training at the registered nurse level. If we are going to continue to move our practice and profession forward, we need to re-evaluate the NP education system from the ground up. 

The first step in fixing a problem is admitting that there is one

Medical school and PA training include a mixture of in-person didactic work and rigorous hands-on clinical rotations. Currently, NP education doesn’t follow a standardized curriculum for clinical rotations, and many programs offer didactic sessions only online. While programs have standards for the number of clinical hours required, there are no universal guidelines for required core clinical rotations, other than stipulations about students needing to see a certain number of patient populations, such as women's health or pediatrics, for some NP specializations. 

Before you sharpen your pitchforks, light your torches, and fire up your social media accounts, I will give credit where it is due to our national organizations that are addressing some of these issues and have already made meaningful contributions to improving NP education.  In 2022, the National Task Force (NTF) for quality nurse practitioner education published updated standards, which, amongst other things, raised the minimum number of clinical hours from 500 to 750, which is a critical step in the right direction. 

The two major issues that still plague our profession are: a lack of core clinical rotation requirements and access to preceptors. Students may struggle to find preceptors in any area or setting, and often go through school with a lopsided exposure to medicine. Many graduates do not complete essential clinical rotations in even the common medical service lines, in part due to a lack of clinical preceptors. These issues are closely intertwined, and the solutions will require buy-in and investment from both our academic institutions and the hospitals and clinics that hire us.

The wisdom of Dr. Osler

“Medicine is learned by the bedside, and not in the classroom.” As a founding member of Johns Hopkins Hospital and the creator of the first physician residency program, Dr. Osler knew the importance of an immersive clinical experience. “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” 

While the rise of telemedicine is a valuable resource that helps expand care, it is not an ideal learning environment for students and should not be an acceptable form of clinical rotations. Learners need to be hands-on with their patients to begin to develop their clinical skills, assessment techniques, and gestalt. 

With hordes of students clamoring for limited clinical spots, they may find themselves doing the majority of their rotations in highly specialized areas, and might spend limited amounts of time in major core areas of medicine. I have personally seen nurses having to sit out multiple semesters from their NP program because they were unable to find a preceptor for high-demand areas like OBGYN or pediatrics. 

The price of preceptors

Graduate school is expensive. While tuition rates vary widely, expect to pay between $30,000 and $70,000 for an MSN and between $40,000 and $75,000 for a BSN to DNP. This is a very broad range, as some online schools may charge less, while private institutions may run well into the six-figure range. 

On top of tuition and fees, thousands of NP students have turned to private preceptor companies for clinical rotations when their schools were unable to secure rotations for them. These services generally cost several thousand dollars per rotation, which students have to take on in addition to their tuition and school fees. 

Imagine taking out over $50,000 in student loans to pursue your dream, only to be told by the school that they are unable to provide you with the most critical part of your education. Imagine being told that you will either have to find your own clinical rotations or be forced to sit out a semester or longer. It would be reasonable to expect that the institution you are paying to teach you would be responsible for the quality of your clinical education, but unfortunately, for many programs, this has become the new normal. 

It’s also important to consider that paying someone to serve as your preceptor also raises a serious conflict of interest after graduation, when you are submitting preceptors as professional references for clinical privileges. You are now asking someone whom you paid to serve as your preceptor to evaluate your clinical skills and competency, and institutions will often ask the person evaluating you to disclose any conflicts of interest. 

New Year's resolutions

We have serious issues facing NP education and training. These are problems that did not happen overnight and will not be resolved quickly. Graduate education is a massive economic machine that is not slowing down. And while there remains a need for more healthcare providers, we cannot afford to sacrifice quality for the sake of quantity. There is no point in churning out record numbers of graduates if they are ill-prepared for the task ahead. 

There have been some good changes to NP education in the past few years, but there are still some serious issues that we need to take ownership of. Join me next month to dive into where we go from here and look at some examples of what is being done right to tackle these issues. 

If you have any comments, concerns, or examples of what you or your organization are doing to push for a higher caliber of NP training, please let me know at NP@hippoeducation.com.