Are We Asking Too Much of Preceptors?

If you’re a nurse practitioner student, or an NP who recalls your grad school days, you know that finding a clinical preceptor can be a total nightmare. Unless you have a number of connections in the healthcare world, convincing a provider to take on the responsibility of training you isn’t easy. Patient care and the demands of an employer take precedent over accepting a student, as they should. Even the most altruistic NPs must work – without this they wouldn’t be able to serve as preceptors anyway. 

As an experienced nurse practitioner, I have considered serving in the preceptor role. I enjoy teaching and mentoring and practice in a vibrant clinical environment. The department where I work is a supportive place to learn, so I would love to give a student a chance to learn and grow there. Logistical problems, however arose when I began to consider the task. 

First, at the time I was thinking of precepting, I was compensated on a productivity basis. The more efficient I was in my practice and the greater number of patients I saw, the more money I earned. Taking time and focus away from providing patient care to precept could make a dent in my paycheck. While my work as a nurse practitioner isn’t all about the money, I couldn’t justify sacrificing my income as my husband and I established ourselves and had personal financial goals to reach. 

Second, the logistics of precepting a student were complex. The medical director where I worked was open to the possibility of a student or two in the department. However, I would need to get formal approval from the hospital as well. Working in a large health system meant bureaucracy and red tape when it comes to requests like working with students. I was willing to navigate these complexities, but it would require significant time on my part – not a luxury available to every nurse practitioner.

I recently spoke with a pediatric nurse practitioner who also practices in Nashville where I work. She has served as a preceptor for a number of years. While she enjoys the role, she expressed that she has experienced similar setbacks in her position. The clinic where she is employed is owned by a teaching hospital that is more accommodating to the time and logistics of hosting students. However, teaching does cause her to work more slowly and means that at times she must take charts to complete home with her in the evenings.

This NP also noted that a number of her students had attained prior preceptorships where the provider wasn’t able to take the necessary time to mentor students leaving them with significant knowledge gaps. There isn’t a formal curriculum for precepting and hands-on clinical experience for nurse practitioner students meaning each graduates with a different level of experience. 

The precepting problem is a big one for the nurse practitioner profession. Students have a difficult time finding providers of all kinds to help with their training. A clinical experience in a less supportive or clinically bland environment means a lesser degree of education than one’s peers. While there are a few benefits to experienced nurse practitioners, physician assistants, and physicians willing to serve in these roles, often the financial implications and time constraints of doing so outweigh the benefits.

Nurse practitioner schools will need to address this issue in coming years as the number of students enrolling in NP programs grows. If they don’t, the quality of education for upcoming NPs stands to decrease. Lack of available clinical sites will delay more and more graduations and force students to train in facilities that aren’t equip for doing so. 

Compensating preceptors or healthcare facilities financially for training NP students is one option to look at. Several private companies are already matching students with preceptors for a cost. This expense might also one day be rolled into nurse practitioner school tuition. What do you think the solution to the preceptor problem should be?

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