How Do We Train Nurse Practitioners 

I have been privileged to work with a lot of wonderful Nurse Practitioners as well as Physician Assistants. Yet, some recent reports have highlighted concerns about the quality and regulation of nurse practitioner (NP) education. A variety of concerns have been noted.

Rapid Proliferation of Programs

The number of schools offering advanced nursing degrees has grown dramatically, with over 600 schools offering such programs in 2022 – three times the number of medical schools nationwide. This type of rapid expansion has raised questions about quality control, standardization across programs, and what type of oversite is present for trainees. Rates of new medical schools do not come close to matching this. 

Limited Clinical Training During Education

NP programs typically require only 500 hours of clinical training, which is may not have much oversite and is unregulated. Further, there are a proliferation of online programs that do not help students find appropriate clinical placements, leaving students to arrange their own clinical experiences. This has led to inconsistent and sometimes inadequate hands-on training. Compare this to training of medical students who have a well-regulated training experience with mentorship and oversite, NP students seem to be responsible for their own bedside training experiences. Medical Schools are regulated, and oversite is maintained by entities such as the ACGME (Accreditation Council for Graduate Medical Education). There are no completely online medical schools. 

Lack of Standardization

NP training programs are not standardized, with many offering coursework entirely online. A study published in the Journal of Nursing Regulation found wide variability in clinical experiences among NP students1. For example:

• Over 10% of students reported never performing certain key pediatric assessments
• 39% prescribed medications to adults 10 times or fewer
• 35% ordered diagnostic tests for adults 10 times or fewer

Concerns About Patient Safety

Some professors have voiced concerns that inadequate training could put new NPs at risk of making serious, potentially life-threatening medical errors. A 2023 study of emergency departments in the Veterans Health Administration found that NPs delivering care without physician supervision resulted in longer patient stays and higher rates of preventable hospitalizations compared to physicians.

Calls for Reform

In light of these issues, there have been calls for urgent changes to NP education to protect patient safety. Some have proposed transitioning all entry-level NP programs to Doctor of Nursing Practice (DNP) programs by 2025 to enhance training.

As someone that has worked with these professionals for years, I am worried that the rapid growth of NP schools, particularly online schools with limited clinical oversite, may be diluting out those graduating from well-regulated programs. While defenders of NP education point to studies showing high-quality care from NPs, the concerns raised in these recent reports suggest a need for careful examination of NP training standards and clinical preparation to ensure patient safety and quality of care. Certainly, it requires us to ensure that new NP’s have an onboarding program in hospitals that is robust and ensures competencies are in place. It is also worth a close look to see which schools students are graduating from and determining what their clinical experiences are like.

References:

1. https://www.ama-assn.org/practice-management/scope-practice/how-family-nurse-practitioners-training-comes-short
2. https://www.nphub.com/blog/clinical-to-professional-expertise-nps
3. https://hooperlundy.com/sb-1451-new-california-law-simplifies-103-and-104-np-certification-updates-patient-disclosures-and-clarifies-physician-licensure-for-postgraduates/
4. https://www.medicaleconomics.com/view/nurse-practitioner-report-calls-for-urgent-change-to-np-education-to-protect-patient-safety
5. https://www.nursepractitioneronline.com/articles/4-reasons-to-support-dnp/
6. https://www.beckershospitalreview.com/nursing/the-shortfalls-of-np-education-report.html
7. https://www.nphub.com/blog/np-clinical-preceptors-role
8. https://www.ama-assn.org/practice-management/scope-practice/what-patient-care-experience-do-nurse-practitioners-have-day-one
9. https://www.physiciansforpatientprotection.org/whats-going-on-with-nurse-practitioner-education/
10. https://www.mssny.org/pulse-8-9-2024-the-shortfalls-of-np-education-report/
11. https://www.physiciansforpatientprotection.org/np-pa-educational-reform-time-for-flexner-style-report/
12. https://www.aanp.org/news-feed/aanp-spotlights-five-critical-health-care-trends-to-watch-in-2025
13. https://www.linkedin.com/pulse/whats-wrong-nurse-practitioner-training-standards-acv8c
14. https://www.aanp.org/advocacy/advocacy-resource/position-statements/clinical-outcomes-the-yardstick-of-educational-effectiveness
15. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/dnp/04_12_23_reaffirming_the_dnp.pdf
16. https://www.aanp.org/news-feed/aanp-responds-to-recent-article-in-bloomberg-news
17. https://www.ama-assn.org/practice-management/scope-practice/series-details-problems-lax-nurse-practitioner-training
18. https://www.doctorofnursingpracticednp.org/2020/01/will-the-dnp-make-it-over-the-top-as-the-new-standard-for-advanced-practice-nursing-by-2025/