5 minute read
Is Nurse Practitioner Education in Need of Reform?
BY NACHOLE JOHNSON, MSN, FNP-BC
If the pandemic has shown us anything, it’s that we need more primary care providers to care for sick individuals. During the pandemic, nurse practitioners (NPs) across the nation stepped up and provided care during the crisis when there was a shortage of physicians. Although this isn’t new–NPs have been providing exceptional care for years preceding the pandemic.
In a study conducted by the Veterans Administration, when compared to their MD counterparts, patients who had NPs as primary care providers (PCPs) experienced similar outcomes and incurred less utilization at a comparable cost relative to those managed by MDs. When evaluating the outcome of this study, NPs seem to be the answer to a cost-effective approach to addressing the shortage of primary care physicians, but this isn’t the case.
Why the hesitation?
Education: The Real Issue at Hand
At the time of the writing of this article, there are currently 24 states and three U.S. territories that grant full practice authority (FPA) to NPs. NPs have worked tirelessly for years to get legislation passed for FPA across the nation. Although studies show that care provided by an NP is comparable to physicians, there is a growing issue within the NP community that many are ashamed to admit.
Educational standards are lacking in some programs and leaving new graduate NPs feeling unprepared for clinical practice.
The lack of a clear consensus of educational standards for NPs is hurting the profession. The minimum requirement of 500 clinical hours needed to graduate, as well as the lack of properly placing students with preceptors in the clinical setting, has taken a toll on the quality of recent NP graduates. Requirements for admission to an NP program are also a cause for concern since they vary between schools. Some programs require previous RN experience prior to admission while others don’t–the same goes with an entrance interview. There is no uniformity in the admission process of an NP program.
When asked about NP educational standards, John Canion, FNP-BC, ENP-C, an emergency nurse practitioner in Texas, says they’re “suboptimal.” “There’s no barrier to entry [to NP school], even if it’s minimal, there needs to be a barrier to entry.”
The issue within the NP community regarding educational standards is starting to seep out with more people taking notice—mainly physicians. Some physician groups make it a point to expose gaps in NP education by humiliating NPs and other midlevel providers online. While one of the website names in question includes “midlevel,” a majority of the posts are not about physician assistants, but NPs. Another physician group, Physicians for Patient Protection, calls their work advocacy to “ensure physician-led care for all patients and to advocate for truth and advocacy regarding healthcare practitioners.”
Changes in Nurse Practitioner Education
There are always two sides to every story and the debate on NP education is no different. Those who have graduated prior to the last decade have seen changes in the education newer NPs receive. When trying to pinpoint the timeframe when changes occurred some believe it was with the introduction of the APRN Consensus Model.
Introduced in 2008, but not fully implemented until 2015, the APRN Consensus Model is a “uniform model of regulation for the future of advanced practice nursing that is designed to align the interrelationships among licensure, accreditation, certification, and education (LACE).” “The [APRN] Consensus Model was designed to resolve the scope of practice issues, but it didn’t resolve the issue—it made it worse,” argues Canion. “People are interpreting it 1,000 different ways.”
According to Jana Zwilling, PhD, APRN, FNP-C, a clinical assistant professor of nursing at the University of North Dakota, there have been two major changes affecting NP education in the past 10-15 years: the increasing need for primary care providers and the shift to clinical doctorates for NPs. “University systems and other educational institutions have built programs to expand the capacity to educate nurse practitioners in the United States in hopes of providing more NPs to fill the gaps in health care access,” says Zwilling.
The Future
In the last few years, the profession has seen the rapid growth of NPs as Zwilling mentions. Between 2010 and 2017, the profession expanded by 109% and continues to grow. The Bureau of Labor Statistics projects that between 2020 and 2030 another 114,900 NPs will be added to the profession with a growth rate of 52% in a single decade. What does the rapid growth of NPs mean for the future if educational standards are not reformed?
If changes don’t occur within the NP educational system a myriad of issues will take place—some are already being witnessed. Due to the unregulated proliferation of NP graduates, wages for NPs have gone down, there are oversaturation issues in some regions, and the public perception of our reputation stands to erode. Canion believes the worst possible outcome would be for states that have FPA to redact privileges. “We’re hurting our profession; what’s eventually going to happen if we don’t fix it [education], is that we’re going to lose full practice authority.”
What the future holds for the profession is unknown, but Zwilling explains that educators are aware of issues and that it takes time to implement new policies.
“The 6th edition of the Criteria for Evaluation of Nurse Practitioner Programs by The National Task Force on Quality Nurse Practitioner Education is due to be published by the end of the year,” says Zwilling. “It will likely address concerns having arisen recently such as clinical sites not accepting students from programs without an on-campus component, having an appropriate number of faculty to support students, and the ability to provide adequate resources for the number of students enrolled.”
While NP educators and practicing NPs expectantly wait for educational reform, physician groups will continue to address shortcomings that erode trust in the public perception of the profession. When discussing the future of the NP profession, Canion says, “We have to be hypercritical of our own education in order to ensure we’re producing the best NPs possible.”
