Private Sector Innovations to Fund NP Clinical Education (Week #9)

Private Innovation with Public Funds

The public sector (i.e. government) discussed in the last post may be big and powerful in its control of funding and regulations of healthcare, the private sector is afforded flexibility and sometimes financial resources to create solutions to meet the needs of patients and providers alike. The Graduate Nurse Education (GNE) demonstration project was established by the Center for Medicare & Medicaid Services (CMS) to study a few options to increase the clinical training for nurse practitioner (NP) students. The project provided funding to five organizations across the United States, with more than 900 advanced practice registered nurses (APRNs) in Arizona benefiting from this four-year study. Unfortunately, it will take time for the data to be fully analyzed and reported; then additional time beyond that for regulatory changes to occur.

Popular Recognitions for Preceptors

Colleges and universities offering degree or certification programs for the NP have a two-fold reason for tackling the problem of preceptors. Schools want to offer students quality sites and schools need faculty. One means to address both the nursing faculty and preceptor shortages is to offer the preceptors adjunct faculty roles (Wiseman, 2013). This process is well established in medical training with the joint appointment many physicians hold with universities (Forsberg, Swartwout, Murphy, Danko, & Delaney, 2015). Creative financing methods used by the colleges to “pay” the preceptor include continuing education vouchers, tuition reduction, and access to campus services or events. The faculty can also aid the preceptor with professional certifications and recognition via manuscript editing, award nomination, and letters of reference. Many successful academic-preceptor partnerships also offer the preceptor free training and support to improve the skills used in mentoring an APRN student (Wiseman, 2013).

Melding Student and Employee Roles

Rosalie Mainous, PhD, APRN, NNP-BC, is now the Director of Academic Nursing Development with the American Association of Colleges of Nursing, but was involved with a very innovative transition to practice program during her tenure as Dean of the Wright State University-Miami Valley College of Nursing and Health (WSU) in Dayton, Ohio. Though this program was designed for the baccalaureate nursing student entering a registered nurse position, it has possibilities for APRNs as well. The final clinical semester is coordinated to also be the new nurses’ orientation time on the job. It provided the student with interview experience and a secured job upon graduation; the organization with 3-year commitment from the student, and reduced orientation and turn-over costs; and WSU with strong, consistent, appropriate clinical sites (Trepainer, Mainous, Africa, & Shinners, 2017). In a personal telephone interview, Dr. Manious stated that it is human nature to learn, as well as teach, slightly different if one is hired and orienting to a new role versus completing a clinical rotation or residency. This academic-organization partnership will not work for every RN or APRN student; however, it shows much promise in meeting the needs of the school, student, organization, and patients in a winning scenario for all.

A Negative Innovation

Some organizations are taking advantage of the limited clinical sites when contracting with universities by charging a fee; YIKES!! “We are the pipeline for their workforce” was Dr. Mainous’ observation regarding the needed relationship between schools and organizations. Schools are already struggling to keep tuition affordable, provide the latest technology teaching tools, and pay their faculty and staff adequate wages; adding a site fee per student could push some programs to the breaking point. From the viewpoint of the organization, their reasoning seems logical; they are paid to take medical students, shouldn’t they get paid for helping train the nursing students as well? Important differences are the funding source for the medical students (i.e, Graduate Medical Education funding through CMS), educational program design, and the coordination of medical school admissions with known site availability.

What Next

It will take all stakeholders in NP, as well as medical, education working together to find cost-effective, quality-promoting, patient-focused solutions to the challenges of securing and remunerating the preceptors and healthcare facilities for their investment. Efforts in the public sector combined with an examination of the many innovations in the private sector will help improve clinical education for the APRN and improve outcomes for the nation’s health.

 

Forsberg, I., Swartwout, K., Murphy, M., Danko, K., & Delaney, K.R. (2015). Nurse practitioner education: Greater demand, reduced training opportunities. Journal of the American Association of Nurse Practitioners, 27, 66-71. doi: 10.1002/2327-6924.12175

IOM (Institute of Medicine). 2014. Graduate medical education that meets the nation’s health needs. The National Academies Press. Retrieved from:  https://www.nap.edu/catalog/18754/graduate-medical-education-that-meets-the-nations-health-needs

Trepanier, S., Mainous, R. Africa, L., & Shinners, J. (2017). Nursing academic-practice partnership: The effectiveness of implantation of an early residency program for nursing students. Nurse Leader, 15, 35-39. doi: 10.1016/j-mnl.2016.07.010

Wiseman, R.F. (2013). Survey of advanced practice student clinical preceptors. Journal of Nursing Education, 52, 253-258. doi:10.3928/01484834-20130319-03

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4 Comments Add yours

  1. I appreciated your blog post this week. It is something that resonates with me at this time. Throughout this program I have had several preceptors to whom I am extremely grateful for their time and their talent of teaching me what they know and applying my didactic knowledge into real life. However, I must say that although they voluntarily give up their time, if they were compensated would be much more inclined to precept. In addition, I dare say we would have more APRNs who would be willing to precept.

    Even something as simple as offering them to be adjunct faculty or discounted tuition for continuing education classes. These were GREAT suggestions! Just like you said, the physicians are paid to take medical students and residents. Not to mention residents are PAID to work with these physicians. The amount is nominal, but it still exists. We as NP students put in up to 225 hours in clinical rotations and receive no compensation. We have a long way to go in changing the face of nursing, particularly how NPs are trained in clinics through preceptorships.

    I found this in a policy brief written by a PA student:
    “The American Medical Association (AMA), which supports legislation or regulations that prohibit “extraordinary compensation for clinical clerkship sites by medical schools or other clinical programs that would result in displacement or otherwise limit the training opportunities” of U.S. medical students in clinical rotations.”” (1)

    I am sure there is plenty of pushback from the medical community to compensate MDs for precepting NPs, especially in the major teaching hospitals. Of course physicians would rather precept or mentor medical students; they receive compensation for taking them. While this has not been my experience and the physicians I have worked with were very accommodating, it took some education on my part to explain to them the need for NPs to take clinical rotations in different primary care and specialty settings.

    You have successfully identified a gap, I look forward to the future when we have answered and filled it in.

    (1) http://paeaonline.org/wp-content/uploads/2015/09/PaymentClinicalSites-PreceptorsPAEducation.pdf

    Liked by 1 person

    1. Deb says:

      Thanks for sharing your experience and ideas. I found the article on PA “clerkships” to be very informative. It also made me realize just how confusing our healthcare training must sound to others. There are residencies, internships, externships, preceptorships, clerkships, clinical rotations, clinical education, clinical experiences, mentorships, and fellowships just to name a few; some during school, some after graduation, some after licensure. Plus, the paths of education, number of classroom hours, and type and number of clinical hours all vary from NP to PA to MD to DO – yet we all see and treat patients, with varying levels of independence and collaboration – often out of site of the patient. Then add physical therapists, speech therapists, respiratory therapists and all the other ancillary personnel, it’s no wonder people are confused. This makes education of the public as the number one step of any type of legislation or funding. I did like the article’s emphasis on the partnership between academia and industry as well as interprofessional training. It will take a huge overall of the current system and old ideas and hierarchies to achieve a true interprofessional pool of sites and teachers (a generic term for the experienced professional working with the student) but I sure like the possibilities for that.

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  2. kyoung2017 says:

    After reading your blog post I had to think about paid preceptorship for a moment. Ultimately, I agree that preceptors should be reimbursed for their time whether it be check, tuition reduction, or some other form of compensation. Preceptors who were compensated would have ownership in the student’s education therefore strive to give the student a valuable clinical experience. Paying preceptors may also result in the retention of preceptors. With a shortage of clinical sites, offering preceptors payment or incentives may be the way to ensure clinical placement and quality preceptors for students. As you mentioned, this would probably result in a tuition increase. However, there are websites that offer to match up preceptors with students who need clinical sites. The preceptors on these sites do get paid to precept. According to Forsberg et al., in order to bring the clinical training of a nurse practitioner to the next level of professionalism, quality NP preceptors must be created and maintained (2015). What do you think about these websites that match preceptors with students and offer incentives? I would rather the University have guaranteed quality clinical sites through incentives offered to preceptors.

    Forsberg, I., Swartwout, K., Murphy, M., Danko, K., & Delaney, K. R. (2015). Nurse practitioner education: Greater demand, reduced training opportunities: Nurse practitioner education. Journal of the American Association of Nurse Practitioners, 27(2), 66-71. doi:10.1002/2327-6924.12175

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    1. Deb says:

      I have seen those preceptor matching sites, but never tried it myself. On a discussion board I started on LinkedIn (https://www.linkedin.com/groups/4662882/4662882-6227886652463865857), several respondents did not have any luck using them. The fees they charge are non-refundable, though one company offered to apply the fee to future searches. One site doesn’t charge until the rotation is approved, but the charge is $15.00 per clinical hour – minimum of $1,200 (https://www.onlinefnpprograms.com/blog/interview-with-dino-soriano-clinical-match-me.html). The clinical match me site makes a reference to the opportunity cost for each semester a course is postponed at $30,000 – so it does make $1,200 seem small in comparison – but why are NPs searching in the first place. I am not aware of any other professional degree that requires the student to find the educator. I also worry that without proper oversight and regulation, there will be poor quality preceptors just taking as many students as possible to gain income. I agree with you that the university should be in charge of the clinical precepting experience. There is value in the practice-academic partnership for all parties involved.

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