Pitfalls of nurse practitioner education made national headlines in July after a Bloomberg Businessweek article criticized programs for allegedly accepting students and graduating them without proper training or experience.
More than 600 NP programs have sprouted up across the country offering advanced nursing degrees — three times more than the number of medical schools. In total, 39,000 NPs graduated from programs in 2022, a 50% increase from 2017, according to the American Association of Nurse Practitioners. NP training programs are not standardized, and many students complete coursework entirely online, according to the report.
"There are programs graduating nurse practitioners with no experience, and that's incredibly challenging for them, for the hospitals and for the clinics they go into," Donna Berizzi, DNP, RN, associate chief nursing officer of the Baltimore-based Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, told Becker's. "Some places will pay for their education and slot them into roles they aren't ready for, without the infrastructure or support to ensure their success. You have someone who goes straight through their education, and by the end, they're a nurse practitioner, but they've never worked on the floor, never taken care of a patient, and they really have no idea what they're looking for."
The Bloomberg report looked at for-profit education programs, not medical centers. However, its far-reaching claims prompted several systems to speak out about their programs.
"This article sheds light on a concerning trend in for-profit nursing programs but it is not representative of the entire nursing education pipeline," Sarah Szanton, PhD, RN, dean at the Baltimore-based Johns Hopkins School of Nursing, wrote in an op-ed piece to Becker's. "It risks tarnishing the evidence-based value of advanced practice nurses and making people afraid to get care from well-qualified nurse practitioners. This is particularly dangerous at a time when our health systems are focused on cutting costs and increasing profit at the expense of the workforce and patients."
Nurse practitioners fill a vital role in the medical ecosystem, supporting physicians and providing primary care to many in low-access areas.
"Millions of patients across the nation choose NPs as their healthcare provider because of the exceptional care they deliver in more than 1 billion visits each year," AANP President Stephen Ferrara, DNP, said in a letter to the editor published in Bloomberg.
But the article did highlight weaknesses in the education system. Becker's reached out to hospital leaders from across the country to find out what is most urgently needed in nurse practitioner education.
Editor's note: Responses have been lightly edited for length and clarity.
Donna Berizzi, DNP, RN. Associate Chief Nursing Officer of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins (Baltimore): If you break down what's missing in nurse practitioner education, the clinical piece is obviously key. I have to agree that programs pushing through nurses without much clinical background into nurse practitioner roles, and without proper clinical rotations, are setting them up for failure. It's unfair to the institutions they'll work for, it's unfair to them and it's unfair to the patients. These programs need to ensure either some minimal prior clinical experience before entering, or there has to be a strong clinical infrastructure. Programs that don't require this should reconsider.
The autonomy piece is also important. They need to be taught some financial aspects during their education. So many different nurse practitioner models exist in the workforce—whether it's a shared-visit model, nurse practitioners working independently in clinics without physicians present or collaborative agreements. They need to know what all that means once they graduate. They need to understand that so they aren't shocked when they face these realities — like billing for their work. There's a ramp-up to independent billing, but they need to know that they'll eventually have to cover their own salary through billing. I don't think schools are covering that part. There needs to be some kind of business sense taught in these programs.
Deborah Bryant, DNP, RN. Chief Nursing Officer of the Bon Secours Mercy Health-Toledo (Ohio) market: Nurse practitioners are critically needed throughout the healthcare system — a need that has prompted many educational institutions to accept nurses into the NP program despite a lack of years serving at the bedside. Practical experience gives our nurses the opportunity to garner clinical expertise before continuing on to a more advanced program. Required bedside experience benefits not only our patients but the NP as well.
Tiffany Murdock, DNP, RN. Senior Vice President and Chief Nursing Officer at Ochsner Health (New Orleans): What is really important right now, especially as we look at how health systems can support the growth and development of nurse practitioners, is how we are collaborating and forming partnerships with academic institutions. At Ochsner Health, we are proud of our work with several local and national schools to partner on curriculum and subspeciality training to help prepare our NPs. Through training, faculty and curriculum collaborations, our NPs are prepared to deliver high-quality and community-based care when they enter the workforce.
Bryan Sisk, DNP, RN. Chief Nursing Executive at Memorial Hermann Health System (Houston): As healthcare becomes increasingly team-based, it's vital that NPs continue to expand critical skills such as delegation, planning, growth, communication and teamwork across various disciplines. We have a rapidly evolving clinical landscape and education is the key for nurses to elevate their voice and continue to make meaningful contributions in strategy, growth, health equity and many other topics that extend beyond clinical expertise.
With the growing specialization of NPs and their expansion into leadership roles, there is a pressing need to incorporate education on healthcare policy, advocacy and leadership training. These areas are essential to prepare NPs not only to excel in patient care but also to influence and shape the future of our care delivery systems. By fostering these competencies, we empower NPs to take on influential roles that drive positive change within the healthcare system.
Barb Tofani, MSN, RN. Senior Vice President of Patient Services and Chief Nursing Officer at Cincinnati Children's: New nurse practitioners at Cincinnati Children's complete a six-month period of orientation to their subspecialty practice but it takes most new graduate NPs a year or more to develop competency and confidence in their role. NP graduate programs could greatly benefit from re-design to meet current and future workforce needs by broadening the NP graduate program curriculum to remove barriers around age scope and patient population, similar to how physician assistants sit for one general national board certification, creating workforce flexibility.
Providing federal funding for post-graduate fellowship programs will be critical to support the growing workforce needs in subspecialties where there are provider shortages.
Stronger academic practice partnerships between healthcare organizations and NP graduate programs could help address the NP faculty shortage. We recognize a need for NP graduate programs to have more standardized clinical placements that mirror the training for medical student and residency programs, and this keeps students from scrambling or paying additional fees to find preceptors and clinical placements to meet the clinical hours required to graduate.
At Cincinnati Children's, we are standardizing the education post hire and leveraging transition to practice programs and fellowships as a solution to better prepare new hires in their role. We are using high fidelity simulation, virtual reality and other creative strategies and will leverage AI to support education and training for the future. The workforce needs and demand for services will outpace healthcare organization's ability to solve these issues independently.