Recently, Bloomberg published an article titled “The Miseducation of America’s Nurse Practitioners” by Caleb Melby, Polly Mosendz, and Noah Buhayar, which brings to the public’s attention the dismal state of education for APRNs. I would like to share my own story and that of several other APRNs who attended my APRN program. This story will demonstrate many of the disturbing facts about the educational system designed to train APRNs.
I attended United States University (USU), an accredited for-profit university. I graduated from the 24-month program with a master’s degree in the science of nursing, specializing as a family nurse practitioner (FNP), despite never having worked in family practice. This allowed me to take boards to become a practicing FNP. With these credentials, I can seek employment in an office setting, emergent care, or hospital. However, in my 24 months of training, I received in-person instruction from faculty for just three days. Along with thousands of others, I am now examining, diagnosing, and treating patients based on these three days of in-person education. Yet the problems at USU began far before this and extended far beyond it.
Soon after enrolling at USU, I realized that this school, and others like it, are dangerous, violating public trust and deceiving lawmakers and regulators. I realized this because my classmates seemingly all received passing grades despite showing little to no grasp of the material, and many of their papers were not good enough to pass a basic English class. I experimented a few times to see what I could get away with, blatantly messing up on assignments and including incorrect clinical information that could harm patients. I still passed. Several times, I wanted to quit the school because of the quality of education, but the courses were non-transferable. After all, USU was cheap and accredited, and upon graduation, I could take the board certification exam and get a job.
Regulation in most states requires rotational hours. In my state, 500 hours are required for licensure. This time is spent shadowing a preceptor who is an MD, DO, or APRN. By comparison, a family physician undergoes over 10,000 hours of strictly supervised residency before practicing independently. During the 500 hours of rotations for an APRN, it is expected that we demonstrate clinical skills under supervision, but we didn’t, as the preceptors were unaware of or unwilling to follow course instructions.
Students are tasked with finding their own preceptors, which amounted to one of the most stressful times of my life—not because of the material, which was easy, but because finding a provider willing to act as a preceptor was nearly impossible. The hours of searching took away precious study time. The preceptors ultimately were anyone willing to say yes who had a license and board certification. Some agreed because I strong-armed them with mutual connections; others did it because I flattered them. One did it because she’s my own doctor, and I practically begged her. Once we found a preceptor, we dared not insist that they follow the course requirements, risking the relationship. The school did not inquire either. I was fortunate to have amazing preceptors who taught me so much. But the most important lesson they imparted was that the required 500 hours of rotations were insufficient to safely examine, diagnose, and treat patients. It was just enough to show me that I had great potential to be a public danger. I have since spent countless hours trying to make up for this deficit so that I am not a danger to my patients.
APRN associations have stated that a minimum of 500 in-person rotational hours under a preceptor are allowed because APRN students have accumulated clinical skills on the job as RNs. This is a lie: Many universities do not require RN experience, including USU. I was accepted to USU with only six months of experience as an RN, and I had not yet finished my orientation. As it turns out, I had more experience than some of my classmates.
State laws vary, but in my state, an APRN must have supervision to mitigate this lack of training. However, this supervision is not regulated, and as a newly minted APRN, I discovered that this training either does not exist or is so minimal that it is absent except on paper. This supervision law is intended to protect the public, but it is being abused, and it must be made stricter.
Simply put, an individual with no clinical experience can see patients independently through a university that does not require RN experience or licensure. This individual can diagnose and treat patients with merely 500 hours of rotations under a provider who is unaware of their role in the individual’s education. No on-the-job training or strict supervision is required. This is legal.
To ensure my competence, I have completed hundreds of hours of continuing medical education, devoured clinical books and videos, sought help from mentors, and capitalized on my four years of knowledge and observations from working as a certified nursing assistant in 25 different hospital units, along with my three years of RN experience. I frequently reach out to specialists outside of my organization. These are not required tasks; I do them out of a duty to my patients and community. I do not believe many other APRNs perform such tasks.
I have received direct feedback from many patients that they have received better-than-expected outcomes under my care. The feedback I receive from other specialists is that I am an astute clinician. I have never received feedback that I caused harm. I am quick to admit when I do not know something and refer to specialists. I do not know what I do not know, but what I do know is that I am one who recognizes this problem.
Joseph Lanctot is a nurse practitioner.
