Background Significance
Enrollment in baccalaureate (5.6%), master’s (4.1%), and doctoral (8.9%) nursing programs continued to increase even during the COVID-19 pandemic.  While enrollment has steadily increased over the last 15 years, about 81,000 qualified applicants are denied admission annually due to the shortage of faculty, clinical sites, and available preceptors (American Association of Colleges of Nursing, 2021). Most concerning is the 12,871 denied applications submitted to graduate programs. Graduate programs train future educators who in turn educate future providers that are desperately needed to care for a rapidly growing and aging population (American Association of Colleges of Nursing, 2021).

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Problem Statement
Nurse Practitioners (NPs) comprise the fastest growing segment of the healthcare workforce (Kaiser Family Foundation, 2021). Despite the nearly 260,000 nurse practitioners (NP) in the United States, there is a national preceptor shortage for NP students. Annually, an average of 28,000 NP students require clinical precepting to meet graduation requirements and prepare for licensure (Gaynor and Barnes, 2021). Precepting has traditionally been an unpaid volunteer position that many NPs do for 1) altruism, 2) the joy of sharing one’s specialty, 3) the pleasure of building a relationship with a student, 4) as a tool for recruitment, and 5) as a method to remain current and 6) to fulfill a professional obligation. However, the increasing demands of patient care and electronic documentation; the impact on productivity and income; competition amongst medical and physician assistant students; and online schools have led to a preceptor shortage (American Association of Colleges of Nursing, 2015; Dallaghan et al., 2017; Gardenier et al., 2019; Gaynor & Barnes, 2021; Germano et al., 2014; Institute of Medicine, 2011). The shortage impacts students’ emotional stress, financial aid support, academic standing, timely graduation, and their ability to remain in the program (Carelli et al., 2019). While the literature supports financially compensating preceptors and multiple companies have been created to help students and universities obtain preceptors for a fee, these efforts have not been enough to resolve the shortage.

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Why is this topic important to me?
I was enrolled in a nurse practitioner program that required the student to find and secure a preceptor for each clinical rotation. Unfortunately, due to preceptor scheduling constraints, limited hours, and other responsibilities, I had to work with seven preceptors (two of which the university helped secure) to obtain the specified number of clinical hours needed for graduation. Finding a willing preceptor was time consuming and stressful. There was no blueprint to follow, and my ability to secure a preceptor was largely dependent on whoever answered the phone or responded to the initial email (the gatekeeper). I had limited time to find a preceptor because I continued to work full time.
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What intrigues me about the topic?
I received an email about the severity of the NP preceptor shortage. I previously served as a board member of a local NP organization for two years. While we briefly discussed the shortage multiple times, it dawned on me that I may be able to help. I recall during NP school, my classmates and I met with the dean to discuss our challenges securing a preceptor and potential solutions for the shortage. Since then, I’ve learned so much about being a change agent, how to use data to support my proposals, and how innovation doesn’t require me to reinvent the wheel. I have identified stakeholders (boards of nursing, local faculty, universities, and students) who feel the problem is urgent, and are eager for help.

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What's next?
In the email, I learned there is an initiative to pass a preceptor tax law in DC similar to what is available in Maryland, Georgia, Hawaii, South Carolina, and Colorado (Campaign for Action, 2018). When preceptors have been surveyed about what incentives would encourage them to precept, financial compensation has been named as only one of many rewards (Carelli et al., 2019; Christner at al., 2016; Dallaghan et al., 2017; Gaynor & Barnes, 2021; Morgan et al., 2017). Continuing education credits, access to university resources, university affiliations, relationships with faculty, and recognition (awards, letters of appreciation, and invitations to network) often rank higher than financial compensation as preferred preceptor rewards. Furthermore, some universities would be unable to compete with schools that have larger financial resources, and many students would be disproportionately affected by rising costs. I have an idea I think would help universities showcase their highly rated preceptor incentives which are meaningful and low-cost (Carelli et al., 2019; Christner at al., 2016; Dallaghan et al., 2017; Gaynor & Barnes, 2021; Morgan et al., 2017). It would reduce university administrative costs associated with securing preceptors and become a selling point to prospective students, thereby potentially increasing enrollment and revenue (a priority strategic goal for many universities) (Carelli et al., 2019).

-What has been your experience securing a preceptor as a student:

-What lengths have you gone to to help your students find a preceptor and graduate on time?

-When it comes to solutions, where do you think we should start?

-What are the biggest barriers to solving the preceptor shortage?

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DMV Dermatology NP + PA Group

If you're an aspiring or practice dermatology nurse practitioner or physician associate in the DMV (DC, Maryland, and Virginia) region, I invite you to join the DMV Dermatology NP + PA Group, a private, member-only Facebook Group. I wrote about the story behind starting the group and my vision for what we can do with it in a previous article.

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Virtual Preceptor Co.

I've started phase 1 of the Virtual Preceptor which includes e-books and digital courses. Visit the Virtual Preceptor Co. shop to see the latest e-books available for immediate download by clicking here.

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Kimberly Madison, DNP, AGPCNP-BC

Kimberly Madison is a nurse practitioner with a passion for writing, entrepreneurship, education, and mentorship. I created this blog to share my journey as source of motivation and as a blueprint as you embark on your journey. Most importantly, I’m looking forward to increasing access to dermatology education and clinical training for aspiring and practicing nurse practitioners. I invite you to view the mission and vision statement on the homepage to see how we can best partner to make our dreams align.

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