Educating Primary Care NPs: Overcoming the Challenges of Practicum Placements

The Affordable Care Act has increased the number of Americans eligible for health care.  This surge in demand for primary care is being met with declining numbers of primary care providers.  Primary care providers are pressured to increase the number of patient encounters which results in less time to spend with the patient. Additionally more residents are choosing specialty fellowships rather than entering primary care.  Similarly many NP students are choosing to work in specialty practices.

Access to primary care is central to controlling health care expenditure.  Primary care providers offer valuable preventive care and screening services that are needed to prevent and manage chronic conditions. Providers in busy practices are often reluctant to precept NP students due to concerns of decreased productivity.  In areas where there are several nurse practitioner programs, students often compete for limited practicum sites and preceptors.  All of these factors negatively affect the NP student’s experience making it challenging for NP faculty to find appropriate clinical learning experiences for NP students. 

Nurse practitioners can ease the burden of the primary care shortage however they must be provided with meaningful learning experiences that will encourage them to remain in primary care.  NP faculty can utilize the principles of community based participatory research (CBPR) to negotiate entry into practicum sites that can provide rich learning experiences for NP students.  The NP faculty must help agencies and providers see the benefit of participating in NP education.  It’s not all one sided but can be a symbiotic and enriching experience for everyone involved, especially the patients.  NP students bring a special set of skills to the learning environment.  Many are registered nurses with years of practice experience and are highly skilled in patient education and case management.  These skills can easily complement the role of the student NP and often prove beneficial for the agency, providers and the patients.  This approach has allowed faculty at Rutgers University College of Nursing to increase the number of high quality primary care agencies and practicum preceptors available to students, especially in pediatrics.