NP Clinical Sequencing: What is the Best Practice?

The overall question to be addressed in this discussion is, ‘What is best placement of NP clinical courses in a formal educational program?’ Appropriate placement of clinical courses was among the topics discussed at the National Organization of Nurse Practitioner Faculty (NONPF) Special Topics meeting in 2013. NP Education models need to adapt to meet the needs of the healthcare system while remaining flexible enough to attract capable students. Above all, ensuring safe, competent and quality graduates remains the focus. Application of learning is required for the NP student and this occurs through activities both in didactic courses and in clinical practicum experiences.  "The student acquires the NONPF Core Competencies through mentored patient care experiences ..." (NONPF, 2013, p.8). Knowles's (1980) theory of andragogy states that adult learners want to immediately apply what they learn, and they learn best by doing. Given that multiple courses in any NP program may contain various means to immediately apply knowledge, the question remains as to the best placement for clinical experiences. A brief review of the literature revealed support for sequential learning from didactic to experiential in mental health counseling students (Feiner, 1998), and for clinical immersion in pharmacy students (Willer and Luer, 2008). However, little research has been done in these areas regarding NP students. The Nurse Practitioner curriculum at this university is being revised to front load all didactic courses followed by a two semester clinical immersion experience during which all students will complete the required 600 hours (300 hours in each of two semesters) of clinical experiences. The curriculum revision puts the MSN NP program at this university in a unique position to study, gather, and analyze data regarding clinical sequence placement. Students who take clinical courses with didactic will be compared to students who take clinical courses after didactic. Factors such as student confidence, preceptor confidence, student performance, and national certification exam scores will be studied for each group. This armchair discussion will present exemplars of what is known, pros and cons of frontloading versus concurrent didactic and clinical course sequence, and one school’s plan to address NP clinical placement.