Should NP Student Programs Continue to Require a Set Number of Direct Clinical Hours?

Article Outline

• Support for Required Clinical Hours
• Rationale Against Required Clinical Hours
• Copyright

Allen Prettyman, MSN, FNP-BC, earned his BSN and MSN from Wilmington University. He is the program coordinator for the nurse practitioner programs at the University of Delaware, where he has been full time faculty for 5 years. He is currently a doctoral student in the University of Delaware Human Development and Family Studies Department and his research focus is obesity. He maintains a part-time clinical practice in the Christiana Care Occupational Medicine Office.

Jane Kapustin, PhD, CRNP, BC-ADM, is an associate professor and assistant dean for master's studies at the University of Maryland School of Nursing. She has served on the board of the American Diabetes Association in Baltimore and is board-certified in advanced diabetes management. She is a past president of the Nurse Practitioner Association of Maryland and was awarded the Nurse Practitioner of the Year in Maryland in 2006. She recently was selected as a fellow of the American Academy of Nurse Practitioners and serves on the editorial board for JNP.

Currently, the National Organization of Nurse Practitioner Faculties (NONPF) Criteria for Evaluation of NP Programs require that NP program/tracks must include a minimum of 500 supervised direct clinical care hours for NP students. As the complexity of NP practice continues to evolve, should there be changes in NP student evaluation methods? In lieu of counting “practice” hours, a model that stems from earlier apprenticeship models, many professions have turned to competency-based education.

NP students have long been accountable for keeping track of their direct care clinical hours, with a written log periodically submitted for faculty review. Recent improvements in student tracking software have allowed compilation of a variety of useful data that benefit both faculty and student. Despite NONPF's clear statement that program clinical hours must be spent in direct care, at times the definition of direct care has been debatable—should simulation learning activities or clinical conference attendance ever be counted as direct care clinical hours? Some research indicates that certification pass rates are negatively impacted if clinical hours are reduced. Although recommended, programs with broad (ie, FNP) or multiple (ie, adult/gerontology) population foci may only require a minimum of 500 hours.

What do you think? Should NP students be required to complete 500 hours of direct clinical care? Contact Section Editor Janet Selway at janet.selway@gmail.com. if you would like to comment on this matter.

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Support for Required Clinical Hours 

Allen Prettyman

Nurse practitioner programs should continue to require students to complete a certain number of clinical hours. Information is lacking about how NP programs determine the number of clinical hours students are required to complete to fulfill graduation requirements. The debate over the hours needed should not be confused with the students' need for time in learning environments moderated by preceptors to achieve clinical competence. Simply tracking the number of students' clinical hours has limited value for NP programs. However, tracking the various subcomponents of the clinical hours can improve our understanding of the students' time spent in the clinical setting.

Tracking software provides a way to better understand what happens during the students' clinical day. The software provides a means to examine the various subcomponents of students' clinical hours. The NP students can file an electronic clinical log for each patient they interact with in the clinical setting. Possible variables examined from the students' logs include number of patients seen each clinical day, patient demographics, student involvement in patient care, clinical diagnosis (ICD-9 codes), and billing information (CPT codes). The many possible uses for the information include examining if students are seeing more complex patients and becoming more independent as they progress in their curriculum. Additionally, the data can be used to identify clinical sites that provide certain types of clinical experiences and match them to students' learning needs.

Clinical hours are the foundation to improving our understanding of NP students' clinical experience. The profession must take the next step by using available technology to improve our understanding of the parts comprised by an NP student's clinical time.

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Rationale Against Required Clinical Hours 

Jane Kapustin

Nurse practitioner programs should not continue to require a set number of direct care clinical hours for several reasons. The selection of 500 hours is an arbitrary number that is not based on evidence. Instead, we need to rely on evidence-driven attainment of competencies in the specialty. This is especially important because many schools of nursing are transitioning their NP programs to BSN-DNP programs, and the assignment of 1000 clinical hours remains highly controversial among academicians because it may prove to add extra time to the program, add costs for additional credits, and create redundancies in NP education.

The clinical experiences across NP programs are highly variable, and attempts to standardize experiences and competency attainment should be made. Ensuring that all students are challenged with sufficient numbers of patient cases in the population focus should be the desired outcome. For example, it is possible for a student to manage numerous essential hypertension cases; however, he/she may miss opportunities to see other common chronic or acute care problems. So the number of hours spent seeing the same patient cases will not add value for the student and may detract from the overall rotation.

NONPF has established minimal competencies for all NP students, and we should strive to monitor their achievement of them. I highly recommend that patient scenarios are tracked carefully to ensure that students are exposed to sufficient numbers of commonly seen problems in the specialty. The use of clinical tracking systems may be helpful. Additionally, the use of standardized patient experiences or objective structured clinical examinations (OSCEs) would offer formative and summative sessions to help “standardize” NP education and ensure the acquisition of skills and competencies.