The NP Preceptor Shortage: What NPs Need To Know

At NPHub we do two things to fight the NP preceptor shortage.

The first one is connecting available preceptors with students who need them.

We try to ensure that these preceptors are ideal for the students, and vice versa. It’s more than just finding available preceptors in your area. It’s about ensuring successful clinical rotations.

However, the second thing we do might be the most important, and it’s the fact that we try to create new preceptors.

When we talk to NPs that could be potential preceptors, and listen to their concerns, sometimes it feels as if we’re asking a little bit too much.

Many of them still find it difficult to make the decision, even though most of them are eager to precept and know about the benefits.

That’s why we always ask ourselves: what is not being done here?

Why is it still so difficult to find an NP preceptor?

There are two reasons why, to this day, it’s so hard for nurse practitioners to find preceptors.

First, we already have a shortage of (non-precepting) nurse practitioners. Second, there might be some barriers to precepting that are not being addressed.

To understand this better, let’s begin with the benefits of becoming a preceptor.

A 2015 study on barriers and incentives to precepting showed that most preceptors identified the following benefits as the ones they wanted most:

• Credit toward professional recertification.
• Program information.
• Access to clinical references.
• Remuneration.

Many universities, and companies like ours, now offer most of these benefits. Some of them have been around for a long time now.

So why do we still have a countrywide NP preceptor shortage?

Well, it’s true that these benefits are not the norm in every state. For example, in some states, paying preceptors is considered to be illegal. Perhaps we need to make these benefits a standard.

But what about the barriers to precepting? Do these benefits help to bring them down? This might not be the case.

For example, in that same study, preceptors said that the two biggest roadblocks to precepting were “time constraints” and “productivity demands.” These are two issues that probably don’t disappear after you introduce CE credits and compensation.

So, what other benefits should we advocate for in the future? Let’s look at what preceptors have to say about it.

What keeps preceptors from becoming preceptors

In 2019, the AANP Journal published a study on tax incentives for preceptors in Massachusetts, and mentioned some of the main reasons for the NP preceptor shortage.

The study says that clinical placements “may be delayed because of institutional issues or preceptor needs, or clinical site logistics.” These include:

• Difficulty completing clearance paperwork and affiliating preceptors.
• A large number of committed preceptors suddenly cancelling rotations.
• Preceptors refusing students for lack of financial compensation.
• Implementation of new EHR systems (the training process it’s too long and difficult).
• “Lack of time or scheduling ability and a lack of physical space within the clinical setting” (as reported by a 2017 national study).
• Conflict with academic institutions.

This study presents a good overview of the problem, and proposes a solution that has been very popular: tax incentives. We’ll come back to that.

A more recent study on clinical teaching (Journal of Nurse Practitioners, 2020), offers a different approach that’s also important. We haven’t really discussed how prepared NPs actually are for precepting.

That study surveyed 195 NPs at a national conference and found that:

• Only 23% of NPs had attended some kind of preceptor education program.
• 63% of them identified preceptor education as the biggest barrier to precepting.
• Time and perceived costs were the second and third biggest barriers.
• 65% of them disagreed with the statement: “I feel prepared to teach.”

It’s not all bad. 58% of preceptors also agreed with the statement: “I have a clear understanding of the educational objectives when working with NP students.” What’s missing is only a way to properly teach. Education is a career all on its own, and not everybody does it right.

So, now that we have a better idea of what’s happening today, let’s look at what’s actually being done about it in 2021.

How people are trying to solve the NP preceptor shortage, as of today

Tax incentives have been a popular idea for a few years now, and it seems to be a growing trend in post-pandemic times.

In Massachusetts, they considered that tax incentives might be a good solution to the NP preceptor shortage, “as evidenced by the current incentives in place” for MDs, and similar incentives for PAs.

In 2021, here’s what every state is doing about tax incentives:

States with pending or rejected tax credit proposals for NP preceptors:

Alabama, Arizona, Connecticut, Idaho, Kentucky, Rhode Island, New York, Louisiana, Maine, Massachusetts, Minnesota, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Virginia.

States with active tax credits for NP preceptors by law:

Georgia, California, Colorado, Maryland, Hawaii, South Carolina.

States without official tax incentive proposals or widespread discussion (right now):

Alaska, Arkansas, Delaware, Florida, Illinois, Indiana, Iowa, Kansas, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming.

You can see how tax incentives, even though people like them, are not really that widespread.

Also, many states do have tax proposals to combat the NP preceptor shortage, but we don’t count them because they only offer those benefits to physicians. They are on list number three.

Most NP organizations have their own ideas on how to take down the barriers to precepting. Many of them don’t have anything to do with taxes.

However, tax incentives deserve their own section on this post, because they’re the first thing that comes up on this subject.

Proposals to solve this issue that don’t include taxes

There’s little information on other proposals, at least on the surface, when you look this up on Google. It requires more research, which is not a bad thing, but does tell us something about how people see the NP preceptor shortage.

We can mention that Alabama recently approved legislation to create a Preceptor Awareness Campaign. Ohio has a private program that pays preceptors for precepting.

The 2019 AANP Journal study, see two sections above, also mentioned that Iowa was considering things like loan forgiveness and scholarships.

Apparently, this is also another popular idea that might get traction in the future, and some NP programs are already doing it. Like Creighton University in California.

You can find examples of beneficial programs and resources for preceptors in almost every state. So there’s no shortage of ideas. All of these things make a preceptorship more appealing.

However, how about making preceptorships easier? More effective? We just read that the NP preceptor shortage is because of time constraints, problems with paperwork, institutional conflicts… Who’s paying attention to that?

The “real” solution to the NP preceptor shortage

As we wrote at the top of the article, we care about creating new preceptors.

We understand that there’s no “real” solution to the NP preceptor shortage, or any shortage in healthcare. It’s a complicated socio-economic problem that’s been going on for decades.

However, if we were to propose a “real” solution, away from the monetary aspect of it, we would try to offer solutions that don’t put the onus of precepting on NPs themselves.

Yes, you can precept because you’re going to get paid. Because they’re giving you a loan, or cutting your taxes, or because companies like ours have an online app that matches you with ideal students.

Or, you could precept because you have all of that, and because it’s easy. Because there’s a structure in place, a system, a working space to do it.

The paperwork comes through, the administration has your back. You receive education before precepting, and then you get paid, as you should. There’s no vagueness, no improv, no bureaucracy.

That is the world we would like to see for our preceptors. And that will require shifting away from the idea of just offering money-related solutions. Certain practices have to change at an institutional level.

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We’ll leave you with that idea, for now. We’ll talk more about that in future posts.

If you want to become a preceptor with NPHub, check out our preceptor page. Also, what do you think about the NP preceptor shortage? Reach out on social media and let us know! Have you precepted NP students? Do you want to precept? We want to hear from you.