For all of our colleague students and faculty working to obtain clinical hours

[DNP Inc.]

For all of our colleague students and faculty affected by an inability to meet clinical hour obligations, please see the following notice.

NONPF is the leader in quality NP education.

Released: March 23, 2020
In light of the COVID-19 pandemic, the undersigned organizations reaffirm that all nurse practitioner (NP) students are required to complete a minimum of 500 supervised direct patient care clinical hours over the course of the NP program. In addition, clinical hours are distributed to support competency development that represents the needs of the chosen population. If additional clinical hours are required by the institution or a certification organization (above the minimum 500 supervised direct patient care clinical hours), these additional hours may be completed as simulation, if students have completed the direct patient care clinical hours that are necessary and required for them to be fully prepared to practice as an NP in the population focus area.

During this COVID-19 pandemic, we realize that programs are assessing the status of course and clinical offerings. Based on these assessments, programs are making appropriate adjustments that ensure students graduate with a quality NP education and are fully prepared for certification examinations and NP practice. This statement is being released in response to the questions that we have received related to this topic.

According to the 2016 Criteria for Evaluation of Nurse Practitioner Programs, 5th Edition, A Report of the National Task Force on Quality Nurse Practitioner Education. Chapter III: Curriculum, Criterion III.E, “the NP program/track has a minimum of 500 supervised direct patient care clinical hours overall. Clinical hours are distributed to support competency development that represents the population needs” (NTFC, page 12).

The elaboration section of Criterion III.E further states that “simulation is recommended to augment the clinical learning experiences, particularly to address the high-risk low- frequency incidents; however, simulation experiences may only be counted as clinical hours over and above the minimum 500 direct patient care clinical hours. Programs are encouraged to track the use of simulation to enhance the clinical experience.” Further, “clinical experiences and time spent in each experience are varied and distributed in a way that prepares the students to provide care to the populations served, which may include telehealth and international direct care experiences” (NTFC, page 12).

If an NP student has completed the minimum 500 supervised direct patient care clinical hours that are necessary and required to be fully prepared to practice as an NP in that particular population focus area, and the faculty has ensured that the student has attained the end of program competencies and met program outcomes, then any additional clinical hours may be waived by the educational institution. The institution may also provide accommodations so that the additional clinical hours (above and beyond the minimum 500) may be completed in a different clinical setting or through the use of simulation.

If students have not had the range of necessary clinical experiences needed to be fully prepared and practice competently as NPs, even if they have completed 500 supervised direct patient care clinical hours, the educational institution is responsible for making arrangements for them to complete their education. For some students, this may mean they will need to extend their education and postpone graduation. The educational institution is responsible for working with each student on a case by case basis to determine the gaps in the program content/courses/clinical hours. The educational institution is responsible for providing clear direction and guidance so students understand how modifications/adjustments may impact them.

The NP certification organizations will continue to require a minimum of 500 supervised direct patient care clinical hours in a population focus for eligibility to sit for the initial NP certification examinations. Collectively we agree that adhering to the above statement is necessary to ensure a quality educational experience for NP students and is in the best interest of institutions, students, public consumers, and employers.

Accreditation Commission for Education in Nursing ACEN Board of Commissioners American Academy of Nurse Practitioners Certification Board
American Association of Colleges of Nursing
American Association of Critical-Care Nurse-Certification Corporation
American Nurses Credentialing Center
Association of Faculties of Pediatric Nurse Practitioners Commission on Collegiate Nursing Education
Gerontological Advanced Practice Nurses Association National Association of Nurse Practitioners in Women’s Health National Association of Pediatric Nurse Practitioners
National Certification Corporation
National Organization of Nurse Practitioner Faculties
NLN Commission for Nursing Education Accreditation

Pediatric Nursing Certification Board Reference:
National Task Force, (2016). The National Task Force on Quality Nurse Practitioner Education, Criteria for Evaluation of Nurse Practitioner Programs, 5th Edition. Washington, DC. https://www.nonpf.org/page/14.

[Abigale Schucker]

Hi, Thank you for this topic!

Lack of clinical hours is a hard issue to solve. I am a big proponent for more clinical hours than 500, so not being able to obtain the 500 is challenging. I also feel that simulation only does so much good. I valued clinical time more than simulation when I was achieving my BSN. So I imagine it would be the same for my DNP degree. It is unfortunate to have to post-pone graduation for students who have to get their clinical hours, and I would be disappointed if I was in that circumstance. However, if that is what is needed to practice safely, then so be it. As a side note, I feel that DNP students, in a direct clinical care track, need more clinical hours to practice with more autonomy. Autonomy is something we are already trying to fight for, and more clinical hour requirements may give us a more substantial basis for arguments this argument across all states.

[Ji B.]

Does anyone have any updates on how obtaining the necessary clinical hours has been progressing throughout the pandemic? In the information provided in the original post, I found it interesting that even though the required 500 clinical hours have been completed, if an acceptable range of experience was not gained, the educational institution is responsible for providing additional clinical opportunities for students. I agree with Abigail’s response that clinical time is crucial in preparing students for the DNP role. While 500 hours is the minimum requirement, I think it is important to note that achieving the minimum is never the best effort. If simulations can help students become exposed to more situations and help with advancing their thought processes in addition to direct clinical experience, it would be most beneficial.

[Avery H.]

Hello, thanks for sharing.

I would like to hear from some DNP students who are currently trying to obtain their clinical hour requirements during this time and what their experiences, thoughts, and feelings are compared to those before the pandemic. I would also like to introduce the idea that as APRN students we have to be responsible for our education and preparation according to our career goals, especially because compared to the medical profession, we don’t have required residency programs or fellowships that are essential to our DNP education. I agree that 500 clinical hours may not be sufficient but instead of placing that responsibility solely on DNP programs and schools of nursing, we should begin to have more conversations with health systems to create more DNP residency programs or fellowships to help translate more confident and equipped practitioners.

[DNP Inc.]

Thank you for your post and question, Avery. The challenge of securing a clinical site (for NP or DNP education) is tremendous. The discussions I see seem to mandate that schools provide the clinical sites yet in reality there are not enough for the number of students. It’s refreshing seeing that you are encouraging the investment of time to build opportunities. This is a good discussion to have.

[Wichanee Borisuthirattana]

Thank you, David, for posting the updates during this unprecedented time. During the normal school year, there are already issues and challenges for clinical DNP students to find and secure clinical site, a preceptor, and clinical hours. It is even more difficult during the pandemic for the students to secure and complete the 500 clinical hours. 500 clinical hours may not be enough for the students to learn about everything they wanted before they apply for a job and actually practice as NPs. However, it may seem a lot during this pandemic time when they are trying to complete all of the hours in order to graduate. I agree with Avery that DNP students are competent enough to be responsible of securing and completing their own clinical hours. Nevertheless, NP residency program may post great benefits for both the NP candidates/graduates and the future of healthcare system. Since 500 clinical hours may not be enough for some students to feel confident to practice as a newly graduated NPs, an optional residency or a fellowship program offered either by the school or teaching hospitals may not only help create more competent NPs in the market, but it may also attract more potential NP candidates. Currently, the responsibility of providing clinical sites may be the school’s, and I understand that there may not be enough students for the school to make an actual contract with the hospitals/primary care practice sites to create a more permanent clinical site. However, I propose that the NP schools and the hospitals/primary care practice sites work together to improve our primary care system. An organization managing NP residency/fellowship programs can be created to act as a liaison and collaborate between the schools and the hospitals/primary care practice sites to facilitate the process. Last but not least, I learned that students may pick and choose NP programs according to their clinical hours requirements and whether they have to secure their own clinical sites. Hence, I believe that creating a new way to facilitate their education and building their confidence to practice will attract more students to the profession.

[DNP Inc.]

I’m slow to respond to your post but salute you for your thoughts and how well you articulated the challenges of securing and completing clinical or practicum hours. I’ve seen some venomous posts on FaceBook by groups that want to do away with programs for this reason yet this seems counterproductive to me. The idea of an organization that could manage NP residencies or fellowships sounds good, but honestly, it may be out of the scope or buy-in from most universities and regions. I know from past experiences that BSN programs struggled to secure their clinical experiences even with a county-wide or regional application that helped to promote this process. So – we continue to struggle and push through. Again, thank you for sharing your thoughts and insights.

[Author]

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