A New Normal: Graduate Nursing Students Paying for Clinical Rotations

By Patrice Brown, via Multibriefs

Aspiring advanced practice nurses enter their prospective graduate programs each semester with the good faith of excelling at their course work and practicum. Unfortunately, that notion may be tarnished by the misfortune of not finding a clinical site.

In some instances, unwarranted cancellations by a preceptor occur, leaving the pupil to hastily find another preceptor. Consequently, if the student is unable to obtain a new preceptor, his/her graduation is postponed for months or sometimes years.

With advent of online advanced nursing education, the demand for preceptors has skyrocketed. Many students spend months calling around for a preceptor to no avail. Plenty of primary care clinics are booked full of students a year or two in advance.

To offset the demand, some practices and healthcare practitioners have begun charging students for time spent precepting in their clinics. Thus, herein lies the "elephant in the room." Is it ethical for clinics to require payment for nursing practicums? Sadly, there is no straightforward answer to this question, yet there are two schools of thought among students.

One school of thought: "It's unethical to pay for a clinical rotation. Why would I pay for something that a person should do out of the goodness of their heart?"

Central to any health profession is service. This act of unselfish kindness and generosity bears meaning to one's career and, above all, sustains and dignifies the future of others. In this instance, a pupil in need of mentoring isn't too lowly for the time and attention necessitating growth.

Unselfish service is marked by giving freely without expecting anything in return, as explained within an excerpt from the Hippocratic Oath: "To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract."

Second school of thought: "You're paying for your education just as you would in a classroom environment."

Some clinics are charging a minimum of $200 per week for a practicum experience. Which translates into $1,600 to $2,000 for an 8-10-week session.

However, not all clinical sites are created equally. Some preceptors allow the pupils to independently see patients, and afterward they confer to execute a treatment plan for the individuals. Alternatively, other preceptors adopt a hands-off approach and throw the student "to the wolves" with little to no experience.

How can schools of nursing solve this burgeoning problem?

Graduate nursing clinical rotations should be regulated by an accreditation body such as the Commission on Collegiate Nursing Education (CCNE). Program effectiveness, assessment and achievement of program outcomes are addressed within CCNE's Standards for Accreditation.

Presumptive regulation of graduate nursing clinical sites should be addressed under section IV-B, "program completion rates demonstrate program effectiveness." How effective is the nursing program if students are not graduating due to sparse clinical sites?

The school of nursing should be held accountable to help their students find practicum placement. If a large percentage of pupils are unable to complete the program of study due to insufficient assistance with securing a preceptor, a mandate should be place upon the school of nursing to provide a written explanation and analysis along with a plan of action for improvement before re-accreditation is approved for the graduate nursing program.

Patrice Brown is an Atlanta-based professional nurse who has worked on various specialty medical-surgical units. Currently she is enrolled at Chamberlain College of Nursing obtaining her Masters of Science in Nursing degree. Ms. Brown is a proud member of Zeta Phi Beta Sorority, Inc. Volunteering and mentoring are two of her passions, and she is active within several professional nursing organizations.