Psychiatric Nursing Students Can't Find Clinical Training |
Psychiatric mental health nurse practitioner training programs may not provide required clinical rotations.
Those that do not provide their own rotations require students to find these themselves, which can be hard.
Many students find this experience highly stressful and there are quality questions about the process.
PMHNP programs should take on additional roles in providing rotations for their students.
An ever-increasing percentage of psychiatric care in the United States is being delivered by Psychiatric Mental Health Nurse Practitioners (PMHNPs). To earn this credential, one must first get a nursing degree. Then, the most common path is to obtain a Masters of Science in Nursing with a psychiatric specialization. These programs typically last two years with the first year being primarily classroom based (which can be online) and the second year being comprised of supervised clinical rotations with students required to see a certain volume of patients or meet a target number of clinical hours.
This pathway is different from that of psychiatrists, who first go to medical school for four years and then specialize in psychiatry for an additional four years of clinical training in a psychiatry residency. To further specialize into fields like child and adolescent or forensic psychiatry, additional year(s) are needed in a fellowship program.
Aside from differences in the duration of training between psychiatrists and nurse practitioners, another key distinction has to do with the clinical training itself. Physicians in residency and fellowship programs participate in highly structured rotations that are highly regulated and accredited by an organization called the Accreditation Council for Graduate Medical Education. Clinical supervision is generally delivered by attending psychiatrists who typically are faculty of academic medical centers. These residency and fellowship programs have standardized rotations at major hospitals and affiliated academic clinics. Aside from extraordinary circumstances, like the pandemic, most of these rotations involve mainly in-person care.
PMHNP programs, however, can be quite different. While some of these programs are indeed part of large academic centers, others are not, and some are largely online. Perhaps most importantly, however, PMHNP students are often not provided clinical rotations as part of the being enrolled in their programs. Instead, they are required to go out and find their clinical rotations themselves, wherever and however they can.
Many students will tell you what an exhausting and difficult process it can be to call and email clinic after clinic, trying to find one willing to provide a supervised rotation. Most sites decline as there is considerable work involved in providing a good teaching experience and the sponsoring program typically offers little to no compensation to preceptors (despite the student still having to pay tuition to the NP program which then is outsourcing the actual work to these clinics and preceptors). As the level of desperation increases, students have to extend their inquiries farther from home and may need to settle on suboptimal learning environments with preceptors who have little to no teaching experience or credentials. They may also be forced to do much of their clinical learning online. As one might expect, this dire predicament has resulted in new businesses that, for a fee, will try to help match students to preceptor programs.
This, then, brings up a second major issue in the process, which is quality control. With little vetting being done of the quality of the preceptor or clinic and students being compelled to accept whatever experience they are able to find, it can be difficult to ensure that they are getting the training experience that they need. This in turn leaves a lot of legitimate doubt in the minds of both patients and medical colleagues about the adequacy of the training these students get before being thrown into often complex and challenging jobs, many of which provide little ongoing supervision.
At the community mental health clinic where I work, we receive these requests from frantic NP students all time. We tried our best to accommodate as many as we could and had a number of bright and eager students spend time with us. Sustaining this model, however, proved impossible and we ended up negotiating with a local medical school that trains both medical and nursing students to have us send them students on a predictable schedule with incentives for our teaching preceptors that appealed to more than their good will and desire to teach.
The current landscape represents a badly managed predicament that is not getting the attention it deserves. Students are stressed, preceptors are undervalued, and perhaps most importantly, the quality of the training being delivered is suspect.
PMHNP programs often like to lay the blame for this predicament externally. They will cite clinic restrictions on teaching, preceptor burnout, or national workforce shortages. The truth, however, is that these programs need reform from within. More need to take more direct responsibility for the education their students are receiving, and a parallel organization similar to the ACGME needs to ensure education standards and increase confidence in this training pathway. Programs should provide students with consistent clinical sites that are affiliated with their institution. They need to vet preceptors and offer them fair compensation for the work that they do. Limits on online experiences need to be established. Meanwhile, applicants to these programs should carefully consider this aspect of their training and be cautious about programs that leave students to establish their own clinical rotations.
Until these improvements are realized, students will remain stressed, teaching preceptors will stay scarce, and major questions will linger about the legitimacy of this training.
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy