Category: Nurse Practitioner Students

Are you a nurse practitioner who is saddled with student loan debt? If so, you're not alone!

For many nurse practitioners, the financial burden of getting their degree is the only downside to the profession. With a nurse practitioner degree costing up to $100,000, it is not surprising that many nurse practitioners take out student loans. In fact, according to the American Association of Colleges of Nursing, the average nursing student loan debt is between $40,000 and $54,999.

The good news is there are multiple student loan forgiveness programs to help ease this financial strain. There are strict guidelines to qualify for the programs, but for those who meet the requirements, they are certainly worth applying for.

Federal student loan forgiveness programs available to nurse practitioners include:

• Nurse Corp Loan Repayment Program (NCLRP)
• Indian Health Services Loan Repayment Program (IHS)
• Public Service Loan Forgiveness (PSLF)

Nurse Corp Loan Repayment Program (NCLRP)

The Nurse Corp Loan Repayment Program is an excellent option for nurse practitioners who want to work in under-served communities or in academics. The program repays up to 85% of student loan debt for nurse practitioners who work in a Critical Shortage Facility (CSF) or who work as faculty for eligible nursing schools.

Eligibility Requirements For Nurse Practitioners

• Applicants must be U.S. citizens or lawful permanent U.S. residents.
• Nurse practitioners must work full-time, which is a minimum of 32 hours per week, at either a CSF or an eligible nursing school.
• Applicants must have an active, unencumbered license and have a post-graduate degree from an accredited nurse practitioner program.
• There are no income requirements, but priority is given to applicants with the greatest financial need.

Amount of Debt Forgiveness

• The baseline loan forgiveness is 60% in exchange for working two years in a CSF or working as a nursing faculty at an eligible nursing school.
• After completing the minimum two year requirement, nurse practitioners have the option of working a third year in their approved practice location to earn an extra 25% reduction, for a total of 85% loan repayment.

How to Apply

• Nurse practitioners interested in the program may apply online using the Health Resources & Service Administration (HRSA) loan repayment application portal.
• For questions about using the portal or the application process, applicants can call 1-800-221-9393.

Indian Health Services (IHS) Loan Repayment Program

The Indian Health Services (IHS) Loan Repayment Program pays a maximum of $40,000 in student loan debt of eligible healthcare professionals in exchange for working two years in healthcare facilities serving American Indian and Alaska Native communities. After the initial two-year commitment, providers may continue to work with IHS until their student loans are paid off in full.

Eligibility Requirements for Nurse Practitioners

• Applicants must be U.S. Citizens.
• In order to apply, applicants must have an unencumbered license or be in the final year of a postgraduate nurse practitioner degree program. Applicants must be licensed prior to starting employment.
• Priority is given to American Indians and Alaskan Natives, but any nurse practitioner who is committed to working at IHS facilities is encouraged to apply.

How to Apply

• Nurse practitioners must have an IHS web account in order to apply and it can be created online here.

Public Service Loan Forgiveness (PSLF)

Public Service Loan Forgiveness (PSLF) is an excellent option for nurse practitioners who have worked at least ten years for a qualified employer and still have student loan debt. In order to be eligible for the program, nurse practitioners must have made a minimum of 120 student loan payments. Unlike income-based loan repayment programs, repayment from the Public Service Loan Forgiveness Program is not taxable.

Eligibility Requirements for Nurse Practitioners

• Applicants must work full-time for a qualified employer, which includes federal, state, or tribal healthcare facilities and non-profit healthcare facilities.
• Only Direct Student Loans or student loans that have been consolidated into a Direct Student Loan are eligible for repayment.
• Applicants must have made 120 student loan payments while being employed by a qualified employer. Individuals who pay ahead on their student loans will not qualify before the ten-year mark.

How to Apply

• Complete the PSLF application and submit it to the US Department of Education via mail, fax, or upload via the MyFedLoan Portal.
• The Department of Education recommends that applicants update and submit the PSLF application annually for each year working for a qualified employer.

State Level Loan Forgiveness

Each state offers loan forgiveness opportunities for nurse practitioners in addition to federally sponsored loan forgiveness programs. The requirements, eligibility, and work commitments vary by state. Information for specific state programs can be found on individual state websites.

If you're a nurse practitioner with student loan debt, don't hesitate to apply for a loan forgiveness program. Paying off your debt is the best way to reap the financial benefits of earning your nurse practitioner degree.

Whether you are an undergraduate, new graduate, or a seasoned nurse, entering a nurse practitioner (NP) program is an exciting time. However, it can also be a stressful one. In fact, you may discover that NP school will be one of the most difficult academic endeavors you experience. At the end of the day, any advanced practice health provider role requires a great deal of studying and the ability to put complex material into practice.

Despite being a full-time graduate student who was no stranger to hard work, I still remember the stress of my first semester. Luckily, my program provided some insightful resources that helped me recognize the importance of learning how to study to achieve success. Based on my experience, here are some useful strategies for new NP students.

5 Tips for Didactic Study

Most NP programs will begin with one to two semesters of didactics. This means that there are no clinical rotations just yet. Whether they are enrolled part-time or full-time, students will juggle two to three classes at a time. Here are my five tips for success during didactic semesters.

1. Time Management

Prior to beginning the program, reflect on when and where you study best. Also, understand that you need a resting period. Someone once told me that graduate school is like a job and it should be treated like one. When working as a nurse, consider a per diem or part-time schedule to help ease the transition into NP school. Remember that graduate school is not like undergraduate work.

2. Invest In a Tablet

If you have the funds (and that is a big if), a tablet can boost efficiency. You can write, type, download notes, and more, and it is highly portable. While it's not a necessity, having a tablet was beneficial throughout my entire graduate experience.

3. Student-Life Balance

You will likely hear that NP students "have no life." While I had to learn to say no to certain social events, I also knew that life existed outside of school. I would typically study from 8AM to 5PM every day including weekends, reserving evenings for time with family and friends.

4. Know Your Study Style

There is an overwhelming amount of material that NP students are expected to learn. In addition to adjusting to the transition of graduate student life, you're also required to maintain certain grades to stay in the program. My recommendation is to know your study style. Louisiana State University has a great resource with surveys to help you determine your best study methods.

5. Know the Course's Objectives

This is something that I wish I knew sooner. The course's objectives offer incredible insight into what students should focus on when studying. Most of these objectives align with the necessary knowledge for boards. Therefore, be sure to review them in the course syllabi and weekly modules.

Clinical Rotation Study Tips

When you enter the clinical rotations phase, it's important to factor in travel time and patient entries as well as other additional assignments. Both can be time-consuming. Here are some tips to study effectively.

1. Listen to Relevant Podcasts

I often played medical podcasts in the car while driving home. As a Family Nurse Practitioner student, my favorites were American Family Physicians and The CurbSiders Internal Medicine. Many of my colleagues purchased MP3s from multiple board review sources such as APEA and Fitzgerald.

2. Learn in Rotations

Rotations offer an opportunity to apply didactic knowledge in hands-on situations. From suturing cysts to pelvic exams, it's critical to advocate for your participation. Learn how to assess for abnormalities while allowing preceptors to educate you. You will utilize these skills when practicing professionally.

3. Review Material

If there is material that you're unfamiliar with as a student, take the time to review it and gain an understanding of differentials and treatment plans. Even after graduating, it's crucial to become accustomed to reviewing and staying updated on current guidelines for treatment and preventive care. Making this a habit during rotations is important for doing well in clinicals and achieving long-term professional success.

Becoming an NP is a path that can only be understood by those who have experienced it. As a new graduate, I can empathize with the difficult transition to student life and working to pass exams every semester. I hope that new students can learn from my experience and utilize my tips. The journey is tough, but ultimately it is a rewarding one.

Simply put, the objective of a nurse practitioner (NP) student is to become a competent clinician. Through clinical rotations, he/she will need to develop and implement foundational skills and knowledge for their future clinical practice. To accomplish this, the NP student should be actively and enthusiastically involved in patient care as a member of the diagnosing and treating team—not a scribe or errand-runner. However, the NP student is not an independent practitioner just yet. Therefore, they can only participate in patient care under the guidance and supervision of the authorized preceptor. The NP student should have a clear understanding of their roles and responsibilities to maximize their time during clinical rotations.

RELATED: Securing Nurse Practitioner Preceptors: Why Are Some Schools and Students Paying for the Privilege?

What to Expect During an NP Preceptorship

There are several key hands-on duties that NP students are responsible for during their preceptorship.

1. Take Patient History, Perform Physicals, and Propose Differential Diagnoses and Treatment Plans

Depending on the clinical setting, a new patient's history may be collected in one visit (such as in urgent care, the emergency room, and the hospital) or over two or three visits (as done in family or internal medicine, pediatrics, and outpatient clinics). Regardless of the setting, the NP student should begin the visit by introducing themselves and asking the patient what they would like to address.

If the patient has one pressing concern, the NP student should address that acute issue without neglecting other chronic conditions and perform the physical exam that's appropriate for the problem at hand. For example, if the patient presents an aching leg, the exam should be focused on the lower extremities. An exam for the eyes may not be needed, unless there is another reason. Based on the clinical findings, the NP student should learn to formulate three to five differential diagnoses and an appropriate treatment plan.

RELATED: How NPs Can Tackle Difficult Conversations with Patients and Families

2. Present Patient Cases to the Preceptor

During the first initial meeting with their preceptor, the NP student should ask about any format preferences for the presentation. Some preceptors prefer abbreviated versions, while others prefer comprehensive formats for teaching purposes. The purpose of the verbal presentation for the preceptor is to convey the problem-oriented essentials of the patient case. This requires more than just a simple reiteration of what the patient and the labs show. A good patient presentation demonstrates the patient's most concerning issues and includes the NP student's clear plan of treatment and critical analysis.

After seeing the patient, the NP student should spend at least a few minutes organizing their thoughts before presenting the case. They should also aim to keep the presentation concise (about three to five minutes for new complex cases), organized (with history in chronological order, pertinent findings, and labs), and well thought-out (three to five differential diagnoses and rationales for each, as well as recommended treatment and follow up). If the NP student is unable to formulate a diagnosis or plan, they should ask for the preceptor's help. This offers an opportunity to conduct further research online or through textbooks, which demonstrates strong enthusiasm and a "self-starter" attitude.

3. Complete Patient Write-Ups

The note that comes from the NP student should demonstrate a comprehensive grasp on the patient's presenting case. It should follow the SOAP format (Subjective, Objective, Assessment, Plan) as learned in NP programs. Since the preceptor is ultimately the person who is legally responsible for the patient's care, the NP student should review the plan with the preceptor first before discussing with the patient. The ‘plan' includes ordering further screening or diagnostic tests, writing prescriptions, and providing patient education. It is important the NP student learns how to write the prescriptions appropriately under the preceptor's guidance. All notes, orders, and prescriptions need to be reviewed and co-signed by the preceptors.

4. Obtain Constructive Feedback from Preceptors

After presenting the case to the preceptor, the NP student may directly request for any suggested improvements to the presentations or write-ups. If the NP student has a specific need for further instructions, they should ask the preceptor if they can go over a certain physical examination such as a cardiac or ankle exam. Additionally, the student should schedule a mid-term evaluation with the preceptor to gauge how they are doing and where they can improve.

RELATED: New Graduate Nurse Practitioners: Keep Learning to Build Confidence

5. Read for More Insights

Reading is a great way to expand your understanding of diseases and different patient cases. Before each visit, it's helpful for the NP student to read the patient's charts and pertinent scientific literature to formulate an approach ahead of time. By understanding the patient's primary concern, the student can determine appropriate questions to ask during the history-taking and establish a physical exam to focus on. Proper preparation before seeing the patient will save time during the interaction.

Before the physical exam, an NP student may briefly read over the patient's chart again or their own notes to ensure that the proposed approaches are correct.

In advance of each case presentation, NP students should review their findings to solidify the rationale and clarify any aspects they are unsure about.

Between patient visits, reading critical medical literature that relates to patient cases can improve overall understanding.

"Get a medical student. The medical schools pay you."

As a nurse practitioner (NP) student, it was shocking and discouraging to hear my physician preceptor say this to his colleague. Whether students are attending a school that supports them with placements or working toward securing one independently, securing preceptors for clinical rotations is a challenging task. Unfortunately, many are desperate enough to pay agencies to find preceptors for them. Has advanced practice education really come to this — all because medical schools pay offices to take on students?

According to a 2014 article from the Society of Teachers of Family Medicine, 23% of medical schools offered payment for community preceptors. In fact, 63% of those who received payment for precepting were also paid by other learners. The article cites the increased competition among other healthcare schools to place students in community settings as the leading reason for providing payment. This ultimately leads to decreased opportunities for NP students, which is why many are having a difficult time securing placements.

RELATED: How to Become a Nurse Practitioner

The Difficulty with Precepting Nurse Practitioner Students

During NP school, I saw the many challenges that preceptors faced. From meeting quality measures to seeing patients and charting, providers were required to fit teaching students into their already hectic schedules. According to "Incentives & Barriers to Precepting Nurse Practitioner Students" the stress involved in the daily workflow of the clinic makes it difficult for providers to precept students – despite their desire to give back to the next generation. If productivity is impacted, a provider's income is affected as well. It is not uncommon to hear providers question their capacity to take on students when they can barely sustain themselves. This is why many providers ultimately choose not to precept students, although they would ideally like to teach.

In the same article, the authors mention the potential benefits of providing some sort of stipend to preceptors as an incentive. While this may help students secure preceptors more efficiently, it won't be useful for a student who is already paying a hefty tuition to serve others.

Thoughts About Payments to Precept

As a newly minted family nurse practitioner (FNP), I decided long ago that I would eventually precept the next generation of FNPs. As one of my preceptors put it, "I'm going to be under the care of you one day. Therefore, I'm going to teach you my ways so that you can care for me and not kill me!" These words always stuck with me, and I've since committed to give back to the next generation by becoming a mentor. Seeing the work that NPs and other providers put in, I know it won't be easy. However, I also know that the issue of paying for preceptors isn't going anywhere.

Precepting students as a nurse practitioner has traditionally been done free of charge. It was a service that NPs committed themselves to as a way to encourage and empower new NPs to effectively serve their communities. However, the shift of medical schools now paying clinical sites to host students has affected both NP and physician assistant students. Some schools are paying up to $100-$450 per week, with anecdotal research revealing that agencies such as NPHub will pay preceptors up to $3,000 per month. Whether it's the school or students who pay for preceptors, it's the student who is ultimately affected.

Looking back at my experience overhearing my physician preceptor and his colleague, I recall my hours being rushed to completion in order for them to take on a medical student. This led me to the realization that incentivized stipends for preceptors can lead to poor clinical experiences. If clinics and their providers are interested in empowering the next generation of practitioners, more support needs to be provided outside of stipends and financial incentives. Should this trend of paying for preceptors continue, I'm curious to see the implications on students' clinical experiences at rotations and the way they practice upon graduation.

When a nurse practitioner (NP) graduates from an accredited program, they are ripe with a combination of masters prepared knowledge and registered nursing experience. Many new graduates are eager to start a position in their new role as a healthcare provider but can feel equally as anxious about the new amount of autonomy and responsibility expected from them. Although accredited nurse practitioner programs require a minimum of 500 supervised direct patient care clinical hours, many employers remain hesitant to hire new graduate NPs due to the lack of experience as a provider in the field. Additionally, there is an employee turnover rate twice the amount of physicians with advanced practice providers, and it is hypothesized that the two factors to blame are experience and receiving a formal orientation. There is, however, a potential solution to creating a comfort zone for both employers and NPs through the use of nurse practitioner residency programs.

What Is a Nurse Practitioner Residency Program?

• A nurse practitioner residency program is a voluntary post-graduate position through which advanced practice nurses shadow other healthcare providers in order to earn critical, on-the-job experience. Most are familiar with physician residency programs, which are required for licensure by their profession. Residents obtain a plethora of hands-on experience that can be more beneficial, in terms of growth of one's professional character, than didactic lessons themselves.
  
• These programs can emphasize gaining skills from numerous different specialties, ranging from primary care, oncology, cardiology, and more.
  
• A typical program lasts one year and is usually hosted by, but not limited to, teaching hospital facilities.
  
• The first nurse practitioner residency program was established in 2007 in Connecticut.
  
• The largest fellowship to date is housed at the Center for Advanced Practice at Carolinas Healthcare System in North Carolina, which accommodates 68 fellows at any given time.

What Are the Positives of Nurse Practitioner Residency Programs?

• Hands-on experience. While shadowing experts in the field, the resident is able to practice first-hand with mentors readily available for review. Since it is established that the resident is technically in training, they may receive more of a grace period for questioning and errors. Residency programs can be viewed as "training wheels," and at the completion of the program, the candidate should feel comfortable removing them.
• Networking. By working alongside experts, one is able to establish relationships directly with professionals in the field. Many new graduates have stated that they found their first positions solely through networking; by attending a residency, future employers may be able to put a face to the name.
• Job satisfaction. According to a survey conducted in 2016 involving nurse practitioners who participated in a post-graduate program, job satisfaction was higher amongst these individuals. This makes sense when relaying back to the previous exponential turnover rate in comparison with physicians. The study concluded that NPs who had formal orientation were less likely to resign. Consequently, the preparedness of the nurse practitioner is directly related to job satisfaction. This factor may be appealing for employers as well, since hiring a nurse practitioner is an investment for the company, and many are wary of hiring candidates with a sporadic work history.

What Are the Negatives of Nurse Practitioner Residency Programs?

• Salary. Most residency programs will only pay the participant approximately 60% of a typical nurse practitioner salary, which may be conflicting for the new graduate who has many student loans to repay. This factor may make candidates who have multiple years of registered nursing experience hesitant, since 60% of the NP salary may be comparable to a veteran registered nurse's salary. Therefore, residency programs could be a very appealing option for a new graduate with minimal prior nursing experience. Additionally, a graduate who has completed an accelerated RN to MSN program with no acting experience in the hospital setting could potentially benefit as well.

• Relocation. Since the concept of residency programs is not yet widely implemented, one may have to move to a different state for a full year in order to complete a program that is aligned to their specialty of choice. This may not be an option for a graduate who has a family rooted in their current location.

Why Aren't There More Nurse Practitioner Residency Programs?

Ultimately, it boils down to funding. Most programs are internally funded, which in return benefits the same hospital system by producing advanced practice providers who can contribute back with readiness and preparedness. In order to increase the number of programs, federal funding must be increased. One may help increase the demand for residency programs by advocating through the legislature. Contact local representatives and propose why adding an NP residency program may help with the increased demand for healthcare providers. There is a dire need for competent advanced practice providers in the field, as the shortage of primary care physicians continues to increase.

Is a Nurse Practitioner Residency Program Right For You?

Is the market in your location saturated with new graduates? If so, what are your cohorts saying about the likelihood of new graduate nurse practitioners actively being hired in the field? Completion of a residency program may highlight you from a sea of applicants. This is especially applicable if one is wanting to work within a specific hospital system. Many applicants can search for as long as six months to find a new graduate position. If the market is saturated and the probability of finding a job is low, consider applying to a residency program to expand your network and add another strong bullet point to your resume. If your state is one of the twenty without programs, consider writing a letter to your legislature to introduce the topic.