Advanced practice nursing education has a problem.
Imagine a graduate nursing student who has been admitted, is paying tuition, and is often working as a nurse while going to school. Some schools match students with preceptors, but this student's school doesn't. The student must find their own preceptors to oversee up to 750 clinical hours. They can borrow to pay a placement company, as one student did with a $16,000 loan for fees, travel, and housing. They can take time away from work and family, adding stress to an already demanding program. They can choose a graduate school based on whether it provides preceptors, or they can search for preceptors on their own. For some, none of these options are workable.
I see this firsthand. Students often ask me to precept them. My heart sinks as I consider these requests, because I feel that teaching will slow me down, reduce the number of patients I can see, and add responsibilities to an already demanding clinical day, often for free.
Precepting is an unfunded mandate. Only about 10% of nursing programs pay preceptors or cover placement costs. Many students turn to placement companies that charge about $2,000 to $2,500 per rotation. That cost falls hardest on students and schools with the fewest resources.
Then there is the question of whom we can teach when requests come from multiple directions. My organization has made the hard choice to serve our own School of Nursing's students first, our employed nurses studying elsewhere second, and outside students last. Most hospitals and practices require the student to have curriculum, didactic training, and professional liability insurance. Students from schools without ties to a large academic medical center have an even harder time securing placements when their school doesn't provide the match or the support.
Rising standards add pressure. In 2022, national NP education standards raised the minimum to 750 direct patient care hours, not counting simulation. The change is being phased in over several years, with no clear plan for the infrastructure and resources it demands. Meanwhile, medical, osteopathic, offshore medical, and PA students compete for the same clinical sites.
Why does this matter? Demand is outpacing training capacity. The Bureau of Labor Statistics projects 41% growth in NP jobs from 2025 to 2035, compared with 4% for physicians. Yet in fall 2025, graduate nursing programs, including master's, DNP, and PhD programs, turned away 16,955 qualified applications, citing too few clinical sites, faculty, and preceptors.
An excellent preceptor takes the role very seriously and can make or break a student’s career. They are prepared, have perhaps completed a curriculum to support them, and are compensated by their employer, as they do their own job in addition to teaching the student. It is not a role to be taken lightly, and it is much more than having a student shadow you silently in the clinic. Precepting is rarely an intuitive skill. They must have excellent (and tireless) clinical and verbal skills and the emotional intelligence to reach learners in a way that makes a difference in their practice. An excellent preceptor's words and tenets are repeated and taught to others throughout a long career. Preceptors build on the didactic learning (pathophysiology, pharmacology, anatomy, psychology) and teach the student how to think like a clinician. How to assess (with and without words) the patient, how to motivate them, reach them, educate them, and partner successfully with them to improve their health. These crucial skills are difficult to teach in a classroom.
Critics argue that NP programs have grown too fast, rely too heavily on online delivery, and let students buy clinical hours. Some of those concerns are fair, and they share a cause. When schools leave students to find their own preceptors, training depends on volunteers and paid middlemen with little oversight. Public funding would bring public standards. This is the most direct fix for both the shortage and the quality problem. But first we must confront a funding and accountability gap.
In fiscal year 2023, Medicare spent $21.2 billion on training physicians. Title VIII, which funds APRN education, received $305.5 million in fiscal year 2026 after surviving proposed cuts, and only part of it supports clinical training. Medicare alone spends about 69 times more on physician training than Title VIII provides for all federal nursing workforce programs. Physicians do train longer, but even per trainee the gap is stark. Medicare spends roughly $180,000 per resident each year. Its own nursing demonstration paid for the clinical training of each additional advanced practice nurse through graduation for about $47,000. Physician clinical training is treated as a necessary public good. Medicare treats NP clinical training as a voluntary favor.
We have already tested a fix, and it worked. From 2012 to 2018, Medicare's Graduate Nurse Education Demonstration paid five hospitals for NP clinical training. For $176.4 million, participating schools increased enrollment by 54% and graduations by 67%. That produced 3,739 more graduates than comparable schools, at about $47,000 each. Because the sites were mostly large urban hospitals, results elsewhere may differ.
A permanent program should build in accountability. Payments should be tied to results such as graduations, placements in underserved areas, and placement quality. Funding should pay for preceptors' teaching time and protect it from the administrative duties already crowding clinicians' schedules. Students need full access to the EHR, preceptors need training as educators, and placements should be the school's responsibility, not the student’s. Finally, this approach should span medical school, physician associate education, and advanced practice nursing education to ensure programs stop competing for the same sites and preceptors.
The country is counting on NPs, yet their training depends on volunteers and on students themselves. Without preceptors, we cannot have NPs who provide Americans with high-quality care. Without preceptors, patients suffer.
