Online clinical education is inadequate for Full Practice Authority for NP students

Ohio Nurse Practitioners are mobilizing to make Ohio the 21st state with Full Practice Authority (FPA). This means that Ohio NPs will be able to practice independently, to the full extent of their education, training and certification. No longer will they have to prescribe according to the Ohio Formulary, nor will APRNS be required to be in a collaborative agreement with a physician. According to a recent study by the RAND Health Corporation, FPA in Ohio will help address the shortage of physicians, and also reduce more than 70,000 unnecessary ER visits. Currently 40% of states allow independent practice by nurse practitioners. As a nurse practitioner for the past 18 years, I applaud this development.

However this momentum for FPA comes with another parallel, very concerning development in Nurse Practitioner education in Ohio. Many Ohio universities and colleges, in an effort to reduce faculty expenditures are making the mistake of transitioning to online NP clinical courses. Increased responsibility and independence require increased education, not less and inferior education. I have taught in NP programs at both Kent State University and the University of Akron and I find this trend scary and appalling. While many master’s level courses can be provided online, it is not possible to teach the clinical skills required in the clinical evaluation and treatment of a patient online. Clinical education requires mentoring by skilled and experienced clinicians. How can the motor and tactile skills of physical examination be taught on a computer? These skills need to be practiced over and over on real humans. What about observational skills? What about history taking, patient interaction, professional, and interpersonal skills? ‘Hands on’ skills require ‘hands on’ education. It is not possible for a physician to practice as a MD or DO after completing some online classes. Why do nurse practitioner programs believe that they can teach NP students to step into the responsibility of Full Practice Authority for NPs with an online education? Full Practice Authority means that NPs will take on many roles formerly monopolized by physicians. Will they be adequately prepared? Would you be comfortable trusting a clinician with an online clinical education? Do you see any medical schools rushing to online education? In addition to requiring medical students to complete computerized exams to be licensed as a MD, they are also required to pass clinical exams where they encounter standardized patients, and are graded on their history and exam skills, communication skills, and also their ability to generate a solid differential diagnosis for the patient’s presenting problem.

What can be done? Perhaps it is possible for the Ohio Association of Advanced Practice Nurses to take a more active role in setting standards for Nurse Practitioner programs in Ohio. Perhaps as Ohio NPs petition the legislature to advance to FPA, they can also petition their Alma Mater to provide only onsite clinical courses. Any prospective NP student should only apply to NP programs offering onsite clinical instruction. Perhaps the Commission on Collegiate Education (CCNE) can examine the effectiveness of online clinical courses (or lack thereof) and set standards for programs nationwide. Perhaps the Nurse Practitioner certification boards should also require NPs to pass a standardized clinical examination in addition to the computerized multiple choice test before certifying a NP to practice.