Fifteen years ago, a nurse practitioner (NP) contacted me because she was looking for a preceptor for her clinical hours. She was not a traditional student, but rather an NP whose certification had lapsed, placing her on “inactive” status. In Texas, where I practice, the Texas board of nursing defines inactive status as an individual “for whom more than 4 years have lapsed since completion of the advanced practice educational program or who have not practiced in the advanced practice role during the previous 4 years” (Texas board of nursing rule 22 T). Returning to active status requires completion of a refresher course or extensive orientation. This includes didactic and/or clinical experiences encompassing advanced assessment, diagnosis and treatment, pharmacotherapeutics, ordering and interpretation of diagnostic tests, and performing procedures safely and competently. The orientation requires a minimum of 400 supervised clinical hours.
My colleague had tried to find a preceptor in the local NP program but was unsuccessful because she was not enrolled as a student. After months of phone calls, emails, and networking, she contacted me, and I agreed to be her preceptor. In addition to the supervised clinical hours, she also took advanced pharmacology and studied for the national certification exam, which she took at the completion of the preceptorship. This process took 2 years, and she is now a practicing NP.
The journey to recertification for the inactive advanced practice nurse (APN) can be lengthy and frustrating, especially when looking for someone to provide supervised, clinical hours. Finding a preceptor can be challenging, particularly in communities where NP programs exist. The recertifying practitioner may be in direct competition with traditional NP students for preceptor hours. Some programs require students to have preceptor agreements prior to starting an NP program. In addition to completion of required clinical hours, most states now require passing a national certification exam as part of the consensus model for regulation of APNs (Hartigan C. AACN Adv Crit Care. 2011;22:50-67). The consensus model of APN regulation was developed in 2007 and requires licensure, accreditation, certification, and education (LACE) as the model for all APNs in the United States (Stanley J. JNP. 2009;5:99-104). Thus far, 17 states have fully implemented the consensus model.
For the APN who is recertifying, it is important to establish relationships with other APNs at the local and national level. Membership in professional organizations provides education, opportunities for networking, and socialization with other APNs. Attending regular meetings and conferences may provide opportunities for meeting potential preceptors and employers. Contacting local NP programs may be another way to connect with APNs willing to provide the necessary hours. Recertifying APNs may need to work with multiple providers to acquire enough hours. Flexibility is key.
Recently, I was approached at a local meeting by an APN who needed a preceptor to complete clinical hours to return to active status. Along with my colleagues, I was able to help her find several APNs who were willing to help, and she was able to complete the required hours. Through networking, professional organizations, and identifying potential preceptors, it is possible to help the inactive APN return to the workforce. I challenge all of my colleagues to step up and assist our fellow APNs to re-join their profession as active, practicing clinicians.
Katherine F. O’Donnell, DNP, APRN, FNP-BC, is a family NP, Department of General Surgery, University of Texas Health Science Center, in San Antonio.