Handheld Computers Can Help Researchers Assess Cost of Training Nurse Practitioners

Analysis of nurse practitioner clinical training costs

The American Association of Colleges of Nursing (AACN) studied the costs of clinical training for nurse practitioners.

Managed-care organization are making growing use of nurse practitioners as mainstream primary care providers, and training programs in this field have experienced a brisk growth. Such training includes extensive hands-on experience of at least 600 hours supervised by practicing clinicians, and much of it is carried out in non-hospital, ambulatory care settings.

Because the advent of managed care is exerting pressures on those settings to reduce expenditures and increase productivity, the cost of teaching time is becoming a contentious issue between nursing schools and their affiliated practice sites.

In contrast to the cost of training medical residents, which is underwritten by the federal Medicare program, there is no equivalent source of funding for the clinical training of nurse practitioners, and the real costs remain unknown.

The AACN reviewed the methodology and results of previous research led by James Boex of Northeastern Ohio Universities College of Medicine, which involved a comprehensive study to ascertain the cost of ambulatory care medical residency training. AACN considered the study's applicability for an assessment of the unique costs, benefits, and quality factors involved in advanced-practice nursing education.

Key Results

To determine the applicability of the model to nursing, investigators:

  • Conducted a literature search.
  • Interviewed leaders in nurse practitioner training.
  • Convened an advisory committee to investigate the model.
  • Consulted with the researcher who developed the model.
  • Conducted research into the feasibility of using personal data assistants (PDAs) to collect information on clinical nurse trainees' and supervisors' activities throughout the day.

    PDAs, which were used in the original Boex study, are handheld computers that are programmed to signal clinical supervisors and/or trainees to respond to a series of questions at intermittent intervals. Data collected with the PDAs enables investigators to see how clinical supervisors and students use their time in the ambulatory setting and provides investigators with the data to estimate how time spent teaching students affects the clinicians' productivity.

    It also provides information on how much clinical care student nurses provide while working in ambulatory settings. A project advisory committee and consultants conducted a review of the PDA program menus and engaged a consultant to complete a reprogramming of the PDA software for use in the study of the cost of training nurse practitioners.

    A pretest of the revised PDA program was conducted by nurse practitioner preceptors and students at three locations: East Tennessee State University in Johnson City, Tenn.; Northeastern University in Boston, Mass.; and George Mason University/George Washington University in Fairfax, Va., and Washington, D.C., respectively, through the Washington Regional Community Partnership.

    Subsequently, nurse practitioner preceptors and students at Northeastern University conducted a more extensive pilot of the modified program. Feedback from participants led to further revisions of the program.

Key Findings

The AACN Researchers concluded the following:

  • The medical residency training cost model would be applicable to nursing with several modifications and an adequate and representative sample.
  • The lack of financial resources available for support of the clinical education of nurse practitioners has created a system in which students are dispersed across many training sites, requiring sophisticated methodological modifications for the collection of data across multiple settings.

An advisory committee member made a presentation on the project at the 1999 Harvard Nursing Research Institute annual meeting. (See the Bibliography for details.)


The Robert Wood Johnson Foundation provided $50,000 in funding from September 1998 to December 2000 to support the project. AACN contributed $12,450 in staff support to the project.