Nearly 1 in 3 new nurse practitioners trained at for-profit schools, Brown researchers find

A new study co-authored by Brown researchers found that nearly one in three newly licensed advanced practice registered nurses in four states were trained at for-profit schools in 2024.

The study examined APRNs in California, Florida, Iowa and Texas. The researchers found that in 2010, roughly 2% of newly licensed APRNs had trained at for-profit schools, but by 2024, that share increased to 31%.

According to Michael Barnett, the study’s senior author and professor of health services, policy and practice, the research was inspired by changes he noticed in the healthcare workforce. APRNs are one of the fastest-growing parts of the industry, Barnett wrote in an email to The Herald. There has also been an increase in for-profit APRN educational programs, many of which are online, he added.

The researchers sought to answer the “basic question” of how many new APRNs these programs are training, according to Barnett. “Nobody had actually measured how much of the new workforce these programs are producing.” 

In 2024, about 41% of newly licensed APRNs had trained in for-profit schools in California, compared to about 35% in Florida, around 21% in Texas and nearly 15% in Iowa, he added.

Co-author Elizabeth White, assistant professor of health services, policy and practice, is a nurse practitioner herself. According to her, the study only examined APRNs who were newly licensed in each state, which does not necessarily assume that they were new to the profession. Nurses who move often need a new license to practice in a different state, she explained.

Researchers acquired data from each state’s board of nursing, which stores records of where every licensed nurse trained, among other information, White said. 

While Florida and Iowa post this information online, Barnett explained that researchers acquired data from California and Texas through public records requests.The researchers then matched the school names of where the NPs trained to the U.S. Department of Education’s College Scorecard data, which shows whether the school was for-profit, he added.

Christopher Koller, adjunct professor of community health at the School of Public Health, who was not involved with the study, told The Herald that because the United States is training fewer physicians, nurse practitioners are more frequently delivering primary care services.

“APRNs are projected to grow by about 35% over the next decade, compared with about 3%for physicians,” according to Barnett. Researchers know very little about the for-profit training sector for NPs, but these workers are “essential to keeping our health system running,” he explained.

“If we’re going to rely more and more on nurse practitioners for primary care, we have an interest in how well they’re being trained,” Koller said. “There’s concern about the quality of training that happens in for-profit settings.” 

The study could help bring attention to the standards for training nurse practitioners, he added.

“It’s important that (NPs) are being prepared with the skills that they need to be able to do the level of care that they’re providing,” White said, adding that these programs are “predominantly online” in their coursework. 

White noted that there’s a lot to explore about whether the current process for accreditation is “appropriately able to monitor these for-profit programs.” 

“It’s going to be really important that we look at the existing regulatory processes (and) accreditation processes to ensure that students coming out of these programs are getting sufficient education to provide care,” she said.

The study does not demonstrate how for-profit training affects patient care, Barnett noted. To examine this question further, Barnett wrote that researchers could analyze prescribing patterns or patient patterns. 

Barnett also hopes to extend the study beyond the four states analyzed to get a “national picture” of the nurse practitioner landscape. 

“This isn’t a criticism of individual nurse practitioners, who are essential to keeping our health system running,” Barnett wrote. “It’s a question about how we train them and whether oversight has kept pace with very rapid growth.”