Impact of direct patient care clinical hours on national nurse practitioner certification pass rates

Nurse practitioner (NP) programs must strike a balance between competency-based education and time-based requirements. Direct patient care clinical hours (DPCC) are widely used, yet the relationship between DPCC hours and certification outcomes remains unknown.

To examine whether DPCC hours are associated with NP certification pass rates and domain scores.

The survey was sent to 462 nursing schools with either family nurse practitioner or adult gerontological primary care nurse practitioner programs in the United States to compile NP certification pass rates and domain scores from American Nurses Credentialing Center (ANCC) and American Academy of Nurse Practitioners Certification Board (AANPCB) reports (2019-2023), as well as other school characteristics. Pearson correlations assessed association between DPCC hours and pass rates. Generalized estimating equations (GEE) regression estimated the odds of achieving a perfect pass rate (100%) and a pass rate of at least 80% as a function of DPCC hours modeled as a threshold (≤750 vs. >750), adjusting for year, faculty-to-student ratio, and total simulation hours.

Direct patient care clinical hours positively correlated with pass rates. In AANPCB models, schools with >750 DPCC hours had an eightfold greater odds of a perfect pass rate (AOR = 8.306, p < .001) and fourfold greater odds of at least 80% (AOR = 4.739, p = .008) compared with those with ≤750 hours. In ANCC models, schools with >750 hours showed 3.5 times higher likelihood of having perfect pass rates (AOR = 3.500, p = .075) compared with schools with ≤750 hours.

Higher DPCC hours are associated with improved certification examination performance. These findings provide support for a minimum of 750 DPCC hours.