For-Profit Schools Now Train Nearly a Third of New Nurse Practitioners

The American nurse practitioner workforce is expanding at a pace few corners of health care can match, and the schools producing those clinicians are changing just as quickly. A new study published in Annals of Internal Medicine reports that nearly one in three newly licensed nurse practitioners in four large U.S. states was educated at a for-profit program in 2024, a share that has surged from just 2.4 percent in 2010. The findings, from researchers at the Brown University School of Public Health, raise pointed questions about oversight and training quality in a sector that has historically attracted regulatory scrutiny.

The research team, led by senior study author Dr. Michael Barnett, a professor of health services, policy and practice at Brown, analyzed licensure records for 117,156 nurse practitioners licensed in California, Florida, Iowa and Texas between 2010 and 2024. The four states were chosen because they are large and geographically distinct, offering a broad cross-section of the national picture. What emerged was a consistent pattern: in every state examined, the proportion of new licensees trained at for-profit institutions climbed steadily over the fourteen-year window.

The magnitude of the shift varied considerably by geography. Among newly licensed nurse practitioners in California, 40.9 percent came from for-profit programs, the highest share of the four states. Florida followed at 35.1 percent, Texas at 21.1 percent and Iowa at 14.8 percent. Even in Iowa, the lowest of the group, the figure represents a dramatic departure from the near-negligible presence for-profit schools held in the nurse practitioner pipeline just a decade and a half ago.

Dr. Barnett described the growth as remarkable given the sheer size of the nurse practitioner workforce. Nurse practitioners are advanced practice registered nurses who hold graduate-level education and are licensed to assess patients, order and interpret diagnostic tests, and prescribe medications in most states. They already constitute one of the largest groups of prescribers and primary care providers in the country, and their numbers are set to grow far faster than those of physicians. The U.S. Bureau of Labor Statistics projects a 35 percent increase in nurse practitioner employment over the next decade, compared with just 3 percent for physicians and surgeons over the same period.

That demand has drawn a wave of new training programs into the market, and for-profit institutions have been among the fastest-growing entrants. The number of for-profit nurse practitioner training programs increased 400 percent between 2007 and 2016 alone, according to prior research cited in the study. Barnett noted that the explosion in the nurse practitioner workforce is pulling more and more schools into training, and that for-profit schools, which he described as having a checkered past in the United States, are among the newer entrants to this space.

The concern driving the Brown team’s analysis is not simply who trains new nurse practitioners, but whether the rapid commercial expansion affects the quality of the education they receive. Previous evidence indicates that for-profit nursing education was a significant predictor of lower pass rates on the National Council Licensure Examinations, the standardized tests that nursing graduates must pass to obtain licensure. Lower pass rates can signal weaker preparation, and for a profession whose members increasingly serve as independent providers of primary and specialty care, gaps in training could carry consequences for patient outcomes.

For-profit nursing programs have a documented history of regulatory problems. Barnett pointed out that such programs have drawn regulatory scrutiny, settlements with the Federal Trade Commission and numerous lawsuits in the past. At the same time, he cautioned that the evidence base remains thin. In his words, there is not yet enough hard data to make decisions about the impact of for-profit nursing programs, and there is currently little transparency available to judge them. That combination of rapid growth and limited visibility is precisely what makes the trend difficult to evaluate from the outside.

The study’s implications extend beyond nursing education into the broader structure of American health care. As nurse practitioners take on larger roles in delivering care, particularly in rural and underserved communities where physician shortages are most acute, the educational pathways that produce them become a matter of public health significance. If a growing share of the workforce is trained in programs whose quality is difficult to assess, patients, employers and state licensing boards all face a common problem: they lack the information needed to distinguish strong programs from weak ones.

Barnett identified transparency as the most important next step. He argued that all nurse training programs should disclose licensure exam pass rates and other student statistics so that the public can better judge the merits of individual programs. Standardized, publicly available outcome data would allow prospective students to compare programs, enable regulators to identify underperforming institutions and give health systems a clearer basis for evaluating job candidates. In sectors such as higher education more broadly, outcome disclosure has repeatedly proven to be one of the most effective levers for accountability, and nursing education has so far lagged in this respect.

The second research priority Barnett outlined is to examine outcomes for patients treated by nurse practitioners with different training backgrounds. Such studies would reveal whether, and where, meaningful differences in quality of care exist between graduates of for-profit programs and those of nonprofit or public institutions. Until that evidence exists, the study stands as a warning about scale and speed: a sector that trained almost no nurse practitioners in 2010 now educates nearly a third of new licensees in some of the nation’s largest states, and no one yet has the data to say what that means for the patients in their care. The work was funded by grants from Arnold Ventures and the National Institute on Aging.

Subject of Research: Growth of for-profit education among newly licensed nurse practitioners in the United States

Article Title: Nearly 1 in 3 new nurse practitioners educated at for-profit schools, study finds

Article References: Nearly 1 in 3 new nurse practitioners educated at for-profit schools, study finds. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: nurse practitioners, for-profit schools, nursing education, licensure, health workforce, Annals of Internal Medicine, Brown University, regulatory scrutiny, NCLEX pass rates, health policy, advanced practice nurses, transparency