Fee-Based Practicums for Nursing Students Raise Ethical Concerns

Nursing students are finding yet another hurdle in obtaining a nursing degree. The clinical rotations required as part of every nursing program are becoming increasingly challenging to schedule.

There are several reasons contributing to the difficulties students are facing when trying to schedule this integral part of the degree program. In many cases, a clinical rotation site is just not available in the area. Another common issue is the increase in preceptor cancelations. If the student is unable to find a replacement preceptor, it can postpone their graduation indefinitely.

Online nursing programs have increased the demand for preceptors. In fact, some clinics are booked up to two years in advance. Due to the high demand, some health care practices have begun charging a fee to students participating in clinical rotations. This has led to a debate within the healthcare system on the ethics of charging students for gaining the experience they need, especially during a time when nurses are in short supply.

On one side of the debate are those who believe that the health profession needs to stand by the Hippocratic Oath and offer selfless service. They feel that the services should be offered to students generously without any expectations.

The other side believes that practicums should be treated just as any other component of education, and therefore justify a charge for service. A ten week practicum can easily cost a student $2,000 in addition to their other tuition and fees.

Critics point out that the practicums are not being handled the same at clinical sites, leaving students to have very different experiences. Some are calling on the Commission on Collegiate Nursing Education and other organizations to step in and regulate the clinical guidelines for a graduate level degree.

Even as the issue is being debated, the new practice of fee-based practicums are likely to continue as the demand grows for clinical sites to host these practicums.


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