PROVIDENCE, R.I. [Brown University] — For-profit schools appear to be playing an outsize role in training the nation’s expanding nurse practitioner workforce. That’s according to a study that found nearly one-third of newly licensed nurse practitioners in four states were educated at for-profit programs in 2024, up from just 2.4% in 2010.

“That is enormous growth, especially since nurse practitioners are such a big workforce to begin with,” said senior study author Dr. Michael Barnett, a professor of health services, policy and practice at the Brown University School of Public Health.

The study, published in Annals of Internal Medicine, examined 117,156 nurse practitioners licensed in California, Florida, Iowa and Texas (which represent different geographic areas of the country) from 2010 to 2024. While there were increases in nurse practitioners trained in for-profit settings in all four states, those were most prevalent in California at 40.9%, followed by Florida at 35.1%, Texas at 21.1% and Iowa at 14.8%.

The study notes that the number of advanced nurse practitioners is projected by the U.S. Bureau of Labor Statistics to grow by 35% over the next 10 years — far outpacing physicians, whose numbers are expected to grow by just 3% during the same period. Also on the rise is the number of for-profit nurse-practitioner training programs, which increased 400% between 2007 and 2016 alone.

“There has been an explosion in the nurse practitioner workforce that is drawing more and more schools into the fray to provide training,” Barnett said. “Among the newer entrants are for-profit schools, which have a checkered past in the U.S.” 

The rise in nurse practitioners graduating from for-profit programs prompted concerns among study authors about the quality of care resulting from for-profit education, especially as prior evidence shows that for-profit nursing education is a significant predictor of lower pass rates of National Council Licensure Examinations.

“For-profit nursing programs have drawn regulatory scrutiny, Federal Trade Commission settlements and many lawsuits in the past,” Barnett said. “We don’t have enough hard data yet to make decisions about the impact of for-profit nursing programs, but there isn’t much transparency to judge at the moment.” 

For Barnett, the next important steps include disclosure of licensure exam pass rates and other student statistics from all nurse training programs so the public can better judge the programs’ merits. He added that researchers should look at the outcomes for patients treated by nurse practitioners with different training backgrounds to understand where or if there is a significant difference in quality of care. 

This study was funded by grants from Arnold Ventures and the National Institute on Aging (R01AG076580).