What Counts as Clinical Hours?

What counts as clinical hours in a nurse practitioner (NP) program? The time you spend giving direct care to patients in your population focus, at a site your program approved, under a preceptor your program approved. Watching another clinician, practicing in a simulation lab and working your regular RN shifts fall outside that definition, even when you learn a lot from them. We’ll explain how the national standards and the certification boards define clinical hours, which activities count and which don’t, and how your program checks every hour you log.

TL;DR

• Direct patient care counts: care you give patients in your population focus, supervised by a preceptor your program approved.
• Telehealth visits can count, though your program may cap them.
• Simulation, skills labs, shadowing and orientation don’t count toward the 750 direct patient care hours in the 2022 national standards.
• Your paid RN shifts stay separate from your clinical hours, even on the same unit.
• Wait for your program to approve your preceptor and site before your first shift, and log every shift the same day.

Which activities count as clinical hours?

Direct patient care counts. The 2022 Standards for Quality Nurse Practitioner Education define direct patient care clinical hours as time in which “direct clinical care is provided to individuals, families, and groups” in one of the six NP population foci. In practice, you’re caring for real patients yourself, with your preceptor supervising.

These activities are direct patient care when you do them under your preceptor’s supervision:

• Taking histories and doing physical exams
• Forming a differential diagnosis and presenting your plan to your preceptor
• Ordering and interpreting tests with your preceptor
• Performing procedures your program and site allow
• Teaching patients and families about their care
• Documenting the visits you took part in, if your site lets you chart

Telehealth care can count too. The national standards say direct patient care hours “may include student provision of care delivered to the patient through telehealth and global health experiences.” So a video visit where you take the history and present the plan counts as direct care.

For an hour to count, three things need to be true:

1. You’re giving care. Observing someone else doesn’t meet the definition.
2. The patients fit your population focus. On the FNP track, that means patients across the lifespan. On the PMHNP track, it means patients with mental health needs.
3. Your program approved the placement. Faculty approve every preceptor and site. The AACN Essentials also say every advanced practicum experience “must have faculty oversight and be verified and documented as a component of a formal course or plan of study.”

How do the national standards and certification boards define clinical hours?

The National Task Force on Quality Nurse Practitioner Education writes the national standards for NP programs, and the certification boards decide who can take their exams. Together they set the rules for what counts as clinical hours, and each one describes the hours it counts a little differently:

• The national standards set a minimum of 750 direct patient care hours for every NP population-focused track. Telehealth care can count, and simulation can’t.
• ANCC (the American Nurses Credentialing Center) asks for at least 500 “faculty-supervised clinical hours” in your NP program. It needs your Validation of Education form and transcripts showing those hours before it authorizes you to test, according to its FNP-BC page.
• AANPCB, which now uses the name NPCB, asks for at least 500 “faculty-supervised direct patient care clinical hours,” according to its candidate handbooks.
• PNCB counts hours in which “hands-on pediatric primary care is provided to individuals and families” for its CPNP-PC exam.
• NCC counts “direct patient care clinical hours” for its women’s health and neonatal NP exams, according to its NP registration catalog.

For the totals on each track, read our guide to nurse practitioner clinical hours requirements.

What’s the difference between direct and indirect clinical hours?

Direct hours involve a patient. Indirect hours support patient care without a patient in front of you. The AACN Essentials define direct care as “a professional encounter between a nurse and an actual individual or family, either face to face or virtual.” Indirect care means decisions and actions taken on behalf of patients or groups, such as administrative decisions, population health planning and policy development.

The two national documents count them differently. The AACN Essentials, which apply to every advanced nursing program, count direct and indirect practice hours together. The national NP standards count only direct care toward their 750-hour minimum.

Your program may accept a small amount of indirect time. Colorado State University Pueblo, for example, accepts up to 30 hours of faculty-approved indirect patient care time in every NP track except PMHNP. If you’re in a DNP program, ask your faculty which of your project hours count as practice hours and which count as direct care.

What doesn’t count as clinical hours?

Some activities feel like clinical work but fall outside the definition of direct patient care.

Simulation and skills labs

The national standards say simulation “is not direct patient care,” so it can’t count toward the 750 hours. Under the standards, your program teaches and tests core patient care skills before your precepted rotations begin, through simulation or faculty-led practice, and that time doesn’t count either.

Simulation can count above the minimum in some cases. PNCB says simulation “can be used to fulfill clinical practice hour requirements for those hours above the 500 direct care clinical practice hours.” The University of Colorado Colorado Springs lets its FNP and AGNP students count up to 20 extra simulation or skills lab hours in their final semester.

Shadowing, observation and orientation

Watching another clinician work isn’t direct care, because someone else is giving the care. A sample checklist in the national standards asks preceptors to plan your progress “from observing to conducting visits with minimal intervention.” One NP program’s preceptor handbook says observation and shadowing “should be no more than a day or so.”

The same checklist asks your preceptor to orient you to the site, the EHR and the team “prior to student’s patient experiences,” so orientation falls outside the definition too. So do travel to your site and meal breaks. Ask your program before you log any of this time.

Your RN shifts

Your paid RN work stays separate from your clinical hours, even on the same unit. Clinical hours are part of a course with faculty oversight, while your employer supervises your RN shifts.

Your program may let you complete a rotation where you work, in your student role. The University of Colorado Colorado Springs, for example, allows it only at a different location, floor or unit, with its clinical coordinator’s approval. For more on pay and clinical time, read Do You Get Paid for Clinicals?

Hours outside an approved placement

Your program also checks your paperwork before it counts your hours. The two programs above won’t count hours like these:

• Hours before your site agreement and preceptor paperwork are signed
• Hours with a preceptor your program hasn’t approved
• Hours when you aren’t registered for a clinical course, or during university breaks
• Hours in a state where your program doesn’t allow clinicals

Who decides what counts as clinical hours?

Your NP program decides which hours count toward your degree. The national standards and the certification boards set the minimums, and your program adds its own rules. Here are a few from the University of Colorado Colorado Springs:

• It counts up to 45 telehealth hours across the whole program.
• It requires FNP and AGNP students to complete their hours in primary care settings, and says hospital hours “will not count toward the required hours.”
• It doesn’t accept family members or close friends as preceptors.

When your handbook doesn’t mention an activity, email your clinical coordinator before you log it, and keep the reply. A written yes protects you if anyone questions your hours at the end of the term.

How do programs verify your clinical hours?

Your program checks your hours three ways:

• Your log. The national standards ask programs to keep “electronic logs and/or e-portfolios documenting clinical encounters.” Programs use tracking systems such as Typhon or Medatrax, and the University of Colorado Colorado Springs also asks for diagnosis and billing codes for each patient.
• Your preceptor. The sample checklist asks preceptors to “verify student clinical hours” and to be present to observe all your clinical activities.
• Your faculty. Faculty review your clinical encounters “for breadth, depth, and type,” and meet with you and your preceptor about your progress.

Log each shift the same day, while you remember the details. A weak entry reads: “Clinic, 8 hours.” A strong entry reads: “March 14, family practice, 8 hours. Saw 14 patients, did histories and focused exams, presented plans to Jamie Lee, FNP-C.” The strong entry tells your faculty what you did, and your preceptor can confirm it quickly. Our guide on how to track clinical hours explains how to keep your log ready for approval.

Do clinical hours differ by NP specialty?

Yes, mostly in where you complete them. The national standards define clinical hours by population focus, and by primary care or acute care “as appropriate,” so the patients you see need to match your track.

• FNP: families and individuals across the lifespan, usually in primary care. Our guide to FNP clinical hours explains how programs organize them.
• Pediatric primary care: PNCB counts only hours in primary care pediatrics.
• PMHNP: psychiatric and mental health care across the lifespan. Read our guide to PMHNP clinical hours, and if you’re considering a remote psychiatry rotation, our guide to virtual clinical rotations explains how telehealth hours work.
• Dual-track programs: under the national standards, hours that “meet the requirements and fall within the scope of practice of both tracks” may count toward each track. Your program decides how much overlap it allows.

What counts as clinical hours: questions students ask

What jobs count as clinical hours?

If you’re an NP student, a job doesn’t count, even a clinical one. Clinical hours happen in your student role, in a clinical course, under a preceptor your program approved, so paid work and caregiving fall outside them. Premed and pre-PA students ask what counts as clinical hours too, but they mean experience before admission. The University of Florida’s PA program, for example, asks applicants for at least 1,000 hours of direct patient care experience from paid or volunteer positions.

Is 500 clinical hours enough?

For ANCC or AANPCB certification, yes: 500 faculty-supervised clinical hours is their minimum. Your program may ask for more, since the 2022 national standards set a minimum of 750 direct patient care hours.

Does simulation count as clinical hours?

Not toward the 750 direct patient care hours in the national standards, or toward PNCB’s 500. A program may count a few simulation hours beyond those minimums, so check your handbook.

Do telehealth visits count as clinical hours?

Yes, when you take part in the patient’s care under your preceptor’s supervision. The national standards and PNCB both include telehealth care, and your program may cap the hours.

Find a preceptor for your clinical hours

Every hour you log needs a preceptor your program approved. Clinical Match Me is a preceptor placement service for NP and PA students in every clinical specialty. Our founder is a nurse practitioner who struggled to find a preceptor as a student, and since 2014 we’ve helped more than 10,000 students find preceptors.

Submit a placement request with your specialty and rotation dates. Choose the states you’re willing to travel to, or enter your zip code and how far you’re willing to travel. We’ll match you with preceptors in those areas. Preceptors review your placement request and send you offers, so you choose your preceptor instead of being assigned one. Our AI preceptor outreach also contacts qualified providers near you, even when there are no matching preceptors in our network.

Your program approves each preceptor and site before your rotation starts. Although many students are placed within days, try to submit your placement requests as early as possible. The sooner you do, the sooner we can place you.

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