Nearly a third of new advanced practice nurses are for-profit grads

Clinical takeaway: Advanced practice nurses are projected to grow 35% over the next decade against 3% for physicians. A rising share of new licensees in four large states trained at for-profit schools, raising potential questions about the quality of their training. 

Physician ranks are projected to stay nearly flat over the next decade, while advanced practice registered nurses (APRNs) are expected to keep growing fast. These nurses have graduate training and national certification. They are trained to diagnose and manage patient problems as well as to prescribe treatment. Whether they can do so without physician supervision or a written agreement depends on the state. And the kinds of schools training them have been changing. 

For-profit programs have grown in recent years. How far that growth has altered the education of the APRN workforce has been unclear. Earlier work linked growth in for-profit education for registered nurses to concerns about care quality. This brief research report quantifies how the share of newly licensed APRNs from for-profit programs has shifted. 

For-profit schools educated 31.0% of newly licensed APRNs in 2024, up 28.6 percentage points from 2.4% in 2010. The share rose in all four states, reaching 40.9% in California, 35.1% in Florida, 21.1% in Texas, and 14.8% in Iowa. That put California's 2024 share 26.1 percentage points above Iowa's. 

The authors analyzed state nursing board rosters covering 117,156 APRNs licensed in California, Florida, Iowa, and Texas from 2010 to 2024. They classified APRNs' highest-degree schools as for-profit or public/nonprofit using the US Department of Education's College Scorecard. A logistic regression tracked the for-profit share of new licensees by licensing year, overall and within each state. 

The four states, the authors note, vary in their density of for-profit programs. Many of those programs, they add, offer distance learning open to students nationwide. The national consensus model for APRN regulation recommends one education floor for every APRN program: accreditation, graduate-level education, and three graduate-level courses in physiology, health assessment, and pharmacology. 

"Although prior evidence has raised concerns about the quality of care resulting from growth in for-profit RN education, further research is needed to test for any association between for-profit education and the quality of care provided by APRNs,” the authors conclude. 

Source: Neprash HT, et al. (2026 Oct 6) Ann Intern Med. Growth in the Share of Advanced Practice Registered Nurses Educated at For-Profit Programs in Four U.S. States