A few years ago, my college-age sons utilized the Common App for college applications. It’s a logical and brilliant concept: one online application that students can use to apply to multiple colleges and universities at once. And it’s accepted by thousands of colleges and universities worldwide. I remember thinking, “Why aren’t we doing this for nurse practitioner (NP) programs?” It seemed like a great solution, so I decided to research it.
Anyone involved in NP education knows that securing clinical training sites with preceptors is challenging. One of the main culprits is the complex and often burdensome process of creating affiliation agreements between schools of nursing (SON) and clinical sites. Adopting a Standardized Affiliation Agreement (SAA) in the NP profession would alleviate this issue and unlock new opportunities for NP students and clinical sites alike.
Affiliation agreements: the hidden barrier
While essential, affiliation agreements have become a significant bottleneck for NP education nationwide. These agreements define the legal, educational, and administrative terms between clinical sites and schools, but their school-to-school variability creates unnecessary hurdles. Many clinical sites, already overwhelmed by requests, are unwilling to establish new agreements due to the extensive legal review and negotiation required, often compounded by liability concerns. These factors have contributed directly to the national shortage of preceptor sites.
Currently, schools and clinical sites must draft individualized agreements for each collaboration, a process that is costly, time-consuming, and highly variable depending on the legal requirements of the state and institution. For schools outside the clinical site’s state, the situation becomes even more complicated. The complexity of these agreements is one reason many students are unable to find clinical placements, leading to delays in their education or, worse, students leaving their programs entirely.
Can we create a standardized affiliation agreement for the NP profession?
A standardized affiliation agreement (SAA) for NPs and advanced practice registered nurses (APRNs) could be a game-changer for the profession. With a consistent framework in place, clinical sites and educational institutions would no longer have to spend excessive time and money negotiating new agreements for every student. This would simplify the process, reduce legal costs, and, most importantly, open more doors for students to gain critical clinical experience.
This concept is not without precedent. Medicine already has a similar solution in place. The Association of American Medical Colleges (AAMC) developed the Uniform Clinical Training Affiliation Agreement (UCTAA), which has significantly streamlined the affiliation agreement process for medical schools and clinical sites. The UCTAA has been widely adopted by medical institutions and has been instrumental in reducing both time and financial burdens. It’s time for the nursing profession to follow suit and create an SAA that works for NP and APRN programs.
A call to action for the nursing profession
As it stands, nearly 500 NP programs in the United States graduate tens of thousands of students each year. Yet many of these programs are constrained by a lack of clinical placements. The shortage of preceptor sites impacts not only NP students but also physician assistant (PA) students, medical students, and residents. It’s a cascading issue, one that a unified approach to clinical affiliation agreements could mitigate.
By developing and implementing a standardized agreement, NP schools could save significant resources. According to a report to Congress on the Graduate Nurse Education Demonstration Project, having strong affiliations with clinical sites can save schools of nursing up to $582,000 per year. These savings come from reducing the time and human resources needed to establish clinical placements. Imagine the cumulative impact on our profession if even a fraction of that savings was realized across the nearly 2,000 nursing programs in the U.S. alone.
The road ahead: Making the SAA a reality
The groundwork has already been laid. Leaders in preceptor-matching for NP students have taken the lead on this issue. Legal experts in both nursing and medicine, along with leaders from key medical education organizations, have collaborated to develop a framework for a Standard Affiliation Agreement (SAA) tailored to NP and APRN programs. Similar to the Common App, addendums can be included for special circumstances.
Whether the profession adopts this SAA or begins anew, let’s give it a try! However, support from academic institutions, clinical sites, and accrediting bodies is essential to move forward.
Key stakeholders, including the American Association of Nurse Practitioners (AANP), the American Association of Colleges of Nursing (AACN), the National Organization of Nurse Practitioner Faculties (NONPF), and the National Council of State Boards of Nursing (NCSBN) can help drive this forward. The nursing profession must champion this initiative to ensure our students have the clinical training they need to become skilled providers.
Here is the AAMC’s goal as listed on their website:
Goal
Our goal is to eliminate unnecessary time and resources currently spent negotiating (and re-negotiating) agreements, when a standard, predictable approach is sufficient. The AAMC Uniform Clinical Training Affiliation Agreement is a simple, one-size-fits-all agreement that resides on AAMC’s website.
What a wonderful goal! The NP profession can have a similar goal.
A collective responsibility
This is not just an issue for schools or clinical sites – it’s a responsibility for the entire nursing community. Preceptors, schools, clinical sites, and professional organizations should work together to make the SAA a reality. Only through collective action can we break down the barriers preventing our students from gaining the education they deserve. This is one step in that direction.
Nurse practitioner education is facing many challenges, but addressing one major barrier could make a world of difference. Implementing a standardized affiliation agreement has the potential to streamline the clinical placement process, open doors to more training sites, cut costs for both schools and clinical partners, and remove one of the biggest roadblocks in NP education. This single, impactful step could bring us closer to ensuring every NP student gets the hands-on training they need to deliver quality care.
Lynn McComas is CEO and founder, PreceptorLink, and a recognized expert in precepting nurse practitioners and advanced practice provider students. With over two decades in primary care, Lynn has served as a coach, advisor, mentor, and preceptor for countless health care professionals, including NPs, nurses, and medical assistants. She co-founded a successful skills and procedures business and speaks nationwide on NP-related issues.
Lynn is also a regular contributor on LinkedIn, KevinMD, Facebook, YouTube, Instagram @preceptorlink, X @LynnMcComas, and her blog, where she addresses the growing NP and PA professions and the urgent need for preceptor sites. Her unique perspective, shaped by her business, clinical, and educational experiences, positions her as a key voice in tackling preceptor shortages. Lynn is committed to driving change—through a paradigm shift in NP education, reducing barriers, offering preceptor incentives, and advocating for reforms within the profession.
