My School is Now Approved in a New State! Great…But is It? Why this may not be good news.

So you got the “great” news that your school just got approved in a new state. Yeah!! Well, it may not be as good of news as you think. As I write this, the song by Meghan Trainor - All About That Bass came to mind. You see, it’s “All About That Affiliation!” (Sorry, now you’ll have that song going through your head all day!) 

If you're an NP student looking for clinical rotations in a newly-approved state, there's one crucial question you need to ask your school before you even start your preceptor search: What sites does my school already have an Affiliation Agreement (AA) in place with in that state (near me)? Your school knows, but you may really have to insist on getting an answer to this question. You may have to give them the names of all the local hospital systems and ask about each of them. 

Many students don’t realize that just because a preceptor or clinical site is willing to take them, it doesn’t mean the school can make it happen. Affiliation Agreements (AAs) are legally binding contracts between a school and a clinical site—and getting a new one signed isn’t always simple. In fact, it can take months, and in many cases, it may never happen at all. This is especially true for a large hospital system. 

Why Getting a New Affiliation Agreement Can Be Difficult

When you're the first student from your school attempting a clinical rotation in a state where your institution has no existing AAs, you're in for an uphill battle. Here’s why:

1. Hospitals and Large Healthcare Systems Are Increasingly Refusing New AAs. 

Many hospitals, health systems, and large organizations have put a freeze on new AAs due to financial constraints, legal complexities, administrative burdens, and a focus on the plethora of students from their already affiliated programs. Some simply refuse to add any new agreements, especially for out-of-state programs.

2. It Can Take Months (or Longer) to Get an AA Signed. 

Even if a hospital or clinic is open to a new AA (which they MIGHT be if they need new NPs), the process is slow. Legal teams must review, negotiate, and finalize contracts, which can take weeks to months. By the time it’s approved—if it ever is—your rotation deadline may have already passed. 

3. Getting a new AA in place with local hospital systems is vital for your school. 

The incorporation of an AA could have significant financial ramifications for SON.  Based on a quote from the Evaluation of the Graduate Nurse Education Demonstration Project: Report to Congress: "…having an affiliation with a hospital decreases the average SON costs by $582,000. This may be because close relationships with hospitals offer the SON reliable and sufficient clinical sites and preceptors which mitigates the fiscal and human resources needed for finding clinical placements for APRN students."

Now if your school could only get that AA in place!

4. Some Schools Won’t Pursue New AAs. 

Not all schools will go through the effort of negotiating a new AA for a single student. Schools prioritize agreements that will benefit multiple students over time. If you’re the first student requesting a new state AA, your school may decide it’s simply not worth the effort. Remember, it costs a school lots of money to get an AA in place…Just saying. 

5. Private Practices May Be Your Best (or Only) Option—But They're Disappearing. 

If hospitals won’t sign new agreements, private practices may be your only choice. However, private practices are becoming increasingly rare, as many are now owned by large healthcare systems—meaning they fall under the same no-new-AA policies as hospitals.

What Should You Do?

1. Ask Your School About Existing AAs Before Starting Your Search

Before investing time into finding a preceptor, confirm that your school has AAs in place in the state where you want to rotate. If not, you may need to rethink your options.

2. Be Open to Alternative Clinical Settings

If hospitals and large clinics aren’t an option, consider smaller independent practices, federally qualified health centers (FQHCs), or concierge medicine practices that may be more flexible.

3. Start Your Search Early

If your school does allow new AAs, start as early as possible. Expect a long approval process, 3-6 months, and be prepared with backup options. (I know, easier said than done!)

Final Thoughts

Being the first student from your school to attempt a rotation in a new state is challenging—and in some cases, nearly impossible. Many hospitals and large organizations won’t sign new Affiliation Agreements, and private practices are becoming harder to find. Save yourself frustration and lost time by confirming your school’s existing AAs before starting your search.

If you're struggling to secure a preceptor, PreceptorLink® can help! We work with a network of vetted preceptors and can guide you through the complexities of Affiliation Agreements.

👉 Need help finding a preceptor? Contact PreceptorLink® today!