What Is an Affiliation Agreement?

What is an affiliation agreement? It’s the contract between your NP program and the clinical site where you’ll train. It defines who supervises you, who carries liability insurance, what records you need before your first day and how long the arrangement lasts. Your rotation can’t start until both sides sign it, and getting those signatures can take anywhere from a couple of weeks to several months.

You usually won’t sign it yourself, but you may need to help get it started. This guide is general information, not legal advice. Your school’s clinical placement office can tell you how its own agreements work.

TL;DR

• An affiliation agreement is the contract between your school and your clinical site.
• It covers supervision, insurance, patient privacy, student requirements and how either side can end it.
• Your school and the site sign it. At a hospital, your preceptor usually isn’t the person who signs.
• It can take weeks or months, so start it as soon as you have a site.
• A preceptor agreement is a separate, shorter form your preceptor signs.

What is an affiliation agreement?

An affiliation agreement is a written contract between a school and a clinical site that sets the rules for students who train there. SUNY Cortland describes it as an agreement that “establishes the expectation of the Host and the student while they are interning or training at the Host site.”

You may also see it called a clinical affiliation agreement, a facility contract or a clinical agency agreement. For example, a nursing school might sign one with a family practice so its NP students can train there. While the agreement is active, every student the school sends to that practice is covered by it.

What does an affiliation agreement cover?

Many agreements cover the same core topics, and Stockton University’s public template is a good example. It includes each of these:

• Supervision. The site supervises all patient care and names someone to coordinate and evaluate your experience. Your school’s faculty handle your overall supervision.
• Insurance. Each side’s liability coverage, including malpractice insurance for students. Some schools cover every student under a blanket policy, like the University of Pittsburgh School of Nursing. Others, like Berkeley College’s MSN program, ask you to buy your own. Our guide to NP student liability insurance explains how that coverage works.
• Patient privacy. For HIPAA purposes, you count as part of the site’s workforce. You follow its privacy policies, and the site gives you an orientation on them.
• Student requirements. Immunizations, a criminal background check, a drug screen, CPR certification, health insurance and compliance training. UNC’s Advanced Practice Provider Center lists each one under its clinical affiliation agreement.
• Conduct. The site can remove a student who breaks its policies, and your school handles any discipline.
• Your status. You’re a student, not an employee, and you aren’t paid for your clinical hours.
• Term and termination. How long it lasts, how it renews and how either side can end it. Stockton’s version requires 90 days’ written notice, and both sides take reasonable steps so current students can finish.

Who signs an affiliation agreement?

Your school and the clinical site sign it. You don’t, and at a hospital or health system your preceptor usually can’t.

On the school side, the signer is often the dean or a contracts office. At the University of Pittsburgh School of Nursing, the dean signs along with a representative of the clinical site. On the site side, it’s whoever can legally sign contracts for the organization. That’s often the owner of a small practice, or a legal, contracts or academic affiliations office at a hospital.

That’s why a preceptor’s yes is only the first step. Allina Health, for example, tells students its preceptors can’t sign these contracts and can only tentatively approve a placement until their leadership gives formal approval. Your preceptor agrees to teach you. The organization agrees to let you train there.

How long does an affiliation agreement take?

It can take a couple of weeks or several months, depending on the site. It’s fastest when the site already has an active agreement with your school, since there’s nothing new to negotiate.

Saint Louis University’s School of Nursing tells students “the contracting period can take anywhere from a couple of weeks to a couple of months.” Cal State Fullerton notes that negotiations “can take up to a year.”

Why do affiliation agreements delay rotations?

Delays often come from negotiating the contract’s terms. Here are common reasons the process takes longer:

• Two templates. Some sites want their own agreement or different wording. At Pitt, the university’s legal department then reviews the contract before anyone signs.
• Insurance limits. A site may ask for more coverage than your school carries. UConn’s review guide says agreements requiring more than the university’s own limits “must be revised accordingly.”
• Public university rules. Public universities may have legal limits on what they can sign. UConn can’t agree to indemnify a site or to settle disputes under another state’s law, so it asks the site to remove or rewrite those clauses.
• Expired agreements. SUNY Cortland’s agreements can’t be more than five years old, so an older one may need renewing before you can start.

How can you speed up your affiliation agreement?

Waiting for a contract after you’ve finally found a preceptor can be stressful. Your school does the negotiating, but you can give it what it needs as soon as you have a site:

1. Ask your clinical coordinator whether your school already has an active agreement with the site.
2. If it doesn’t, ask the site whether it needs a full contract. Saint Louis University notes that some sites accept a letter of good standing and a copy of the school’s liability insurance instead.
3. Ask for the name of the person at the site who handles student contracts. This is usually someone other than your preceptor.
4. Send your school the site’s legal name, address and contact person, plus your preceptor’s name and your rotation dates.
5. Finish your own requirements, such as immunizations and your background check, while the contract is in review.
6. Check in with your coordinator weekly, and treat your start date as tentative until they confirm the signed agreement.

Our NP clinical placement timeline shows how far ahead to start your search so the paperwork is done in time. Still looking for a site? Our guide on how to find NP preceptors explains creative ways to reach clinicians beyond cold emails.

How is an affiliation agreement different from a preceptor agreement?

The affiliation agreement is between your school and the site. A preceptor agreement is a shorter form in which your preceptor agrees to supervise and evaluate you. Many programs need both.

At William Paterson University, for example, students make sure their preceptor signs a Preceptor Agreement Form, while the university negotiates the affiliation agreement with the clinical site.

What should you agree on with your preceptor?

Preceptor agreement forms are often short, so talk through these details before your first day:

• Your start and end dates, weekly hours and clinic days
• What you’ll do at first, such as histories, exams and notes, and how your role will grow
• How often your preceptor will observe you and review your notes
• Who signs your hour logs, and when evaluations are due
• Who to contact if you’re sick or running late, and how you’ll make up missed hours
• What happens if your preceptor takes leave or the clinic changes its schedule

Write a short summary and share it with your preceptor and your clinical coordinator. Our list of questions to ask a preceptor can help you prepare.

Affiliation agreement questions

What is an affiliation agreement for?

The agreement protects your school, the site and you by setting expectations before your rotation starts. At some schools, it’s also what extends liability coverage to you. SUNY Cortland says its agreement “is required for a student to be covered by SUNY’s general and professional liability insurance.”

How long does an affiliation agreement last?

Many agreements last several years. Stockton University’s template runs for three years, then renews automatically one year at a time. Once your school has an agreement with a site, later students can often start sooner.

Do I need a new affiliation agreement for every rotation?

Only when your school has no active agreement with that site. If your preceptor works at more than one location, ask whether each one needs to be listed. Cal State Fullerton requires students and faculty to include every other site the student will visit with their preceptor.

What is an affiliation agreement in healthcare?

In healthcare education, the phrase means the contract that lets a school place students at a hospital, clinic or practice. Universities also use it more broadly. Tufts University uses it for agreements with other institutions “in support of academic cooperation,” including student and faculty exchanges.

How does Clinical Match Me handle affiliation agreements?

When you match with an NP preceptor through Clinical Match Me and your school requires an affiliation agreement, we handle it using your school’s existing template. After that, the start date depends on your schedule and how fast your school approves the affiliation agreement.

If you run a practice and would like to precept students, you can become a clinical rotation site. We’ll handle the affiliation agreement with each student’s school.

Sign up for free, submit your placement requests and receive offers from preceptors who match your profile. Many students receive their first preceptor offer within 24 hours of registering. Then compare offers, choose the best preceptor for your schedule and learning goals, and start your rotation.

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