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We discuss the transformative potential of a standardized affiliation agreement (SAA) in nurse practitioner education with Lynn McComas, CEO and founder of PreceptorLink. As a recognized expert in precepting nurse practitioners and advanced practice provider students, Lynn shares insights into how an SAA could streamline clinical placements, reduce barriers for preceptors, and ensure students receive the hands-on training they need to succeed in their careers.
Lynn McComas is CEO and founder, PreceptorLink, and a recognized expert in precepting nurse practitioners and advanced practice provider students.
She discusses the KevinMD article, “How a standardized agreement could end the preceptor shortage.”
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Transcript
Kevin Pho: Welcome to the show. Subscribe at kevinindy.com slash podcast. Today, we welcome back Lynn McComas. She’s a nurse practitioner and a CEO and founder of PreceptorLink. Today’s KevinMD article is “How a Standardized Agreement Could End the Preceptor Shortage.” Lynn, welcome back to the show.
Lynn McComas: Thank you so much. I appreciate you having me back.
Kevin Pho: All right. So tell us about this latest article. What’s it about?
Lynn McComas: Yeah, so in our business, I noticed over and over again that one of the largest barriers that the students and the schools were having was the inability to secure new affiliation agreements. So there’s almost 500 nurse practitioner schools nationwide, and every single school has a different agreement. The process to create a new affiliation agreement is extremely time-consuming. It’s expensive, and it involves legal teams. Every time they do it, more money and more time are required. Many times, school affiliations are not made because they don’t want to create a new one within the new site. So students are frequently turned down from sites because of the affiliation agreement.
For years after I started our business, I kept seeing this, and I thought, well, there’s got to be a better way. At the time, my son was going through college applications, and he was using the Common App to apply to colleges. I thought, gosh, that’s a great idea. It seems like we should be able to do something like that with affiliation agreements. So I started to explore this, and I thought, you know, let’s see if anything like this exists already.
And it did. It exists in medicine. The Association of American Medical Colleges developed something called the Uniform Clinical Training Affiliation Agreement, the UCTAA. They did exactly what I was thinking would be useful. They streamlined the affiliation agreement process so that medical schools could be more easily affiliated with clinical sites. It’s been well adopted, and it’s been used for years by hundreds of different medical institutions and schools, so it’s definitely saving money. At the time, I thought, let’s not reinvent the wheel. Let’s see if we can utilize this. I actually reached out to the lawyer who wrote it, and he was extremely helpful and forthcoming. He said, “Use it. Take it. It’s public.” So I did reach out to a lawyer, we rewrote it for nursing, and I’ve been trying to get the profession to embrace it. It really could save so much money and time.
There was a report to Congress many years ago on the Graduate Nursing Education Demonstration Project, a well-known project that was done in Florida in the nurse practitioner world, and it showed that having a strong affiliation with a clinical site can save schools of nursing up to five, 582,000 a year. So there really is a tremendous amount of potential that could be used, probably not just for NP programs, but even nursing programs and PA programs. To me, it seemed like there’s a lot of potential that could be done here with this idea.
Kevin Pho: So let me see if I have this right. If you’re a nurse practitioner student, you cannot precept at a clinical site unless they have an official affiliation agreement with that school, and each school has to have separate affiliation agreements—there’s nothing standardized—and that is an obstacle for some clinical sites to accept students from certain schools that don’t have this agreement. Is that right?
Lynn McComas: That is exactly correct. Yes. Same is true with medicine. Same is true with physician assistant PA schools. It’s all the same, and that’s one of the big barriers.
Kevin Pho: And in order to arrange such an agreement, you have to go through multiple layers of bureaucracy and legal issues before they make that commitment?
Lynn McComas: Exactly true, yes.
Kevin Pho: So when you approached some of the nurse practitioner authorities about perhaps a standardized agreement, similar to the AAMC, what was their response?
Lynn McComas: Well, unfortunately, I just couldn’t get anywhere with it. I couldn’t get to anyone who was willing to think this was a great idea. There are several different organizing bodies within the NP profession. Someone should take this. They don’t need to pay us. We’ll just give it to them, or they can take the idea and redo it themselves. Whether it’s a national organization, nurse practitioner faculty, NONPF, AANP, or one of the many other organizations, someone, I really think, should at least try this. Of course, there are different state requirements. Of course, there are different school requirements and site requirements. Generally, though, the basics are uniform; they are the same. Then there could be addendums, just like with the Common App. There could be addendums for each school or each site that could be added on. I just never got much interest, which is part of the reason I wanted to come on—to see if we could spark some interest and conversation. Maybe there are reasons behind the lack of interest, but at least let’s talk about it.
Kevin Pho: And is there no way for a prospective nurse practitioner student to precept at a site without an agreement? They can’t do it under the table? They can’t do it informally? Is there no way for them to do that?
Lynn McComas: Rarely there’s a site—rarely, rarely, rarely—that does not require an affiliation agreement. But in general, every site has to have some type of agreement for liability and safety between the site and the school.
Kevin Pho: So give us an example or a story of how this lack of an agreement, or a lack of a standardized agreement, impeded some of your clients or some of the students that you’ve heard trying to get preceptorship positions.
Lynn McComas: Gosh, it happens on a daily basis where we might have a willing preceptor. For example, the hospitals are where this is the biggest issue. At private practice, it’s not usually quite as big a deal because they’re more willing to take on an affiliation that’s kind of a one-off. But with the hospitals, they will do a handful of schools, and that’s it. Even their employee who maybe works there but goes to a different school than what they already have listed and approved would just be turned away. So we might have a willing preceptor and a student, and everything fits perfectly, but the hospital says, “I’m sorry, we’re not doing any more affiliation agreements,” and this poor student is then left having to start over again with the search. The search to find a preceptor is not an easy one; it’s a very difficult, very difficult process for the students, which is why they come to us. It’s not easy for us as well. So it happens on a daily basis where the school doesn’t have an affiliation in place with the clinic or the site—or the hospital—and the student then cannot proceed.
Kevin Pho: And what exactly goes into these agreements?
Lynn McComas: Well, it’s the typical kind of things: where they accept the requirements for liability insurance or supervision of the nurse practitioner or the physician preceptor. You know, all of the typical concerns that go on any affiliation agreement. It’s a lot of standard things. But again, each school phrases it a little bit differently. We see them all the time. We see them come through, and some of them really don’t look that different—just slightly different wording—which is why I think the standardized agreement really just makes sense now.
Kevin Pho: For those looking for preceptor positions, you mentioned that private practices don’t have as much stringent bureaucracy. Do you advise them to target private practices first because they don’t have as much of a rigid policy regarding these agreements?
Lynn McComas: Yeah, so it depends, because sometimes if there is an affiliation agreement in place, the hospital can be great because it might open up multiple opportunities. But with a private practice, number one, they’re becoming fewer and fewer; there just are not as many as there used to be. The big hospital institutions are buying up practices, so that option just isn’t there as much anymore. Even if it is a private practice, it might be owned by a hospital, and they still have to go through the same affiliation process. It’s just not that easy. There aren’t as many as there used to be, and the processes are difficult. Even at a private practice, it’s going to have to have an agreement and go through the liability. The standardized affiliation could still work for a private practice as well.
Kevin Pho: So tell us a success story, I guess, if your ideal vision came to be, and there was a standardized agreement for nurse practitioner preceptorships. What exactly would that look like if everything that you want went according to plan?
Lynn McComas: Well, I think it’s everything that the profession should want, ideally—not just me. You know, our goal is to try and help streamline this whole process, and this is one step in that direction. So the students and the school and the site would already know that they’re using the common contract or standardized affiliation—whatever it’s called. They would know there’s a list, just like there is for the one in medicine, showing all of the places that take it. It would just simplify and streamline something that can literally take two, three, even six months to put in place. It could probably be done much less expensively, much more quickly, and be able to bring through more students in a much more simplified way. That would be my vision.
Kevin Pho: We’re talking to Lynn McComas. She’s a nurse practitioner and the CEO and founder of PreceptorLink. Today’s KevinMD article is “”How a Standardized Agreement Could End a Preceptor Shortage.” Lynn, as always, we’ll end with some take-home messages that you want to leave with the KevinMD audience.
Lynn McComas: Yeah, so I do want to say that this would not end; this would help simplify the preceptor shortage, but it’s one step—just one little step. I hope that the profession will be open to this and explore it. I’m happy to talk to anyone about what we have created and share it with any of the organizing bodies out there so that we can help simplify this one process. Thanks again for having me on.
Kevin Pho: Lynn, thank you so much again for sharing your perspective and insight. Thanks again for coming back on the show.
