Nurses Are Paying Thousands Out of Pocket Just to Graduate: ‘I Was So Ready to Give Up’

Nurse practitioner students across the country are stalling out just short of graduation because they cannot find a clinician willing to supervise their required clinical hours, according to an August 24 investigation by The Hechinger Report. 

Reporter Colleen Connolly followed Yesenia Raithel Vargas, a 45-year-old mother of four in Chicago studying to become a psychiatric-mental health nurse practitioner (PMHNP), who got desperate enough to post a plea in a Facebook group for local moms, asking if any licensed therapist would let her sit in on sessions. “I must have sent 50 emails, or made phone calls, just trying to figure this out,” Raithel Vargas said. She eventually found someone, but the delay pushed her graduation from the University of Cincinnati’s online program back a full year.

She is not an outlier. In fact, she is becoming the norm and so is her Facebook plea. NP students must log at least 500 hours of supervised patient care with a preceptor to graduate, and the supply of willing clinicians has not kept pace with a profession exploding in size. Columbia University School of Nursing research published in Health Affairs found the NP workforce grew roughly 10% a year between 2016 and 2023, compared with 1.1% for physicians.

The BLS projects NP employment will grow 40% from 2024 to 2034, adding 128,400 jobs and making it one of the fastest-growing occupations in the country. The BLS does not break down NP specialties in its projections.

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The two major accrediting bodies for NP programs require schools to provide clinical placements or help students find them. In practice, many schools satisfy that by handing students a list of doctors and nurses who have precepted before, then leaving the rest to the student.

Elaina McAdams, a health care executive with a doctorate in nursing who built the AI-enabled matching platform CAUHEC Connect, told Hechinger that even schools with placement coordinators often rely on outdated methods. “Many schools have a spreadsheet and they call around, but they aren’t always successful,” McAdams said. “There are schools that’ll say, ‘Hey, we found someone. They’re 100 miles away, if you can make it.’ So technically, they find the preceptors, but is that reasonable for a student who’s paying tuition?”

Medical schools rarely have this problem, partly because they are tied to teaching hospitals and partly because the money is not comparable. The U.S. spends roughly $20 billion a year training medical residents, mostly through Medicare, while nursing gets around $300 million in federal workforce development funding, only a portion of which is dedicated to clinical training. Preceptors, meanwhile, have traditionally worked for free, and with burnout widespread across health care, more clinicians are saying no.

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Students Are Paying Preceptors Out of Pocket, and Taking Out Loans to Do It

Raithel Vargas was initially opposed to paying for a preceptor, having supervised students for free as a midwife. She gave in anyway, paying a Chicago nurse practitioner $10 an hour for 168 hours in her most recent rotation.

A for-profit industry has grown around that desperation. Krish Chopra, who founded matching company NPHub in 2017, said the average rotation on his platform costs $2,500, with 50 to 60% going to the preceptor and the rest to his company. Competitor Clinical Match Me typically charges a flat $1,995, with $1,000 passed to the preceptor. “Finding and securing clinical sites is a sales job,” Chopra said. “Universities don’t have the infrastructure to be able to do it.”

The costs stack up fast. Kim Orta of rural Crescent City, California, took out a $16,000 loan to cover preceptor fees, travel and hotels for rotations hours from home, nearly as much as her Purdue Global tuition. She could have done rotations in Oregon, 17 miles away, but her school bars placements in that state. Shani DeShield, an RN in her mid-50s who moved from Alberta, Canada to Chicago for school, had to restart her search after Oak Point University abruptly closed in 2024. She and her classmates were transferred to Lewis University, which had different preceptor requirements. “It was almost a full-time job trying to find a preceptor,” DeShield said.

The workaround raises unresolved ethical questions, with some nursing educators worried that paid preceptors could feel pressure to pass the students signing their checks. The worst case, McAdams said, is “what happens when a student pays cash out of pocket, and they’re not really safe to practice?”

Any nurse in a Facebook group dedicated to nursing or healthcare has likely seen the daily posts: someone begging for help finding a clinical site or a preceptor. Prospective students can protect themselves before enrolling by asking programs directly who is responsible for securing clinical placements, what happens if a placement falls through, and what the school requires for a preceptor to be approved.

Nursing schools turned away 93,176 qualified applications in 2025, according to the American Association of Colleges of Nursing (AACN), citing shortages of faculty, clinical sites and clinical preceptors. Every NP who delays graduation a year is a provider not yet on a schedule, in a country counting on nurse practitioners to fill primary care and mental health gaps.

The cost lands on individual nurses as extra tuition terms, lost NP-level salary and fees financial aid usually does not cover. For nurses already in practice, precepting remains unpaid labor stacked on a full patient load.

Tim Porter-O’Grady, an advanced practice nurse and clinical professor at Emory University’s school of nursing, argues the profession has to own the fix. “Nursing is the single largest profession within health care, and it has paid little or no attention, as a discipline, to standardizing our transition to practice in a way that is effective, meaningful, evidence-based and sustainable,” he said, adding that law, engineering, medicine and architecture are not run this way. He wants schools to build health system partnerships and take back responsibility for placements, and hospitals to protect and pay for preceptor time.

There are early signs of movement. The Society of Clinical Placement Professionals, formed in 2022, expected about a dozen people at its first virtual summit last year and got 150. “There’s a missed opportunity for collaboration,” co-founder Abigail Smetana said. “And a lot of finger-pointing.”

🤔 Have you had to pay out of pocket for a preceptor, or turned down a student because your employer wouldn’t give you the time? Tell us what it actually cost you in the comments.

Nursing Industry Research