Why Clinical Rotations Are Under Pressure (And How to Protect Student Readiness)

The shortage of suitable clinical sites and preceptors is putting pressure on nursing programs. This blog post explores the roots of the problem, its systemic nature, and why approaches like simulation-based learning are central to the solution. 

According to the American Association of Colleges of Nursing (AACN), more than 65,000 qualified applicants were turned away from nursing programs in the United States in 2023. At the same time, the Health Resources and Services Administration projects that, by 2030, the U.S will see a shortfall of 63,720 nurses. 

Clearly, there are people willing to fill that shortfall, and there’s no lack of commitment from the institutions training them. So, why are prospective student nurses getting rejected? 

The AACN has identified a wide range of factors contributing to this problem, ranging from a lack of capacity and suitability among clinical sites to limited preceptor availability.  

Whether you call it a preceptor shortage, clinical site shortage, or (to a UK-based nurse practitioner) clinical placement crisis, the reality is the same: there aren’t enough opportunities for students to complete the clinical hours and experiential learning they need to become fit for practice.  

At the heart of this problem is a mismatch between student demand and clinical training capacity. Nursing schools are trying to scale up in response to workforce shortages, but the infrastructure hasn’t kept pace. Students are experiencing delays, educators are burning out, and the healthcare system is struggling to balance quantity with quality. 

Read on to discover: 

• The importance of clinical rotations 

• What’s driving the clinical rotation crisis 

• What it means for learners and institutions 

• How digital simulation can support and strengthen clinic experience 

Clinical Rotations Are a Critical Part of Healthcare Training 

Even for those well-acquainted with clinical rotations, it’s worth taking a moment to define them clearly, especially given the structure, setting, and terminology involved can vary across regions and disciplines.  

A brief refresher also helps to fully contextualise the scope of the problem at hand and acknowledge the pedagogical enrichment that clinic experience offers students across the healthcare disciplines. 

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What Are Clinical Rotations? 

Clinical rotations (sometimes called clinical experiences, practicums, or placements) are the part of a healthcare degree in which students leave the classroom and enter real clinical settings. They work alongside qualified professionals, treat real patients (under supervision), and apply their skills in high-stakes, real-world environments. 

In nursing, rotations are often organized by specialty: medical-surgical, pediatrics, maternity, mental health, and so on. Rotations serve two major purposes: skill application and professional readiness. Under the guidance of licensed professionals, they allow students to: 

• Put theoretical learning into practice 

• Develop confidence 

• Build communication, decision-making, and non-technical skills 

These experiences are essential both for passing assessments and for developing the situational awareness, adaptability, and professionalism required in patient-facing roles. Without clinical rotations, healthcare education becomes abstract, and graduate readiness suffers. 

Why Do Clinical Rotations Matter? 

Rotations serve two major purposes: skill application and professional readiness. These placements also develop softer but equally essential attributes such as teamwork, time management, resilience, and empathy. 

And they’re not optional. Most health professions have regulatory minimums that mandate clinical experience before a student can graduate or sit for licensing exams. 

• In the United States, for disciplines like nursing, clinical hours requirements for licensure are set by state boards, often split across core specialties like adult health, pediatrics, and mental health. As the AACN notes, advanced-level programs can mandate a 500-hour minimum. 

• In the UK, the Nursing and Midwifery Council (NMC) mandates that 50% of pre-registration nursing education must be practice-based, typically amounting to 2,300 hours of placement experience. 

For regulators and educators, clinical rotations are a key safeguard: for institutions, they ensure that students can apply their learning in safe, authentic environments before they become autonomous practitioners. For students, they’re the experiences that bridge the gap between competence and confidence. 

Why Students Are Struggling to Secure Clinical Rotations 

Clearly, clinical rotations are essential to healthcare education in terms of both learning quality and regulatory compliance.  

A casual observer might be surprised to learn, then, that in spite of this clear importance, clinical placements are becoming increasingly difficult to secure. This has been attributed to a tangle of overlapping pressures encompassing: 

• A shortage of clinical sites 

• A lack of available preceptors 

In the sections that follow, we’ll unpack the key factors driving the clinical placement shortage, with a focus on the US system but implications that apply globally. 

Clinical Site Shortages Are Worsening 

A key driver of the clinical placement shortage is the limited availability of suitable, placement-ready clinical sites: the hospitals, clinics, and community settings where students complete their hands-on training. These sites need not only the right infrastructure and supervision capacity, but also the ability to offer clinical exposure aligned with program and regulatory requirements. 

For example, a hospital’s nursing education department may technically have the resources to host students, but if it doesn’t provide direct patient care, it won’t meet the requirements for a student’s clinical learning. 

This clinical site capacity shortage isn’t a new issue, but it’s one that’s becoming harder to ignore as student numbers rise and site capacity fails to keep pace. 

In fact, according to one AACN report, insufficient availability of clinical sites was cited as the primary reason 69% of schools felt unable to admit qualified students: a clear barrier to nursing program admissions at scale.  

And, while this data was collected during the pandemic, the subsequent high volumes of rejected applications discussed above suggest that this hurdle remains firmly entrenched. 

What’s Causing the Nurse Preceptor Shortage? 

Nursing rotations need clinical sites, but they also need qualified professionals to oversee and supervise students in practice. And, as with clinical sites, the availability of these preceptors is in a state of decline. 

This preceptor shortage stems from several compounding factors, beginning with the number of qualified practitioners. Underscoring the decrease at work here, AACN data published in 2024 shows that PhD program enrollment decreased by 17.5% between 2013 and 2023.  

Simultaneously, 2023 data from the National Council of State Boards of Nursing (NCSBN) projects that approximately 900,000 registered nurses will have left the workforce by 2027. This is no surprise, given that (according to a 2025 meta-analysis published in BMC Nursing) burnout is common, with around a third of nurses experiencing emotional exhaustion. 

These factors have all the makings of a vicious cycle: burnout drives preceptors away from the profession, resulting in fewer admissions and, by extension, fewer people who go on to gain the advanced qualifications nursing educators require. And those that do risk further burnout as they shoulder more and more of the burden. 

That said, the preceptor crisis is a solvable problem, and one that invites innovation, collaboration, and a renewed focus on educator support. 

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What Can Institutions Do to Mitigate the Clinical Site and Preceptor Shortage? 

For institutional leaders whose programs feel the burden of nursing education challenges most heavily, perhaps the most frustrating element of the clinical rotation shortage is that its solutions often fall outside their sphere of influence. That’s not to say there aren’t exciting movements underway to: 

• Pass new professional legislation 

• Fund new pathways into nursing education 

• Streamline postgraduate placement systems 

But these ambitious steps are often undertaken by national or state-wide bodies with more reach than individual schools can achieve, and they take time to accomplish. In that light, the question for individual institutions becomes: what practical steps can be taken to mitigate the impact of the clinical rotation shortage? 

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Digital Simulation-Based Learning Can’t Solve the Shortage, but It Can Soften the Impact 

Given the number of systemic and structural factors underpinning the rotations crisis, the goal for leaders is to use measures they can control to ensure students make the most of their rotation opportunities. That means ensuring students are: 

• Well-prepared before they arrive 

• Well-supported while they’re there 

• Well-equipped to consolidate and build on what they’ve learned afterward 

Among the options available, simulation-based learning stands out as a practical, evidence-aligned means of supporting these goals.  

The NCSBN’s National Simulation Study provides one of the strongest foundations for this approach. While focused on traditional simulation, it demonstrated that students who incorporated simulation more heavily into their clinical hours could achieve comparable levels of clinical competence and readiness to those in traditional clinical settings. 

Given that this study establishes simulation as a pedagogically valid substitute for part of clinical training (and given that in countries like the UK, simulated practice can make up 600 of student nurses’ clinical hours), it follows that the right digital simulation resources can readily complement real-world placements. 

Curriculum-aligned virtual clinical simulation can help students develop procedural confidence, clinical judgment, and decision-making skills in a safe, repeatable environment. And when those simulations reflect real clinical tasks, they help institutions maintain learning quality and student readiness even when placement hours are constrained. 

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Frequently Asked Questions

Final Thought: When There Aren’t Enough Sites, Every Hour Counts 

Clinical site and preceptor shortages are limiting students' access to essential hands-on training, and institutional leaders can’t afford to wait for national solutions to catch up.  

By making every rotation hour count, and reinforcing clinical learning through well-designed digital simulation, schools can protect student readiness, support faculty capacity, and continue contributing to the healthcare workforce, even when placements are under pressure. 

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This article was reviewed for clinical accuracy and educational relevance by Hilary Gupte (BSc, PGCE), a registered nurse and experienced clinical educator.