I can only speak for Brookhaven, and I am only in my 1st semester. The hospitals for rotations (at BHC) are pre-determined, and you get to chose which of those hospitals you go to based on a random number lottery. Each student picks a number out of a hat, and you sign up in that order. This means spots are first come, first served based on the number you drew. Actually, you draw a number first semster and keep that number, but they rotate each clinical group of 10 each semester. For example, the people who initially drew 1-10 and got to pick first, will have to go last during second semester, then next to last third, etc. This way no one gets super lucky with a number 1-10 the entire time. It would stink to have drawn the last number each semester and have no choice really!
Anyway, Brookhaven teaches in a block format- this means that you learn one set of skills each semester that build on another. For example, you will learn assessment the first semester, but wouldn't assess a pregnant woman until you get to OB/Maternity in the third semester. Some schools have an integrated curriculum that introduce a small amount of many things the entire time, as you go along. BHC's first semseter hospitals were Medical Center Plano, and a few of the Baylors. MCP puts BHC students in their first semester on the ortho floor. I dont know about the Baylors. With this being said....
Each school has certain hospitals, this way no one hospital is bombarded with students. At Brookhaven you will be assigned to a floor that coordinates with the content you are learning that semester. There is no choice in that matter. I do have a friend who is in the last semester at Brookhaven and she told me there were 10 specialty spots open that were not part of the normal curriculum (Like ER/OR/etc). They had to "apply" for those spots, interview with the preceptor, and write a letter of intent, outlining why they felt they deserved and were good for that spot. The remaining students will go through their normal clinical.
If you have an interest in a specialty area, let your instructors know up front. Some instructors are known to allow a special clinical day in a specialty area if you show determination and good promise, among other things. Also, network with nurses at the hospital at each clinical. It is true that students often get jobs where they did their clinical, but not necessarily where their last semester was. I want to be an ER nurse but Brookhaven doesn't offer that in their curriculum. That was one of the 10 special spots in 4th semester. My plan is to talk to all the nurses I meet, and maybe even talk to Human resources about how to get in there. I'm sure I will meet an ER nurse at lunch or something... I think most students tend to work med-surg initially, which is a good stepping stone.
Other schools may offer more clinicals in specialty areas. It is best to contact those nursing departments directly- I am sure it makes a big difference in where you decide to graduate from!
If you don't mind me asking, what area would you like to get into?
Sorry to be so long winded!