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Extern Programs Promote Confidence and Reduce Anxiety With Clinical Decision Making in Nursing Students

White, Krista A. PhD, RN, CCRN-K, CNE; Fetter, Mary E. MSN, RN; Ruth-Sahd, Lisa A. DEd, RN, CCRN, CEN, CNE

doi: 10.1097/NNE.0000000000000625
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Background Clinical decision making (CDM), expected of professional nurses, affects patient outcomes but is arduous for nursing students to learn. Psychological barriers (low self-confidence [SC] and high anxiety with CDM) have an impact on its achievement. Externship programs help mitigate these barriers.

Purpose The aim was to examine the impact of summer employment (nurse extern [NE], nursing assistant, and non–health care employed) on students' confidence and anxiety with CDM.

Methods The study used a quasi-experimental before-and-after design using the Nursing Anxiety and Self-Confidence with Clinical Decision Making scale. Associate and baccalaureate degree students (N = 134) from 2 nursing and 2 extern programs were included.

Results The NEs reported significantly increased SC (F = 14.02, P < .001) and reduced anxiety (F = 8.64, P < .001). Nonsignificant improvements were noted in other groups.

Conclusions Externships appear to enhance students' SC and lessen their anxiety with CDM.

Author Affiliations: Assistant Professor (Dr White), Department of Advanced Nursing Practice, Georgetown University, Washington, DC; Instructor (Ms Fetter), Department of Nursing, Pennsylvania College of Health Sciences, Lancaster; and Professor (Dr Ruth-Sahd), Department of Nursing, York College of Pennsylvania, Pennsylvania.

Partial financial support was provided by the Pennsylvania College of Health Sciences Academic Scholarship & Research Committee.

The authors declare no conflicts of interest.

Correspondence: Dr White, Georgetown University, School of Nursing & Health Studies, 3700 Reservoir Rd, NW, Washington, DC 20057 (

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Accepted for publication: October 1, 2018

Published ahead of print: November 8, 2018

Online date: November 9, 2018

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