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Considering the benefits of student nurse externship programs

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

doi: 10.1097/01.NURSE.0000577728.62251.d1
Department: LEARNING CURVE
Free

Krista A. White is an associate professor in the department of advanced nursing practice at Georgetown University in Washington, D.C. Mary E. Fetter is an assistant professor in the department of nursing at the Pennsylvania College of Health Sciences in Lancaster, Pa. Lisa A. Ruth-Sahd is a professor in the department of nursing at York College of Pennsylvania in York, Pa.

The authors have disclosed no financial relationships related to this article.

EXPERIENCES in nursing programs are designed to foster learning, improve confidence, and reduce anxiety through real-life clinical, skills lab, and simulation experiences.1-3 Many nursing students lack confidence in their clinical decision-making skills and in their ability to delegate responsibilities, set priorities, and communicate with both patients and the healthcare team.4-7 They may benefit from opportunities to augment their education and strengthen their skill sets outside of formal nursing programs.

When it comes to learning, being proactive is typically more effective than being reactive. Students must take responsibility for their education, know their strengths and limitations, develop awareness of their learning habits, and seek opportunities to continue learning. One option for supplementing education and proficiency is through a student nurse extern program (SNEP). This article defines SNEPs and discusses how these programs can help nursing students achieve both short- and long-term career goals.

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Easing the transition

SNEPs originated in the late 1970s as summer programs to ease the transition from student to nurse.8 Although curricula and implementation strategies have been modified over the years, SNEPs have similar objectives today. These include:4-6,8

  • enhancing patient care through improved clinical competence and better staffing
  • fostering confidence, delegation, priority setting, and clinical decision-making skills in nursing students
  • enhancing recruitment and onboarding
  • reducing costs associated with hiring and the time needed for orientation
  • narrowing the education-practice gap.

SNEPs vary across programs, but they typically last 8 to 10 weeks in acute care hospital settings. The externs are full-time hospital employees and work side by side with RN staff in 8-hour or 12-hour shifts, a structure that allows for consistent, repeated clinical exposure and experience to help solidify learning through continuity of care. These repeated exposures and clinical successes are key to developing decision-making skills, building confidence, and improving patient care.3,7,9

Most SNEPs are implemented through and managed by healthcare facilities.6 However, some programs collaborate with schools of nursing whereby the nursing faculty assists with clinical oversight and conferencing.5 Most programs involve clinical content comprised of hands-on patient care and didactic time, such as postconference sessions, to address various aspects of nursing. For example, students may review new equipment or skills, debate end-of-life care, or examine evidence-based practice policies. The curriculum may also review basic clinical content, such as arterial blood gas and cardiac rhythm interpretation, and discuss nonclinical nursing skills, such as delegation and team-based communication.4-6,8

Despite some differences in their implementation, one commonality exists across all externship programs: quality experiential learning opportunities through collaboration with professional nursing staff.

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Applying to SNEPs

The application process for SNEPs can be time-consuming and competitive. Nursing students applying for an externship are typically required to submit an application, one or two letters of reference, and transcripts to validate their progress through at least 50% of the clinical courses in their nursing program. Applicants must be within a year of graduation and in good academic standing.

When applying, nursing students should ask the recruiter if they will be considered as internal or external candidates upon graduating and completing the application process. One advantage of participating in an externship is that many institutions will allow externs to apply to full-time positions as internal candidates, giving them an edge over other applicants.

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Short-term benefits

SNEPs offer both short- and long-term benefits for nursing students. The short-term benefits are typically realized by students upon returning to nursing school after the program concludes. Most extern-eligible nursing students have approximately a year left in their academic program. The participating externs report less anxiety, more confidence, and an improved overall knowledge base in clinical settings.4-6

A recent research study of 134 nursing students demonstrated that SNEP participation improved confidence and reduced anxiety about clinical decision-making significantly.10 One participant even went so far as to report improvement in her overall academic performance as a result of her involvement in an SNEP.4

Prolonged patient and family interactions represent another short-term benefit of the real-world learning opportunities provided by externship programs. In academic settings, nursing students' clinical experiences are often brief and fragmented. Their clinical time may range from several hours once a week to an 8-hour day once or twice per week. These brief encounters make it challenging to develop relationships with patients, observe the recovery progress, watch clinical trends, and experience real-life challenges patients face from admission to discharge.

Externships give nursing students the opportunity to learn experientially in a nonjudgmental clinical environment alongside practicing RNs without the pressure of being graded that they may experience in school evaluations. The enhanced ability to connect real-life experience with classroom learning helps nursing students reduce the education-practice gap.4,5,8

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Long-term benefits

The long-term benefits are typically realized after graduation, as new graduates take and pass the NCLEX-RN and look for their first positions. For many new nurses, the job search is competitive and produces anxiety. Some valuable long-term advantages of SNEPs include identifying clinical areas of interest, observing healthcare team dynamics in action, and being immersed in nursing culture.

Externship opportunities provide nursing students with an insider's perspective on the profession and the healthcare system. Nursing students whose experience is limited to completing clinical rotations and other short-term encounters on nursing units have a far different experience in patient care.

New nurses with SNEP experience have enhanced credibility as they seek employment, giving them an edge over their nonextern counterparts. These new nurses should use this exposure to their advantage when completing job applications and interviewing for positions.

Additionally, nursing students mentoring under professional nurses may develop friendships that that last beyond the externship. After graduation, these new nurses may opt to return to the same unit, having already developed great working relationships. In this way, SNEPs can act as recruitment tools for healthcare organizations.

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A step in the right direction

Nursing school education gives students a solid foundation, but they may also benefit from additional strategies and opportunities to augment their education. Participating in an SNEP can be a big step in the right direction.

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REFERENCES

1. Manetti W. Evaluating the clinical judgment of prelicensure nursing students in the clinical setting. Nurse Educ. 2018;43(5):272–276.
2. Koharchik L, Caputi L, Robb M, Culleiton AL. Fostering clinical reasoning in nursing students. Am J Nurs. 2015;115(1):58–61.
3. Ross JG, Carney H. The effect of formative capstone simulation scenarios on novice nursing students' anxiety and self-confidence related to initial clinical practicum. Clin Simul Nurs. 2017;13(3):116–120.
4. Mang L. Seize the opportunity an externship offers. Nursing. 2011;41(2):9–10.
5. Ruth-Sahd LA. Impact of a summer extern program on nursing student's awareness of interprofessional collaboration and healthy, healing environments: a level II quasi-experimental design. J Nurs Educ Pract. 2016;6(12):63–70.
6. Shipman D, Hooten J, Lea L. The unique value of externships to nursing education and health care organizations. Fed Pract. 2016;33(7):29–34.
7. White KA. Development and validation of a tool to measure self-confidence and anxiety in nursing students during clinical decision making. J Nurs Educ. 2014;53(1):14–22.
8. Harkins SB, Schambach AV, Brodie KJ. Summer externs: easing the transition. Nurs Manage. 1983;14(7):37–39.
9. Zapko KA, Ferranto MLG, Blasiman R, Shelestak D. Evaluating best educational practices, student satisfaction, and self-confidence in simulation: a descriptive study. Nurse Educ Today. 2018;60:28–34.
10. White KA, Fetter ME, Ruth-Sahd LA. Extern programs promote confidence and reduce anxiety with clinical decision making in nursing students. Nurse Educ. [e-pub ahead of print Nov. 8, 2018.]
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