Nurse Externships a Boon to Student Nurses, Recruiters
Texas hospitals tackle the nursing shortage by seeding clinical skills in student workers
By Melissa Gaskill
March 28, 2005
Katherine Smalling, RN, who held an externship at Children’s Medical Center in Dallas in summer 2003, describes the experience as on-the-job training with a safety net.
“You can observe without the responsibility. I gained so much knowledge of day-to-day nursing that you can’t get unless you’re with a nurse on an entire shift,” says Smalling. “It definitely made me a better nurse.”
It also led to her eventual staff position at Children’s, completing a payoff for both parties. The nursing student had a chance to boost her clinical skills, according to Gay Nassri, RN, director of recruitment, and the hospital got a leg up on landing a valuable nursing school graduate.
Nurse externs are typically students in their junior and senior years of nursing school with one or two clinical rotations under their belt. Externs work as full-time paid staff for anywhere from six to 10 weeks, supervised by RN preceptors.
“You’re basically attached at the hip to an RN,” says Pat Cornett, RN, MSN,EdD, vice president of education and research for Methodist Healthcare System in San Antonio. “You’re exposed to decision making, critical thinking, prioritizing, problem solving — all the things an RN does all the time for a multiple patient load.
“An externship is a pure learning environment,” says Cornett. “We put them in with both feet.”
In 2004, Methodist had 133 externs, with six full-time employees dedicated to the program.
Texas Children’s Hospital in Houston started its program in 2002 and for this summer had 111 applications for the 12 open positions. Ashley Breland, RN, MSN, CCRN, staff development specialist, attributes the program’s success largely to its flexibility.
“We allow externs to work in any area of the hospital that can accommodate them,” she says. “The scheduling is very flexible, too. They don’t necessarily have to work an eight- or 12-hour shift.”
The 10-week externship program at Children’s Medical Center started in 2000, says Nassri, and has expanded from 15 to 45 positions, with applicants increasing from 45 to more than 125.
Externships in general are growing more popular, says Cornett, because hospitals are recognizing the potential for developing future nurses and finding that externships are a greatway to recruit.
In 2003, for example, Methodist hired nearly half of its externs and in 2004 brought 55% of them on board. But the benefits go beyond those numbers, says Cornett. “They’ve gained experience with our system, documentation, and policies and procedures, and that’s a big help when you start a new job.”
Even when externs choose to work elsewhere, the hospital has made a contribution to their development and to easing the nursing shortage in general, Cornett adds.
About 65% to 70% of Children’s Medical Center externs work there after graduation. “I think it channels people into pediatric nursing who might not have gone into it,” says Nassri. “It gives them the experience firsthand.”
Externships typically include enrichment sessions and classes.
“In our classes, we talk about near-drowning, asthma, the latest interventions in cancer therapy, and how to write a rE9sumE9 and interview for the first job,” says Nassri. “The classes are part of their paid work hours, and last year some nursing schools gave college credit for them.”
The Children’s Medical Center program also requires externs to do a group case presentation.
“It’s amazing how innovative and creative the presentations have been,” says Nassri.
One of the biggest challenges of the programs is ensuring that externs are functioning fully in the role, says Cornett, and nurse managers on the units are key to making externships work.
“We have educators to work with RNs and preceptors,” says Cornett, “and a full 16-hour preceptor course for our RNs on teaching and developing others.”
This summer, Smalling will come full circle, serving as a preceptor to an extern.
“It’s a wonderful experience,” she says. “You’re getting paid to learn. It’s also great networking — you get to meet people in the hospital and decide if that is where you want to work. I would absolutely recommend it to other nursing students.”
Melissa Gaskill is a freelance health care writer.