A Literature Review of Nursing Extern Program Outcomes

Early engagement: The value of MRIT student externs in supporting recruitment, retention, and the future of the medical imaging professions

The healthcare system faces critical challenges in recruitment and retention due to increased patient volumes, post-pandemic recovery needs, and a departing experienced workforce. The concept of an 'extern' role, increasingly explored in professions such as nursing, allows healthcare students to take on paid employment in assistive roles in settings relevant to their future profession. The cornerstone of such an initiative is to bridge academic learning with practical clinical support, engaging the future of the workforce in a safe and meaningful way.

METHODS

An extern program was piloted at a major urban multi-site medical imaging department beginning in 2022. Over three cohort years, it has explored two types of extern roles (junior and clinical) across three entry-to-practice MRIT disciplines - radiological technology, nuclear medicine and molecular imaging, and ultrasound. In developing roles, compliance with legislative regulations, considerations in defining roles and eligibility criteria, and aligning work commitment with student learning schedules were paramount in informing the program's structure and success. Seventy-three candidates applied to related roles and 34 externs were hired.

BENEFITS/CHALLENGES

Benefits to the program include engagement in clinical and administrative tasks, facilitation of departmental efficiency, and support for the existing workforce. Specific tasks for clinical externs included supporting staff in patient transfers and positioning, cleaning and restocking rooms, triaging patients and demands, calling inpatients and coordinating porters, and monitoring patients and schedules. For junior externs, tasks involved record-keeping, curating teaching cases, and supporting billing code reviews and quality control exercises like lead apron testing.

IMPACTS/OUTCOMES

The program's value in shaping the future of healthcare professions has been recognized, particularly in enhancing student transition into practice and increasing recruitment opportunities for the host site. Staff overtime hours were reduced, and new graduates who had worked as externs were more quickly able to work autonomously following hire. The program was mutually beneficial to existing staff and future professionals, reinforcing the workforce without sacrificing the higher level learning achieved through university-based preparation for practice.

Quality Improvement Project to Standardize a Nurse Extern Program Across A Multistate Health System

A multistate health system updated the nurse extern policy and skills list. Because of a knowledge gap and inconsistent practices, there was a need for a standardized program. A literature review, Internet search, and focus group informed the creation of the nurse extern program. The program, which includes a toolkit and role-specific pathways, aligns training practices across the health system.

New Graduate Nurse Residency: Taking Rehabilitation Nurses' Transition to Practice to a New Level

ABSTRACT

It began with a challenge from our Chief Nursing Officer. As a Magnet hospital, it was time for our nurse residency program to be recognized as an accredited program for new graduate nurses. This article shares our experience using the Association of Rehabilitation Nurses competency statements in a creative way when applying for recognition as the first American Nurses Credentialing Center-accredited specialty hospital nurse residency program. Although these competency statements were used initially to meet the requirements of the accreditation application process, they also led to the creation of a document that serves two purposes. First, it can be used to instruct new graduate nurses on the structure and processes of a nurse residency program in which competency statements are used to guide curriculum development. Second, it can be used to inform nurse residency program managers on new graduate nurses' progress throughout the nurse residency program by tracking competency completion. The end result of this accredited program is a new graduate nurse who understands not only what it means to be a nurse but also what it means to be a rehabilitation specialty nurse.

Better Together: Collaboration to Enhance the Nursing Workforce

Nursing is a demanding profession that calls for nurses to devote time, energy, advocacy, and compassion to improving clients' lives while providing safe, efficient care. Nurses make personal sacrifices to meet their clients' needs, which do not come without costs to their well-being. An increased migration of novice nurses out of the profession and the need to increase the volume of the nursing workforce by an average of 8% annually to address the projected nursing shortage presents a compelling need for immediate action. Reimagining the concept of academic-service partnerships to provide exposure to opportunities that can equip and empower novice nurses as they emerge into professional practice cannot be underestimated. Implementing approaches to assess, support, and nurture the health and well-being of nurses and health care organizations is foundational to retention.

Student Employment Models for Undergraduate Nurses and Midwives in Australia: A Scoping Review

Introduction

Evidence has shown that throughout their undergraduate years, many nursing and midwifery students obtain paid employment in a wide variety of clinical and non-clinical positions. Across Australia, inconsistencies exist in the models of clinical employment available to these student groups. Previous Australian studies have described the employment of undergraduate nursing and midwifery students in regulated and unregulated clinical roles. No studies have reported on the various regulated roles available to both student nurses and midwives in Australia. The purpose of this scoping review is to identify and synthesize evidence related to nursing and/or midwifery students employed in regulated and unregulated clinical roles in Australia.

Methods

This scoping review utilized published recommendations for data screening, abstraction, and synthesis. One of the authors, a librarian, undertook systematic searches in CINAHL Complete (1937-present), Emcare on Ovid (1995-present), Scopus (1969-present), and Ovid MEDLINE(R) (including Epub Ahead of Print, In-Process, and In-Data-Review & Other Non-Indexed Citations, 1946-present). The initial searches were completed in April 2019 and repeated in March 2021 and May 2022 to identify any new literature. Manual searching of reference lists in the included papers was also undertaken, together with selected organizational websites. The extracted data included the lead author, date, title, study design, study sample and location, and key findings.

Results

From the 53 items retrieved, 23 peer-reviewed studies met the inclusion criteria and were included in the review. All items were published between 2011 and 2022. Only four of the studies focused upon student midwives. Undergraduate nursing and midwifery students in Australia obtain paid employment in a variety of regulated and unregulated clinical roles.

Conclusion

The literature reported here demonstrates that there are differing models, nomenclature, educational requirements, and pay scales in place for student employment in clinical roles across Australian states and territories.

Nursing Students and Nurses' Recommendations Aiming at Improving the Development of the Humanistic Caring Competency

BACKGROUND

Most nursing education programs prepare their students to embody humanism and caring as it is expected by several regulatory bodies. Ensuring this embodiment in students and nurses remains a challenge because there is a lack of evidence about its progressive development through education and practice.

PURPOSE

This manuscript provides a description of nursing students' and nurses' recommendations that can foster the development of humanistic caring.

METHODS

Interpretive phenomenology was selected as the study's methodological approach. Participants (n = 26) were recruited from a French-Canadian university and an affiliated university hospital. Data was collected through individual interviews. Data analysis consisted of an adaptation of Benner's (1994) phenomenological principles that resulted in a five-stage interpretative process.

RESULTS

The following five themes emerged from the phenomenological analysis of participants' recommendations: 1) pedagogical strategies, 2) educators' approach, 3) considerations in teaching humanistic caring, 4) work overload, and 5) volunteerism and externship.

CONCLUSION

The findings suggest the existence of a challenge when using mannikins in high-fidelity simulations with the intention of developing humanistic caring. The findings also reaffirm the importance of giving concrete and realistic exemplars of humanistic caring to students in order to prevent them from making "communication" synonymous to "humanization of care".

Experiences and Perceptions Gained by Student Nurse Externs Working During a Pandemic

ABSTRACT

There are no data available presenting the experiences and perceptions of student nurse externs (SNEs) working during the COVID-19 pandemic. This qualitative study was conducted with 12 SNEs to determine their experiences and perceptions during the summer of 2020. The Colaizzi method was used to identify and analyze statements. Four main themes emerged from the data: 1) appreciating holistic compassionate care, 2) progressing from fear toward hope, 3) desiring ethical decision-making skills, and 4) recognizing communication barriers. Implications include emphasizing communication, ethical decision-making strategies, disaster preparedness, and externships as a way to bridge the gap between education and practice.

An evaluation of the Veterans Health Administration National Nursing Education Initiative

BACKGROUND

Since 1999, the Veterans Health Administration's (VHA) National Nursing Education Initiative (NNEI) has provided 16,294 scholarships for registered nurses to attain baccalaureate and advanced nursing degrees.

PURPOSE

The goal of this evaluation was to determine factors that enhanced or hindered a scholarship recipient in the completion of their degree and service obligation.

METHODS

A regression analysis was performed to identify predictors of degree completion for 10,043 participants in 162 VHA facilities.

FINDINGS

Significant predictor variables for degree completion were intended occupation, entry degree, gender, age, and year entering the program. Eighty-six percent (86.7%) of participants completed the degree requirement. Of those who completed their degree, 97% completed the service obligation.

DISCUSSION

As recruitment and retention initiative, NNEI scholarships are poised to address the VHA nursing staffing shortages as well as build a highly qualified nursing workforce capable of providing the best care to our Nation's Veterans.