Case Study of a Nursing Externship Program

1. Case Study of a Nursing Externship Program Annie Moore-Cox, PhD, RN Director Strategic Accounts NEC Corporation of America Research Sponsored by Rutland Regional Medical Center

2. Background • Current model of clinical education includes groups of students assigned to patients who remain “co-assigned” with a staff nurse under the supervision of a faculty member • While Benner et al. (2010) feel clinical education is something nursing does well, critics raise concerns about cost, scheduling, and ineffectiveness of model. Annie Moore-Cox PhD, RN

3. Purpose of the study • To explore the experience of 4 externs during and two years after participating in a 6 week externship program • Research Question: What impact, if any, did participation in the nursing externship program have on the former externs’ subsequent experiences in school and as new graduates? Annie Moore-Cox PhD, RN

4. Details of the externship program • Students were in between first and second years of an AD program • Had to be in good academic standing • Had to be far along in the application process for their LNA license • Recommended by faculty and selected by an interview process • Students assigned to one unit for entire 6 weeks • Attempted to assign to the same one or two preceptors • Faculty member onsite but not “over the shoulder” • Students paid as LNAs but could perform some RN skills with supervision as outlined by State Board Annie Moore-Cox PhD, RN

5. Theoretical Underpinnings • Lave and Wenger’s (1991) Legitimate Peripheral Participation—The Community of Practice Examples include tailors in West Africa, Yucatec midwives, and members of Alcoholics Anonymous Learning in context as a legitimate member of the profession even at the beginning of training. Annie Moore-Cox PhD, RN

6. Method • Field notes taken for entire 6 weeks of externship • Interviews conducted two years post externship • For two of the subjects, a digital voice recorder was employed after the subjects had spent time “training” Dragon NaturallySpeaking voice recognition software used for transcribing voice to text • One other subject was interviewed by telephone Annie Moore-Cox PhD, RN

7. Interview questions • Tell me what you recall of your externship experience? • In what ways did your externship enable or not enable a view into what being a new nurse was like? • Speak to how the externship affected your last year as a student and first year as a nurse? • Describe some of the differences between the externship experience and clinical instruction at school? • What were important aspects of externship in terms of learning? Annie Moore-Cox PhD, RN

8. Findings (similar to those found in other studies) • Part of the team- being on the inside, relating as a colleague, working as a team (Rush et al., 2004; Starr and Conley, 2006) • Empowered learning- jumping fearlessly into learning, taking the initiative, learning in quantum leaps (Rush et al., 2004) • Growth- gaining basic skills, confidence and critical thinking skills (Starr and Conley, 2006) Annie Moore-Cox PhD, RN

9. Findings (similar to those found in other studies) • Gaining an understanding of the role of the nurse (Starr and Conley, 2006) • Being a part of the real scene- experiencing the true world of nursing (Cantrell and Brown, 2005) Annie Moore-Cox PhD, RN

10. Findings unique the present study • Getting the basics down liberates the externs to really learn nursing • Observation of nurses nursing is a powerful learning tool Annie Moore-Cox PhD, RN

11. Discussion • 3 out of 4 externs have remained at hospital, 2 on the units in which they were externs • Externship was a powerful learning experience that enhanced both their final year in school and subsequent entry into practice • Observation, lack of pressure, identification as part of the team, repetition, and being on the same unit for weeks at a time were important aspects of this experience for the externs Annie Moore-Cox PhD, RN

12. Implications • Cannot generalize • Externship was of great value for these students • Study findings point to the value of the externship model- particularly being on the same unit with the same people and developing relationships without the mediating effect of faculty. These may be things to consider when planning externship experiences for students. Annie Moore-Cox PhD, RN