Nurse extern program gives students real-life experiences before graduation

Nurse extern program gives students real-life experiences before graduation

The summer break was no break for more than two dozen East Carolina University College of Nursing students who got to see what their post-graduation life could be like with a new student nurse extern program sponsored by ECU Health Medical Center in Greenville.

In the summer of 2023, shortly after an expansive academic-practice partnership agreement was signed between ECU Health and the College of Nursing, leaders from both organizations explored options to help expand the number of new graduates who could fill vacant nursing ranks across eastern North Carolina.

One of the initiatives the group quickly agreed on was an extern program: nursing students would be certified as nursing assistants and then work in a variety of care settings across the health system to gain practical experience before starting their final semesters of nursing school.

To be eligible for the extern program, student nurses would be required to complete Nurse Aide II certification, which all nursing students are eligible for, but not all take advantage of. Nurse Assistants are allowed to perform limited patient care activities as well as assist licensed health care workers with taking notes and uncomplicated wound care.

Dr. Jeanne Martin, chair of the baccalaureate nursing program, said the certification gave ECU Health leaders the confidence that the nursing students could "function within the scope of an NA II all the while learning the RN role with their preceptor."

"During clinical experiences, students function under the licensure of their faculty and may administer meds or other skills not part of NA II certification," Martin said.

While their practical role was limited, Martin stressed that the intangible skills the students learned - like how to comfort a patient and translate complex medical terminology and procedures to a patient's families, was invaluable.

On July 9, the graduates of the first extern program gathered at the Monroe Center on the ECU Health campus to celebrate their accomplishments with their preceptors and the leaders who originated the program.

"I'm so grateful that you took this journey with us and congratulations. We appreciate the opportunity to partner with you on your professional journey," Dr. Trish Baise, ECU Health's chief nursing executive, said to the graduates during the ceremony. "Our goal is for you to be as prepared as you possibly can be as you transition into practice."

Baise said she plans to expand and evolve the program so that more nursing students have an opportunity to gain valuable experience while still in school because nursing care is increasingly complicated and challenging.

Dr. Bim Akintade, dean of the College of Nursing, was an early proponent of the academic-practice partnership and said he is thrilled at the results the inaugural cohort of externs achieved during their eight-week experience.

"We are very thankful for ECU Health's efforts to give our students a chance to learn some of the inner workings of their profession now, before they graduate. Once they are licensed and at the bedside, their nurse managers, and more importantly their patients, will rely on them to be ready on day one, and this experience puts them in an excellent position to be ready," Akintade said.

Tracy Langston, ECU Health's director of nursing professional development and innovation, was the medical center's lead for the extern program and responsible for placing the students in their roles. She is most proud of the growth the student nurses achieved with developing their time management and communication skills.

"It's been a phenomenal experience for our externs. They really increased their confidence as nurses, they are excited about the skills they were able to achieve and experience, and they'll use that as they finish nursing school," Langston said. "They spoke about how this program helped them work on their time management skills and prioritization as they prepare to hopefully join us as new graduate nurses after graduation."

During the ceremony, students recounted their experiences during the extern program.

Blair Beaulieu, a nursing student from Greenville, said working alongside the family medicine team gave her insights into the working life of a nurse that she just couldn't get from textbooks and classroom lectures.

"This program allowed me to explore the various opportunities and interdisciplinary communication, walking information down to the laboratory, transferring patients who needed higher acuity needs of various floors - just seeing those inner workings of a hospital," Beaulieu said.

Kiley Fisher almost missed the graduation ceremony and was dressed in grey scrubs, rather than Pirate nurse purple, having raced over from the hospital after helping with a birth.

Fisher credits her experience with reinforcing foundational skills - like drawing blood and placing Foley catheters - which gave her space to work on critical thinking and communication with all members of the care team.

"I can now not freak out when a patient asks a question that I don't know the answer to and how to continue to look professional while saying I don't know, let me find out for you," Fisher said. "It's reaffirmed that nursing is where I'm meant to be."

Emma Campbell, a nursing student who worked in the ambulatory clinics, found her footing, and her voice, while working directly with patients.

"I was challenged to develop my interprofessional communication, my confidence in my interactions with patients," Campbell said. "Working with family medicine clinics, I was able to improve in these areas substantially."

Kinsey Cook, one of the student nurses, said the extern program forced her to gain new levels of self-confidence, largely because she wasn't given a choice.

"I was shy and nervous around other team members, but I gained confidence throughout this program by answering the phone and assessing the plan of care with doctors. I was able to talk to pathology, labs, pharmacy, nutrition services, and I got to see more than just the nursing aspect of patient care," Cook said.

Cook spoke with pride at learning to believe in herself in the clinical role, as well as advocating for the patients she interacted with, a skill fostered by spending time with a charge nurse in the unit to which she was assigned.

Ankita Das said her experience working with palliative care teams helped her to develop a set of skills that can't be learned in the classroom - one-on-one interactions with patients and the loved ones in the room with them.

"During this externship I realized I needed to further develop, and learn more about, comforting patients, family members and what to say when their loved ones passed," Das said. "I observed the chaplains' interactions with the families - they were empathetic and always offered to talk about memories with family. They lent a shoulder to cry on and a listening ear, this helped me learn what to do and what to say when a patient passes."

The program's success has given its leaders hope for future iterations, and opportunities to expand student participation in the future across the health system's locations in eastern North Carolina.

"One of the reasons for implementing a student nurse extern program is that it's an excellent recruitment and retention tool," Langston said. "This is just the start. We are looking forward to continuing our student nurse extern program in 2025, so students - get ready to apply in December."

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