BSN Students Get Hands-on Nursing Experience

For 10 weeks this past summer, 30 nursing students who completed the junior year of their BSN programs participated in Cleveland Clinic’s new Nursing Associate Extern (NAE) program. Cleveland Clinic’s Zielony Nursing Institute developed the program to address performance gaps in new graduates transitioning from academia to professional clinical practice. “We thought we could impact students between their junior and senior years, helping emphasize concepts and develop skills that will then be reinforced during their last year of nursing school,” says Cynthia Willis, DNP, MBA, RN, CMSRN, Senior Director of Nursing Education at Cleveland Clinic.

A mix of interactive workshops and clinical observations

Nursing students from 18 schools in six states participated in the NAE program from June 1 to Aug. 7, 2015. The program began with an orientation week focused on skills training typically emphasized for clinical technicians. In addition, the participants received training on competencies required on medical-surgical units, such as Foley catheter insertion, 12-lead electrocardiogram interpretation and tracheostomy care.

After orientation, the nurse associate externs were immersed in a mentored clinical experience that featured five interactive didactic workshops and three clinical observations. The hands-on workshops included facilitated discussions, skills acquisition, case study presentations and critical thinking exercises. Participants broke into groups of six and traveled to five stations during each workshop, covering a wide range of topics.

Some lessons focused on skills such as performing basic neurological assessments and interpreting arterial blood gas measurements. Others focused on techniques that may enhance clinical decision-making, such as reflective journaling and the “Six Thinking Hat” method for influencing patient care. The participants also received guidance on their upcoming job searches with classroom time devoted to developing a career plan, compiling a resume and interviewing for jobs.

Clinical observation experiences were available in various units, from emergency departments to labor and delivery, at Cleveland Clinic’s main campus and four regional hospitals. The externs shadowed experienced nurses selected by unit nurse managers and got hands-on experience, when appropriate. For many, the NAE program presented the first opportunity to try a skill. For example, more than 75 percent of participants indicated that this was the first time they collected a urine specimen and more than 60 percent said it was a first time for doing a telemetry placement.

Experience elevates students’ impressions of the nursing profession

Perhaps the greatest achievement during the NAE program was a collective deeper understanding of the role nurses play. “I was amazed as the weeks progressed to see the students’ sense of what nurses do rise,” says Willis. “The externs were wowed by what nurses do – that they are not simply task-oriented, but are patient advocates and caregiver collaborators.”

In post-program surveys, three elements of the NAE experience stood out as particularly strong: the workshops and simulations, interprofessional collaboration and connections with working nurses. Ten of the participants have already committed to returning to work at Cleveland Clinic on a regular basis or during breaks before their graduation. The Zielony Nursing Institute is already planning for next year’s NAE program.

“We are excited about expanding the program in 2016 to include the operating room as a placement location,” says Willis. “We also will have two different cohorts starting in 2016, doubling the number of participants.”