Nurse Associate Extern Program Realizes Continued Success

Program components can benefit nursing organizations


By Kelly Hancock, DNP, RN, NE-BC


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From increasing confidence levels to improving critical thinking, one of Cleveland Clinic’s newest student nurse education initiatives – the Nurse Associate Extern (NAE) program – is proving extremely beneficial for both nursing students and Cleveland Clinic.

The 10-week summer program is designed for junior-level BSN students who are entering their senior year of nursing school. The foundation of the program is lifelong learning and patient safety.

Students work 40 hours per week with experienced nurse mentors and participate in classroom time. They are hired in temporary positions as nurse associates in specialties such as medical-surgical, critical care, heart and vascular, neonatal intensive care, labor and delivery, behavioral health and operating room nursing. They also observe outpatient settings like primary care, care coordination, telehealth nursing and home healthcare.

More than a shadowing initiative, the Nurse Associate Extern program encourages participants to grow collaboratively and learn necessary skills such as teamwork, communication and delegation. Externs also exercise critical thinking and problem solving, influence patient care and ethical situations, experience patient advocacy first-hand, and gain confidence in themselves and their future careers.

Participants of the program meet weekly in small groups with a nursing professional development specialist from Cleveland Clinic’s Office of Nursing Education and Professional Development. In this meeting, they are taught how to apply principles of nursing to abstract scenarios by debriefing on a topic relevant to an experience from the previous week.

For example, if the topic is patient advocacy, nurse associates will share their perspective of patient advocacy based on what they witnessed on the nursing unit they were observing. In this specific scenario, many program participants have revealed their amazement at how nurses advocate for patients. Several times later in the externship, the topic of patient advocacy will be revisited. However, instead of discussing how participants witnessed patient advocacy, nurse associates will discuss how they modeled patient advocacy for their RN mentor’s patient. Often, the results are a true transformation from observation to application.


Unique real-world job experience, notable benefits to students and organization

Cleveland Clinic initially piloted the Nurse Associate Extern program in the summer of 2015 with 35 nurse associate externs. Resulting in incredible response and interest from nursing schools and students, the program officially launched the following summer and included 70 nurse associate externs. In the program’s most recent year, which concluded in August, 90 nurse associate externs were hired. And in 2018, Cleveland Clinic plans to expand total participation to 100.

One of the greatest benefits of the program is that it speaks for itself. Long before announcing the 2017 dates, graduates of the 2016 externship were actively recruiting and encouraging fellow nursing students to participate in the opportunity.

Additionally, through word of mouth and a very small amount of marketing and promotion, the program has a track record of attracting students locally, regionally and nationally. In both 2016 and 2017, nurse associates represented more than 30 different schools of nursing from throughout the country.

Much of the feedback received from students and nursing schools is that the experience is invaluable. Past program participants have made statements such as: “I hope to continue my journey with Cleveland Clinic next spring with a future in obstetrics, and I will keep telling others about this wonderful opportunity. I hold the friends and memories from this program close to my heart.”

The externship program is also a great recruitment tool. By identifying students who display the attributes and possess the values and vision that align with Cleveland Clinic Nursing, the recruitment team wants to build a pipeline of potential candidates. In fact, 53 of the 70 nurse associates from 2016 were hired as new graduate registered nurses. And already, numerous 2017 program participants have applied to work per diem at Cleveland Clinic as patient care nursing assistants or clinical technicians throughout their senior year of nursing school.

Food for thought

If your organization has, or is planning to launch, a similar student nurse education program, here are a few considerations to keep in mind:

  • Strategically hire and place nurse associate externs based on vacancy trends and workforce planning data.
  • Make sure recruiters formulate strong relationships with the nurse managers of nursing units that participate in the program.
  • When hosting recruiting events at schools of nursing, invite past nurse associate externs from the school to your event booth to talk about their externship experience with other potential nurse associate candidates. Also, use the opportunity to discuss job interests and potential openings at your organization in anticipation of the student’s upcoming graduation.

Additionally, while some organizations may not have the resources to initiate a comprehensive externship program, there are a few components of Cleveland Clinic’s program that could be modified for consideration as smaller-scale student nurse education initiatives.

  • Host day-long student-shadowing/observation opportunities: Include the option to meet with both hiring staff and nursing staff to introduce students to your organization, your hiring requirements, and the range of opportunities offered, while also allowing participants to actively observe patient care settings.
  • Assign RN mentors to nursing students: Enlist experienced nurses to serve as regular student nurse mentors for local schools of nursing, offering a helpful resource in navigating the ins and outs of a student’s future career in nursing.
  • Offer a professional nursing workshop for soon-to-be graduate nurses: As a half-day workshop, invite nursing students to meet with members of your nursing education and hiring departments to garner advice on professionalism, tips and tricks to getting hired and building a resume – or have their resumes reviewed by professionals.

For any student observation or education opportunities your organization offers, have nurse managers partner with nurse recruiters. This is essential to ensuring a revolving pipeline of potential new graduate nurse hires.

Kelly Hancock is the Executive Chief Nursing Officer of the Cleveland Clinic Health System, and Chief Nursing Officer of Cleveland Clinic Main Campus.

Follow Kelly on Twitter at @kkellyhancock.

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