Professional Pipeline Program Expands to Meet Needs of Changing Workforce

This summer marks the 10th anniversary of Cleveland Clinic’s Nurse Associate Externship. Nearly 850 nursing students have participated in the paid program, which pairs nursing students entering their final semester of school with an RN mentor at the healthcare system’s main campus, a regional hospital in Ohio or Cleveland Clinic Florida.

“Every nursing student should be able to experience an externship like this because it not only gives you the opportunity to learn, but it allows you to get additional hands-on experience,” says Cassandra Holman, ADN, RN, who was a nurse associate extern on a medical-surgical/telemetry unit at Cleveland Clinic Avon Hospital in 2023. "Everything our externs learn can be used in their clinical rotations and carried forward long into their nursing careers.”

Holman was among the first group of nurses enrolled in an associate degree program to participate in the externship, which was previously reserved for students earning a bachelor’s degree in nursing. Nursing leaders expanded the participant pool last year based on feedback presented by the Dean’s Round Table, a collaborative group of local nursing school deans or delegates who meet with nursing leaders to strengthen academic and practice partner relationships.

“Support of associate degree nursing (ADN) programs combined with the current nursing shortage prompted our inclusion of eligible ADN students,” explains Jeanne Henry, MEd, BSN, BS, RN, Nurse Associate Externship lead.

Three program options

Along with opening the externship to a broader group of students, the program added two scheduling options — advanced and flex — in 2023 during the standard 10-week externship.

• Traditional — Nursing students work as unlicensed providers
40 hours a week beside a nurse mentor.

• Advanced — Students are simultaneously enrolled in nursing
school (where they are earning college credit) and the
externship, which allows them to perform practicum-level skills
like administering medication and starting peripheral IVs under
a direct partnership with an RN.

• Flex — Externs, who are onboarded just like their traditional
and advanced peers, work 15 12-hour shifts on a nursing unit
over the externship period.

“We recognized that we had a group of caregivers who couldn’t commit to 10 full weeks during the summer, so we put the flex program in place,” says Henry. The flex option has attracted students who play college sports, work other jobs or have family commitments.

The flexible schedule was a lifesaver for Holman, who has a husband and children at home. “The nurse manager would send me a list of potential work dates, and I would choose the shifts that allowed me to still manage my home life.”

No matter which option externs select, they are leaders when they return to the classroom for their final semester of nursing school, says Henry.
“After the externship, participants are stronger and more confident in their skills because they experienced continuity on the clinical floor and know what it’s like to work a full shift,” she says. “They experience interdisciplinary collaboration and collective decision-making while learning the value of resources and teamwork.”

Externs see nursing teamwork firsthand by working hip-on-hip with a nurse mentor. Terrance Lindsey, BSN, RN, a former nurse associate extern on a cardiovascular stepdown unit at main campus, says he had an “amazing” mentor.

“Not only did she make me feel welcome on my unit the first day, but she allowed me to grow and develop my nursing practice in a safe manner,” he says. “She always encouraged me to advance my practice in new skills and was receptive when I asked for more responsibility.”

More than the unit

The number of nursing externships is rising across the U.S., as hospitals are increasingly recognizing their value as staffing pipelines. However, Cleveland Clinic’s Nurse Associate Externship is unique in its organizational commitment to providing rich, varied educational opportunities, says Henry.

Most notably, the program includes educational workshops and “experience days.” Students in the traditional and advanced tracks attend five workshops, and flex students participate in two. Topics covered include urgent and emergent care, perioperative nursing, holistic nursing, mobility and delirium, care and maintenance of central vascular access devices, and more.

“The workshops, which are taught by our nursing professional development specialists, are designed to increase externs’ critical thinking skills and provide essential support when they return to school,” says Henry.

Holman says the combination of working on the unit and attending workshops was invaluable. “Confidence is something nursing students lack,” she says. “This program gave me the opportunity to learn how to be confident in both my nursing and communication skills.”

During experience days, which are offered to traditional and advanced externs, the students spend a day on three different units.

“Experience days give externs the ability to explore other service lines, hospitals and forms of nursing delivery,” explains Cindy Willis, DNP, MBA, RN, Senior Director of Nursing Education. “The information these students gather can be enormously helpful when it’s time for them to consider a future career.”

As a nurse associate extern, Lindsey opted to visit intensive care units on his experience days. “I really liked the fast pace of the ICU environment and was grateful for the chance to experience postoperative patient care following open heart surgery,” he says. After graduating from Michigan State University’s nursing program in 2022, Lindsey joined the heart failure/coronary ICU at main campus.

A commitment to the next generation

Although approximately half of Cleveland Clinic’s nurse externs eventually return to work for the healthcare system, Willis says the retention rate was higher before the COVID-19 pandemic. The program’s leaders hope the more inclusive admission requirements and addition of flexible scheduling options will continue to boost enrollment numbers.

The externship is already attracting more participants, growing from 30 externs in 2015 to more than 150 this summer in two 10-week sessions: May 13-July 20 and June 3-August 10, 2024.

“This program represents Cleveland Clinic’s commitment to the next generation,” adds Lisa Baszynski, DNP, RN, NE-BC, Associate Chief Nursing Officer of Nursing Education and Professional Development. “It provides professional socialization and acculturation not only to our institution, but to the greater field of nursing. We give our externs a leg up.”

Holman agrees. She received her ADN from Lorain County Community College, earned her nursing license and, in March 2024, began working in the Avon Hospital unit where she externed. “As an extern, it was inspiring to watch the nurses and patient care nursing assistants in their daily routines and imagine what a day in the life of an RN would be like for me,” she says. “I love to learn, so this was the perfect environment for me.”