Case Study of a Nursing Externship Program

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Case Study of a Nursing Externship Program Powered By Docstoc
      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

Annie Moore-Cox PhD, RN                                  November 2010
                Purpose of the study
      To explore the experience of 4 externs during and
       two years after participating in a 6 week externship

      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

Annie Moore-Cox PhD, RN                                    November 2010
         Details of the externship
      Students were in between        Students assigned to one
       first and second years of an     unit for entire 6 weeks
       AD program
                                       Attempted to assign to the
      Had to be in good                same one or two
       academic standing                preceptors

      Had to be far along in the      Faculty member onsite but
       application process for          not “over the shoulder”
       their LNA license
                                       Students paid as LNAs but
      Recommended by faculty           could perform some RN
       and selected by an               skills with supervision as
       interview process                outlined by State Board

Annie Moore-Cox PhD, RN                                      November 2010
      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                                 November 2010
      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                 November 2010
                  Interview questions
      Tell me what you recall of your externship
      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
      What were important aspects of externship in terms
       of learning?
Annie Moore-Cox PhD, RN                                    November 2010
        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                                  November 2010
        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                                 November 2010
                  Findings unique the
                     present study
      Getting the basics down liberates the externs to
       really learn nursing

      Observation of nurses nursing is a powerful learning

Annie Moore-Cox PhD, RN                                November 2010
      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                                 November 2010
      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                                November 2010

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