Nurse externships are a vital component for junior nursing students transitioning into their senior year. Externships allow students to narrow clinical interests, gain real world clinical experience, and form professional relationships. The combination of these factors ultimately prepares students to be registered nurses, and definitely assists students approaching the job application process. Although the externship process may evoke a sense of anxiety and nervousness for some students, it is an important progression that will not only reduce the stress associated with job application process, but will significantly enhance clinical and professional development, and narrow clinical interests for students as they become closer to becoming registered nurses.
This summer I had the opportunity to work as a Nurse Extern at the Children's Hospital of Philadelphia (CHOP). During this ten-week experience, I transformed from a junior nursing student, to a senior nursing student with a clear picture of what it is like to be a pediatric nurse. This externship helped establish a new sense of confidence in my clinical practice, solidified my clinical interest in pediatrics, and furthered my foundational nursing education.
Experience and Exposure
A team of clinical nurse specialists, nursing recruiters, educational nurse specialists and clinical nurse experts lead the Summer Nursing Externship. This year, the nurse externship at CHOP was divided into four different rotations: the Flynn Oncology Fellowship, Intensive Care, Procedural/Emergency, and Medical rotation. I participated in the Medical cohort.
I was able to experience a Hospitalist floor, with a focus on asthma, a Pulmonary Floor, and finally a Gastroenterology/Endocrine floor. Completing these rotations taught me the importance of flexibility and adaptability, in addition to exposing me to a variety of clinical areas within pediatrics. Although I had some expectations of each floor, I learned the importance of keeping an open mind while embracing the experience. It was really interesting to see my perception of each unit change during, and after working on that unit.
On my first unit I worked with one main preceptor, and on the other two units I worked with several preceptors. I felt that working with a variety of preceptors taught me how different nurses complete the same tasks and have unique patient assignments with corresponding care requirements. These observations taught me how to differentiate the most efficient and accurate ways to complete tasks, which could be easily incorporated into my own practice. Although externs do not give medications, I felt the most challenged the days the nurses helped me look up patient medications, coordinate a schedule balancing care with medication administration, and pay strict attention to hourly IV fluid intake.
Intertwining the Classroom with Clinical Experience
This externship was extremely valuable to both my education and future career as I learned through seminars, as well as through comprehensive hands-on experience. During the first week of the program externs participated in a variety of lectures and seminars that focused both on patient care and professional development.
Besides some of the formal learning that occurred through the seminars, the hand- on clinical learning truly defined this experience. On my second rotation, a pulmonary floor, one of the clinical nurse specialists included me in a mock code simulation. I observed a team of medical residents, attendings, and nurses work together to solve the presented code situation. It was one of the nurses who really led care by speaking up and directing the team's attention to critical details about the patient's condition. This experience calmed my nerves and gave me a sense of future preparedness. As a nursing student who had previously observed codes in a clinical setting, I felt a sense of helplessness and fear that I would not know what to do if I was at the bedside and my patient's condition deteriorated. This mock code was a safe setting to be an observer, to understand the dynamics of a code, the importance of direct communication, and the different roles in administering care.
CHOP is known worldwide for being a hospital of many firsts, and home to many accomplished professionals. Therefore, CHOP draws a very unique patient population, and many of the cases admitted to the hospital often account for a small number of the cases seen in general pediatric population. There, they seem common. As a result there is an added level of quality of care and clinical experience that healthcare providers at CHOP offer in managing such diagnoses. From their example, and my participation in collaborative rounds with the medical teams, I learned about care plans for these patients, as well as observed the functionality of interdisciplinary teams in caring for such patients.
Even though I knew this summer would be challenging and would greatly broaden my clinical knowledge and experience, my expectations of working in pediatrics and the CHOP culture were greatly surpassed. The pediatric professionals I had consulted leading up to this externship all discussed the theme of patients' resiliency. However, observing the pediatric spirit first hand was much different than I had ever dreamed it would come to life. Pediatric resiliency was best captivated by the example of my nine-year-old patient with a complex medical history, getting out of bed and showing me his version of a dance called the "Whip and Nene". This moment will forever resonate in my heart and will remind me of why I decided to become a nurse. I strive to be a member of a team with a common goal to get these kids back to dancing, playing, and living.
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The Next Step
As this program came to an end, there were still many opportunities to build on the experience and education obtained during this externship both in the hospital and classroom settings. My externship evolved into a nurse tech position on the Hospitalist floor. In my new position, I continue to learn under the mentorship of the clinical nurse specialists and nurses who served as my preceptors. As a nurse tech there are increased responsibilities and an increased patient load that will better prepare me for the future working as a registered nurse. The juxtaposition and transition from extern to nurse tech has reminded me that no matter your title, to continue to make time to be with your patients because that is the initial reason we all aspired to be nurses.
This program from start to finish, including the interviews and résumé writing was great practice for the future application process for pursuing a career in nursing. I know that the future is bright for rising nurses. The opportunity for nursing students to have a nurse externship will reaffirm their goals and will make future connections that will last throughout their entire career.
Erin L. Kramer is a senior nursing student at Thomas Jefferson University in Philadelphia.