Creating a Bridge between Academic and Clinical Realities for Student Nurses: Evaluation of a Summer Student Internship Program

Acknowledging the tension between the current availability of nurses and the need to create opportunities for student nurses, the SCO Health Service in Ottawa developed a nursing Summer Student Internship Program. This paper describes the development, implementation and evaluation of this program. A mixed-methods approach was used in this cross-sectional descriptive study. Nineteen student nurses completed a self-administered questionnaire, and seven staff nurses participated in a semi-structured interview. The findings suggest that the program was a mutually rewarding experience for students Creating a Bridge between Academic and Clinical Realities for Student Nurses: Evaluation of a Summer Student Internship Program Kathleen Holdway, RN, MScN Research Assistant, Elisabeth Bruyere Research Institute Ottawa, ON Sylvie Corbeil, RN, MScN Interim Chief Nursing Officer, SCO Health Service Ottawa, ON Christine J. McPherson, RN, PhD Research Scientist, Elisabeth Bruyere Research Institute Assistant Professor, University of Ottawa, ON Sylvie Oremush, RN, BScN Director of Nursing and Scheduling Resources, SCO Health Service Ottawa, ON Mary Ann Murray, RN, MScN, CON(C), GNC(C) Advance Practice Resource Nurse, SCO Health Service Ottawa, ON ON-LINE EXCLUSIVE 1 Nursing Leadership On-line Exclusive • April 2005 2 and staff nurses. Students reported that the program facilitated their integration into nursing practice, increased their confidence in clinical proficiency and improved their organizational skills. The program provided a vehicle for student nurses to optimize and strengthen their learning. Most students expressed an interest in future employment as a summer intern. Nurses’ responses were also positive and favoured continuing the program. Nurses appreciated the opportunity to mentor students within a unique program and considered the students’ contribution to patient care valuable. Future research should examine the utility of such a program in terms of attracting, recruiting and retaining novice and experienced nurses. In 2002, a nursing Summer Student Internship (SSI) program was piloted with five students at the SCO Health Service in Ottawa, Ontario. The SSI program was expanded in 2003, based on a high level of participant and organizational satisfaction. Twenty-four students participated. The primary goal of this program was to help address organizational summer staffing requirements in a new and innovative way. At the time of SSI program inception, the registered practical nurse (RPN) vacancy rate was about 10%. There was also an anticipated additional 10% RPN requirement to meet summer relief needs. Furthermore, there was no graduating RPN class for 2003 based on changes in program length of the RPN course curriculum. The secondary goals were to create an environment for students to acquire new knowledge, to socialize students to nursing practice and to foster professional growth. This paper describes the development, implementation and evaluation of the SSI program. Literature Review A limited number of articles have focused specifically on student nurses’ summer employment in nursing (Desrosiers 2000; Grinstead 1995; McAlpine and Cargill 1992; Tritak et al. 1997). These summer employment programs are often referred to as externship programs. An externship program is actually like an internship program but is external to the nursing program of study (Desrosiers 2000). In a pre-test and post-test study of six student nurses who had participated in a summer hospital employment program, McAlpine and Cargill (1992) examined students’ attitudes towards the profession, role identification and degree of knowledge of the hospital organization. Results indicated that students had more positive attitudes towards their profession, greater knowledge of the hospital organization and felt more “like nurses “ at the end of their summer employment. Students’ task performance was also observed and timed. Results suggested that as the number of skills performed by students per day increased, the quality of performance decreased. When interviewed, the students acknowledged that their performance was not as it should be. They reported “there is not time to take all those steps “ and “everyone does it. “ When students were observed, it was often noted that they appeared to be modelling behaviours of nurses on the unit. Other findings indicated that the students felt that they received greater support and reinforcement of their identities as “nurses” from individuals with little connection to the professional system (e.g., families, cleaners) compared to those with more connection (e.g., nurses, doctors). Lastly, although students “felt more like nurses” at the end of the summer program, the majority agreed that they wouldn’t really feel like a nurse until they passed their licensing exams. Tritak and colleagues (1997) examined nursing autonomy and dimensions of professional activity among 41 student nurse externs. Pre-test and post-test results revealed no significant differences in autonomy or dimensions of professional activity. At post-test (i.e., one year later), the results revealed significantly greater professional autonomy. Students also reported greater self-confidence and ease at answering examinations; better time management and insight into staff nurse duties; skills and knowledge development; and the opportunity to earn and learn simultaneously. Finally, the academic averages of the externs were compared with a representative group of students who did not participate in an externship program. Results found that externs obtained significantly higher mean grade-point averages, compared to the sample of non-externs. While the literature on summer student programs is limited, there was suggestion that a SSI approach would benefit students. Therefore, a decision was made to develop and implement the SSI program. Development of the SSI Program A new job category for student nurses was created through partnership and negotiation with key stakeholders. Newly defined role expectations included (1) performing care traditionally undertaken by unregulated personal care attendants (PCAs), (2) performing selected nursing skills and (3) working in close collaborative practice with a registered nurse (RN) or a registered practical nurse (RPN). Student nurses were recruited from nursing programs at two colleges and one university. An advanced practice nurse (APN) with expertise in nursing education and preceptorship reviewed the course curriculum of each school to formulate a draft list of selected skills that would be applicable to all care settings within the organization. Prior to student recruitment, the draft skills list was reviewed and refined by nurse leaders until consensus was reached. Students eligible to participate in the SSI program had successfully completed the second year of a RN program and were available for full-time work (i.e., 37.5 hours per week; 7.5 hours per shift) on either a day–evening or a day–night rotation. Prior to being interviewed by the Director of Nurse Scheduling, students’ applications were screened for eligibility by the Human Resources Department. Implementation of the SSI Program Following initial approval of the program by the Chief Nursing Officer (CNO), the Director of Nurse Scheduling in collaboration with Human Resources and the Creating a Bridge between Academic and Clinical Realities for Student Nurse 3

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