Academic journal article Nursing Education Perspectives

TRANSFORMATIVE LEARNING during a Nursing Externship Program: The Reflections of Senior Nursing Students

Academic journal article Nursing Education Perspectives

TRANSFORMATIVE LEARNING during a Nursing Externship Program: The Reflections of Senior Nursing Students

Article excerpt



Many nursing students participate in summer extern programs to augment their clinical experience in school and ease the gap between education and the real world of nursing practice. The purpose of this descriptive, qualitative research study is to gain an understanding of the transformative learning that takes place during a summer externship program. Examining outcomes of externship programs will help nurse educators, practitioners, and administrators understand the full dimension of these programs. Seventy-eight nurse externs, from baccalaureate, associate, and diploma nursing programs, participated in an eight-week extern program at a large, inner-city trauma hospital in the northeastern United States. Data collection took place throughout the program. Individual discussions, midpoint focus group discussions, and reflective surveys administered immediately following the externship experience were used as data sources. Findings indicated that some of the externs' perceptions, values, and beliefs were transformed as a result of the program. Three themes emerged from the analysis of the findings: affirming assumptions, validating values, and banishing some core beliefs. The results suggest implications for nursing education, practice, and research.

Key Words Nursing Externship - Qualitative Research - Reflection - Transformative Learning

FOR NEARLY THREE DECADES, externship programs have been flourishing as a means to augment the nursing student's clinical experience outside the traditional educational setting and inside the realistic world of nursing (Rush, Peel, & McCracken, 2004). Many nurse educators recommend summer externships (Cantrell & Browne, 2005, 2006; Cantrell, Browne, & Lupinacci, 2005; Dempsey & McKissick, 2006; Kilpatrick & Frunchak, 2006; Rhoads, Sensenig, Ruth-Sahd, & Thompson, 2003), which usually take place prior to the final year of a basic nursing program. Nursing students, seeking opportunities to work alongside registered nurses and gain clinical experience, find these programs helpful in easing the transition from the classroom to practice (Rhoads et al.).

Support for participation in externship programs comes from a variety of sources. Hospital administrators see such programs as a recruitment tool that may decrease the time needed for orientation of new RNs (Cantrell & Browne, 2005); nurse educators see them as a way for students to gain clinical experience and immerse themselves in the environment of nursing (Cantrell et al., 2005); and human resource personnel encourage extern programs as a way to get to know future employees (Cantrell & Browne). Nursing students often report that such programs increase their self-confidence and knowledge base and make their senior year somewhat easier (Rhoads et al., 2003).

While such programs appear to be beneficial, no studies have reported the actual outcomes of nursing externship programs as they affect the professional beliefs, values, and assumptions of participants. This study, therefore, has the following purposes: a) to obtain reflective feedback from nurse externs in order to gain an understanding of the nature of transformative learning during a summer externship program; and b) to add to the current literature on nurse externship programs as a way to enrich nursing practice, education, and future research. The investigators, two faculty from a baccalaureate nursing program and one nurse recruiter from a large, inner-city trauma center, were all curious about how the nurse externship experience may change or transform their students or their future employees. Reflective practice (Schön, 1990) and transformative learning theory (Brookfield, 2004; Mezirow, 2000; Taylor, 1998) comprise the theoretical framework for this study.

Review of the Literature The first articles on externships to appear in the literature looked at how participation eased the "reality shock" of working at a busy clinical setting (Edwards & Cummings, 1982; Harkins, Schambach, & Brodie, 1983). …

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