At first glance, Laura Saunders is just another nurse checking vital signs and helping turn over patients on the stroke ward at Hamilton General Hospital.

She is one of 87 nursing students from McMaster University currently working as externs in Hamilton’s two hospital systems, helping with the hospital nursing shortage during the pandemic, while offering a pathway to full-time work after graduation.

The externships are paid roles for the students to supplement their work experience while finishing their program, but the work is not counted as part of their academic training.

As an extern, Saunders typically works 12 hours a week, balancing her job with her schooling. She will likely continue working full-time after graduation and has already been invited to job fairs.

“The nursing team I work with is absolutely awesome and they really do need all hands-on deck right now. I love all the problem solving that goes on in nursing and I feel so excited and motivated to make this my career,” said Saunders, a fourth-year student at McMaster’s School of Nursing (SON).

“Being in the hospital environment definitely helps me practice ‘hard’ skills like taking blood pressure, recording patient charts, or fixing an IV line, as well as my soft skills, as I’m interacting with patients all the time.”

Ontario’s Ministry of Health launched the extern program in February to support nursing capacity while the province responds to the pandemic but most, including Saunders, are not working with COVID-19 patients.

“Some of our senior learners may be in settings where care of COVID-positive patients is required,” said Joanna Pierazzo, assistant dean of undergraduate nursing programs at the SON.

Of the 87 current SON externs in late September, 57 are working at Hamilton Health Sciences (HHS) hospital sites and another 30 are at St. Joseph’s Healthcare Hamilton’s hospital locations.

In addition, 27 students from Mohawk College and another eight from Conestoga College are working as externs at HHS.

So far, 25 SON graduates who worked as externs have been hired as nursing staff by HHS.

All externs work under the supervision of both registered practical nurses and registered nurses and are reminded that their schooling comes first.

While extern work does not count towards students’ course credits, it has nonetheless given both Saunders and fellow student Ivan Zhang a massive confidence boost during the practical sessions of their program. SON students typically complete 12 practicum days during a level two or three clinical course.

“I definitely feel more confident in my proficiencies and clinical skills in general, as well as communicating with patients. I’m just more comfortable in the clinical environment as a whole,” said Zhang, who works at the McMaster Children’s Hospital.

For Zhang, effective patient communication and soft skills are vital when dealing with sick children, many of whom have cancer, as well as their parents.

His young patients are often frightened and distressed when they come to hospital with their parents. It is up to Zhang to put them at ease, smiling and joking with them as they undergo cancer treatments.

“Many of them are anxious and crying when they come to hospital, so it feels really good to put a smile back on their faces,” said Zhang.

“I look forward to really making their day and affecting them in a positive way, especially little kids. You get to know them and become their friend, in a professional way.”

The externs’ contribution is welcomed by McMaster’s hospital partners.

“As we encounter nursing shortages directly impacted by the pandemic, the presence of our nursing externs on clinical units brings unique value to our healthcare organization,” said Erin Doherty, director of nursing practice at St. Joseph Healthcare Hamilton.

“Externs’ ability to contribute to care planning, and provide assistance to patients and families, permits our nursing staff the ability to complete other subspecialized, controlled nursing tasks. To date, we have successfully recruited 30 BScN students from McMaster University to work throughout our inpatient environments, inclusive of our emergency department and urgent care centre.”

 Doherty’s sentiments were echoed by Charissa Cordon, chief of nursing practice at HHS.

“Clinical externs have been involved in delivering care to our patients, including completion of head-to-toe assessments and vital signs, promoting patient safety through falls risk assessments and skin assessments, helping with activities of daily living and other interventions that are assigned or delegated to them within various departments of our hospital,” said Cordon.

 “The extern program provides them with opportunities to strengthen their clinical and communication skills and be part of an interprofessional care team.

 “We have received very positive feedback from leaders and clinical externs at HHS about the program. We have successfully transitioned many of our graduating externs into nursing positions at HHS.”

 Pierazzo said students like Zhang and Saunders may sign up for extern positions from their second year if on the regular four-year nursing program. Students completing the two-year accelerated nursing program may sign up halfway through their second year.

 “It’s incredible to be able to support the extern program. As a SON leader, it is so wonderful to help our learners transition from students to practice. It is a fantastic continuum,” said Pierazzo.

 “This is a perfect fit, as learners who signed up as externs and later succeed in becoming full-time nurses will definitely help plug the nursing shortfall in Ontario. I am impressed with how many externs are now full-time nurses.”






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