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Nurse Extern to Hired Nurse?

There is no doubt that a staffing crisis has arrived in nursing. This wasn’t pandemic-related. The ANA reported that by the year 2022, over 500,000 nurses would be ready to retire, and the country would already be over 100,000 nurses short. 

No one anticipated a pandemic in that mess. The annual turnover rate rose to 18.9 in 2020, the largest leap in over 7 years. The same article noted that up to 22% planned to quit in 2021. While the final numbers aren’t in for 2021, we can bet you have seen your fair share of people leave over the last year.

You could argue any number of reasons for this trend, though burnout would likely be at the top of your list. The truth is, nurses have options right now with big sign-on bonuses, wage increases, and lucrative travel opportunities.

Your hospital likely needs nurses, and new nurses need a leg up before they graduate. But, unfortunately, it’s a challenging world to learn in with fewer preceptors and less than desirable working conditions.

Early Recruitment is important.

A few hospital systems have started recruiting from nursing schools to supplement their CNA staff. This gives those students a first-hand look at hospital life and a chance to create connections within their hospital system.

These intern or extern style programs allow nursing students to experience healthcare in its true format. According to at least one study, it helped raise their confidence, improved their communication skills with patients and other providers, and helped them gain a more realistic view of nursing. Perhaps even more importantly, the study noted that 10 out of the 12 externs hired on to the company.

  • Interns typically shadow nurses. Internships may be paid or unpaid and may be as short as one or two weeks. The goal is to get students in the door to shadow real nurses. This helps them decide what unit they may prefer and how the hospital system works. It gives the hospital a chance to recruit them if their values and attitudes would make a great addition to their team. Internships are usually run during common breaks in school, like over the summer or during winter or fall holidays. 
  • Externs typically have to complete a certain level of schooling and function as CNAs in the hospital until graduation. These students are working, often part-time, while in school. The extern gets plenty of opportunities to see nursing care but functions independently with their own set of responsibilities. These positions are usually paid. The extern role helps the student nurse become more familiar with patient care, more confident, and helps them decide which unit they prefer.

Both programs mean the nursing student can work as a nurse more prepared to be successful and require less intensive training than the average new nursing graduate. 

If you work with new nurses, you may have noticed that the field has become much more competitive for recent graduates. Many hospitals are now offering sign-on bonuses and extensive residency programs and hiring new grads well before their graduation dates to prevent other systems from stealing them.

Perhaps the Intern/Extern concept is the next logical step in this puzzle. When you were a new grad, would getting experience in the hospital have given you a leg up?

Tell us your thoughts in the comments!




Amanda Ernst, DNP, RN, CEN

Amanda Ernst, DNP, RN, CEN


Amanda is an ER nurse with 10 years of healthcare experience. She currently works as a nurse educator and as an adjunct professor for several schools. She also works as a freelance healthcare writer in her spare time. Amanda thinks the greatest thing about nursing is the endless possibilities and opportunities to learn. What have you learned today?


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