ECU nursing externship gives students real-world skills beyond the classroom

ECU nursing externship gives students real-world skills beyond the classroom

Chloe Hamlett, a fourth-semester East Carolina University nursing student from Nashville, North Carolina, could have spent her summer at the beach or working a part-time job at home. Instead, she spent 12-hour days learning the ropes of the nursing profession in one of the most challenging settings possible - the cardiac surgery intensive care unit at ECU Health medical center.

After a year at N.C. State, Hamlett transferred to ECU to get into the nursing program, because it is the most direct way to help people.

"Being with people in their darkest moments - if you can bring a little bit of comfort to them and their family members, that can mean the world," Hamlett said.

In the fall semester, representatives from ECU Health gave a presentation about a paid nurse extern program that would provide immersive clinical experiences far above and beyond the skills that can be taught in simulations in nursing school.

"I knew I wanted to come to this unit after graduation so I thought, 'If I can get on that unit, that would be awesome,'" Hamlett said.

Nurse externs were selected from student applicants from the College of Nursing as part of a robust academic-practice partnership signed by the college and ECU Health. The partnership encourages ECU Health employees to teach and continue their education at the college; diversifies learning experiences in clinical settings for students; and recruits those students to meet the needs of health care delivery in eastern North Carolina.

Students accepted into the nurse extern program are required to complete training to be qualified as a nurse assistant II, allowing them to provide supervised, limited practice at the bedside where they learn from their clinical coach nurse mentors.

The extern program restarted last year after a hiatus forced by the COVID-19 pandemic. This year's cohort started in May, just after the end of the spring semester, and ran for eight weeks.

The experiences she has had, though, have been more expansive and impactful than she could have imagined, Hamlett said.

She said the support she has received from everyone at ECU Health has made the experience even more rewarding and reinforced her decision to accept a position on the same unit after graduation.

"It's high stress, but I've never been nervous to come to work. I can ask any questions, and they are so willing to help me," Hamlett said.

Todd Mizell, one of Hamlett's preceptors - or clinical coaches, as the hospital calls them - has been a patient teacher who has taken the time to explain why they were changing a medicine dosage or setting on a life-saving medical device, rather than just showing how to complete the task.

"Todd has been great. I've seen hemodynamic monitoring, vasoactive drugs, arterial lines and ECMO - things we haven't really had experience with, which has been awesome," Hamlett said. Extracorporeal membrane oxygenation, or ECMO, is a highly advanced system that oxygenates blood for patients with severe cases of heart failure and is a device that simply couldn't be taught to undergraduate nursing students outside of extern programs.

These expansive experiences are exactly what the extern program was designed to accomplish, said Beth Jaramillo, who oversees Hamlett's learning on the unit and manages onboarding and continuing education for the permanent staff assigned to two of the hospital's critical care units as a professional development specialist.

The Grimesland native said the job of nursing schools is to get all students prepared to enter the workforce with the skills to be competent entry-to-practice nurses. Students who know the specialty they want to pursue have limited opportunities to learn the advanced skills they will need on day one. The nurse extern program does just that.

"We have so many like Chloe who are interested in critical care; that's what I want to do. Having this opportunity where they are working to hone skills but also get to spend time one on one with nurses to see the sickest of the sick, and have that explained, they never see that in clinicals," Jaramillo said.

Jaramillo said the nurse externship has proven a wonderful recruiting opportunity. The three student nurse externs she has worked with have all accepted positions in the units with which they were partnered.

Jaramillo said Hamlett is a perfect example of the kind of student for which the program is designed. She takes advantage of opportunities by asking questions of the providers and perfusionists, taking every advantage to soak up knowledge and learn. Not all new grad nurses are up for the demands of critical care.

"She is so far ahead of those that are wanting to maybe come to a unit once they finish school," Jaramillo said.

Hamlett said the nurse extern experience has made her much more confident in her clinical skills, but also her ability to communicate with peers, patients and families.

"If there are abnormal vital signs, I can go right to the providers and I don't feel like any of them look at me like I'm just a student," Hamlett said. "I'm tremendously more confident going into my fourth semester."

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