“We want to make sure nurses remain in health care”: How an early immersion program sets up nursing students for success

It’s the end of another full day for Graham Pegg.  He’s just finished the first of three 12-hour shifts on the medical surgical unit at Yarmouth Regional Hospital.  He’s working as an Undergraduate Student Nurse (USN) while studying full time in the Bachelor of Science in Nursing program at the Yarmouth Campus of Dalhousie University. 

“It’s hard to wrap your mind around certain things we learn in nursing, but if we get to see it, it makes everything click a lot better,” said Pegg. 

Pegg is part of the Early Immersion Program (EIP) that offers senior nursing students the chance to work as a USN in Nova Scotia hospitals.  It’s voluntary, and students set their own schedule around their academic work. The goal is to help students transition from the ideals they study in school to the realities of working in today’s busy, often understaffed hospitals. 

“It’s better preparing them for the real world which we cannot do in a simulation lab,” said Dr. Shelley Cobbett, Site Administrator at the Yarmouth Campus of the Dalhousie School of Nursing and lead evaluator for the EIP pilot. 

“The nursing programs are great, but they don’t fully prepare you for exactly what the nursing job is,” said Pegg.  “You hear a lot about new nurses leaving as much as older nurses taking early retirement because the stress is just too much for them.  I think it’s really going to help those of us who have taken this opportunity because we have a real-world view of what nursing is.”

The USN program addresses two pillars in Nova Scotia’s Action for Health plan by helping create a healthy workforce and recruit and retain nurses. 

“We want to make sure that nurses remain in health care,” said Nancy McConnell-Maxner, Director of Academic and Community Partnerships, Interprofessional Practice and Learning for Nova Scotia Health.  “We don’t want them to leave the system, and the challenge for new nurses coming in is that it can be overwhelming.  This allows a safe transition to practice in a comfortable, supportive way that we hope keeps them in nursing practice.”

Three cohorts of students have now been through the pilot program, and Cobbett has been evaluating the results.  “Their confidence and their competence increased drastically over the course of this pilot.  It’s increased their coping abilities; it’s increased their resiliency.  Our hope is that as these new grads transition to practice they begin at a place that is beyond where the student coming out of a program with no extra clinical immersion begins.”

That is the kind of feedback Grace Nicely is getting from staff at the Aberdeen Hospital in New Glasgow.  She’s joined their team as a USN as she completes her final year of nursing at St. Francis Xavier University.  “The charge nurses and other people I work with have noticed a big difference in confidence and skills compared to a fourth-year student who is not in the program,” said Nicely.

The USN positions are only open to senior nursing students who have completed 440 hours of clinical practice.  They are placed in units where they will gain foundational nursing skills such as medical, surgical and long-term care. They are not counted as core staff but can perform many of the proficiencies and skills similar to a registered nurse, with minimal supervision. 

 Cobbett is tracking how the students are being received on the floor. “The evaluations showed students felt welcomed on the unit and part of the interprofessional team rather than quote-unquote seen as an additional workload.”

At a time when there is a shortage of nurses, those extra hands can be critical. “They have been really valuable to teams,” said Angela Foote, Professional Practice Leader with Interprofessional Practice and Learning for Nova Scotia Health. “These folks are keen, they want to help, they want to do their best, and that definitely helps other nurses that may be feeling a bit of burnout, to have someone really positive and trying to help out and mobilize the patient or answer the phone.  Those things can be huge in a practice setting,” said Foote.

EIP students are supported by academic and clinical mentors, including retired nurse Leotra Jarvis. “I think it is extremely important that they have a support system and someone they feel they can communicate with outside of the workplace,” said Jarvis.  In her calls, they’ve talked about everything from communication skills to pay dates. 

Those communication skills are essential as students transition from an academic setting to working as part of a health care team.  “Team based care is a requirement of our organization,” said Cindy MacQuarrie, senior director of Interprofessional Practice and Learning at Nova Scotia Health. “Our health care providers need to understand their role and understand the role of others, and this is even more critical now because of our experiences with COVID-19 and the human resources issues that we’re facing in the province.” 

One unique feature of Nova Scotia’s EIP is that students work as much or as little as they want, typically on weekends or during breaks between semesters.  This protects time for academics while earning $25 an hour to offset the cost of their education. “I had one student tell me it was easier for her to work one 12-hour shift weekly than to work three eight-hour shifts in a retail store.  She said I make the same amount of money and I’m also advancing my career and helping to prepare for my transition to practice,” said Cobbett.

The success of the program as a hiring and recruitment tool will be measured. It's hoped that after graduation, USNs will choose to work in hospitals where they’ve trained.  That’s the plan for both Pegg and Nicely. Nicely, from Arisaig, Nova Scotia, has accepted a job in the telemetry unit at Aberdeen Hospital. Pegg, from Toronto, has accepted a two-year contract in the emergency department at Yarmouth Regional Hospital. 

 “Health care is in a really tough spot,” said Pegg. “I just kept thinking about these small rural hospitals and especially this one with a campus right in front of it, who train all these nursing students and then most of them go away. I really just wanted to give back and be part of it for a bit.”