Limitations
All participants in this study were nurses with excellent academic grades. It is possible they were highly motivated and might not have had any difficulty transitioning to the RN role. The principal investigator in this study was a VALOR program coordinator who knew 3 of the study participants—a potential source of bias. It is possible participants did not want to speak negatively about the program for several reasons: the interviewer was their coordinator, they received a salary during the externship, and several worked for the VA at the time of the survey.
Researchers have acknowledged the likelihood that not all VALOR students have positive experiences. It is possible that students with negative experiences did not discuss them or did not participate in the study. Increasing the size of the study sample may have brought in students with negative experiences. There is also the possibility of researcher misinterpretation and bias. Although bracketing was used, it was not possible to eliminate all potential sources of bias from this qualitative study.
Future Research
This is 1 of only 2 studies on the VALOR externship. Given the contradictory findings of these studies—Nuttall reported VALOR experience did not affect students’ transition to the RN role,3 whereas in the present study VALOR students thought the program positively affected their successful transition—additional quantitative and qualitative research is needed.
In addition, the low recruitment rate of VALOR students should be compared with other studies’ recruitment rates. The 38% VALOR extern recruitment rate for the period 2007 to 2012 is lower than the rate for other programs (G. Fuller, August 27, 2014, e-mail communication). The VALOR program does not track retention of participants after employment. Longitudinal studies should compare VALOR participants’ length of employment with that of nonparticipants’.
Conclusion
Externships provide clinical experience outside the classroom, expose students to the realities of nursing practice before graduation, and serve as a recruitment tool for hospitals. These programs, in conjunction with school-based practicums, increase exposure to the clinical environment. Before graduation, students have the opportunity to practice skills, interact with interprofessional staff, and experience different hospital units, all of which contribute to career decisions. The present study found that the VALOR externship helped new graduate nurses with their transition to the workplace. However, it is important to recognize the limitations of this study.
Interviewees indicated they were confident when they were transitioning to their new nurse role and caring for patients before receiving their RN licensure. New graduate nurses discovered they acclimated to the hospital environment quicker. The reality of working day-to-day in a hospital setting allowed students to select a compatible work environment and understand the daily challenges health care professionals encounter. Interviewees shared that they felt “like the RN” during the externship, which lessened the shock of actually assuming the RN role.
Van Manen asserted there is no conclusion or ending to a phenomenological study.26 Continued research on hospital-based externships will demonstrate how these programs can assist in the development of new graduate nurses, ease their transition to practice, and benefit nursing education, practice, research, and public policy.