What is a clinical extern?
In November 2020, staffing levels at hospitals were becoming more and more dangerous. As an effort to provide some relief to the hospitals, the province of Ontario created the Clinical Extern position. Clinical Externs are nursing students, paramedic students, physiotherapy or occupational therapy students. Externs are there to help with floor duties and are paid between $16-$25/hour depending on the hospital. Generally, externs are hired on a part-time casual basis but can work full-time hours. The contracts are typically one year and will be eligible for renewal for as long as the government continues to provide funding and for as long as the hospital still wants to keep the extern program going.
To Become an Extern:
I can only speak to the process of hiring for Sunnybrook, but I don’t think there is a significant difference between hospitals.
My long-term care placement was at the Sunnybrook Reactivation Care Centre in North York. In March of 2023, I got an email from HR saying that Sunnybrook was holding an information session for anyone interested in transitioning from clinical student to staff. I attended the session and took notes on what the recruiters wanted in the application. At the end of the session, they provided us with their direct emails and asked that anyone interested in a position email them a cover letter and resume, and asked us to fill out the online application as well.
After the Clinical Extern recruiter sent my application to the hiring manager, the manager reached out to me to schedule an interview. After the interview, I was asked to fill out a more formal application form that included 3 references and my school transcripts. Once all of that was in, it was pretty much a waiting game. It was a good two weeks from the time of my interview to the time I got the job offer. Even after everything was put together and my references had been checked; I followed up with HR and she still had to attend one more meeting before I got a definite answer. Note: I highly recommend following up with HR periodically throughout the process. It shows that you’re invested in the job and every organization wants people that really want to be there. From the time that I applied to the time I got the offer, it was approximately one month.
The Scope of an Extern:
Sunnybrook has two levels of Clinical Externs. Everyone starts off at level one. When you start, you’ll be doing a lot of ADL’s, vital signs, and assisting the nurses with the more controlled tasks. My unit is Burns, Trauma, and Complex Care Rehabilitation; so while I am unable to perform wound or burn care by myself, the nurses were quite willing to teach me and have me assist in those tasks. Once you move into level two, you’re able to give non-controlled PO medications, check glucose levels, insert and remove Foley Catheters, and provide low-flow oxygen. After you’ve completed your day two training, you need to be supervised by a nurse 1-3 times minimum to be signed off to perform these tasks unsupervised. Even once you can perform these autonomously, everything needs to be clearly documented by both the extern and the nurse, and each task needs to be formally delegated by the nurse to the extern.
Clinical Extern interview
You’ll be asked some customer service-based questions like Tell me about a time that you encountered conflict at a previous job and how you resolved the situation. You’ll also be asked some clinical situation questions such as: “You walk into a patient’s room and notice they are lying down and struggling to breathe. Their SpO2 is 88% and you notice they have an inhaler at their bedside. What do you do? Hint: you’re not allowed to administer inhaled medications as an extern. Another question they may ask is one in which there is a situation where you are asked to do something outside of the extern scope of practice. How would you respond? They will likely ask you how your school clinical placements will help you in the job and talk to you about any acute care experience you have. Toward the end of the interview, they’ll ask you about your career goals and where you would see yourself working after graduation. In hiring Clinical Externs, the organization is really hoping to hire their future nurses. So if you’re going through the process and it seems cumbersome or over the top, remember they want to keep you for years to come.
You’ll Narrow Down Your Interests:
Being a Clinical Extern gives you a much clearer picture of life as a nurse than most clinical placements. This is especially true if you work full-time or close to full-time hours as an extern. You start to see patterns in behaviour of staff and patients and you gain a better understanding of what you do and don’t like about the job which can help you narrow down the type of unit or area of nursing you want to pursue. Further, shadow shifts were offered to all clinical externs at Sunnybrook. I had the opportunity to spend a day in the Ross Tilley Burn Centre which is one of very few burn ICU’s. It was very valuable to see burn patients in their acute state; I’m used to seeing burns that are mostly healed and progress very quickly. After spending the day in the burn centre I had a better understanding of ICU’s and I came to the realization that a trauma unit would likely be better for me.
My Favourite Part of the Job:
My favourite part of this job was learning and participating in burn and wound care. I've been planning on specializing in wound care so seeing everything from burns to surgical wounds to cellulitis has been very valuable.
The Hardest Part of the Job:
The emotional toll of the job was significant at times. Some of the burn patients were suicide survivors, some of them were victims of assault, and others perhaps had a lapse in judgment for which the consequences are lifelong. For the rest of my career, I’ll always remember my first patient; he spent four months in the acute care burn centre followed by four months in rehab. When he left, I was overjoyed to see how he had progressed even in just the time that I spent with him, but I still miss seeing him every day when I go in for my shift. I wish him only the best.
To Conclude
Go in with an open mind, and go in to learn. Master the basics of nursing and take advantage of whatever specialized skills your unit requires. I would have avoided burn care at all costs, but it ended up being my favorite part of the job.
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