Content area
Background:
The transition from student to RN is challenging, contributing to high turnover of new graduate nurses (NGNs). Student externships and nurse residency programs (NRPs) bridge academic-practice gaps, contributing to improved NGN retention. This study assesses the impact of student externship participation on NGN outcomes within an NRP.
Method:
The single-hospital study compares NGNs in an NRP who had completed a student externship during nursing school (Student-Extern NGNs) with those who had not (Traditional-Pathway NGNs). Validated surveys were used to collect work experience data, and comparisons were drawn between groups.
Results:
Student-Extern NGNs reported higher mean scores for satisfaction, work effectiveness, organizational commitment, and group cohesion. They also showed a greater increase in self-efficacy and a lower actual turnover rate (10%) compared with Traditional-Pathway NGNs (22%).
Conclusion:
Student externship participation positively influences NGNs' perceptions of their roles and work environment, enhancing satisfaction, commitment, self-efficacy, and ultimately, retention within an NRP.
Full text
The transition from nursing student to RN was viewed as both a challenge and an opportunity by nurse leaders, even before the coronavirus disease 2019 (COVID-19) pandemic. Health care organizations implement nurse residency programs (NRPs) in an attempt to minimize the gap between academia and practice. Some health care organizations are also looking at opportunities to address this challenge by strengthening academic-practice partnerships and developing student externship programs. This article shares a single hospital's outcomes, comparing new graduate nurses in an NRP who completed a student externship program during nursing school with those who did not.
Literature Review
The most recently reported first-year turnover rate was 23.8% (NSI, 2024). Work environment, support systems, and satisfaction are widely known factors that affect the intention of new graduate nurses (NGNs) to leave the organization (Lyu et al., 2024; Shinners et al., 2021). The increased dependency on NGNs as a primary source of staffing means remedies such as academic-practice bridge programs, NRPs, and student externship programs must be effectively implemented to strengthen the workforce pipeline (Africa & Grimley, 2024).
Academic-practice bridge programs create formal relationships between schools of nursing and health care organizations to improve student and staff satisfaction, enhance student performance, and increase the school of nursing's capacity to admit more students (Trepanier et al., 2017). The NGNs who participated in an academic-practice bridge program while in nursing school have shown higher retention of employment compared with those who did not (Trepanier et al., 2017).
Student externship programs, primarily implemented and managed by health care organizations (White et al., 2019b), provide immersive experiences for nursing students as an augmentation to their clinical practicum to experience real-world operations and nursing practice (Ruth-Sahd, 2022; Ruth-Sahd et al., 2010). Although the nursing clinical practicum serves as the primary method by which nursing students learn to apply foundational nursing skills and competencies, there is a tremendous variation in clinical practicum hours (Liu et al., 2022). Clinical simulation in lieu of clinical practicum hours in prelicensure nursing education also added complexity in ensuring that nursing students receive the necessary exposure and quality experience in a clinical environment (Hayden et al., 2014). Nursing students participating in student externship programs benefit from understanding the real world of health care, the nursing profession, and the organization's culture (White et al., 2019a). Santiago et al. (2024) reported that student externship program participants believed that the experience served as the foundation for their clinical practice.
Conversely, NRPs focus on supporting NGNs' transition to practice after completion of their academic experience. Health care organizations implement NRPs to bridge academic-practice gaps and ease NGNs' workforce transition (Goode et al., 2018; Spector et al., 2015; Ulrich et al, 2010). The American Academy of Nursing recommended that all NGNs participate in an NRP to support their transition to practice (Goode et al., 2018).
Much of the literature focuses on the experience of nursing students in externship programs or NGNs in an NRP (Trepanier et al., 2017). What is not well documented is the comparison between the experience of NGNs in an NRP who have participated in a student externship program while attending nursing school and that of NGNs who did not.
Background
Bakersfield Memorial Hospital is Kern County's largest health care facility, handling more than 94,000 emergency department visits and 16,000 admissions annually. As a critical stakeholder in the local health care infrastructure, Bakersfield Memorial Hospital is vital in delivering comprehensive care to an underserved and medically complex community. It provides a broad range of medical services, including Joint Commission–accredited stroke, chest pain, and total joint programs, and it has the area's only pediatric intensive care and burn intensive care units.
Bakersfield Memorial Hospital has been implementing a year-long NRP in partnership with a national provider of NRPs and has partnered with local schools of nursing to implement a formalized student externship program. Table 1 compares the student externship program and the NRP at Bakersfield Memorial Hospital.
| Variable | Student externship | Nurse residency |
|---|---|---|
| Participants | Referred to as student externs, nursing students enrolled in a nursing program | NGNs who completed their academic requirements, had less than 6 months of employment experience, and were RNs |
| Both NGNs who participated in the student externship program (Student-Extern NGNs) during nursing school and those who did not (Traditional-Pathway NGNs) | ||
| Requirements | Enrollment in a nursing program | Hired as employees |
| Completion of employment application and panel interview | All NGNs required to participate | |
| Participation not required during nursing school | Completion of a student externship program during nursing school not required | |
| Employment status | Paid clinical immersion | Paid employment |
| No guarantee of employment after completion | ||
| Program length | One to two semesters, based on application cycle | Year-long program |
| Clinical experience | Rotation through multiple units with assigned preceptors | Hired directly into a unit with assigned preceptors |
Student Externship Program at Bakersfield Memorial Hospital
Although it was not mandatory, a student externship program was implemented at Bakersfield Memorial Hospital in an effort to strengthen academic partnerships and improve the retention of NGNs. The externship program provides nursing students, at a minimum, a 75-hour paid clinical immersion opportunity to foster organizational enculturation and enhance competency in high-acuity specialties under the supervision of a trained preceptor employed by the organization. Student externship program applicants benefit from the experience of a professional application and formal interview process. At least two semesters of nursing school must be completed, and school officials must validate good standing before a participant can start the program. Talent acquisition team members and experienced nurse leaders conduct the panel interview. The student externship program occurs each spring, summer, and fall. Nursing students were assigned to multiple units, working with preceptors to meet specific objectives outlined by academic partners. Lists of high-risk skills that may not be performed, such as procedural sedation, defibrillation, and advanced life support drug administration, are provided to both nursing students and preceptors during the onboarding process to ensure safe and effective patient care.
Between August 2022 and July 2024, 43 of the 47 nursing students who participated completed the student externship program. Thirty-nine applied for employment after graduation and received employment offers. Thirty were hired as NGNs in the NRP between March 2023 and August 2024.
Nurse Residency Program at Bakersfield Memorial Hospital
During the year-long NRP, NGNs complete a learning needs assessment to identify knowledge gaps and learning styles. Appropriate learning materials, didactics, and resources are provided to remediate competency gaps and develop critical thinking through simulation and case study activities. Competencies encompass clinical and professional skills to provide safe, effective, high-quality, patient- and family-centered care. The NGNs are assigned specialty-specific competency profiles that guide the immersion experience in easy-to-follow steps that allow assessment, measurement, and validation of a new graduate's skill level from novice to expert by a nurse preceptor. The NGNs are expected to be validated on 100% of their competencies before practicing independently.
Method
The program evaluation included two groups of NGNs hired between March 2023 and August 2024: NGNs who participated in the student externship program during nursing school (Student-Extern NGNs) and those who did not (Traditional-Pathway NGNs). This article highlights and compares evaluation results between the two groups.
Both groups completed their academic requirements, obtained licensure to practice as RNs, and were hired by the organization as NGNs in the NRP across nine department types: critical care, acute care/medical-surgical, float pool, maternal/child health, emergency services, neonatal intensive care, pediatric acute care/medical-surgical, pediatric float pool, and pediatric critical care/intensive care units.
Of the Student-Extern NGNs, 70% had a bachelor's degree and 30% had an associate's degree. Of the Traditional-Pathway NGNs, 46% had a bachelor's degree, 52% had an associate's degree, and 2% had a master's degree.
Valid and reliable survey instruments with the greatest impact on NGN turnover intent were used as part of implementing and evaluating the national NRP used at Bakersfield Memorial Hospital (Shinners et al., 2021). Demographics and self-efficacy were completed at the beginning of the NRP and at 100% competency validation, which determines when NGNs can practice independently. Satisfaction, organizational commitment, conditions of work effectiveness, group cohesion, and turnover intent data were collected at 100% competency validation. Actual turnover was obtained from the human resources department. Descriptive statistics were conducted, and comparisons between the two groups were completed. Because the NRP uses the survey results as part of internal program evaluation and quality improvement, institutional review board approval was not obtained (Bass & Maloy, 2020). The NGNs were notified that completing the surveys was not mandatory.
Results
Respondents included 175 NGNs (30 participated in the student externship program during nursing school). Because survey completion was not mandatory, the number of NGNs who completed the surveys varied, as indicated in Table 2.
| Subscale | Student-extern NGNs | Traditional-pathway NGNs |
|---|---|---|
| Satisfaction | n = 18 | n = 69 |
| Total | 4 | 3.78 |
| Work satisfaction | 4.18 | 3.89 |
| Satisfaction with colleagues | 4.37 | 4.14 |
| Salary | 3.13 | 3.08 |
| Conditions of work effectiveness | n = 16 | n = 58 |
| Total | 4.57 | 4.24 |
| Access to information | 4.38 | 4.18 |
| Access to support | 4.71 | 4.33 |
| Rewards and recognition | 4.22 | 3.73 |
| Availability of opportunities | 4.85 | 4.56 |
| Organizational commitment | n = 16 | n = 61 |
| Total | 4.15 | 3.90 |
| Group cohesion | n = 16 | n = 62 |
| Total | 4.34 | 4.09 |
| Productivity | 4.38 | 4.06 |
| Efficiency | 4.31 | 4.03 |
| Morale | 4.25 | 3.95 |
| Belongingness | 4.19 | 3.97 |
| Personal feelings | 4.44 | 4.29 |
| Working together | 4.5 | 4.26 |
| Self-efficacy | ||
| Beginning of program | 3.83 (n = 18) | 3.88 (n = 84) |
| 100% competency validation | 4.43 (n = 13) | 4.09 (n = 52) |
Satisfaction Survey
The 21-item Satisfaction Survey included three subscales: Work Satisfaction, Satisfaction, and Salary using a Likert scale with responses ranging from 1 (strongly disagree) to 5 (strongly agree). The Student-Extern NGNs' total mean score was higher than that of their counterparts (4 and 3.78, respectively). Student-Extern NGNs reported a higher mean score (4.18) than Traditional-Pathway NGNs (3.89) for the Work Satisfaction subscale (perception of having enough time available for patient care). Student-Extern NGNs also reported a higher mean score on the Satisfaction With Colleagues subscale (4.37 and 4.14, respectively). The Salary subscale had the lowest mean score for both Student-Extern NGNs (3.13) and Traditional-Pathway NGNs (3.08).
Conditions of Work Effectiveness Questionnaire
The Conditions of Work Effectiveness Questionnaire is an 11-item survey with four subscales: Access to Information, Rewards and Recognition, Access to Support, and Availability of Opportunities (Laschinger et al., 2000, 2001). The questionnaire uses a Likert scale with responses ranging from 1 (none) to 5 (a lot). The total mean score was higher for Student-Extern NGNs (4.57) than for Traditional-Pathway NGNs (4.24). The Availability of Opportunities subscale had the highest mean score for both groups (4.85 for Student-Extern NGNs and 4.56 for Traditional-Pathway NGNs). Conversely, the Rewards and Recognition subscale had the lowest mean score for both Student-Extern NGNs (4.22) and Traditional-Pathway NGNs (3.73).
Organizational Commitment Questionnaire
The Organizational Commitment Questionnaire is a 15-item survey using a Likert scale with responses ranging from 1 (strongly disagree) to 5 (strongly agree) measuring commitment to the organization based on one's identification with an organization's goals and values, willingness to exert considerable effort for the organization, and desire to stay at the organization (Porter et al., 1974). Student-Extern NGNs reported a higher mean score (4.15) than the Traditional-Pathway NGNs (3.90).
Group Cohesion Survey
Group cohesion was measured using a six-item survey asking about perceptions of the work environment's productivity, efficiency, morale, belongingness, personal feelings, and working together using a Likert scale with responses ranging from 1 (very much below average) to 5 (very much above average) (Good & Nelson, 1973). The total mean score was 4.34 for Student-Extern NGNs and 4.09 for Traditional-Pathway NGNs. The Personal Feelings subscale had the highest mean score for both Student-Extern NGNs (4.44) and Traditional-Pathway NGNs (4.29). Among Traditional-Pathway NGNs, the Morale subscale was rated lowest (3.95) and the Belongingness subscale was second lowest (3.97). Alternatively, the Belongingness subscale was rated lowest among Student-Extern NGNs at 4.19 and the Morale subscale was second lowest at 4.25.
Self-Efficacy Survey
Respondents to the 19-item Self-efficacy Survey rated their confidence level to independently perform basic nursing competencies using a Likert scale with responses ranging from 1 (strongly disagree) to 5 (strongly agree). At the beginning of the NRP, the Student-Extern NGNs' mean score was 3.83, increasing to 4.43 at 100% competency validation. The Traditional-Pathway NGNs mean score at the beginning of the NRP was 3.88 and increased to 4.09 at 100% competency validation.
Turnover Intent
Respondents were asked about their intent to leave the organization within the next year using a 5-point Likert scale with responses ranging from 5 (strongly disagree) to 1 (strongly agree). Both groups indicated low intent to leave (Figure 1). A small percentage (6%) of the Traditional-Pathway NGNs reported a neutral score.
Actual Turnover
Actual turnover rates were lower among Student-Extern NGNs (10%) compared with the Traditional-Pathway NGNs (22%). Of the Traditional-Pathway NGNs who left the organization, six were terminated due to performance issues. Student-Extern NGNs who left the organization cited personal issues, including pursuing higher education and family illness.
Discussion
Data analyses indicated that Student-Extern NGNs have a more positive perception of their role and work environment compared with the Traditional-Pathway NGNs. These results are important because satisfaction, conditions of work effectiveness, and organizational commitment influence NGNs' intent to leave (Shinners et al., 2021).
Student-Extern NGNs reported higher mean scores in work satisfaction and satisfaction with colleagues compared with Traditional-Pathway NGNs. Student-Extern NGNs' additional opportunities to develop time management, organizational skills, and exposure to the work environment and workforce dynamics may have affected the scores. Salary, the lowest mean score for both groups, is of concern because AMN Healthcare (2024) reported that 75% of nurses surveyed indicated that better pay affects their satisfaction with employment.
New graduate nurses enter a complex and stressful health care environment. A healthy work environment is necessary for well-being and satisfaction (Gutiérrez-Fernández et al., 2024). In recent years, health care organizations have attempted to establish rewards and recognition programs (Grubaugh et al., 2023). Both groups in our study agreed that factors influencing work effectiveness are present in their organization. However, the Rewards and Recognition subscale had the lowest score for both groups, which can suggest that NGNs may not consider the rewards and recognition programs meaningful, or that the programs must be highlighted more effectively.
Organizational commitment is significantly correlated with intent to leave (Lyu et al., 2024; Shinners et al., 2021). Student-Extern NGNs' higher organizational commitment mean score compared with the Traditional-Pathway NGNs might be a demonstration of reciprocity for the time and resource investment the organization made during the student externship program.
Work group cohesion influences performance (Wei et al., 2024), making it vital for leaders to develop a cohesive work environment. Both groups indicate positive interactions and strong emotional connections with their work environment. Surprisingly, Morale and Belongingness were the two lowest rated subscales for both groups. Morale's critical impact on work and productivity must be considered. Not all Student-Extern NGNs completed the student externship program in the same department they were hired into, which might have affected their sense of belonging. This might also have affected the Student-Extern NGNs' lower self-efficacy score at the beginning of the NRP. However, the Student-Extern NGNs' mean score increased from 3.83 to 4.43, a 15.67% change, compared with their counterpart, which increased from 3.88 to 4.09, a 7.63% change. The higher percentage change among Student-Extern NGNs may be attributed to their length of experience at the organization, where they developed a stronger comfort level with the patient population.
Turnover intent is the strongest predictor of actual turnover (Shinners et al., 2021; Ulrich et al., 2010). All Student-Extern NGNs indicated that they did not intend to leave the organization within the next year. The small number of Traditional-Pathway NGNs who reported a neutral score might be at risk for leaving because the likelihood of NGNs intending to leave who responded with a neutral score can be up to 63% (Shinners et al., 2021). Although a formal correlation study was not conducted as part of this analysis, the lower turnover rate among Student-Extern NGNs of 10% compared with the Traditional-Pathway NGNs' turnover rate of 22% suggests that a student externship program may affect an NGN's retention.
Implications
Early exposure and immersion in a clinical environment have been shown to decrease nursing student anxiety and improve clinical decision-making (White et al., 2019b). An NRP length of 6 months to a year is recommended to support NGN transitions (Goode et al., 2018; Spector et al., 2015). Student externship programs before employment as NGNs provide opportunities to reinforce skills, facilitate relationship building, and increase self-confidence. Student externship programs can serve as a talent pipeline for organizations. Nurse leaders and nursing professional development practitioners can identify and cultivate potential NGNs for employment, whereas nursing students can gain first-hand experience in understanding organizational attributes aligned with their values. Collaboration between academic institutions and health care organizations is crucial to improving quality care while simultaneously supporting the development of students, practicing nurses, educators, and clinical leaders (Phillips et al., 2019; Trepanier et al., 2017). Nursing professional development practitioners are in a unique position to foster academic-practice partnerships and relationships through programs that support NGN transitions.
Limitations
The student externship program has been beneficial for the organization and the NRP NGNs. However, this study has several limitations. Only a small number of student externship program participants were hired as employees. Less than 60% of both Student-Externship NGNs and Traditional-Pathway NGNs completed the survey when they reached 100% competency validation. This study was limited to a single hospital. Finally, because this was not a research study, the authors cannot infer causality or determine relationships as part of the evaluation and analysis.
Conclusion
Both recruitment and retention of a skilled nursing team are essential to ensure delivery of high-quality care and operational efficiency. Student externship programs are an innovative and effective intervention to encourage organizational enculturation and improve NGNs' self-efficacy, satisfaction, organizational commitment, and conditions of work effectiveness. These programs allow NGNs to reconcile the disconnect between academic learning and real-world nursing practice. Although this study demonstrated more favorable outcomes for NGNs who completed a student externship program compared with those who did not, conducting a financial analysis would further underscore the benefits of investing in such programs.
Africa, L., & Grimley, K. (2024). Createaburning platform for the C-suite: Investing in the nursing workforce today forasustainable tomorrow. Nurse Leader, 22(6), 773–777. 10.1016/j.mnl.2024.07.012
AMN Healthcare. (2024). 2024 nurse pulse survey. https://www.amnhealthcare.com/amn-insights/nursing/whitepapers/2024-Nurse-Pulse-Survey/
Bass, P. F., III, & Maloy, J. W. (2020). How to determine ifaproject is human subjects research,aquality improvement project, or both. The Ochsner Journal, 20(1), 56–61. 10.31486/toj.19.0087 PMID: 32284684
Good, L. R., & Nelson, D. A. (1973). Effects of person-group and intragroup attitude similarity on perceived group attractiveness and cohesiveness: II. Psychological Reports, 33(2), 551–560. 10.2466/pr0.1973.33.2.551
Goode, C. J., Glassman, K. S., Ponte, P. R., Krugman, M., & Peterman, T. (2018). Requiringanurse residency for newly licensed registered nurses. Nursing Outlook, 66(3), 329–332. 10.1016/j.outlook.2018.04.004 PMID: 29724451
Grubaugh, M., Africa, L., & Neisinger, K. (2023). Managing the current workforce: Status of new graduate nurse well-being and clinical development 2018–2021. Nursing Administration Quarterly, 47(3), 257–268. 10.1097/naq.0000000000000585
Gutiérrez-Fernández, E., Amo-Setién, F., César, L. C., Concepción, S. S., Roberto, M. M., Jesús, M. M., & Carmen, O. M. (2024). Effectiveness of intervention programs aimed at improving the nursing work environment:Asystematic review. International Nursing Review, 71(1), 148–159. 10.1111/inr.12826 PMID: 36646079
Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN national simulation study:Alongitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S3–S40. 10.1016/S2155-8256(15)30062-4
Laschinger, H. K., Finegan, J., Shamian, J., & Casier, S. (2000). Organizational trust and empowerment in restructured healthcare settings: Effects on staff nurse commitment. Journal of Nursing Administration, 30(9), 413–425. 10.1097/00005110-200009000-00008
Laschinger, H. K., Finegan, J., Shamian, J., & Wilk, P. (2001). Impact of structural and psychological empowerment on job strain in nursing work settings: Expanding Kanter's model. Journal of Nursing Administration, 31(5), 260–272. 10.1097/00005110-200105000-00006
Liu, Y., Wang, L., Shao, H., Han, P., Jiang, J., & Duan, X. (2022). Nursing students' experience during their practicum in an intensive care unit:Aqualitative meta-synthesis. Frontiers in Public Health, 10, 974244. 10.3389/fpubh.2022.974244 PMID: 36249222
Lyu, X. C., Huang, S. S., Ye, X. M., Zhang, L. Y., Zhang, P., & Wang, Y. J. (2024). What influences newly graduated registered nurses' intention to leave the nursing profession? An integrative review. BMC Nursing, 23(1), 57. 10.1186/s12912-023-01685-z PMID: 38243209
NSI Nursing Solutions, Inc. (2024). 2024 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf
Phillips, J. M., Phillips, C. R., Kauffman, K. R., Gainey, M., & Schnur, P. L. (2019). Academic-practice partnerships:Awin-win. The Journal of Continuing Education in Nursing, 50(6), 282–288. 10.3928/00220124-20190516-09 PMID: 31136672
Porter, L. W., Steers, R. M., Mowday, R. T., & Boulian, P. V. (1974). Organizational commitment, job satisfaction, and turnover among psychiatric technicians. Journal of Applied Psychology, 59(5), 603–609. 10.1037/h0037335
Ruth-Sahd, L. (2022). Experiences and perceptions gained by student nurse externs working duringapandemic. Nursing Education Perspectives, 43(4), 238–240. 10.1097/01.NEP.0000000000000939 PMID: 35234216
Ruth-Sahd, L. A., Beck, J., & McCall, C. (2010). Transformative learning duringanursing externship program: The reflections of senior nursing students. Nursing Education Perspectives, 31(2), 78–83 PMID: 20455362
Santiago, C., Weiser, N., Bellicoso, D., Vingoe, K., McShane, J., Benny, N., Beswick, S., Valenzano, T. J., Topolovec-Vranic, J., van Biljouw, T., & Harris, A. (2024). Perceptions of and experiences inaclinical externship program during the COVID-19 pandemic. Nursing Leadership(Toronto, Ont.), 37(1), 64–80. 10.12927/cjnl.2024.27355 PMID: 39087274
Shinners, J., Africa, L., Mallory, C., & Durham, H. (2021). Versant's nurse residency program:Aretrospective review. Nursing Economics, 39(5), 239–246. 10.62116/NEC.2021.39.5.239
Spector, N., Blegen, M.A., Silvestre, J., Barnsteirner, J., Lynn, M.R., Ulrich, B., Fogg, L., & Alexander, M.. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 26(1) 53–57. 10.1016/S2155-8256(15)30031-4
Trepanier, S., Mainous, R., Africa, L., & Shinners, J. (2017). Nursing academic-practice partnership: The effectiveness of implementing an early residency program for nursing students. Nurse Leader, 15(1), 35–39. 10.1016/j.mnl.2016.07.010
Ulrich, B., Krozek, C., Early, S., Ashlock, C. H., Africa, L. M., & Carman, M. L. (2010). Improving retention, confidence, and competence of new graduate nurses: Results froma10-year longitudinal database. Nursing Economics, 28(6), 363–376 PMID: 21291057
Wei, H., Zhang, S., Qu, W., Liu, M., Yan, Z., & Luan, X. (2024). The association between team cohesion and performance:Anetwork analysis of nurses. Nursing & Health Sciences, 26(1), e13089. 10.1111/nhs.13089 PMID: 38356046
White, K. A., Fetter, M. E., & Ruth-Sahd, L. A. (2019a). Considering the benefits of student nurse externship programs. Nursing, 49(9), 58–59. 10.1097/01.NURSE.0000577728.62251.d1 PMID: 31436725
White, K. A., Fetter, M. E., & Ruth-Sahd, L. A. (2019b). Extern programs promote confidence and reduce anxiety with clinical decision making in nursing students. Nurse Educator, 44(5), 239–244. 10.1097/NNE.0000000000000625 PMID: 30418342
From Healthcare Workforce Solutions-Ascend Learning, Burlington, Massachusetts (LA); and Bakersfield Memorial Hospital, Bakersfield, California (JW, RS).
Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
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