Expanding the borders of public health nursing student externships

Background: Numerous reports draw attention to continuing disparities in the health of minority populations, a dire shortage of public health nurses, and better preparation of student ability to care for poor, underserved, and racially/ethnically diverse minority populations. This presentation will share the evaluation results of a 3 year project to fund undergraduate nursing student summer externships in underserved rural and racial/ethnic community settings with the goal of increasing students' cultural competence, providing service to underserved communities, and, ultimately, increasing the number of students who choose to work in community-based settings that serve poor and underserved minority populations. This project expanded externship opportunities outside of hospitals to agencies that previously did not have the infrastructure or financial resources to support paid externships. Methods: We recruited and placed 8 externs (nursing students who completed their junior BSN year) in community-based settings serving rural and underserved populations (health departments and community health centers), 13 externs in year 2, and 11 externs in year 3. Agencies and externs signed a letter of agreement clarifying the nature of the project (the university paid the stipends through a grant award) and the agency provided opportunities for an externship similar to that of an employer/employee relationship. Externs completed paper assignments related to the externship for a course. Statistical testing with ANOVA was used to compare the results of each extern's pre- and post-cultural competence tests, and qualitative analysis using thematic analysis examined the textual data from an exit interview and a short survey before graduation. Results: Eighty-four percent of the externs were very satisfied with the externship, cultural competence post-tests improved, 97% of the externs indicated their cultural skills improved, and almost all expressed a strong interest in working in a similar public health setting during their nursing career. Nine externs were offered additional summer, part-time work, or job offers upon graduation. Externs identified low salary as the main barrier to future work. Conclusions: The PHN student externship is a promising model to foster interest in public health and improve cultural competence. Challenges exist with funding the externships and offering competitive salaries in public health settings.