Data Collection and Analysis
Data collection began in March 2013 with a pilot test of the interview questions for appropriateness. Open-ended, semistructured questions were used to elicit nurses’ descriptions of their experience. Field notes were written, and all interviews were tape-recorded and professionally transcribed verbatim. Data saturation was reached after 12 nurses were interviewed. Transcripts were analyzed and interpreted using van Manen’s line-by-line approach.26 All 12 interviewees were invited to review the findings of the data analysis. Eleven of the 12 interviewees verified and validated the study findings.
Rigor using Lincoln and Guba’s criteria of credibility, dependability, transferability, and confirmability added trustworthiness to the study findings. Bracketing helped eliminate potential bias.27 Credibility was achieved with prolonged engagement and triangulation. To further enhance credibility, the authors invited qualitative research experts to validate the emerging themes and create an audit trail. For dependability, a flow chart was created for use by researchers who might want to replicate the study. Rich, lengthy descriptions and interviewees’ quotations were provided so researchers could judge the study’s transferability to other settings. Maintaining an audit trail and having a doctor of nursing practice independently code the data aided with confirmability. This study used findings from the literature, audio recordings, member checking, and field notes to assess data accuracy.
Results
The overarching theme discovered in this study was confidence. Subthemes were transitioning to the RN role, making decisions, and interacting with interprofessional staff.
Confidence
Interviewees felt confident in transitioning to the RN role, making decisions, and interacting with interprofessional staff. They shared that they had applied to the externship to gain additional clinical experience and that the program increased their self-confidence with respect to transitioning to the new role as RN. However, it is possible that these interviewees were highly motivated and would not have had difficulty transitioning to the RN role—this is addressed in the Limitations section of this article.
Interviewees said they initially approached VALOR with fear and apprehension but completed it feeling confident about becoming an RN. One interviewee stated, “The VALOR program gave me the confidence in my own abilities, so I was not scared and had confidence that, yes, I could do this job.” Another said, “Honestly, the entire externship program, regardless of which question you ask, my answer is going to always fall back on confidence. I became prepared for the RN job, I feel, before I graduated because of the [externship] experiences.”
Transitioning to RN Role
Transitioning involved understanding the RN’s scope of practice and feeling clinically competent. Students worked 40 hours a week over the summer and gained firsthand insight into working as an RN daily. Interviewees believed completing the externship made it easy to transition to the RN role because they knew what to expect.
Working side-by-side with nurses, students gained insight into RNs’ responsibilities and scope of practice. Interviewees reported that, after the externship, they had a better understanding of their patient care and licensure legal responsibilities.
Students began to feel clinically competent during the externship. Interviewees shared that they had had several opportunities to practice basic skills, such as giving injections. One interviewee said, “I don’t think I tried to stick a single IV when I was in school or in clinical [training].” Interviewees also commented that repeatedly practicing skills increased their self-confidence.
Students also gained firsthand insight into working with veterans and their families. During the externship, they learned about communicating therapeutically, providing education for caregivers, and advocating for patients and their families. Before the externship, they felt apprehensive about communicating with patients. One interviewee said that after the program, “Eventually you had to talk to patients, and eventually figured it out that it wasn’t so scary.”
Students found that patients were not always happy with their care, and procedures did not always go as planned. They also discovered that education did not end with the patient; family members needed education as well. The externship experience heightened students’ awareness of the RN’s role as patient advocate. One interviewee explained it is the RN’s responsibility to intervene on the patient’s behalf. Interviewees were surprised that patients would not tell their health care provider that they did not understand what was said or that they wanted another course of treatment.
The externship helped decrease learning-related stress. Interviewees indicated they had learned without fear of reprisal. One described feeling free to learn: “Uninhibited learning...you can ask what you need to without fear of not graduating.” Externship students were able to focus on learning the RN role without worrying about the next test or grade. They felt free to ask questions without fear of failing their clinical rotation.