Nurse Extern Job Duties

[PaigeD]

Hello! I am currently working as a Nurse Extern in a pediatrics clinic and I am trying to track down my job description without causing a stir. I was working with nurses at the clinic while I was on orientation, but now that my training period is done, I am working independently as a rooming nurse. I do medication reconciliations, take vitals and chart, and administer nebulizer treatments and immunizations. I am a CNA as well so I know my scope of practice in that position, but I can't help but feel like I should not be working this independently at my externship.

I asked my supervisor if I could come in on shifts when I am not covering for other nurses (Yes I work in place of registered RNs), so I can shadow and actually learn more, but I was turned down. I feel like I am basically just functioning in the RN role at this clinic but being paid much less. If I was one of the parents of the children I take care of, and I knew that my child was not only being taken care of by an extern who doesn't have a license, but that there wasn't a nurse behind the scenes even checking any of her work or supervising, I would be furious. In my gut I feel like this is wrong, but I can't confront my supervisor about it because she is passive aggressive and truthfully not very nice. I don't want to step outside my bounds, but I also do not want to loose my position as an extern because I know it will look good on applications in the future.

What should I do?!

[Sour Lemon]

That doesn't sound like an RN role, to me. The medical assistants at my doctor's office do the same things, and they are not nurses of any kind. They draw blood, runs labs and do patient teaching, too.

[PaigeD]

I hear what you're saying, but I am not licensed or registered as a MA or an LPN either. I am a nursing student. I feel capable of doing what I am doing, but I'm concerned because in all Nurse Extern job descriptions it states that everything is done "under close supervision of a RN".

[Sour Lemon]

I hear what you're saying, but I am not licensed or registered as a MA or an LPN either. I am a nursing student. I feel capable of doing what I am doing, but I'm concerned because in all Nurse Extern job descriptions it states that everything is done "under close supervision of a RN".

It may depend on the state, but in some places a medical assistant only needs a GED and on the job training ...and the GED might even be optional. "Close supervision of an RN" may simply mean that an RN has determined your competency. As RNs, we also supervise and delegate to CNAs ...but we don't literally stand over them and supervise. Once we know that they know what they're doing, they normally take some initiative and require very little direction.

[Apples&Oranges]

Unless you left something out, nothing that you are doing would fall under "nursing" duties. Contrary to popular belief, very little of what real nurses DO are tasks like this. Your job sounds like more of an MA or office assistant position. Most people who complete these tasks have no formal training at all, other than a week long orientation. Other than the respiratory treatments, which unlicensed parents do all the time, you are not performing "nursing" duties. It will look great on a resume, and may lead to a real nursing job, but I don't think you have any reason to worry.

[llg, PhD, RN]

It sounds to me like this is a case of different expectations and conceptualizations of what an extern role is.

There are 2 differing conceptualizations of extern roles. One is that the extern is viewed as an source of inexpensive labor. The extern is hired to do tasks that can be done by and RN, but that can also be done by a CNA, MA, etc. The other conceptualization is that an extern is there to learn -- to work closely with an RN preceptor to acquire nursing skills. In the first view (cheap labor), the purpose is to get the tasks completed while paying less money than you would pay someone with a higher level of education/licensure. In the second view, the purpose is to train nursing students to better prepare them for RN roles and hopefully, recruit them to work for you as an RN after they graduate.

Different extern programs emphasize different aspects of the role. Some emphasize the cheap labor aspect: others emphasize the education 7 recruitment aspect. I think most programs do some of both ... but the emphasis varies.

It seems to me as if the OP has been hired into a program that strongly emphasizes the first aspect -- the cheap labor aspect. However, what she really wants is an extern program that emphasizes the learning/recuitment aspects. It's a mismatch of expectations. So ... it's just a matter of coming to terms with the fact that the employer has a different agenda than the extern. The extern has to decide whether or not that particular externship is worth it or not to her.

Good luck with whatever you decide!

[PaigeD]

Thank you for your response. I was under the impression that all nurse extern positions were made for the purpose of educating and training prospective nursing staff. Although I'm not thrilled about being a source of cheap labor, it does make me feel better knowing that this is something that does happen.