CLINICAL COMPETENCE AND CLINICAL ENVIRONMENT: A COMPARATIVE STUDY OF NURSE EXTERNS AND NON-EXTERNS

Abstract

ABSTRACT CLINICAL COMPETENCE AND CLINICAL ENVIRONMENT: A COMPARATIVE STUDY OF NURSE EXTERNS AND NON-EXTERNS by Sherri Ann Hanrahan The University of Wisconsin-Milwaukee, 2025Under the Supervision of Professor Julia Snethen Background: Student nurse externship programs historically increase during nursing shortages or patient care demands. Today’s healthcare environment faces challenges, including significant nursing shortages and rising patient acuity, making it essential to examine externship perceptions. This study compares how externship participation impacts perceived clinical competence and evaluations of the clinical environment versus non-externs.Methods: A quasi-experimental, cross-sectional correlation design was conducted with 46 nursing students (35 externs, 11 non-externs) from two Midwestern baccalaureate programs. Participants completed two validated self-report measures via Qualtrics or in-person surveys. Descriptive statistics summarized characteristics. Between-group differences were tested using ANCOVA, controlling for age, healthcare experience, BSN track, and weekly clinical hours. Pearson’s r and Spearman’s ρ examined relationships between perceived competence and clinical environment; moderation analyses explored interaction effects of externship status and environmental factors. Results: Externs reported slightly higher adjusted mean scores than non-externs across general-performance, core nursing skill, and advanced skills, yet none reached statistical significance (p > .05). ANCOVA showed no main effect of externship participation on overall perceived competence (F(1,40) = 1.72, p = .20, η² = .04), and effect sizes were uniformly small (η² < .06), indicating limited practical impact. SECEE Learning Opportunities and Preceptor Facilitation subscales demonstrated moderate positive correlations with overall competence (r ≈ .30, p < .05), but externship status did not significantly moderate these relationships. Stratified analyses revealed a strong association between Core Nursing Skills and overall competence among externs (ρ = .929, p < .001). Conclusion: Although externship participants rated competence marginally higher in some domains, externship participation alone did not significantly improve perceived clinical competence. Competence development appears multifactorial, shaped by personal, educational, and environmental interactions. Strengthening externship models through structured, supportive environments may enhance measurable gains. Future multi-site studies, larger samples, and longitudinal designs are warranted to assess externship effects on NCLEX-RN® outcomes.