Rural facilities, such as those in southwest Minnesota, often have greater difficulty attracting applicants due to lower salaries and fewer city amenities compared with metropolitan areas.1 However, Minnesota is projected to need 20,330 new RNs by 2025.1 In response to this impending shortage, an organization in southwest Minnesota partnered with the Nursing Internship Implementation Group (NIIG) to attract and support future nurses while allowing them to practice to their full potential as interns.
Forming partnerships
Nurses in Minnesota representing clinical and academic organizations gathered together to form the NIIG to provide a framework for the type of work interns can perform during internships.2 As a result, the NIIG developed a common summer internship course description and objectives for all participating schools of nursing within the state of Minnesota.3
The academic course was developed to meet both the Minnesota Board of Nursing and Minnesota Nurse Practice Act requirements, with one to three credits being offered for the internship. Minnesota Statutes Section 148.271 states that interns may practice nursing in Minnesota without a Minnesota nursing license when they're under academic supervision through a postsecondary education internship program.3
The organization has been committed to interns for many years, expanding the internship program from one to six hospitals within the healthcare system. Four of the six hospitals are considered critical access, which is a hospital with no more than 25 inpatient beds.4 In a rural region with more than half of its hospitals designed as critical access, recruitment and retention issues exist, thus the need for alternative recruitment efforts.
The organization's internship program allows interns to interact with patients and staff, engage in nursing processes, think critically about patient situations, learn about teamwork and collaborative efforts, earn college credit, and get paid for hours worked. Interns can perform any skill or procedure for which they've received academic preparation as designated by their clinical instructor and/or preceptor. (See Table 1.) Internship coordinators continue to enhance the program to ensure that interns develop a rich understanding of the science and art of nursing through a preceptor-led, hands-on patient care experience.
Intern selection
The intern selection process is designed to identify motivated, high-quality nursing students who have the same vision as the organization. Applicants are required to be in good academic standing (minimum 3.0 grade point average) and have completed their junior year of a baccalaureate nursing program before the beginning of the internship. Candidates are also required to complete the organization's online application for a position as an intern, which includes the following information: verification of grade point average, current CPR certification, a list of acute care clinical experiences, and three essay questions. (See Table 2.) The essays are evaluated with a rubric designed to assess the intern's intent to stay with the organization.
Preceptor selection
Preceptors focus on moving interns toward their academic and professional goals by providing them with feedback and guidance, role modeling good team dynamics and communication skills, and serving as spokespeople for the organization to assist in recruitment efforts.5 Primary and secondary preceptors are identified to provide a variety of shifts and learning opportunities, consistent coverage, and reduction of preceptor burnout.6 Preceptors complete a 4-hour team-building day with the interns during their first week of orientation.
Interns benefit from establishing ongoing relationships with their preceptors, which encourages consistency with assignments and skill development.7 A unique observation is that previous interns hired as RNs by the organization eagerly volunteer to be preceptors when they meet the qualifications.
The internship program
The internship begins the first week of June each year, with interns working up to 40 hours a week over the next 10 weeks. The interns attend new employee and nursing orientation; topics include infection control, safe patient handling, medication administration, chaplain services, point-of-care testing, infusion therapy, surgical considerations, and electronic health record (EHR) training. In addition, they attend an internship orientation, with topics that include the internship experience, professional goals, skills acquisition, intern roles, I.V. training, scheduling and pay processes, preceptor roles, academic partnerships, personality inventory assessment, and team-building activities with their preceptors.
During orientation, preceptors and interns meet for the first time, allowing them to discuss goals, nursing roles, preceptor roles, intern practice guidelines, documentation support, and conflict management solutions. Interns lead their preceptors in completing the personality inventory and then discuss each person's personality type and the impact it has on the team. The personality inventory helps increase self-knowledge, facilitate stronger teamwork, minimize conflict, and develop a better understanding of others.8
During the program, interns work up to 400 hours on their assigned units; in addition, they're given the opportunity to observe two nursing care areas outside of their assigned unit for 4 hours each. Upon completion of the shadow experiences, interns attend educational sessions led by the internship coordinator. These sessions provide the interns with time to discuss their observation experience and talk about how these roles directly support bedside nursing practice.
Interns are also required to present a 15-minute educational offering to their peers related to their assigned areas. Previous educational topics have included bedside report, hourly rounding, catheter-associated urinary tract infection, laboring down for epidural patients, oral care, and compression stocking use.
A final educational day is provided that offers a life course with information on interview skills, real-life budget management, stress management, communication, and team-building.
Funding
Throughout the state of Minnesota, internship placements have decreased due to limited budgets for nursing education support. The organization has proactively worked to increase awareness of the internship program among its community benefactors. As a result, benefactors have designated nursing education funds to ensure the continued success of the internship program. Benefactors appreciate that interns are placed in the communities in which they desire to work, often rural communities that the interns grew up in or have a connection with. The benefactors also desire for healthcare to remain viable in their local community by recruiting and retaining the best nurses for growing healthcare demands. Funds are used to pay interns' wages so that they can focus on learning and not have to balance the demands of another job. Interns are offered a competitive wage so that pay isn't the deciding factor and the opportunity to learn can take center stage.
Recruitment and retention
The paid internship can be viewed as a recruitment program because advertisement costs and recruiter fees aren't used to fill open positions. Furthermore, RN orientation time is reduced because the interns have already completed clinical classroom orientation and EHR training. Additionally, unit orientation time can be reduced based on the interns' previous experience with patient flow, unit-specific skills, and team-building.
Interns are also more likely to return to the organization that supported them during their educational programming. When asked about their previous internship experience, current employees commented: "It was the most valuable and rewarding aspect of my education." "It allowed me to learn to be a nurse before becoming a nurse." "It made utilizing the skills and education to transition into a position as a nurse more relaxing." "It increased my confidence, I learned improved communication and how to take care of patients more holistically, and I learned the importance of prioritizing and time management as a nurse." Interns who stay with their hiring organization often move into leadership positions over the course of their nursing career.
Since the implementation of the internship program, the organization has maintained a retention rate of 73%. (See Table 3.) It's important to note that placement of graduating interns varies based on job availability; during lower percentage years, there were fewer jobs available.
A working interview
Internships are an effective recruitment and retention strategy for rural organizations, serving as a working interview. Reach out to local academic partners about the potential to develop a joint program. Work with senior leadership and benefactors to secure funds to sustain the program. Interns thrive in organizations that support them as learners. Over time, many employees who were once interns become preceptors themselves and/or move into leadership positions as they grow professionally.
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