Alexandra Sanial was on track to earn her associate degree in nursing from Howard Community College in December 2024 when she applied — almost casually — for the Johns Hopkins Hospital and Bayview Medical Center clinical nurse extern (CNE) summer immersion program. She had no idea how profoundly it would affect her budding career. 

“I was just looking online for something to do over the summer, hoping to maybe get some practical experience, and it turned out to be the best decision I’ve ever made,” says Sanial. Not only did she get a chance to work one-on-one with a nurse mentor in a hospital setting, getting hands-on exposure to complex medical equipment and procedures and learning time management and critical thinking skills, Sanial was introduced to and fell in love with a specialty — neuroscience — that she hadn’t even considered. 

“It just broadened my whole outlook on nursing,” she says. In fact, she learned so much, and so quickly, she was offered and accepted her first full-time nursing job. Upon graduation, she began her career as a Johns Hopkins nurse on her now-beloved neurosciences critical care unit. “It’s a wonderful outcome of my time as a CNE, and an exciting new chapter,” she says. 

The CNE program is an opportunity for nursing students to get firsthand exposure to the many facets of nursing, and Johns Hopkins has been hiring and educating externs for years. But externships were traditionally managed by individual units. It was only four years ago that clinical nurse externships were centralized as a 10-week immersion program, which gave aspiring nurses a chance to work on a wide range of units in both hospitals, and gave nursing leadership a chance to take an already productive training and recruitment program to the next level. 

Last summer, 112 nursing students (out of 280 applicants) from 62 nursing schools in 21 states were admitted to the program. And four, including Sanial, have already accepted full-time positions at Johns Hopkins. 

“Our aim for the revamped CNE program is twofold,” says Eric Croucher, director of nursing for the resource management office and float pool. “We want to help support the Hopkins mission of training the next generation by creating an exceptionally exciting and enticing opportunity for nursing students. And we also want to create a reliable recruitment pipeline that really prepares student nurses to enter the Hopkins workforce.” 

To that end, Croucher and his team introduced a number of innovations. A big one was giving externs who were rising seniors, and had successfully completed the summer immersion program, the chance to continue working individually with nurse mentors during the academic year in a “continued immersion pathway.” (Students who weren’t set to graduate in the upcoming academic year could remain employed in a role similar to a patient care technician.) Because nursing school is demanding, participants are required to work a limited number of hours. 

“Our hope is that they’ll learn why Hopkins is such a great place to work, and will ultimately choose to start their R.N. careers here,” says Croucher. An added plus, he says, is that new nurses who have been through the program can hit the ground running and experience a shorter orientation period.

“I love this new aspect of the program because it gave me so much more confidence,” says Sanial, who was one of 22 graduates of the summer extern program accepted into the continued immersion program last fall. “Working one-on-one with a nurse, you not only get more comfortable at the bedside, you really start to understand how and why they schedule their day and manage their care, and you get to observe situations with patients that you wouldn't otherwise get to experience. While you’re in school, you can think every day that you want to be a certain kind of nurse, but you don’t really know yourself as a nurse until you get on a unit and start working as one.”

Croucher’s team has been able to coordinate with nurse educators at both hospitals to hold regular information sessions for externs on everything from professionalism in nursing to how to read an electrocardiogram. “It’s such a neat opportunity for our CNEs to experience Johns Hopkins nursing education,” he says.

Croucher says coordination and communication — among nursing educators, his own float pool team, nurse recruitment, nursing students and schools, and all of the units at both hospitals — is key to further strengthening the program. His team has started collecting more data, including surveying the externs and the hospital staff who mentor them. The feedback so far is overwhelmingly positive, he says. They are also following up with externs to keep track of their career plans. And Croucher is making regular rounds of the hospital units to get feedback about the program and find out which externs will continue their career at Johns Hopkins. 

“It is incredibly inspiring to work with nursing students, as their experiences provide a continual reminder of how exciting and fulfilling a career in nursing can be,” he says.

- By Joan Cramer