What is the Difference Between Nursing Externships and Internships?

In nursing school, you may have heard the terms nursing externship nursing and nursing internship. But, what’s the difference between the two?

Back in 2009, I completed an 8-week paid externship in between my junior and senior years of nursing school on a trauma med-surg and stepdown unit, and had the opportunity to shadow other units during that time. During my senior year of nursing school in 2010, I completed a lengthy unpaid internship in an emergency department that was part of one of my courses.

Let’s dig into the differences between nursing externships and internships.

Please note: This article will outline the differences between the general definitions of these two terms, but please know these terms are not standardized. Sources may provide differing definitions, it can depend on if you’re referring to an associate’s, bachelor’s, master’s, or doctorate level program.

What is a Nursing Internship?

Internships are completed during nursing school as part of graduation requirements. The goal of a nursing internship is to provide practical training, support professional development, and prepare nurses for a successful career in the healthcare field.

Most often, nursing internships are part of your college course work. Successful completion would be required for graduation. If it is part of your course requirements, then it would not be paid. You likely would have a set amount of hours to complete, as well as various assignments (papers, care plans).

You may be assigned to work with a specific nurse in a specific setting for the duration of the experience. I was paired with a long-time emergency department nurse and essentially followed her schedule for a certain number of weeks.

What is a Nursing Externship?

An externship is an internship that takes place outside a formal institution like nursing school. This could occur in between semesters (as I did mine between my junior and senior year), or it could be after graduation but before getting licensed as a nurse.

Back when I was a sophomore in nursing school, I knew the hospital I wanted to eventually work at offered summer externships for nursing students who were entering their senior year. I applied for the position like any other job, and was paid CNA wages for my time. I was paired with a nurse on a specific unit (3 weeks on days, 3 weeks on nights) and then had a few weeks where I was able to shadow on different units (stepdown, PACU, peds). I functioned like a CNA (I couldn’t pass meds or perform RN-specific procedures) but by being paired with an experienced RN, they explained essentially everything they were doing and I became much more comfortable with patient care during summer break. (And I got paid!) To say it was valuable would be a vast understatement. I highly recommend completing one, if possible.

Now let’s talk about how these can be structured post-graduation.

Let’s say you graduated from nursing school on May 1st. It takes time to get your transcript sent to the Board of Nursing, take an NCLEX prep course, pass the exam, and get your license in-hand to be able to start work. It can be 2-3 months before you’re able to start. Also, many hospitals have all of their May and December graduates start at the same time to save on orientation costs. So, even if you were ready earlier, you might not be able to start until a specified time.

To hit the ground running with their new hires and prepare them to function as an RN, some hospitals allow their new grad hires to work as an externs before their nursing license is active.

This means that the extern would function more like a certified nursing assistant (CNA) practically at the bedside, but may also get additional educational experiences. For example, they may be paired with a specific nurse on a unit for a certain number of week, and then transferred to another unit.

These can be helpful to ease the learning curve from school to practice by familiarizing the new graduate with how more basic tasks are performed, and allowing them to get acclimated to the new hospital prior to working as registered nurse for the first time.

Nursing Externship versus Nursing Internship

Nursing externships and nursing internships are both types of experiential learning opportunities for nursing students and new graduates, but there are some key differences between the two. Let’s go through them, but keep in mind that these are very general differences and can vary widely.

Duration

Nursing externships are usually shorter in duration than nursing internships. Externships can last weeks, while internships can last months.

Eligibility

Nursing externships are usually available to nursing students who have completed at least one or two years of a nursing program. Often, prospective externs must apply to the hospital they would like to work at, like any other job opening.

Nursing internships are typically completed as part of nursing school, towards the end of the program, and are set up by the nursing department.

Focus

Internships may function as part of a specific class (critical care, for example) and therefore the focus would be more precise.

The externship may be more flexible to allow the nursing student to be exposed to more departments of the hospital to enhance learning and preparedness.

Level of Responsibility

Nursing externs typically have a lower level of responsibility than nursing interns. They may assist with basic tasks such as taking vital signs. Often, externs have the functional capacity of a nursing assistant but are able to shadow RNs to learn and observe. This reduces liability for the healthcare organization substantially.

Nurse interns are often completing hours for nursing school, which would enable them to function more in line with RN responsibilities under the direct supervision or another nurse. Nurse interns can often given meds and perform basic procedures with an RN, much like they can in a normal clinical situation.

Structure

Nursing residencies are usually structured programs with a defined curriculum, specific learning objectives, and formal evaluations. Nursing externships may be less structured and may involve more informal learning experiences.

What’s the Difference Between Nursing Residency, Nurse Internship, and Nurse Externship?

Residency programs are different than nursing internships and externships.

These programs are designed to support new graduate nurse hires as they transition to practice (often in acute care). Residency programs start when a fully licensed nurse begins orientation on their department. These programs are not for nursing students, or nursing school graduates who have yet to receive their license.

These programs are also for any RN who has not worked in a specific area before (hospital or outpatient) but has been hired into that area to help the transition to the fast-paced environment and improve retention rates.

They last anywhere from a few months to a full year, and these programs can receive accreditation.

(We’ve got a self-paced residency program that you can learn more about here.)

Does An Externship Mean Working for Free?

Not necessarily. While some nursing externships are unpaid, others may offer a stipend or hourly wage. Additionally, some externships may offer other benefits such as housing, transportation, or professional development opportunities. It is important to research and carefully review the details of each nursing externship opportunity to determine if it is paid or unpaid, and what benefits may be included.

What Should College Student Expect During Externship?

During a nursing externship, college students can expect to gain hands-on experience working in a healthcare setting under the guidance of a registered nurse (RN) or other healthcare professional. The specific experiences and activities involved in a nursing externship will depend on the type of nursing unit or department where the externship is taking place, as well as the goals and objectives of the externship program.

However, some common activities and experiences that nursing externs may participate in include:

1. Shadowing an RN or other healthcare professional to learn about their role and responsibilities.
2. Assisting with basic patient care activities, such as taking vital signs, helping with activities of daily living, or transporting patients.
3. Observing and participating in clinical procedures or treatments.
4. Attending educational sessions or in-service training programs.
5. Participating in interdisciplinary team meetings or rounds.
6. Contributing to the development of nursing care plans or patient education materials.
7. Completing assigned projects or tasks related to the nursing unit or department.

Throughout the nursing externship, college students can expect to receive feedback and guidance from their preceptor or other nursing staff, and to have the opportunity to reflect on their experiences and learning. They should also expect to abide by the policies and procedures of the healthcare organization where the externship is taking place, and to maintain professionalism and ethical behavior at all times.

Reasons Why Companies Offer Externship Vs Internship Nursing

Companies may offer externships or internships in nursing for a variety of reasons, including:

Recruitment

Externships and internships can be an effective way for healthcare organizations to identify and recruit top talent for future employment. By providing students with hands-on experience and exposure to their organization, they can build relationships with potential future employees and create a pipeline of talent for their workforce.

Education

Externships and internships provide an opportunity for nursing students to apply what they have learned in the classroom to real-world healthcare settings. This helps to bridge the gap between theory and practice, and can help students to better understand the complexities of healthcare delivery.

Training

Externships and internships can be used as a training tool to develop specific skills or competencies among nursing students. By providing targeted learning experiences and feedback, companies can help students to improve their clinical and professional skills.

Community Engagement

Many healthcare organizations offer externships or internships as a way to engage with the broader community and support workforce development. By investing in nursing education and training, companies can help to strengthen the healthcare workforce and improve access to quality care.

Overall, companies may offer externships or internships in nursing as a way to support education and training, build relationships with potential future employees, and contribute to the development of the healthcare workforce.

How to Find Internship and Externship Opportunities

At your college, check with your career services department. This resource is part of your tuition, so use it! Ask them for assistance in finding one of these opportunities. You can also look at the website of the local hospitals, and ask around on the units during clinical. You can also ask your professors or any other healthcare provider you may know.

Tip: I recommend getting a LinkedIn profile set up so that you can network with ease.

More Resources

• How to Land a Job as a New Nurse
• Best Nurse Residency Programs in USA
• Clinical Tips for Nursing Students – From Experienced Nurses!
• New Nurse Master Class: A Self-Guided Nurse Residency Program
• Test-Taking Strategies for Nursing Students
• Maryville University: Nursing Internships Explained (illustrates differences in definitions)