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Images of two extern employees, Afnan on the left and Marya on the right
Enhanced Extern Program provides valuable experience for aspiring care professionals

In October 2022, Holland Bloorview Kids Rehabilitation Hospital introduced the Enhanced Extern Program, offering clinical learners in nursing, occupational therapy (OT), physiotherapy (PT) and respiratory therapy (RT) fields of study the opportunity to grow and advance in their careers under the guidance and mentorship of regulated care professionals.

“Our goal is to leverage the expertise and resources at Holland Bloorview and enhance system capacity for children and youth with complex care needs,” says Felicia Lau, registered nurse and enhanced extern coordinator. “In addition, this initiative helps provide clinical learners further opportunities for mentorship and experiential learning specific to our pediatric rehabilitation setting as they transition to regulated healthcare professionals.”

Under the oversight of collaborative practice leadership, clinical learners will be hired as enhanced externs – nursing, PT, OT or RT positions based on their program of study. Enhanced externs will support clinical care activities by extending support needed to provide safe, compassionate, effective, timely and efficient care. Enhanced externs will assist on the Brain Injury Rehabilitation Team (BIRT), Specialized Orthopedic Developmental Rehabilitation (SODR) and Complex Continuing Care (CCC) units. Their roles will include assisting with activities of daily living care such as bathing, dressing and feeding, collaborating on unit projects, quality improvement and safety initiatives, and other discipline-specific activities, to name a few.

In an effort to highlight the unique extern experience, we spoke with two existing extern employees. Meet Marya Koddous, a third-year nursing student at Toronto Metropolitan University and nursing extern, and Afnan Osman, a second year respiratory therapy student at Michener institute and respiratory therapy extern. Both are currently employed in the enhanced extern program and have been working at Holland Bloorview since December 2022. We asked each of them to share insight on their experience in the program and the role it’s played in their educational journey so far.

Tell us about your experience during the program.

Marya: I’ve had a phenomenal experience from the moment I started working here at Holland Bloorview Kids Rehabilitation Hospital! Everyone is welcoming and helpful. As this was my first time in an extern role working with a pediatric population, everything was new to me. The orientation was thorough, and we even got to practice some of the skills we would be using on the floor beforehand. My favourite part was when we had the opportunity to shadow nurses on the different units. I felt that experience really helped, because I was able to get a glimpse into what the nurses did on the floor and apply that to when I was working more independently, off of orientation.

Afnan: During the extern program at Holland Bloorview, I had the opportunity to work with the pediatric population for the first time. It was a great learning experience and gave me the chance to observe and practice some of the skills that I learned in school settings. 

How has the extern program prepared you for your transition into becoming a regulated healthcare professional?

Marya: The extern program has definitely prepared me in my transition into becoming a future pediatric registered nurse. I was able to practice my communication skills in family-centred care and understand pediatric illnesses. As a nursing student, the extern program has given me an opportunity to experience a variety of different situations on the floor. When I graduate, I know I will feel confident in the care that I provide because of this experience. For example, when I first started off as an extern, one of the insecurities I had was doing vital signs on patients. I was scared and nervous because pediatric vital sign values were all new to me. With time and practice as an extern, I have now better developed my ability to confidently take pediatric vital signs. Another example would be talking to a patient’s family member. My communication skills have excelled and I have the extern program to thank for my growth in both of these areas.

Afnan: Through the program at Holland Bloorview, I was able to experience the working environment and how different clinicians work together to deliver the best care for patients. 

What impact do you think the extern program has had on you and your career?

Marya: The extern program has introduced me to the many ways one can enter the world of pediatric care. The beautiful thing about Holland Bloorview is the variety of patients that we see on a daily basis. There is so much opportunity for growth and development across our Complex Continuing Care unit, Specialized Orthopedic and Development Rehab and Brain Injury Rehab Team. Each of these departments is unique with their own set of skills.  The advantage of being an extern is I can work across all three settings, learn what each unit has to offer and apply my experiences to any setting I will work in during my career.

Afnan: As a respiratory therapy (RT) student, moving to a hospital environment as an RT extern and being able to both observe and practice the skills I am currently learning about in school is a great way to transition from lectures to the clinical setting.

What advice would you give for those just starting out in the healthcare field?

Marya: Believe in yourself! You didn’t make it this far for nothing. You worked hard, now believe you got this!

Afnan: At Holland Bloorview, I learned the significant role that interdisciplinary care plays in patient care. How different types of therapies such as art and music are utilized to help in the process of the patient rehab journey. I think it is important for new healthcare professionals to view patient care from a lens that includes everyone and everything that could have an impact on the overall outcome of the patient. 

Why is the extern program important to you and to Holland Bloorview?

Marya: The extern program is important to me as it allowed me to grow in the field of nursing.  I was able to develop several new skills with a population I have never worked with before. The extern program is important to Holland Bloorview as they are training and preparing a new generation of nurses to use their critical thinking in tough situations while applying a strengths-based, client and family-centred approach to their care.

Afnan: The extern program provided me with the ability to bridge the knowledge and the skills I gained through the RT program into real practice. As an RT student, it was important to go beyond the numbers and the theoretical values that we focus on and see what a holistic approach would look like in a clinical setting. On the other hand, I think the extern program is a great way for new and soon-to-graduate professionals to learn how the hospital's family-centered care operates. This knowledge could lead them to either be part of that team in the future or apply that approach in their practices in other hospitals.  

If you have questions about the program, or want to provide feedback, or if you’re interested in applying for a position, please contact Felicia Lau, RN, enhanced extern coordinator, at