Building a better system for mental health nursing through the CAMH Clinical Externship Program

Nursing externships give nursing students an invaluable way to gain on-site hospital experience while still in school. Similar to an internship program, externships enable students in their later years of study to provide assistance and support in clinical situations. These programs have existed for decades at many hospitals, providing students a way to learn from experienced clinicians while getting paid for their contributions.

For nursing students interested in getting into the mental health field however, there were often less opportunities to learn about mental health nursing. Many nursing programs are focused on traditional nursing roles, with limited education on how to address mental health clinical care, and many nurses relied on on-the-job training to gain the experience they need.

This has been changing with the introduction of the CAMH Clinical Externship Program, which was successfully piloted in 2021 and returned again earlier this year.

“Last year we had a total of 60 externs, of which 16 transitioned into permanent roles at CAMH,” says Meghan Fyke, a Clinical Nurse Specialist in the Trauma and Neurosurgery Program at St. Michael’s Hospital, who formerly led this program as the Extern Mentor Coordinator. “Extern programs have existed for a few decades, but they have gained a lot of popularity in the last couple of years as an approach to help with human resource related challenges with staffing in hospitals.”

Kelyang Tenzin, an RN and Nurse Educator, currently supports the program in the EMC role at CAMH. “A key benefit of this program is that it allows students to explore mental health nursing, which is often a neglected (and stigmatized) nursing specialty.”

“Additionally, we have a wealth of experience from all levels of staff at CAMH,” she adds. “Through this program, students then have the opportunity to partner with and learn from our clinicians in a diverse range of programs and specialties.”

Addressing a need for new nurses

Staffing shortages across the healthcare sector, illness and career burnout experienced by front-line workers has created a larger need for these types of programs. Aside from the additional support that an extern can provide, it also serves as an opportunity for newly-graduated nurses to transition into roles within organizations.

“Mental health was not a field I originally planned on working in,” says Matthew, a Clinical Extern working in the Crisis and Critical Care (CCC) building at CAMH. “However, once I gained some experience in mental health on an inpatient psychiatry unit, I began to develop a passion for helping individuals experiencing a mental health disorder.”

“My experience in the program has been incredibly educational and shed new light on different aspects of mental health,” he adds. “I had the pleasure of working at the Medical Withdrawal Service, which brought a different perspective into addictions that I previously was not aware of. Now I work at CCC5, ironically the same unit that my former preceptor works at, which added depth into my experience with youth and young adults that I could build upon.”

“My interest in mental health was spurred prior to starting at CAMH, when working in shelters and group homes for clients living with mental illness,” says Sheridan, another Clinical Extern who is also working in CCC at CAMH. “The Clinical Extern role helped me to develop my knowledge base, learn clinical skills, and gain confidence about transitioning into practice.”

For Sheridan, one of the benefits of working in this capacity has been the ability to work directly with patients in the hospital. “The highlight of the program has been establishing trusting and therapeutic relationships with colleagues and clients. My continued interest in mental health nursing is renewed each time a client confides in me and expresses that the support I provide is meaningful.”

Other externs like Lauren had already been working in mental health before their externships. “I actually worked at CAMH prior to this position, as a Program Assistant at the College Street site. I left to pursue a career in nursing, but always wanted to come back in some capacity.”

For Lauren, having the knowledge and the breadth of scope of CAMH’s work only adds to the experience. “The rewarding part is seeing clients improve and be able to go back into the community with new insights and coping skills. The ongoing research that CAMH conducts into mental illness and addiction is fascinating.” 

Learning with Externs

“Initially, it was difficult for everyone to discern how this position differed from that of nursing students, as Clinical Externs are nursing students we’ve hired as unregulated care providers,” says Kelyang. “Since the program's early days, we’ve come a long way to have a better sense of what externs can do, and this comes from the exemplary work of the externs themselves and the teams supporting them.”

For nursing students who might want to consider becoming a Clinical Extern at CAMH, Kelyang shares a few tips: “I would encourage them to review common psychiatric diagnoses and treatment modalities, the Mental Status Examination, and the history around mental health and illness. It’s important to not only understand what we’re doing but what’s led to this, to truly provide trauma-informed care.”

Looking ahead, the hope is that this program is able to help nurture future generations of nurses, whether they decide to work in a mental health hospital or not. “Our goal is to be able to support a robust pool of future nurses who understand that mental health is health. And we want to make sure that nursing students are able to consider mental health nursing as a valuable and viable part of their nursing career.”