# Abstract

 

## Background New graduates report intense stress during the transition from school to their first work settings. Managing this transition is important to reduce turnover rates. This study compared the effects of an externship program and a corporate-academic cooperation program on enhancing junior college students' nursing competence and retention rates in the first 3 months and 1 year of initial employment\*.\* 

## Methods This two-phase study adopted a pretest and posttest quasi-experimental design. All participants were graduating students drawn from a 5-year junior nursing college in Taiwan. There were 19 and 24 students who participated in the phase I externship program and phase II corporate-academic cooperation program, respectively. The nursing competence of the students had to be evaluated by mentors within 48 hours of practicum training and after practicum training. The retention rate was also surveyed at 3 months and 1 year after beginning employment. 

## Results Students who participated in the corporate-academic cooperation program achieved a statistically significant improvement in nursing competence and retention rates relative to those who participated in the externship program (*p \<* 0.01 and *p \<* 0.05, respectively). 

## Conclusions The corporate-academic cooperation program facilitates the transition of junior college nursing students into independent staff nurses, enhances their nursing competence, and boosts retention rates. # Results 

## Baseline characteristics of hospitals and mentors In the EP and CACP groups, 19 and 24 students were enrolled and 19 and 23 students completed the programs, respectively. At baseline, the hospital characteristics and demographics of the mentors in the 2 groups were examined by chi-squared analysis and independent t-tests to ensure homogeneity. Table [1](#) shows that there were no significant differences in the baseline characteristics of the 2 groups. However, 39.5% and 60.5% of the graduating students were placed at the medical center and regional teaching hospitals for the practicum, respectively. Most students were trained in medical wards (51.2%). Forty-three RNs participated in this program as mentors and were characterized as follows: mean age of 28.86 years (SD= 2.51), most were college-educated (33, 76.8%) and single (29, 67.5%), and the average number of working years as a nurse and average tenure in the present ward were 6.28 and 5.47 years, respectively. ::::table-wrap

::: caption
The baseline characteristics of the two groups
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**Item** **EP group** **CACP group** **Total** ***X***^***2***^**/t** ***p***

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**n (%)** **n (%)** **n (%)**    \
Levels of training hospitals       0.87 0.35 ^a^
Medical center 9 (47.4) 8 (33.4) 17 (39.5)
Regional teaching hospital 10 (52.6) 16 (66.6) 26 (60.5)
Training setting       0.18 0.91 ^a^
Medical wards 10 (52.6) 12 (50.0) 22 (51.2)
Surgical wards 6 (31.6) 7 (29.2) 13 (30.2)
Intensive/special units 3 (15.8) 5 (20.8) 8 (18.6)
Number of graduating students
Enrolled 19 (100.0) 24 (100.0) 43 (100.0)
Completed 19 (100.0) 23 (95.8) 42 (97.7) - 1.00 ^a, c^
Education level of mentors       1.32 0.25 ^a^
College 13 (68.4) 20 (83.3) 33 (76.8)
University 6 (31.6) 4 (16.7) 10 (23.2)
Marital status of mentors       0.60 0.44 ^a^
Single 14 (73.7) 15 (62.5) 29 (67.5)
Married 5 (26.3) 9 (37.5) 14 (32.5)
Age (yr) of mentors (means±SD) 28.84 ± 2.57 28.88 ± 2.51 28.86± 2.51 0.04 0.97 ^b^
Length of nursing working (yr)
In all nursing settings (means±SD) 6.39 ± 2.23 6.19 ± 2.11 6.28 ± 2.14 0.30 0.77 ^b^
In current nursing setting (means±SD) 5.42 ± 2.23 5.50 ± 2.12 5.47 ± 2.14 0.12 0.90 ^b^

EP group, the externship program; CACP Group, the corporate-academic
cooperation program; SD, Standard deviation; ^a^: Chi-square; ^b^:
independent 2-sample t test, 2 tailed; ^c^: correction by Fisher's exact
test.:::: 

## Group comparison in nursing competence at baseline At baseline (T0), the mean total nursing competence scores of the students based on mentor ratings in the 2 groups were 94.68 (SD=27.14) and 121.92 (SD=39.80), respectively. All 6 subscale scores in the EP group were lower than 50.0% of the possible score, ranging from 31.1% (T/C) to 47.2% (PD). The CACP group, in contrast, ranged from 43.7% (T/C) to 64.2% (PD). Some mentors evaluated the nursing competence of the training students as "cannot do". The 3 variables with the lowest percentages of total scores across the 6 subscales for the EP group were T/C, P/E and CC, and the scores on these 3 subscales relative to the possible score ranged from 31.1 to 37.0%. The rankings on the 6 subscales were comparable for the EP and CACP groups. However, students in the CACP group exhibited higher scores than students in the EP group for the total nursing competence score and in the 6 subscales. Univariate tests on the 6 subscales showed statistically significant differences between the mean scores of the EP and CACP groups, with the exception of the P/E and IPR/C subscales (Table [2](#)). ::::table-wrap
::: caption
The nursing competency of graduating students in two groups at baseline
and after practicum training
:::

**Items** **Possible score range** **T0**   **T1**   **Difference : CACP group versus EP group Mean difference ± SE (95%CI)** ***P*** ^**a**^

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**EP group (n=19) Mean ± SD** **CACP group (n=24) Mean ± SD** ***P*** **EP group (n=19) Mean ± SD** **CACP group (n=23) Mean ± SD** ***P***\
The total score 46-230 94.68 ± 27.14 121.92 ± 39.80 0.02\* 117.63 ± 19.01 158.52 ± 23.19 0.000† 36.43 ± 7.73 (20.71 - 52.14) 0.000†
CC subscale 7-35 12.95 ± 4.50^4^ 16.63 ± 6.51^4^ 0.04\* 16.74 ± 2.75^iii^ 23.09 ± 3.88^iii^ 0.005† 5.89 ± 1.22 ( 3.42 - 8.37) 0.000†
T/C subscale 7-35 10.90 ± 5.87^6^ 15.29 ± 7.21^6^ 0.04\* 15.90 ± 3.97^i^ 20.48 ± 5.43^iv^ 0.000† 4.93 ± 1.63 ( 1.61 - 8.26) 0.005†
P/E subscale 6-30 10.47 ± 3.73^5^ 13.33 ± 6.30^5^ 0.09 14.00 ± 3.09^ii^ 19.83 ± 4.11^i^ 0.000† 4.89 ± 1.26 ( 2.33 - 7.46) 0.000†
IPR/C subscale 11-55 25.16 ± 7.49^3^ 29.79 ± 10.73^3^ 0.12 30.84 ± 4.94^iv^ 40.83 ± 5.32^ii^ 0.000† 9.33 ± 1.94 ( 5.39 - 13.26) 0.000†
PD subscale 10-50 23.63 ± 6.29^1^ 32.08 ± 9.61^1^ 0.00\* 27.21 ± 4.80^v^ 37.26 ± 5.83^v^ 0.002† 7.79 ± 1.84 ( 4.04 - 11.53) 0.000†
Leadership subscale 5-25 11.58 ± 3.12^2^ 14.79 ± 4.35^2^ 0.01\* 12.95 ± 2.70^vi^ 17.04 ± 3.23^vi^ 0.000† 3.60 ± 1.10 ( 1.37 - 5.84) 0.002†

CC, Clinical care; T/C, Teaching /collaboration; P/E, Planning
/evaluation; IPR/C, Interpersonal relations/communication; PD,
Professional development; T0, 48 hours within practicum training; T1,
after practicum training; EP group, the externship program; CACP group,
the corporate-academic cooperation program; ^a^: Multivariate analysis
of covariance (MANCOVA) with the level of six nursing competence
variable at baseline applied as a covariate; SD, Standard deviation; SE,
Standard error; \*: *p* < 0.05; †: *p \<* 0.01;
^1, 2, 3, 4, 5, 6^: the ranking of percentage of maximum possible
scores across six subscales; ^i, ii, iii, iv, v, vi^: the ranking
of percentage of improvement across six subscales.:::: 

## Group comparison in nursing competence following practicum training At T1, all students in both groups showed improvement in their total nursing competence scores, with mean scores of 117.63 (SD=19.01) and 158.52 (SD=23.19), respectively. Most mentors agreed that students had achieved the "can do much" level for the nursing competence questionnaire. Table [2](#) shows that the CACP group achieved higher scores than the EP group following practicum training (T1) across all 6 subscales. For further comparisons, we used the baseline levels of the 6 nursing competence subscales as covariates for control the baseline variation of 2 groups. The MANCOVA test revealed a significant difference in the mean scores of the EP and CACP groups across the 6 subscales at T1 (Wilks' lambda: *F* = 4.000, d.f. = 6, *p* = 0.005), and a comparison of the mean scores for every subscale at T1 revealed significant differences between the 2 groups: CC (*p* = 0.005), T/C (*p* = 0.000), P/E (*p* = 0.000), IPR/C (*p* = 0.000), PD (*p* = 0.002) and leadership (*p* = 0.000). Furthermore, based on pairwise MANCOVA comparisons with the baseline levels of the 6 nursing competence subscales applied as covariates, the mean difference of CACP and EP groups at T1 (e.g., differences in total nursing competence scores, including all 6 subscale scores in these 2 groups at T1) also showed significant differences (Table [2](#), the last column), and the power of the study to detect the multivariate effect of 2 trial groups was 0.933. Besides, we also noted that group discrepancy was apparent in the "top 3" ranking in terms of percentage of change (i.e., the mean difference of T1-T0 divided by the total subscale score) across the 6 subscales. In the EP group, the T/C, P/E and CC subscales showed the highest improvement; however, the "top 3" rankings in the CACP group were the P/E, IPR/C and CC subscales. 

## Group comparison of retention rate The retention rate declined over time in both groups. After practicum training, 19 students (100%) remained in the EP group and 23 (95.8%) remained in the CACP group, and most of the students were engaged in a clinical job. However, as time passed, more students chose to leave their first hospital of employment. In the EP group, 10 students remained in the hospital for 3 months after beginning employment, and only 8 students remained employed 1 year after beginning employment. Three months and 1 year after beginning employment, the retention rates were 52.6% and 42.1% for the EP group and 91.7% and 79.2% for the CACP group, respectively. Over time, the retention rate in the CACP group was significantly higher than that in the EP group (Table [3](#)). ::::table-wrap
::: caption
The retention of graduating students at three months and one year after
beginning employment
:::

**EP group (n=19)** **CACP group (n=24)**

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**Item** **n** **(%)** **n** **(%)** ***X***^***2***^ ***p***
Number of graduating students
Three months after beginning employment 10 (52.6) 22 (91.7) ^-^ 0.005 ^c^ †
One year after beginning employment 8 (42.1) 19 (79.2) 6.234 0.025\*

EP group, the externship program; CACP group, the corporate-academic
cooperation program; \*: *p \<* .05; †: *p* < .01; ^c^: correction by
Fisher's exact test.::::


Extracted trial result:
Outcome: improvement in nursing (continuous)
Intervention: phase I externship program
Comparator: phase II corporate-academic cooperation program
Intervention group size: 19
Intervention mean: 117.63
Intervention standard deviation: 19.01
Comparator group size: 23
Comparator mean: 158.52
Comparator standard deviation: 23.19
Notes: Used post-intervention values.