Nursing Internship Program

The internship program is divided into two phases (Attachment No. 1 Internship Program Structure) as prescribed below.

Phase I

Phase I covers 32 weeks period and its requirements are unified for all interns. It is structured to facilitate consolidation of interns’ clinical experience, knowledge and professional conduct in medical, surgical, maternity and pediatric areas.

 Phase II    

General guidelines for phase I clinical placement:

• CON are responsible for conducting adequate orientation sessions/workshops/activities targeting the staff in the clinical setting who will be involved with the interns.

• Rotation placement plan should ensure that the clinical units, where interns are assigned, are suitable to achieve the rotation specific learning outcomes.

• As much as possible, an intern will work day shifts only during the first two months of her initial placement in the clinical site. This will allow the intern to understand the hospital system, attend required orientations, and complete required generic clinical competencies/skills. Nevertheless, in situations when such arrangement incur hardship on the unit operations, an intern may rotate earlier to weekend/night shifts provided that adequate support of her learning needs is available.

• Clinical units selected for interns’ placements are expected to incorporate and emphasize Professional Core competencies in interns’ learning plan. Professional Core competencies include: professionalism, teamwork, self-direction, leadership, communication, lifelong learning, critical thinking as well as clinical skill competence. 

• The Nurse Manager in the placement unit shall assume responsibility over interns’ entire clinical experiences. She/he shall follow closely the intern’s progress toward achieving the learning outcomes and shall plan and implement any remedial plan to improve the intern’s performance as needed in collaboration with the concerned CON.

• An intern will practice under the supervision of a preceptor. The preceptor shall supervise the interns’ clinical performance, facilitate her bedside learning, and work collaboratively with her to achieve the learning objectives specified for this particular clinical rotation.

• At the completion of the first three months of the program, an intern is expected to meet the nursing care needs of a 50% work load of a registered nurse in area of assignment under supervision of a preceptor.

• At the completion of Phase I of internship program, a Nurse Intern is expected to meet the nursing care needs of a full load of patients during day, night and weekend shifts in area of assignment under supervision of a preceptor.

• An intern will not move forward to Phase II unless; she demonstrates ability to meet the nursing care needs of a full patient load, she achieves all required learning outcomes and competencies specified in phase I of the program, and she commits to the timeline and attendance requirements.

Phase II of Internship Program

Phase II covers a period of 16 weeks and starts after successful completion of phase I.

A major strength in the KSAU-HS nursing internship program is that it is career-linked. Meaning to say that phase II of the program is designed to prepare the interns effectively for their targeted future positions as nurses.  Such approach is believed to improve the interns’ functionality, adaptability and improve their retention on their first employment. 

In preparation for phase II, the division of Nursing Services at the clinical settings in collaboration with the CON will offer structured career counseling activities so that the interns can make an informed decisions about their possible future career path within the clinical settings where they are placed. 

In phase II, interns may choose either a general or specialized career path. Therefore, phase II placement could be arranged in any general medical, surgical or pediatric area, any critical or specialized unit, outpatient clinics, home health care services, and any other relevant area provided that it provides direct patient care services and is approved by the concerned college of nursing. 

Generally emphasizes; progressive socialization to employment real life,  developing a solid knowledge background related to the area of practice, refine the acquired clinical skills and expand on it, consolidate professional behaviors and competencies; and finally progressive mobility toward independent practice. 

Upon completion of phase II, the intern is expected to demonstrate that she has achieved all the intended learning outcomes of the agreed internship pathway and met all the Saudi Nursing Council and Ministry of Education requirements for registration as a Staff Nurse 1.

Internship Program is stipulated and managed by CON. Participating hospitals are expected to facilitate the program implementation under direct guidance from CON.

Each College Of Nursing at the KSAU-HS in Riyadh, Jeddah, and Al-Ahsa will be responsible academically and administratively for interns assigned to the region where it is located, regardless of the student initial registration site.  The three colleges, however, shall be committed to a unified program implementation as per the stipulations of the dean’s agreement dated and signed on March 2009.

A Regional Internship Program Committee will be formed by each CON to facilitate implementation and management of the program regionally.

The Regional Internship Program Committee will comprise representation from the division of Nursing Services in the recruited clinical sites 

The said committee shall provide the venue where all issues related to the internship program implementation and the progress of CON interns in this particular region are discussed. 

The committee major charges are:

• Facilitate regional implementation of the Internship Program

• Oversee CON interns’ annual clinical placement plan within the respective region

• Monitor interns overall progress in the clinical settings

• Implement activities which promote quality program implementation and quality clinical experience

• Investigate incidents related to interns performance or professional conduct and to recommend actions accordingly

• Review appeals/issues of dispute/concerns endorsed by interns in relation to their clinical placement/performance, then recommend actions as appropriate

• Contribute to interns’ counseling activities through a designated committee member when required

• Recommend solutions to common concerns between the CON and the clinical setting within the framework of the program regulatory structure

• Oversee planning and implementation of career counseling activities of CON interns

• Facilitate implementation of relevant assessment activities generated for the purpose of quality improvement, accreditation and nursing research.

Internship training is conducted in clinical settings that are properly recruited by the university whereby a placement agreement between the two parties is signed.

Currently, the Ministry of National Guard Health Affairs Hospital is the primary placement site for KSAU-HS Nurse Interns, specifically the following sites:

• King Abdulaziz Medical City- Riyadh
• King Abdulaziz Medical City- Al-Ahsa.
• King Abdulaziz Medical City- Jeddah

However, non-NGHA hospitals might be explored if a need to expand clinical placement sites arises. Exploring, approving, and recruiting new clinical placement settings remain entirely the responsibility of the concerned CON.

The Nursing Service Division in each clinical setting will select and approve, mutually with the concerned CON, the clinical teaching units designated as appropriate for interns’ clinical training taking into account the following considerations:

• Training needs of the interns.
• Appropriateness of the selected clinical areas to the program objectives.
• Inputs from the respective CON.
• Availability of related clinical experience identified by the program.
• Support structure available within the selected unit to promote quality of mentoring and bedside instructions.

Basic Life Support (BLS) Certification

Interns should have a valid BLS certification in order to start training.

It is the responsibility of each intern to arrange for re-certification of BLS, if needed, prior to starting the training unless facilitated otherwise by the recruited clinical site.

Immunization

Interns should comply with all immunization requirements requested by the clinical setting prior to commencing bedside practices. 

English Proficiency Exam (EPE)

CON interns are expected to take the Ministry of National Guards Health Affairs English Language Proficiency Exam (MONGHA ELPE) on level 5 (three levels before internship).

The pass score for this exam is 65% for employment requirements. However, the minimum qualifying score to commence internship is 50%.

Students who obtain a score of 65% or above in the exam will be exempted from writing it again as interns, resident, or as new employee by MONGHA (as per APP 1419-016 Saudi Nurses Career Path at the MONGHA.

Nevertheless, students who obtain a score less than 65% have to retake it every level after until a score of 65% is secured or, at least, a qualifying score to commence internship (that is 50%).

Potential interns who score a mark less than 65% are expected to exercise personal responsibility over improving their English language.

A. Time Period of internship training:

The internship training for national BSN graduates is one calendar year (52 weeks), inclusive of two weeks leave for Eid Al-Fetr, two weeks leave for Hajj, and one day leave for the Saudi National Day.

That leaves an actual 48 weeks clinical rotation time inclusive of orientation activities defined mutually by CON and the clinical settings.           

In order to fulfill time requirements of the program, the CON Intern must attend a 100% of the specified clinical time. Therefore any missing clinical time, due to absenteeism, marriage, deferment or else, must be made up for before completion of the program.

B. Leaves and Absence Stipulations:

CON has developed policies, procedures and guidelines to guide and regulate different types of leave privileges during the internship year. It also provides guidance in relation to punctuality, unauthorized and authorized absenteeism. The above policies can be found on the KSAU-HS, CON homepage under internship program section (please note attachment No. 8) 

C. Working Hours:

• The CON Intern shall follow the clinical site shift patterns and working procedures including working nights and weekends. In so doing, the Intern will gain an understanding of patient care needs, continuity of care, and will be able to function more independently.

• The CON Intern shall work a roster of 44 hours per week.

• During the holy month of Ramadan, the Interns will work reduced hours (30 hours per week instead of 44 hours) as per Saudi Labor Law stipulations.

Evaluation of interns is primarily focuses on three major domains, namely; professional conduct, clinical practice and care delivery, and competency acquisition.

Interns are expected to meet satisfactorily predetermined performance criteria by the end of each clinical rotation.

CON recognizes building clinical competencies as a major goal of the program; therefore an Intern is expected to achieve certain generic and rotation specific competencies by the end each rotation.

An Intern’s progress shall be reviewed on regular bases by the concerned nursing staff involved in her training including the Nurse Manager.

Based on the assessment outcomes, the plan to achieve the rotation specific objectives or plan for remediation shall be discussed and negotiated actively with the intern and documented if needed. 

A CON intern is held accountable for monitoring her own progress and for self evaluation. She is expected to contribute to her own evaluation process through self-assessment and awareness of own strength and areas in need for improvement.

A CON intern will receive two structured evaluations per rotation; the first is a non-graded mid-rotation evaluation. It is usually carried out by the Nurse Manager and nursing services staff involved in her training.  Mid-rotation evaluation will be conducted using the formal behavioral evaluation tool developed by the CON.

Evaluators and the intern are required to document progress toward learning objectives, challenges, and any remediation needed.

The second evaluation is a graded final evaluation at the end of each clinical rotation.

End of rotation evaluation is conducted by a panel comprising representatives from CON and Nursing Services.

The intern must complete and present her own self-evaluation to members of the panel identifying her major achievements and areas in need for improvement. Then the panel will discuss her self-evaluation further based on comments made by nursing staff. 

The panel will provide constructive and goal focused feedback to the intern utilizing a non-threatening approach. The intern is expected, however, to be open to feedback and to the suggested plan for improvement if needed. 

A CON intern will pass a clinical rotation when:

• All performance behavioral objectives are met.
• All learning outcomes of the rotation are achieved.
• All rotation specific competencies are signed off.
• Timeline requirements of attendance are met.

In cases when the above requirements are not achieved (in full or part), the Evaluation Panel will decide on the best course of action that ensure compliance with the stated requirements. The panel decision may be one of the following:

• Extend current rotation time so that the intern can achieve the lacking requirements. In this case, the length of extension should mach the lacking requirements extent. Further, an Incomplete Grade will be assigned to that intern that will later be converted to a Pass Grade when the lacking requirements are achieved satisfactorily.

• Assign the intern a Fail Grade. In such case, the intern has to repeat the entire clinical rotation.

Nurse interns are required to present five in-services during the training year; one in-service in each clinical rotation (medical, surgical, pediatric, maternity and phase II). Two (2) out of the 5 presentations will address health related topics from Saudi cultural perspective. These 2 presentations will be referred to as “cultural presentations” later.  It is crucial that selection of cultural presentation topics reflects; challenges rise when healthcare is delivered by a multinational team to national Saudi patients, Islamic religious practices and healthcare, and Moslem/Saudi patient responses to certain disease process and treatment modalities.

The other 3 presentations will address clinical related issues directly linked to the practice within the area of assignment. The presentation could be in a cases study format. However, other topics and formats are also invited. Interns may address issues/topics such as; specific disease, specific nursing intervention, specific practice related guidelines or policy,…etc. 

The presentation will be done using PowerPoint and must observe the following:

• A clear and concise introduction to the topic

• Aims and outcomes of the presentation

• Clear, readable English writing and grammar

• Conclusions and recommendations

• Current evidence from research (references and proper citation)

• Presentation time is 10 minutes minimum and 15 minutes maximum 

It is imperative that the nurse intern has the in-service reviewed prior to delivery. The in-service can be reviewed by a Nurse Educator, Clinical Resource Nurse, Nurse Manager, or Assistant Nurse Manager. 

The review should occur at least 5 days prior to the presentation being delivered. It is the nurse intern’s responsibility to book a date for the in-service presentation in their clinical area.

All interns’ presentations will be graded by the concerned Nurse Educator or Clinical Resource Nurse or Nurse Manager or Assistant Nurse Manager using a unified presentation evaluation form generated by CON (attachment No. 15)

During internship training the CON intern is expected to:

• Be accountable for own learning and progress toward achieving training objectives.

• Demonstrate progressive clinical judgment, problem solving, critical thinking, and time management skills.

• Consistently demonstrate a sound knowledge background in nursing, biological, social, and behavioral sciences, and integrate it in day to day practice.

• Demonstrate progressive clinical competence throughout the internship year.

• Function effectively as interdisciplinary team member in the assigned clinical area.

• Collaborate and communicate effectively with members of the interdisciplinary team.

• Comply with hospital standards of care, policies and procedures and the nursing practice model to ensure patient safety in all activities.

• Deliver ethical nursing care.

• Conduct self professionally.

• Act as a role model for fellow students and interns.

• Realistically identify own strength and limitation.

• Be committed to own professional growth and life-long learning..

• Demonstrate sensitivity to diversity of patients, colleagues, and healthcare team members.

• Demonstrate effective use of information technology.

• Act as patient and family advocate.

NM is responsible for the clinical unit standards and the overall interns’ clinical placement.

• Ensure that the Nurse Interns practice within the established policies and protocols of the clinical site and the CON.

• Maintain and ensure completeness of interns’ Log Book

• Provide an effective unit-specific orientation that will facilitate the integration of the Nurse Intern into the unit team.

• Monitor interns’ attendance and ensure compliance to interns’ attendance/absenteeism policies.

• Ensure availability of adequate clinical supervision and resources to the Nurse Interns to ensure safe practice at all times.

• Coordinate the allocation of a Preceptor to each Nurse Intern

• Supervise and monitor the patient assignment process to interns

• Ensure that the Clinical Resource Nurses/Clinical Educators and Preceptors are prepared to teach, assess and facilitate the learning objectives of the Nurse Interns and that all participants in the learning process are supported at all times.

• Create a clinical environment that is conducive and supportive to the learning objectives of the Nurse Internship program in accordance with patient rights and safety.

• Act as a professional role model and nurture professional behavior and development in interns.

• Assist the Nurse Intern to assimilate into the nursing environment. 

• Contribute to intern's performance evaluation.

• Monitor the Nurse Intern's progress. Schedule regular meetings with the CRN, Nurse Intern , and the Preceptor to discuss the Nurse Intern's progress and obtain feedback.

• Provide regular feedback to the Clinical Resource Nurses/Clinical Educators, Preceptor, and Nurse Intern.

• Encourage lifelong learning

• Redirect operational, conduct performance and educational concerns about the Nurse Intern immediately to the concerned CON and Nursing services administrative appropriately

• Engage the interns in unit based quality teams and committees.

• Ensure that unit staff are aware of internship related resources.

• Monitor interns’ leadership skills progress.

• Contribute to interns’ professional counseling as needed.

• Formally hand over the intern’s formal booklet to the next NM upon completion of the clinical rotation.

• Contribute to the assessment activity generated by Nursing Services and the CON for the purpose of quality improvement, program evaluation, and research.

Preceptor is responsible for the interns’ bedside clinical teaching and clinical supervision and is accountable to the NM.

• Orientate the Nurse Intern into the clinical unit to ensure a smooth transition into the clinical setting.

• Introduce the Nurse Intern to all key members of the multidisciplinary team and explain the various roles.

• Facilitate a smooth transition into the field of clinical nursing practice by informing and assisting the Nurse Intern to understand social, psychological, religious, and cultural aspects related to nursing.

• Facilitate an optimal learning environment to promote attainment of the clinical learning objectives and ensure continuity during breaks and absences.

• Mentor the Nurse Intern and prepare her to holistically care for the patient.

• Act as a professional role model and display a positive attitude and acceptable level of conduct.

• Ensure the Nurse Intern has a sound understanding of her learning objectives and limitations in relation to the Intern scope of practice.

• Encourage the Nurse Intern to implement evidence based clinical practice. Instill a sense of enquiry and critical thinking in the workplace.

• Provide adequate supervision and support to the Nurse Intern ensuring that theory is integrated with clinical practice, providing sound consolidation of nursing practice.

• Create an environment that provides optimal clinical learning opportunities for Nurse Intern, inclusive of participation on the unit and quality action teams.

• Be available at all times for interns and ensure that interns do not engage in direct patient care activities without supervision.

• Contribute to and participate in the Nurse Intern's formative and summative assessment and evaluation requirements.

• Provide regular feedback on weekly basis to the NM regarding the Nurse Intern's clinical performance.

• Redirect Nurse Intern related clinical concerns, scope of practice issues or requests for patient allocation to the NM.

• Report matters of concern such as attendance issues and practice to the NM immediately.

• Act as a resource person for the intern and address their clinical/professional queries appropriately.

• Enforce implementation of related professional/clinical policies, care protocol pertinent to area of practice, and enhance developing progressive independent practice by interns.

• Acts as client, family, and learners’ advocate.

• Contribute to the assessment activity generated by Nursing Services and the CON for the purpose of quality improvement, program evaluation, and research.

Upon successful completion of internship program, CON intern will be awarded a degree of: Baccalaureate in Nursing Sciences from CON, and this will confer her as a professional nurse licensed to practice nursing in the Kingdom of Saudi Arabia.

Interns are expected to register with Saudi Council for Health Specialties immediately after completion of internship training.