{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T00:34:00Z","timestamp":1792974840451,"version":"4.5.0"},"reference-count":9,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Healthc Manage Forum"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:p>In 2025, University Health Network expanded its annual influenza and COVID-19 vaccination campaign by integrating nursing Clinical Externs (CEs), nursing students working as paid unregulated care providers, to administer the injections under delegation. This case study describes the program implementation and how education and competency validation were structured. The program was grounded in adult learning principles and Benner\u2019s Novice to Expert Theory. CEs completed surveys assessing confidence, comfort, and preparedness for intramuscular injection administration. Post-intervention surveys reported a 71% increase in extreme confidence, 71% increase in high comfort, and 56.6% increase in being very prepared. CEs supported high-volume clinic workflows and administered 1,575 vaccinations across multiple hospital sites, enabling occupational health services nurses to focus on clinical oversight and more complex occupational health assessments. Integrating CEs into immunization delivery built learner competence and expanded vaccination capacity. This program can offer a scalable model for hospitals seeking cost-effective workforce solutions for immunization campaigns.<\/jats:p>","DOI":"10.1177\/08404704261467878","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:01:37Z","timestamp":1784865697000},"page":"525-530","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Leveraging Clinical Externs to Support High-Volume Employee Immunization Campaigns: A Proof-of-Concept Study"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5984-4929","authenticated-orcid":false,"given":"Shaindel","family":"Kestenberg","sequence":"first","affiliation":[{"name":"University Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinder","family":"Bains","sequence":"additional","affiliation":[{"name":"University Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwladys","family":"Ruscio","sequence":"additional","affiliation":[{"name":"University Health Network"},{"name":", University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene Marie","family":"Razon","sequence":"additional","affiliation":[{"name":"University Health Network"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karelin","family":"Martina","sequence":"additional","affiliation":[{"name":"University Health Network"},{"name":", University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Dus","sequence":"additional","affiliation":[{"name":"University Health Network"},{"name":", University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"e_1_3_5_2_2","volume-title":"Scope of Practice. Toronto, ON: College of Nurses of Ontario","author":"College of Nurses of Ontario","unstructured":"College of Nurses of Ontario. Scope of Practice. Toronto, ON: College of Nurses of Ontario; 2025. Available from: https:\/\/cno.org\/Assets\/CNO\/Documents\/Standard-and-Learning\/Practice-Standards\/49041-scope-of-practice.pdf. Accessed April 27, 2026."},{"key":"e_1_3_5_3_2","volume-title":"Universal Influenza Immunization Program","author":"Ontario Ministry of Health","year":"2025","unstructured":"Ontario Ministry of Health. Universal Influenza Immunization Program. Toronto, ON, Canada: Ontario Ministry of Health; 2025. https:\/\/www.ontario.ca\/page\/universal-influenza-immunization-program. Accessed April 27, 2026."},{"key":"e_1_3_5_4_2","volume-title":"Building Tomorrow\u2019s Health Care Teams Through the Enhanced Extern Program","author":"Ontario Health","year":"2025","unstructured":"Ontario Health. Building Tomorrow\u2019s Health Care Teams Through the Enhanced Extern Program. Toronto, ON: Canada; Ontario Health; 2025. https:\/\/www.ontariohealth.ca\/news\/enhanced-extern-program. Accessed April 27, 2026."},{"key":"e_1_3_5_5_2","volume-title":"Working with Unregulated Care Providers","author":"College of Nurses of Ontario","year":"2019","unstructured":"College of Nurses of Ontario. Working with Unregulated Care Providers. Toronto, ON, Canada: College of Nurses of Ontario; 2019."},{"key":"e_1_3_5_6_2","volume-title":"University Health Network. Clinical Externs at UHN. Toronto, ON: University Health Network","year":"2026","unstructured":"University Health Network. Clinical Externs at UHN. Toronto, ON: University Health Network; 2026. Available from: https:\/\/www.uhn.ca\/healthcareprofessionals\/Meet_Professions\/Collaborative_Academic_Practice\/ClinicalExterns. Accessed April 27, 2026."},{"key":"e_1_3_5_7_2","volume-title":"The Adult Learner: A Neglected Species","author":"Knowles MS","year":"1984","unstructured":"Knowles MS. The Adult Learner: A Neglected Species. 3rd ed. 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