Leveraging Clinical Externs to Support High-Volume Employee Immunization Campaigns: A Proof-of-Concept Study

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's 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 OHS 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.