Clinical decision making is difficult for nursing students to learn especially for students who lack confidence and have high anxiety about their decision making skills. A study with ADN and BSN students compared the outcomes of summer employment as a nurse extern, a nursing assistant, and in non health care roles on students' confidence and anxiety with clinical decision making. Students who were nurse externs had significantly increased confidence and reduced anxiety compared with the other groups. Working alongside a nurse as an extern led to the most improvement in outcomes.