Abstract:

Background: Hospital and community health nurses often come into contact with people who are poor, uninsured, or indigent. Because there is a great need for nurses in rural and underserved areas, it is critical nurse educators explore and address students’ attitudes toward vulnerable groups before learners begin to further develop their professional careers. This will help determine when educational experiences should be implemented to influence positive change. How nursing students’ attitudes influence career choice has not been well studied. Because there may be a relationship between attitude (e.g., intention to provide care) and behavior, the objective of this study was to assess nursing students’ attitudes toward future practice with the underserved.

Methods: A cross-sectional, correlational research design was used to determine the influence of certain attitudes (e.g., personal responsibility to treat, patients’ rights to treatment) on nursing students’ intention to provide care to underserved patients as a career choice. Seventy-nine nursing students completed the anonymous pen-and-paper questionnaire which included Crandall et al.’s (1992) Medical Students Attitudes Scale, adapted for nursing. Single items were used to assess demographic variables (e.g., age, gender). Data were analyzed using Pearson correlation coefficients (r).

Results: The ages of participants' (N=115) ranged from 19-57 years (M=34, SD=8.6). Forty-nine percent were Black (28% Caribbean Black, 21% African American), 35% White, 6% Asian/Pacific Islander, the rest ‘other.’ Of those who participated, 25% identified themselves as Hispanic. Fifty-five percent were born outside the United States, most of which were low-income nations. Thirty-nine percent reported having been on public assistance in their lifetime (e.g., Medicaid). The most frequently reported areas of interest were pediatric (23%) and forensics (18%). Of those participants born outside of the United states, 21% reported they were likely to return to their country of origin to practice. Twenty-four percent reported there were groups who should not receive free medical care, such as illegal immigrants and people who “take advantage of the system.” Ninety percent had interest in volunteering for programs during their training that provide medical care to the needy. Multivariate modeling successfully explained 19% of the variance in predicting intention to provide care with the underserved, which was significantly related to scores on the opinions of health care service (a subscale of the MSATU), interest in obstetrics/gynecology and rural nursing as a career choice, F = 9.850, df = 3, p < .001.

Conclusions: The opinion that healthcare services should be provided regardless of personal characteristic or ability to pay and interest in obstetrics/gynecology and rural nursing as a career choice were associated with intent to practice nursing with the underserved. Findings from this study provide some insight into nursing students’ attitudes toward future practice and guide academic programming efforts to help produce more community and rural nurses. The recruitment and retention of nurses in rural and underserved areas is a continuing challenge. Training nursing students to care for medically underserved, uninsured and indigent populations might include adapting the curricula to address student attitudes and perceptions as well as promote student interest in practice with vulnerable populations.

Keywords:

Nursing education, medically underserved, student attitudes, rural medicine, global health care.