Nursing Students’ Intention to Work in Rural Areas after Graduation: A Mixed Approach Study

Introduction: A key issue of Human Resources for Health and constraint to Universal Health Coverage is a disparity between the number of healthcare providers in urban and rural areas. The accessibility to health services has been found difficult in rural areas due to shortage of health workers. As final-year nursing students are the prospective human resource for health, this study aimed to assess the intention of nursing students to work in rural areas and identify the motivating and discouraging factors associated with their intention. Methods: Cross-sectional research design with mixed methods was conducted among final-year bachelor-level nursing students of Pokhara, Nepal from December 2019 to July 2020. A census method using a self-administered questionnaire was used for the quantitative method and in-depth interviews were conducted for the qualitative method. For quantitative method, descriptive and inferential statistics were used while content analysis for the qualitative method was carried out. Results: About one-third (33.3%) participants intended to work in rural areas. The motivating factors were an opportunity for career advancement (AOR: 3.8; 95% CI: 1.35-10.77), locating near to family (AOR: 3.58, 95% CI: 1.36-9.45),  high salary/incentives, and high healthcare needs in rural areas; whereas discouraging factors were separation from family and friends (AOR 4.10, 95% CI 1.34-12.52), less availability of recreational facilities (AOR 3.68, 95% CI 1.11-12.21), inadequate salary/incentives, lack of equipment and resources, low utilization of skills and knowledge and low self-perceived competency. Conclusions: Only one-third of the participants had the intention to have the job placement in rural areas. The participants preferred to work staying with or nearby their family. The enrollment of students of rural origin/residence or background in a nursing program should be ensured. Various motivating factors like training, attractive incentives, infrastructures, and facilities should be offered to make rural jobs more attractive.