---
title: "Nursing undergraduates’ willingness to work in long-term care: qualitative insights from a geriatr"
id: "plos-one-16-willingness-of-nursing-undergraduates-to-work-in-long-term-care-facilities-a"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-16-willingness-of-nursing-undergraduates-to-work-in-long-term-care-facilities-a"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357086"
published_at: "2026-08-28T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Nursing undergraduates’ willingness to work in long-term care: qualitative insights from a geriatr
## Provenance & Clinical Metadata
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- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357086)
- **Published At:** 2026-08-28T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This qualitative phenomenological study explored the career willingness and attitudes of 14 undergraduate nursing students who voluntarily enrolled in a **geriatric nursing** minor and completed associated theoretical and clinical training. Interviews continued until thematic saturation. - Data were collected via semi-structured, in-depth individual interviews conducted between September 2024 and June 2025 and analyzed using thematic analysis. - Three primary themes emerged: nascent interest in **geriatric care**; perceived gaps in professional competence for elder care roles; and an underdeveloped “government–society–family” collaborative ecosystem for geriatric services. - Participants recognized strong market demand for **long-term care** professionals but expressed a preference for hospital employment due to concerns about social status of long-term care institutions, high labor intensity, limited career advancement, and perceived mismatch between their skills and role requirements. - The study used Social Cognitive Career Theory (SCCT) as an analytic framework, emphasizing self-efficacy, outcome expectations, personal goals, and contextual moderators such as family support and policy environment. - The research setting was a university–facility cooperative “order-based” training model; the minor program and collaborations aimed to cultivate skilled care professionals to address population aging. - Recruitment criteria included voluntary minor enrollment, completion of coursework and practicum, and stipulated attendance thresholds; 43 students were eligible and 14 participated after confirming saturation. - Ethical considerations: participants provided informed consent and data access is restricted due to privacy; requests for interview data must be directed to the university ethics committee as specified by the authors. - Funding sources were the Anhui Education Department Humanities and Social Sciences Research Project (2023AH051723) and the National Student Innovation and Entrepreneurship Program (202310368038); funders had no role in study conduct or reporting. - Authors declared no competing interests. The study’s findings aim to inform nursing educators and policymakers involved in geriatric workforce development.
## Clinical Analysis & Structured Key Points
Willingness of nursing undergraduates to work in long-term care facilities: A qualitative study | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Purpose This study aimed to explore the willingness and attitudes of undergraduate nursing students enrolled in a geriatric nursing minor program toward pursuing careers in long-term care facilities. Methods A qualitative phenomenological approach was adopted. Semi-structured, in-depth individual interviews were conducted with fourteen students minoring in geriatric nursing. Interview transcripts were analyzed using thematic analysis. Results The analysis identified three primary themes: (1) Nascent Interest in Geriatric Care; (2) Perceived Deficiencies in Professional Competence for Geriatric Care; and (3) The “Government-Society-Family” Collaborative Geriatric Care Ecosystem Remains Underdeveloped. Conclusion While nursing undergraduates recognize strong market demand for geriatric care professionals, their current career preferences favor hospital settings. This inclination is influenced by considerations of the social status associated with long-term care facilities, perceived misalignment between their skills and role requirements, limited career advancement pathways, and high labor intensity in long-term care. Citation: Hou X, Wang Y, Wang F, Li Q (2026) Willingness of nursing undergraduates to work in long-term care facilities: A qualitative study. PLoS One 21(8): e0357086. https://doi.org/10.1371/journal.pone.0357086 Editor: Heather Leggett, The University of York, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND Received: January 22, 2026; Accepted: August 12, 2026; Published: August 28, 2026 Copyright: © 2026 Hou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: Due to the sensitive nature of the interview data, the author has committed to the research subjects not to disclose their privacy. If you require access to the interview data, please email the Ethics Committee of the School of Nursing of Wannan medical university to obtain it. Email: 20200032@wnmc.edu.cn . Funding: The Humanities and Social Sciences Research Project of the Education Department of Anhui Province, People’s Republic of China (2023AH051723) and National Student Innovation and Entrepreneurship Program(202310368038). Role of Funder Statement: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: All authors declare that there are no conflicts of interest in this paper and that the article has not been considered for publication elsewhere. Introduction The global acceleration of population aging has positioned elder care as a critical societal priority. According to the United Nations World Population Prospects 2024, the population aged 65 and over is projected to exceed 2.2 billion by the late 2070s, surpassing the number of children under age 18. By the mid-2030s, individuals aged 80 and above will reach 265 million, exceeding the infant population [ 1 ]. China has long been an aging society. Data from the Ministry of Civil Affairs indicate that by the end of 2023, the population aged 65 and above reached 216.76 million, accounting for 15.4% of the total population, with an old-age dependency ratio of 22.5% [ 2 ]. The old-age dependency ratio is defined as the number of people aged older than 65 years divided by number of working-age people aged 18–64 years, it is desirable that this figure remains low in any population [ 3 ]. Relative to younger populations, older adults experience progressive physiological decline and a high prevalence of multimorbidity. In China, approximately 72.68% of older adults suffer from two or more chronic conditions. The National Health Commission reports that around 190 million older individuals live with chronic diseases, and over 40 million require care due to disability—a figure projected to surpass 77 million by 2030. Furthermore, China has more than 9.5 million older adults with dementia, a number expected to exceed 40 million by 2050. Increasing life expectancy, combined with high rates of chronic disease, disability, and dementia among the oldest-old, has substantially increased the complexity of care needs. Demographic shifts in family structure have further strained traditional care arrangements. China’s current working-age population is predominantly composed of individuals born during the era of the one-child policy [ 4 ]. Smaller household sizes have eroded the traditional reliance on familial support, leaving many families—especially those in rural areas without pension income—unable to meet the financial, temporal, and caregiving demands of supporting four to eight elderly parents and grandparents [ 5 ]. In this context, long-term care facilities have become a critical component of China’s elder-care system. By the end of 2023, China had 404,000 such facilities providing 8.23 million beds [ 2 ], increasingly serving as the preferred option for older adults with advanced age, chronic conditions, disability, or dementia, and their families [ 6 , 7 ]. Nevertheless, a severe shortage of professionally trained care personnel persists in long-term care facilities worldwide. Japan, facing rapid aging, will need 2.5 million geriatric care workers by 2025, with an estimated deficit of 340,000 [ 8 ]. Similar trends are seen in Western countries. The UK will require an additional 160,000 care workers by 2032 [ 9 ], and the US will need a substantial workforce to care for nearly 15 million older adults by 2050 [ 10 ]. In Germany, data from the Federal Statistical Office show that of approximately 1.7 million nursing care personnel, nearly 30% work in long-term care settings, and as demand for elderly care grows, the qualified personnel shortage intensifies [ 11 , 12 ]. Staffing in Chinese long-term care facilities typically consists of registered nurses and care aides who often receive only brief training before employment. Low social recognition, weak professional identity, high workloads, and persistent ageism contribute to high turnover, an aging workforce, and inadequate clinical competencies among care teams [ 13 , 14 ]. These staffing challenges compromise care quality and limit the capacity to meet residents’ needs. Research indicates that understaffing is associated with unfinished care, elevated rates of adverse events such as pressure injuries, deep-vein thrombosis, falls, depression, and increased mortality [ 15 ]. A systematic review further concludes that higher staffing levels and richer skill mixes in long-term care are correlated with better care outcomes, with registered nurse staffing inversely associated with pressure ulcers, hospitalizations, and urinary tract infections [ 16 ]. Developing a skilled workforce for elder care is therefore essential for China to respond actively to population aging, enhance older adults’ quality of life and social well-being, and promote the healthy development of the long-term care industry. In response, China has implemented reforms in geriatric care education, including the establishment of higher-education programs in elder services and management, and the promotion of professional certification schemes led by bodies such as the China Association of Social Welfare and relevant government departments [ 17 , 18 ]. To systematically examine the factors influencing nursing undergraduates’ willingness to work in long-term care, this study adopts the Social Cognitive Career Theory (SCCT) as its analytical framework [ 19 ]. SCCT posits that career interests, choices, and performance are shaped by the dynamic interaction of three core cognitive variables, namely self efficacy beliefs, outcome expectations, and personal goals, all of which are moderated by contextual factors. Self efficacy refers to an individual’s judgment of their ability to successfully perform career related tasks. Outcome expectations refer to an individual’s estimates of the physical, social, and self evaluative consequences of engaging in a particular activity. Personal goals translate interests into specific choice behaviors. Contextual factors, such as family support, policy environment, and social norms, indirectly influence the formation and adjustment of these cognitive variables by providing support or creating barriers. This theory provides an integrative analytical lens for understanding the interaction between individual cognition and environmental context. Undergraduate nursing students represent a vital talent pool for improving the quality of elder care services. Their willingness to work in long-term care facilities significantly influences the future development of a high-quality geriatric care workforce [ 20 , 21 ]. Aligned with national policy, our university offers a minor in geriatric nursing and maintains collaborative partnerships with long-term care facilities, implementing a school-enterprise cooperative model to cultivate skilled care professionals [ 22 , 23 ]. This study examines the willingness of undergraduate nursing students who have voluntarily enrolled in a geriatric nursing minor to pursue careers in long-term care facilities, and explores the factors shaping their attitudes within the current sociopolitical context. The findings aim to provide insights for nursing educators and policymakers engaged in geriatric care workforce development. Participants and methods Participants This qualitative study utilized a purposive sampling approach to recruit undergraduate nursing students enrolled in a geriatric nursing minor program, which operates as a cooperative “order-based” training partnership between our university and municipal long-term care facilities. Recruitment and data collection took place between September 2024 and June 2025. The minor curriculum was delivered during the fall semester of the participants’ junior academic year. A total of thirty and twenty-eight nursing undergraduates from the 2021 and 2022 admission cohorts, respectively, elected to pursue geriatric nursing as their minor specialization. Recruitment continued until thematic saturation was achieved, defined as the point at which subsequent interviews yielded no new substantive insights. Inclusion criteria consisted of: (1) voluntary enrollment in the geriatric nursing minor program; (2) participation in the university–facilities cooperative training initiative; (3) completion of all required theoretical and clinical coursework in geriatric nursing; and (4) provision of informed consent for participation and audio recording. Exclusion criteria included: (1) attendance below 90% in theoretical geriatric nursing courses, or (2) attendance below 100% in long-term care facilities practicum courses. A total of 14 students participated in the study. A total of 43 students met the inclusion and exclusion criteria. After 12 interviews, it was observed that no new themes or substantive elaborations on existing themes were emerging. To confirm saturation, two additional interviews were conducted, which likewise contributed no novel information. Consequently, a final sample of 14 undergraduate nursing students specializing in geriatric care participated in the study. As a token of appreciation for their time and contribution, each participant received one entry into a post-study lottery. Prizes consisted of practical items such as daily necessities, supermarket vouchers, and USB flash drives. All incentives were funded through the designated budget of the research team. Methods Researcher characteristics. Research Team Members . The research team comprised four members. The first author, a university faculty member with a master’s degree, was responsible for laboratory management and practical course instruction for third- and fourth-year students. She possessed comprehensive knowledge of the students’ academic and clinical curriculum and was directly involved in their laboratory teaching and management. In this study, she was responsible for study design, conducting all 14 core in-depth interviews, managing audio recordings, writing field notes, transcript verification, independent coding, and manuscript writing. The second author, a second-year master’s student in nursing, was responsible for participant recruitment, literature review, transcript verification, independent coding, and thematic framework discussion. The third author, a university faculty member with a master’s degree, was responsible for laboratory management and practical course instruction for first- and second-year students in fundamental nursing courses, with nine years of teaching and geriatric nursing research experience. She was responsible for study design review, coding arbitration, and educational practice validation. The fourth author held a master’s degree in nursing and was a head nurse at a tertiary hospital in Beijing, with eight years of geriatric care research and clinical management experience. She was responsible for clinical relevance verification, thematic framework review, and long-term care setting validation. All team members had nursing professional backgrounds and received qualitative research training. The first, third, and fourth authors completed dedicated training in qualitative research methods and in-depth interview techniques during their respective master’s degree studies. The second author received qualitative research training during undergraduate studies and ongoing master’s coursework. Only the first author had a teaching relationship with participants. Positionality statement. The first author’s dual role as a faculty member and researcher may create several biases. First, power imbalance may lead participants to worry about academic evaluations, causing them to express overly positive career intentions or avoid sensitive topics like teaching evaluations. Second, relationship closeness may affect data quality. Familiar students might share more deeply due to trust, but could also participate just to save face. Unfamiliar students might feel nervous, avoidant, or give perfunctory responses. To mitigate these biases, we emphasized voluntary participation and grade independence in the consent form, used peer data collectors for supplementary conversations, conducted core interviews in neutral and private settings, had participants transcribe their own interviews, and maintained independent coding with team discussion of discrepancies. Mitigation of interviewer bias. To minimize power-related bias from the interviewer’s dual role as instructor and researcher, the following strategies were implemented. Data Collection Phase: (1) Recruitment. Conducted by the second author; the first author was not involved. Recruitment occurred after class meetings when the instructor had left, ensuring voluntary participation. (2) Timing. All interviews were scheduled after grades were finalized. Fourth-year students were interviewed in mid-May after graduation exam scores were entered; third-year students in early April after final grades were submitted, before clinical internships. (3) Power dynamics. Participants received written assurances that content was for research only, that the interviewer had no role in academic evaluation, and that all information was confidential. The consent form provided Ethics Committee and university complaint channels. The interviewer maintained neutrality, avoided judgment, and refrained from leading questions. (4) Peer supplementary conversations. Two trained peer data collectors conducted informal conversations on sensitive topics. These data were used solely for validation, not core thematic analysis. Data Analysis Phase: (1) Independent coding. The first and second authors independently coded all 14 transcripts, discussed disagreements, reviewed original context, and reached consensus. The third author arbitrated unresolved codes; the fourth author reviewed the framework for clinical and long-term care relevance. (2) Member checking. Finalized transcripts were returned to participants for verification. (3) Reflexive practice. The interviewer wrote field notes within 24 hours, documenting emotional reactions, value judgments, and power dynamic perceptions. The team reviewed these weekly to identify interpretive bias. Interview guide development. A semi-structured interview guide was developed based on the study objectives. The guide was piloted with two eligible students and refined iteratively to enhance clarity and relevance. The final guide included the following core domains: (1) What motivated your choice to pursue the geriatric nursing track? (2) How important is the role of nurses in long-term care facility? Please describe their potential contributions. (3) Would you consider working as a nurse in long-term care facilities in the future? Please explain your reasons. (4) Do you believe most nursing undergraduates are willing to work in long-term care facilities? Why or why not? (5) What are the strengths and weaknesses of the current educational collaboration between the university and partner long-term care facilities? (6) What improvements could be made to attract more young nursing graduates to geriatric care? Data collection. Core Interviews (n = 14). Data were collected through face-to-face, in-depth, semi-structured individual interviews. Interviews were conducted in quiet, private study rooms to ensure confidentiality and minimize distractions. Only the interviewer and participant were present. Sessions were scheduled at times convenient for participants, avoiding meal breaks and rest periods. With prior consent, all interviews were audio-recorded. The interviewer also maintained handwritten field notes to document nonverbal cues and contextual observations. A neutral, non-judgmental stance was maintained throughout, and leading questions were avoided. Each interview lasted approximately 30–40 minutes. Peer supplementary conversations (n = 9). To obtain candid feedback on sensitive topics (e.g., educational collaboration), a peer supplementary conversation mechanism was introduced. Two class officers (a class monitor and an academic representative) served as peer data collectors. In the Chinese higher education system, a class monitor assists with daily class management and monitors student well-being, while an academic representative serves as a liaison between students and course instructors regarding learning needs and difficulties. The peer data collectors were in the same class as participants during the first two years. After third-year specialization, they shared core courses but had different minor tracks (operating room and critical care, respectively), thus not meeting the inclusion criteria. Their role was limited to data collection and transcription; they did not participate in coding or thematic analysis. Before the conversations, researchers provided 3.5 hours of training on: (1) reviewing of qualitative research methods (1h); (2) ethics and confidentiality, including non-disclosure to faculty (1h); (3) non-leading questioning and audio equipment (0.5h); and (4) role-playing exercises (1h). Both signed ethical commitment forms after training. The two peer data collectors conducted informal, open-ended conversations with nine additional third-year students (not among the 14 core participants) in informal settings (e.g., cafeterias, playgrounds). These exploratory dialogues used prompts such as “What do you think about the teaching collaboration?” and “What are the strengths and weaknesses of our curren
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