Impacts of clinical psychiatric posting experience on specialization intention and associated factors among Nursing Science students

Globally, prevalence of mental disorders are on the increase across all age group and social class with more being projected by 2030, but without commensurate measures or resources for mental health care delivery [1, 2]. Mental disorders are very common in developing countries like Nigeria where there are poor access to mental healthcare due to lack of resources, lack of funding and other inhibitory factors [3‐6]. In Nigeria, about 20% of over 200 million people living in the country suffer mental disorders [5]. More recent studies showed increasingly higher incidence of the disorders in Nigeria but without commensurate human resources for mental health care delivery [2, 7]. Despite alarming rate of mental disorders among the people, over 2/3 of patients with mental disorders globally do not have access to mental healthcare from healthcare workers due to lack of mental healthcare professionals, discriminatory attitudes and stigma [8]. In Nigeria, less than 0.6% of people with mental disorders receive care from mental health professionals due to lack of mental health professionals and poor funding of mental healthcare [9, 10]. In sub-Saharan African Countries, there is less than one mental health professional per one million people [5]. As reported by world health organization, there is no traceable record of available mental health professionals in Nigeria and there is poor research output on the status of mental healthcare delivery including human resources, nationwide prevalence of mental disorders and mental health funding in Nigeria [11]. More recently, evidence showed gross shortage of mental health professionals in Nigera [12]. This is a threat to the wellbeing of the citizens of the most populous country in Africa. This calls for research studies as to provide reliable evidence for policy advocacy and formulation.

Psychiatry and mental health is rarely an area favoured by healthcare providers, including medical and health sciences students thereby threatening future availability of human resources for mental health services delivery [13]. According to empirical evidence, nursing students are unwilling to specialize in psychiatric and mental health nursing as their career pathway, and only few nursing students chose psychiatric nursing as likely area of expertise when compared to other fields of nursing [14‐18]. Globally, health sciences students have reported preference of children, emergency and intensive units over psychiatry as possible areas of career pursuit [13]. This lack of interest in this important aspect of healthcare could constitute a serious challenge to universal healthcare coverage of United Nations because it would exert negative influence on the healthcare delivery. This was attributed to some educational and personal factors such as knowledge of psychiatry, poor funding, family influence, clinical experience and public image of psychiatry among others [18]. Though other studies have been done on the concept in other countries [18‐20], due to cultural diversity and country specific peculiarities in Nigeria as discussed above and the fact that there is paucity of literature on the concept in Nigeria need exist for this study.

Knowing that nurses play crucial roles in mental healthcare delivery like in other aspects of health and that nursing students are the future human resources for mental health services, there is need to assess their career preferences and determining factors. This will help to inform basis for policy formulation and interventions as to prevent projected healthcare workforce shortage of 10–15 million by 2030 [21‐23]. There is also paucity of literature on the career preferences of nursing students from Nigeria. Secondly no existing research study has examined effects of psychiatric posting, an essential component of nursing training on students’ career preference. It is therefore important to examine the training modality (psychiatric clinical posting) used in training the students to know if need exist for improvement as to enhance equitable distribution of human resources for healthcare delivery.

In line with literature on career choices among health sciences students [18, 24, 25], this study showed that career choices among nursing students in Ebonyi state, Nigeria favoured medical specialties and community health nursing while psychiatry was least preferred among nursing students in the various institutions with only 6% of the respondents considering psychiatry as a likely career choice. This has serious implication on the teaming population of people living with mental disorders in the country and globally. This implies that in nearby future the shortage of mental health care professionals might be more severe if nothing is done to change the situation and ensure equitable health workforce distribution across specialties. This finding further confirmed the projected shortage of human resources for healthcare delivery by 2030 ²¹. To improve on this situation requires frantic efforts from educators and policy makers as to ensure universal healthcare covering all aspects of health as no aspect is less important than the others. This report is more threatening than the report of a similar study in India which showed 13% choice of career in psychiatry [26] but similar to the findings of a study in Singapore on career choices in psychiatry among Singapore students which reported 5% choice of psychiatry [25]. It also further confirmed the report of a review paper which stated that there was a gross shortage of mental health professionals in Nigeria [12]. The differences across studies and countries could be explained by the status of psychiatry, supports given to it, level of publicity among the society, level of exposure of the students and the overall national perception of the specialty [27]. Though there was an increase in the percentage of students willing to specialize in psychiatry after clinical psychiatric placement, the change was not statistically significant. This could be due to the short duration of the posting and the experiences of the students during the posting. Improving the duration of posting and their experiences may bring more significant increase in choice of psychiatry.

Findings revealed numerous determinants at preliminary stage but four key independent variables remained statistically significant in final model as determinants of career choices in psychiatry among the respondents. Interest in psychiatry (AOR = 16.06 (95% CI1.10, 14.96) p-value = 0.009) among the respondents determined to a great extent the likelihood of career choice in psychiatry and mental health nursing. Those respondents who had interest in psychiatry or who saw psychiatry as interesting were 16 times more likely to choose career in psychiatry than others. This implies that any effort geared at arousing the interest of the potential health professionals in this all important specialty will yield an increase in the choice of psychiatry as career and possibly the future availability of mental health professionals across countries. This is because evidence showed that the degree of efforts, supports and publicity given to any specialty is a key determinant of its status and choice among potential healthcare givers [28]. This result is in line with similar studies among health sciences students in other countries [25, 29].

Another important influencing factor of career choice in psychiatry revealed by this study was family influence (AOR = 13.76(1.74, 12.02) p = 0.013). Those students who were allowed to choose which specialty they desired as career area were 13.7 times more likely to choose career in psychiatric and mental health nursing when compared to those students whose career choices were influenced by their family members. This finding implies that the family members’ view and perception about psychiatry go a long way to determining the choice of psychiatry among prospective healthcare professionals. Therefore every necessary effort must be put in place to address this situation as to improve human resources for mental healthcare delivery. This finding is in line with similar study in china which showed that the family members played key roles in the students’ choice of career areas [30]. Though the result is similar, the situation is worst in developing nations like Nigeria where parents and other family members decide for students what to study or not to study. The result is in contrary to the result of same concept in Singapore which did not report family influence as determinant of students’ career choices [31]. This difference among the studies could be accounted for by the differences in level of stigma and negative view attached to psychiatry across countries which has been reported to play key role in the perception of psychiatry and choice as career [25].

Additionally, interest in community services (AOR = 4.01(95% CI = 1.32, 12.20) P = 0.014) showed statistically significant association with choice of career in psychiatry. Those students who had interest in community services were 4.01 times more likely to specialize in psychiatry than others. This therefore calls for urgent implementation of community based mental health services in developing countries where mental health services are still institutionalized. This would promote the acceptance of psychiatry among future healthcare professionals and even by the society. Locally drafted policy on community mental health services delivery is encouraged by this finding as this would promote public acceptance of the specialty [12]. This finding agreed with that of similar study by Ibrahim [32] which reported desire to help as a motivating factor to choice of career among health science students.

Job satisfaction (AOR = 0.10(0.03, 0.26)p < 0.001) showed a statistically significant association with choice of career in psychiatry. The students considered their satisfaction with the area of specialization is one of the factors to consider in deciding which area to major. Those who considered level of satisfaction with the works associated with a given aspect of nursing were 0.10 more likely to choice psychiatry if they envisage being satisfied with the roles and functions of the psychiatric nurses when compared to others. Though the adjusted odd ratio of job satisfaction was not much, it is a very important area of work people most times do not joke with. It is therefore imperative that all aspects of nursing or healthcare should be made equally attractive as to enhance recruitment and retention in the areas. In Nigeria, there is undue emphasis placed on physical aspect of health to the detriment of psychological aspect [12]. This finding therefore, calls on policy makers and healthcare administrators to ensure equity in healthcare setting in terms of funding, remunerations and placement to ensure acceptance among future professionals.

Psychiatry was not a common choice of career among nursing students in Ebonyi state Nigeria. Clinical psychiatric posting showed no significant impact on the choice of psychiatry as career among nursing students. This study revealed key determinants of career choices in psychiatry among nursing students to include interest in psychiatry, interest in community services, job satisfaction and family influence. Therefore, these factors would be vital in policy formulation and interventions aimed at improving acceptability of psychiatry to the prospective healthcare professionals.