The woman lived in a makeshift shelter, part of a homeless encampment far from the city's skyscrapers and coffee bars.

Each week, two nursing students from the Washington State University College of Nursing in Spokane visit the encampment to check on the residents' health. One woman in particular continued to provide the students cause for concern. She was severely depressed, and they suspected she was diabetic, but their attempts to have her evaluated at the university's medical clinic were always met with resistance.

Then, one day several months ago, the students experienced a breakthrough with their patient. Maybe it was something one of the students said, or maybe it was the compassion they had shown the woman during the past year. Whatever triggered her change was cause for celebration-the woman agreed to accompany them to the university's People's Clinic for further evaluation and treatment.

Today, for the first time in many years, the woman receives consistent medical care for her mental and physical conditions.

Washington State is one of many nursing schools across the country giving students real-world experience in caring for indigent patients. Beyond the classroom doors, the students visit worlds that are a far cry from the middle-class neighborhoods most call home. From homeless shelters to roadside encampments to single-room occupancy hotels, these students serve as health care providers to an often-overlooked patient population.

"Working with homeless patients provides our student nurses with a powerful learning experience," said Carol Allen, Ph.D., MSN, RN, an instructor in the Intercollegiate College of Nursing at WSU's College of Nursing. "And in many cases, we are the only health care providers for this population."

For the past 15 years, WSU community health students have worked in pairs providing care to some of Spokane's poorest residents. They work two days a week, two to six hours a day, caring for low-income and homeless patients with chronic health problems, mental illness and drug addictions.

Nursing students provide services such as blood pressure screenings, dietary counseling for good nutrition, smoking cessation counseling and disease management counseling for diabetes and hypertension.

"The first day one of our nursing students visits the homeless, they return with a 'deer in the headlights' look about them," Allen said. "But over time, they discover these people are strong and resilient, they have names and they are no longer invisible people you avoid looking at on the street."

The WSU program isn't mandatory for nursing students, but it is one of the most popular course options.

"We have more requests from students who want to be involved in this program than we can fill," Allen said. "It's a learning experience far different than anything our students experience in the classroom."

At the University of California, San Francisco, prelicensure nursing students in the master's entry program of nursing and advanced practice nurses complete part of their residency requirements at the Glide Health Clinic.

The clinic, founded in 1997, is a joint partnership between the UCSF School of Nursing's Department of Community Health Systems, Glide Memorial United Methodist Church and Catholic Healthcare West-West Bay Region.

"Glide has always provided a variety of services to vulnerable individuals, including persons who are homeless," said Joanne Saxe, MS, ANP, RN, director of the adult nurse practitioner program and clinical professor at the Department of Community Health Systems. "For example, Glide has provided the needy with food, recovery and child care programs, so a health clinic was a natural extension of their offerings."

The Glide Health Clinic is open four half days a week and is staffed by UCSF nurse practitioner faculty members, nursing students and Glide clinicians and staff members. The students complete anywhere from 30 to 400 clinical hours during any given academic year at the clinic, which serves about 2,000 clients.

In addition to offering a full range of primary care and psychiatric services, the clinic offers complementary care services including acupuncture, chiropractic care, massage therapy, guided imagery, energy healing and Reiki.

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