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"Many of our clients haven't had access to health care in many years, so their initial visit can be a daunting experience," Saxe said. "Many of our patients discover that starting out with complementary care services is a comfortable first step for engaging in care."

At the University of Iowa, health promotion and disease prevention are lessons taught to the homeless as part of the nursing students' clinical health rotation.

"Our college town, Iowa City, has a growing homeless population that many students never knew existed," said Susan Lehmann, MSN, RN, clinical instructor at the College of Nursing. "Our students are accustomed to caring for clients in hospital settings that are clean and controlled. This program shows them that many persons live with limited resources and in difficult circumstances once they leave the protection of the hospital."

Although caring for the homeless can be a life-changing experience for many nursing students, it might not be feasible for all universities to implement such a program.

"Universities need to have a faculty member who sees the potential impact that nursing students can have with this population," Lehmann said. "The school needs to be willing to develop relationships with key advocates in the community and to be creative in finding a location to offer the services."

Funding also can be a challenge for student nursing programs. The University of Iowa began its nursing outreach program two years ago when it received the Helene Fuld Grant, which provides funding for community health studies.

Each semester, students volunteer as nurse case managers at Shelter House, a homeless facility.

"All of our services are provided free of charge and often prevent minor health problems from escalating into emergency room visits," Lehmann said.

Working in a program for indigent patients can also alter the career paths of many nursing students.

Students learn how important it is to build trust with their homeless patients and get hands-on experience practicing their communication and critical thinking skills as they work with patients who often have tremendous needs, chronic problems and may have trouble articulating their needs.

"Some students realize that working with low-income populations is their passion," Lehmann said. "Others, while appreciating the training, find they are more cut out to work in a traditional hospital setting."