{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:08:43Z","timestamp":1779170923248,"version":"3.51.4"},"reference-count":76,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:p>\n                    Workforce migration is often cast as a matter of personal choice or national shortage. This policy and practice review contends that the prevailing framing inadequately captures the dynamics of nursing mobility throughout the workforce lifecycle. It emphasises that this mobility is influenced by various stages, including education, early professional socialisation, active practice, and international migration. These stages ultimately contribute to systemic challenges by resulting in structural losses that affect the overall workforce. Using Nepal as a case study with wider relevance for low- and middle-income countries, the review examines how\n                    <jats:italic>aspiration<\/jats:italic>\n                    ,\n                    <jats:italic>governance<\/jats:italic>\n                    , and\n                    <jats:italic>depletion<\/jats:italic>\n                    become mutually reinforcing rather than discrete phenomena. Drawing on a targeted review of empirical literature indexed in MEDLINE, CINAHL, and Scopus, together with key governmental reports and International Council of Nurses and World Health Organisation documents, and guided by Walt and Gilson's policy triangle, the paper analyses how migration intent is\n                    <jats:italic>formed<\/jats:italic>\n                    ,\n                    <jats:italic>mediated<\/jats:italic>\n                    , and\n                    <jats:italic>reproduced<\/jats:italic>\n                    over time. The analysis shows that migration is seeded early, during undergraduate training, where educational-clinical disjuncture, hierarchy, weak professional recognition, and normalised expectations of overseas opportunity begin to orient students toward exit. These aspirations are then structured through governance mechanisms, including bilateral recruitment arrangements, such as the Nepal\u2013UK Memorandum of Understanding, and definitional shifts in nursing that increase nursing's portability and international legibility. The effects are not confined to workforce numbers. They surface in compromised clinical supervision, ethical dissonance, and psychological strain among students; in moral distress, managerial overload, and widening rural disadvantage among practising nurses; and in a broader weakening of the domestic system's capacity to reproduce its own workforce. The review concludes that nurse migration is not simply a retention problem. It is a governance failure in the social and professional reproduction of nursing. Effective policy must therefore move beyond moral appeals to stay and instead align domestic professional revaluation, student-pipeline protection, and reciprocal mobility governance.\n                  <\/jats:p>","DOI":"10.3389\/frhs.2026.1851983","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:40:30Z","timestamp":1779169230000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Training for departure? Policy, professional portability, and the fragile future of Nepal's nursing workforce"],"prefix":"10.3389","volume":"6","author":[{"given":"Animesh","family":"Ghimire","sequence":"first","affiliation":[{"name":"Sustainable Environment Foundation Nepal","place":["Kathmandu, Nepal"]},{"name":"School of Nursing, Chitwan Medical College","place":["Chitwan, Nepal"]},{"name":"School of Public Health, Chitwan Medical College","place":["Chitwan, Nepal"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"B1","volume-title":"Nursing and Midwifery","year":"2025"},{"key":"B2","volume-title":"State of the World\u2019s Nursing Report","year":"2025"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1080\/09692290.2025.2450399","article-title":"The \u201cethical recruitment\u201d of international nurses: Germany\u2019s liberal health worker extractivism","volume":"32","author":"Hanrieder","year":"2025","journal-title":"Rev Int Political Econ"},{"key":"B4","doi-asserted-by":"publisher","first-page":"105305","DOI":"10.1016\/j.healthpol.2025.105305","article-title":"Global health and care worker migration requires a global response","volume":"155","author":"Kuhlmann","year":"2025","journal-title":"Health Policy"},{"key":"B5","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1002\/hpm.3776","article-title":"The impact of international health worker migration and recruitment on health systems in source countries: stakeholder perspectives from Colombia, Indonesia, and Jordan","volume":"39","author":"Sax dos Santos Gomes","year":"2024","journal-title":"Int J Health Plann Manage"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e014096","DOI":"10.1136\/bmjgh-2023-014096","article-title":"Market making and the production of nurses for export: a case study of India-UK health worker migration","volume":"9","author":"Merz","year":"2024","journal-title":"BMJ Glob Health"},{"key":"B7","volume-title":"Review of International Migration of Nurses from the State of Kerala","year":"2022"},{"key":"B8","volume-title":"National Human Resources for Health (HRH) Strategy","year":"2021"},{"key":"B9","volume-title":"Vision, Mission and Goal of Nepal Health Sector Strategic Plan 2023\u20132030","year":"2023"},{"key":"B10","year":""},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0004260","DOI":"10.1371\/journal.pgph.0004260","article-title":"Contributing and mitigating factors of brain drain among healthcare workers from cardiac care facilities in Nepal\u2014a qualitative case study","volume":"5","author":"Jha","year":"2025","journal-title":"PLOS Glob Public Health"},{"key":"B12","volume-title":"Nurses and Midwives (per 1,000 People)","year":"2023"},{"key":"B13","volume-title":"State of the World Nursing","year":"2025"},{"key":"B14","volume-title":"Memorandum of Understanding between the Government of Nepal and the Government of the United Kingdom of Great Britain and Northern Ireland on the Recruitment of Healthcare Professionals","year":"2022"},{"key":"B15","volume-title":"Health Workforce Support and Safeguards List","year":"2023"},{"key":"B16","volume-title":"Renewing the Definitions of \u201cNursing\u201d and \u201cA Nurse\u201d","author":"White","year":"2025"},{"key":"B17","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1177\/15271544251408441","article-title":"From global standards to local action: practical pathways for adopting the international council of nurses\u2019s (ICN\u2019s) updated \u201cnursing\u201d and \u201ca nurse\u201d definitions in low- and middle-income countries","volume":"27","author":"Ghimire","year":"2026","journal-title":"Policy Polit Nurs Pract"},{"key":"B18","doi-asserted-by":"publisher","first-page":"106414","DOI":"10.1016\/j.nedt.2024.106414","article-title":"Exploring the factors affecting undergraduate nursing students\u2019 migration intention: a qualitative study","volume":"143","author":"Ghimire","year":"2024","journal-title":"Nurse Educ Today"},{"key":"B19","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1177\/15271544251322493","article-title":"Beyond borders: a longitudinal study of Nepali nurses\u2019 dreams, realities, and the pursuit of a global career","volume":"26","author":"Ghimire","year":"2025","journal-title":"Policy Polit Nurs Pract"},{"key":"B20","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1186\/s12912-024-02578-5","article-title":"A generation at risk: the unseen consequences of Nepal\u2019s nursing shortage on undergraduate nursing students clinical education","volume":"23","author":"Ghimire","year":"2024","journal-title":"BMC Nurs"},{"key":"B21","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1177\/09697330251374392","article-title":"Ethical implications of nurse brain drain on undergraduate nursing students","volume":"33","author":"Ghimire","year":"2026","journal-title":"Nurs Ethics"},{"key":"B22","doi-asserted-by":"publisher","first-page":"312","DOI":"10.3390\/nursrep15090312","article-title":"Concealing, connecting, and confronting: a reflexive inquiry into mental health and wellbeing among undergraduate nursing students","volume":"15","author":"Ghimire","year":"2025","journal-title":"Nurs Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1186\/s12912-025-02878-4","article-title":"Between duty and despair: the ethical toll of brain drain on Nepalese nurse managers","volume":"24","author":"Ghimire","year":"2025","journal-title":"BMC Nurs"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1093\/heapro\/day052","article-title":"A guide to policy analysis as a research method","volume":"34","author":"Browne","year":"2018","journal-title":"Health Promot Int"},{"key":"B25","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1093\/heapol\/9.4.353","article-title":"Reforming the health sector in developing countries: the central role of policy analysis","volume":"9","author":"Walt","year":"1994","journal-title":"Health Policy Plan"},{"key":"B26","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1093\/heapol\/czn024","article-title":"\u201cDoing\u201d health policy analysis: methodological and conceptual reflections and challenges","volume":"23","author":"Walt","year":"2008","journal-title":"Health Policy Plan"},{"key":"B27","doi-asserted-by":"publisher","first-page":"100493","DOI":"10.1016\/j.lansea.2024.100493","article-title":"Neocolonial echoes in healthcare: ethical quandaries of the Nepal-UK nurse recruitment memorandum of understanding","volume":"30","author":"Ghimire","year":"2024","journal-title":"Lancet Reg Health Southeast Asia"},{"key":"B28","volume-title":"WHO Global Code of Practice on the International Recruitment of Health Personnel","year":"2010"},{"key":"B29","doi-asserted-by":"publisher","first-page":"100016","DOI":"10.1016\/j.hpopen.2020.100016","article-title":"Health policy triangle framework: narrative review of the recent literature","volume":"1","author":"O'Brien","year":"2020","journal-title":"Health Policy Open"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.34172\/ijhpm.2022.7580","article-title":"Modelling the health policy process: one size fits all or horses for courses?","volume":"12","author":"Powell","year":"2023","journal-title":"Int J Health Policy Manag"},{"key":"B31","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13012-015-0242-0","article-title":"Making sense of implementation theories, models and frameworks","volume":"10","author":"Nilsen","year":"2015","journal-title":"Implement Sci"},{"key":"B32","doi-asserted-by":"publisher","first-page":"iii35","DOI":"10.1093\/heapol\/czu063","article-title":"Mapping the existing body of health policy implementation research in lower income settings: what is covered and what are the gaps?","volume":"29","author":"Erasmus","year":"2014","journal-title":"Health Policy Plan"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/17449871251385950","article-title":"Nursing for justice: reflections on the new ICN definition","volume":"30","author":"Garmy","year":"2025","journal-title":"J Res Nurs"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bmjgh-2023-012338","article-title":"Drivers of health workers\u2019 migration, intention to migrate and non-migration from low\/middle-income countries, 1970\u20132022: a systematic review","volume":"8","author":"Toyin-Thomas","year":"2023","journal-title":"BMJ Glob Health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1186\/s12912-024-02180-9","article-title":"Migration intentions among nursing students in a low-middle-income country","volume":"23","author":"Laari","year":"2024","journal-title":"BMC Nurs"},{"key":"B36","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/1478-4491-6-5","article-title":"Intent to migrate among nursing students in Uganda: measures of the brain drain in the next generation of health professionals","volume":"6","author":"Nguyen","year":"2008","journal-title":"Hum Resour Health"},{"key":"B37","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.nepr.2017.11.012","article-title":"Exploring migration intention of nursing students in Nepal: a mixed-methods study","volume":"29","author":"Poudel","year":"2018","journal-title":"Nurse Educ Pract"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e13009","DOI":"10.1111\/inr.13009","article-title":"Linking nursing students\u2019 professional identity, clinical learning environment, financial incentives, and career opportunities with migration intent: structural equation modeling","volume":"72","author":"Valencia","year":"2025","journal-title":"Int Nurs Rev"},{"key":"B39","doi-asserted-by":"publisher","first-page":"675","DOI":"10.3390\/healthcare12060675","article-title":"Shifting horizons: the impact of global events on the intention to migrate of the next generation Romanian nurses","volume":"12","author":"Popescu","year":"2024","journal-title":"Healthcare"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5430\/jnep.v15n1p22","article-title":"Pandemic perspectives: a scoping review of undergraduate nursing students\u2019 motivations in the age of COVID-19","volume":"15","author":"Ghimire","year":"2025","journal-title":"J Nurs Educ Pract"},{"key":"B41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.54530\/jcmc.1549","article-title":"Migration intentions among nursing students in the age of COVID-19: a mixed method scoping review: migration intentions among nursing students","volume":"14","author":"Ghimire","year":"2024","journal-title":"J Chitwan Med Coll"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1186\/s12912-025-03962-5","article-title":"Migration intent, health, and higher education plans as determinants of professional identity and image of nursing among future nurses in resource-limited health systems: a cross-sectional study","volume":"24","author":"Ravi","year":"2025","journal-title":"BMC Nurs"},{"key":"B43","volume-title":"Code of Practice Red and Amber List of Countries","year":"2025"},{"key":"B44","volume-title":"Code of Practice for the International Recruitment of Health and Social Care Personnel in England","year":"2025"},{"key":"B45","volume-title":"Hampshire Hospitals Welcomes Intake of Nepalese Nurses as Part of Government Pilot","year":"2024"},{"key":"B46","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s12960-016-0117-8","article-title":"Challenges to implementation of the WHO global code of practice on international recruitment of health personnel: the case of Sudan","volume":"14","author":"Abuagla","year":"2016","journal-title":"Hum Resour Health"},{"key":"B47","doi-asserted-by":"publisher","first-page":"2013600","DOI":"10.1080\/16549716.2021.2013600","article-title":"Governance systems for skilled health worker migration, their public value and competing priorities: an interpretive scoping review","volume":"15","author":"Yakubu","year":"2022","journal-title":"Glob Health Action"},{"key":"B48","doi-asserted-by":"publisher","first-page":"117","DOI":"10.2471\/blt.23.290028","article-title":"Health workforce data needed to minimize inequities associated with health-worker migration","volume":"102","author":"Walton-Roberts","year":"2024","journal-title":"Bull World Health Organ"},{"key":"B49","volume-title":"NHS Long Term Workforce Plan","year":"2024"},{"key":"B50","volume-title":"Nursing Workforce\u2014international Recruitment","year":"2025"},{"key":"B51","volume-title":"UK is Pinching 1 in 4 of its Nurses from Countries with Desperate Shortages","author":"Bychawski","year":"2022"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1177\/09697330241305574","article-title":"Ethical considerations in the UK-Nepal nurse recruitment: Nepali nurses\u2019 perspectives","volume":"32","author":"Ghimire","year":"2025","journal-title":"Nurs Ethics"},{"key":"B53","doi-asserted-by":"publisher","first-page":"104983","DOI":"10.1016\/j.nedt.2021.104983","article-title":"Nursing students\u2019 evaluation of clinical practice placements using the clinical learning environment, supervision and nurse teacher scale\u2014a systematic review","volume":"104","author":"Cant","year":"2021","journal-title":"Nurse Educ Today"},{"key":"B54","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1177\/20571585211029857","article-title":"Nursing students\u2019 professional identity development: an integrative review","volume":"42","author":"Vabo","year":"2022","journal-title":"Nordic J Nurs Res"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1418","DOI":"10.1177\/09697330241287856","article-title":"Moral distress among undergraduate nursing students in clinical practice: a scoping review","volume":"32","author":"Santos","year":"2025","journal-title":"Nurs Ethics"},{"key":"B56","doi-asserted-by":"crossref","first-page":"302","DOI":"10.62547\/YEIS2105","article-title":"Artificial intelligence in nursing education: opportunities and challenges","volume":"82","author":"Glauberman","year":"2023","journal-title":"Hawaii J Health Soc Welf"},{"key":"B57","doi-asserted-by":"publisher","first-page":"104148","DOI":"10.1016\/j.nepr.2024.104148","article-title":"Artificial intelligence in nursing education: a scoping review","volume":"80","author":"Lifshits","year":"2024","journal-title":"Nurse Educ Pract"},{"key":"B58","doi-asserted-by":"publisher","first-page":"107111","DOI":"10.1016\/j.nedt.2026.107111","article-title":"Recalibrating the value of presence: a qualitative study on generative AI, attendance, and professional formation in undergraduate nursing","volume":"163","author":"Ghimire","year":"2026","journal-title":"Nurse Educ Today"},{"key":"B59","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1186\/s12912-024-02472-0","article-title":"Designing and evaluating ECG interpretation software for undergraduate nursing students in Iran: a non-equivalent control group pretest-posttest design","volume":"23","author":"Kohan","year":"2024","journal-title":"BMC Nurs"},{"key":"B60","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1093\/ehjdh\/ztab027","article-title":"Utility of mobile learning in electrocardiography","volume":"2","author":"Viljoen","year":"2021","journal-title":"Eur Heart J Digit Health"},{"key":"B61","doi-asserted-by":"publisher","first-page":"104330","DOI":"10.1016\/j.nepr.2025.104330","article-title":"Redefining pedagogy with artificial intelligence: how nursing students are shaping the future of learning","volume":"84","author":"Ghimire","year":"2025","journal-title":"Nurse Educ Pract"},{"key":"B62","doi-asserted-by":"publisher","first-page":"104669","DOI":"10.1016\/j.nepr.2025.104669","article-title":"Application of generative artificial intelligence by nurse academics in higher education: a scoping review","volume":"90","author":"Hamilton","year":"2026","journal-title":"Nurse Educ Pract"},{"key":"B63","doi-asserted-by":"publisher","first-page":"104993","DOI":"10.1016\/j.ijnurstu.2025.104993","article-title":"The prevalence of mental health issues among nursing students: an umbrella review synthesis of meta-analytic evidence","volume":"163","author":"Efstathiou","year":"2025","journal-title":"Int J Nurs Stud"},{"key":"B64","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.1192\/bjo.2023.603","article-title":"A systematic review of peer support interventions for student mental health and well-being in higher education","volume":"10","author":"Pointon-Haas","year":"2023","journal-title":"BJPsych Open"},{"key":"B65","doi-asserted-by":"publisher","first-page":"5443770","DOI":"10.1155\/jonm\/5443770","article-title":"The role of leadership in supporting and mitigating moral distress in nursing: a scoping review","volume":"2025","author":"Bolton","year":"2025","journal-title":"J Nurs Manag"},{"key":"B66","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s12960-023-00807-7","article-title":"Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review","volume":"21","author":"Imam","year":"2023","journal-title":"Hum Resour Health"},{"key":"B67","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12961-025-01321-z","article-title":"Transforming health in Nepal: a historical and contemporary review on disease burden, health system challenges, and innovations","volume":"23","author":"Mishra","year":"2025","journal-title":"Health Res Policy Syst"},{"key":"B68","doi-asserted-by":"publisher","first-page":"100195","DOI":"10.1016\/j.ijnsa.2024.100195","article-title":"Transitioning experiences of internationally educated nurses in host countries: a narrative systematic review","volume":"6","author":"Rajpoot","year":"2024","journal-title":"Int J Nurs Stud Adv"},{"key":"B69","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s40878-020-00210-4","article-title":"A theory of migration: the aspirations-capabilities framework","volume":"9","author":"de Haas","year":"2021","journal-title":"Comp Migr Stud"},{"key":"B70","doi-asserted-by":"publisher","first-page":"2217","DOI":"10.2147\/jmdh.S321963","article-title":"Experiences of healthcare worker returnees in their home countries: a scoping review","volume":"14","author":"Efendi","year":"2021","journal-title":"J Multidiscip Healthc"},{"key":"B71","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s12992-026-01201-3","article-title":"Back home, beyond borders: a bioecological study of returnee public health scholars in a globalized health system","volume":"22","author":"Ghimire","year":"2026","journal-title":"Global Health"},{"key":"B72","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1111\/j.1475-6773.2007.00716.x","article-title":"Nurse migration from a source country perspective: Philippine country case study","volume":"42","author":"Lorenzo","year":"2007","journal-title":"Health Serv Res"},{"key":"B73","doi-asserted-by":"publisher","first-page":"e0000717","DOI":"10.1371\/journal.pgph.0000717","article-title":"Scope of health worker migration governance and its impact on emigration intentions among skilled health workers in Nigeria","volume":"3","author":"Yakubu","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"B74","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4102\/hsag.v24i0.1284","article-title":"Community service nurses\u2019 experiences regarding their clinical competence","volume":"24","author":"Matlhaba","year":"2019","journal-title":"Health SA"},{"key":"B75","doi-asserted-by":"publisher","first-page":"100496","DOI":"10.1016\/j.ijans.2022.100496","article-title":"Perspectives of nurse graduates, hospital managers and mentors regarding transition support needs during compulsory community service in South Africa","volume":"17","author":"Scheepers","year":"2022","journal-title":"Int J Africa Nurs Sci"},{"key":"B76","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/5023419","article-title":"New graduate nurses\u2019 experiences and challenges during a one-year clinical rotation programme in the volta region of Ghana: implications for nursing management and nursing workforce retention","volume":"2022","author":"Adatara","year":"2022","journal-title":"BioMed Res Int"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1851983\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:40:39Z","timestamp":1779169239000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1851983\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":76,"alternative-id":["10.3389\/frhs.2026.1851983"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1851983","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"article-number":"1851983"}}