Training for departure? Policy, professional portability, and the fragile future of Nepal's nursing workforce.

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 aspiration, governance, and depletion 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 formed, mediated, and reproduced 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-UK 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.