Denis Karki
Nepal stands on the edge of a healthcare crisis that could spiral into collapse if urgent action is not taken. At the center of this storm are the country’s nurses—the quiet, relentless heroes of our healthcare system. These young professionals, many no older than 30, have dedicated their lives to caring for others, yet their own voices of distress are largely ignored. Overburdened and underpaid, they are struggling not only against disease but also against a system that has failed to protect and support them.
This is not merely a professional crisis for nurses; it is a national emergency. Without an adequate nursing workforce, hospitals cannot function, patients will be left unattended, and healthcare outcomes will deteriorate. As global demand for nurses intensifies, Nepal is losing its best-trained professionals to countries offering better pay, better conditions, and brighter futures. The question is no longer whether this will impact Nepal’s healthcare system—it already has. The real question is: how much longer can we expect the backbone of our healthcare system to carry this burden alone?
Nepal and the Global Nursing Shortage
The nursing shortage is not unique to Nepal. The World Health Organization (WHO) warns of a global shortfall of 4.5 million nurses and midwives by 2030, with the hardest-hit regions including Africa, Southeast Asia, and Latin America. Wealthier nations, such as the United States, the United Kingdom, and Australia, are actively recruiting nurses from countries like Nepal to fill their gaps.
The WHO recommends that every country maintain at least 40–45 nurses per 10,000 people to meet basic healthcare needs. Nepal falls far below this threshold, and the gap is widening as migration accelerates. Where richer countries have invested in increasing their nurse-to-patient ratios, Nepal is hemorrhaging its talent pool, leaving its healthcare system under-resourced and overstretched.
Why Are Nepal’s Nurses Leaving?
The shortage of nurses in Nepal is driven by a confluence of factors, each feeding into the other to create a crisis that is both systemic and avoidable.
1. Migration for Better Opportunities
International recruitment is an attractive option for Nepali nurses. Salaries abroad far exceed what is offered domestically, often by a factor of ten or more. Countries like the UK, USA, and Australia provide better working conditions, career advancement, and professional recognition. Reports suggest that over 40,000 Nepali nurses have applied for migration documentation, seeking opportunities overseas.
2. Low Wages and Poor Working Conditions
The starting salary for a nurse in Nepal hovers around NPR 15,000 (approximately $110), a figure that fails to reflect the critical importance of their work. Long shifts, understaffed wards, and inadequate benefits further drive nurses to seek better opportunities. While they remain the backbone of the healthcare system, they are often treated as expendable labor rather than as professionals vital to national well-being.
3. Government Policy Failures
Perhaps the most egregious factor is government inaction. The closure of dozens of nursing schools has decimated the pipeline of new professionals. While regulatory standards—such as requiring nursing schools to have a 100-bed hospital—may have been well-intentioned, the failure to provide alternatives or support for institutions has resulted in a catastrophic drop in nurse training capacity.
4. Limited Career Growth
Professional stagnation is another driver. Nepal offers few avenues for nurses to specialize or advance within the healthcare hierarchy. Ambitious nurses are forced to look abroad for opportunities to pursue higher education or more specialized roles.
The Education Bottleneck
The numbers tell a grim story. A decade ago, Nepal had 113 nursing schools. Today, due to closures triggered by rigid regulations, only a fraction remain. The annual training capacity has plummeted from over 4,000 students to approximately 1,800—1,500 at the Proficiency Certificate Level (PCL) and 300 at the bachelor’s level.
The closures have stranded over 3,600 aspiring students who might have joined the healthcare workforce. Meanwhile, international demand for Nepali nurses is growing, creating a brain drain that Nepal is ill-prepared to counter. Of the 72,550 registered nurses in Nepal, around 25,000 are already working abroad. With global shortages intensifying, this exodus is likely to accelerate unless bold interventions are made.
A Delayed Crisis
The present crisis is the direct result of years of neglect and policy failure. For five years, applications to open new nursing schools were ignored while existing ones were shuttered. The impact of this short-sightedness is being felt now, but rebuilding the nursing workforce will not be quick. Even if the government were to act immediately, it would take at least 5 to 7 years to restore the training pipeline to its previous levels—and even then, it would not be enough to meet the growing healthcare demands of a population of nearly 30 million.
The Overburdened and Overlooked
The nurses who remain in Nepal are fighting a lonely battle. Many work double or triple shifts, filling the gaps left by vacant positions. They are exhausted, underpaid, and stretched to their limits. These women—many between the ages of 18 and 30—entered nursing out of a deep sense of service. For them, nursing is not just a job but a calling.
However, their commitment is being exploited. Expecting nurses to shoulder impossible workloads without relief is like sending soldiers into battle with no reinforcements. Their loyalty to patients prevents them from walking away, but this loyalty is neither sustainable nor fair. Burnout is rising, and with it, the risk of medical errors and declining quality of care.
Everyone’s Problem
The nursing shortage is not just a healthcare issue—it is a societal one. Every Nepali depends on the healthcare system at some point in their life, whether for childbirth, emergencies, or chronic illness. Without enough nurses, hospitals and clinics cannot function, and the entire healthcare infrastructure is at risk of collapse.
Recent advertisements by hospitals urgently seeking thousands of nurses reveal the scale of the crisis. If unaddressed, this shortage will undermine not only patient care but also public trust in the healthcare system.
The Way Forward
Nepal cannot afford to wait. The government must declare the nursing shortage a national emergency and take immediate, concrete steps to address it.
Reopen and Expand Nursing Schools
The closure of nursing institutions has crippled the workforce pipeline. The government must provide financial and regulatory support to reopen schools and establish new ones in underserved areas.
Incentivize Retention
Competitive salaries, better working conditions, and clear career pathways are essential to keep nurses in Nepal. Retention policies, such as loan forgiveness for nursing graduates who work in rural areas, could help stabilize the workforce.
Create Opportunities for Professional Growth
Investing in advanced training, specialization, and leadership programs will help nurses envision long-term careers in Nepal rather than abroad.
Public-Private Partnerships
Hospitals and private institutions must partner with the government to co-fund nursing education and improve working conditions.
Migration Management
While migration cannot be stopped entirely, policies should ensure that the outflow of nurses does not exceed the capacity to train new ones. Bilateral agreements with destination countries could include provisions to invest in Nepal’s healthcare workforce.
Conclusion: A National Call to Action
Nepal stands on the precipice of a healthcare workforce collapse. Nurses—who form the backbone of our healthcare system—are being lost to migration, policy neglect, and burnout. Without immediate investment in education, retention, and professional development, the country will be left with a hollowed-out healthcare infrastructure.
This is a crisis that touches every household. It is not enough to praise nurses as heroes while ignoring their pleas for support. The government, healthcare institutions, and the public must come together to rebuild the nursing workforce. Failure to act now will mean sending the remaining nurses to fight a losing battle—one that none of us can afford to lose.