A generation at risk: the unseen consequences of Nepal's nursing shortage on undergraduate nursing students clinical education.

Background: The global nursing shortage has particularly severe consequences in resource-constrained countries like Nepal, where a significant outflow of healthcare professionals exacerbates the crisis. While the impact on patient care, workforce dynamics, and organizational challenges within healthcare settings have been extensively researched, the profound implications of this crisis for nursing education remain underexplored. This qualitative study sheds light on the often-unseen consequences of the nursing shortage on undergraduate nursing students' clinical education.

Methods: Data were collected from three focus group discussions involving eighteen final-year nursing students from two tertiary institutions. The first two discussions took place in June 2024, with the third one in July 2024. Thematic analysis was employed to identify and interpret the key themes.

Results: Four overarching themes emerged: (1) Compromised Learning, highlighting the detrimental impact on skill acquisition and student preparedness; (2) Abandoned in the Field, revealing the emotional toll of isolation, with students describing themselves as "ghosts, silently observing from the sidelines"; (3) Forging Ahead, showcasing the unintended resilience and resourcefulness of students seeking alternative knowledge sources; and (4) Digital Mentors, spotlighting the innovative use of Artificial Intelligence (AI) as a supplementary learning tool in overburdened clinical settings.

Conclusion: The nursing shortage in Nepal has created a challenging and often isolating clinical learning environment (CLE) for students. While their resilience and adaptability are commendable, these qualities are not substitutes for nurse staffing shortages and inadequate mentorship. This study underscores the urgent need for systemic change, including increased investment in the nursing workforce, cultivating a supportive learning environment, and integrating technology into nursing education. These findings have implications for Nepal and other resource-constrained settings grappling with the challenges of a nursing shortage.