Between duty and despair: the ethical toll of brain drain on Nepalese nurse managers.

Background: The relentless exodus of skilled healthcare professionals from low- and middle-income countries to wealthier nations, known as the 'brain drain,' poses a grave threat to global health equity. Nepal, a prime example of a source country, faces a critical shortage of nurses due to this migration. Nurse managers, uniquely positioned at the intersection of leadership and frontline care, face considerable challenges in times of crisis. These challenges encompass ethical dilemmas associated with resource allocation, staffing shortages, and maintaining quality care standards. Additionally, nurse managers must navigate their own experiences of moral distress, further complicating their decision-making processes and overall effectiveness in managing healthcare teams and patient outcomes. This study delves into their lived experiences, aiming to expose the far-reaching consequences of brain drain and spark a global dialogue on ethical and sustainable healthcare workforce practices.

Methods: This qualitative descriptive study examined the lived experiences of ten nurse managers in Nepal, employing semi-structured interviews and inductive content analysis. Participants were chosen through a combination of purposive, snowball, and convenience sampling methods, ensuring representation from both urban and rural settings.

Results: Thematic analysis revealed five core themes: (1) Moral Distress on the Frontlines; (2) Unequal Burden, Unequal Access; (3) The Ripple Effects of Exodus; (4) Beyond the Hippocratic Oath; and (5) Policy at the Crossroads.

Conclusion: Policy interventions prioritizing improving working conditions, investing in the domestic healthcare workforce, and promoting ethical recruitment practices are essential to ensure equitable and sustainable healthcare. The voices of nurse managers at the forefront of this crisis provide a powerful call to action. Their experiences and insights urge national and global stakeholders to recognize the human cost of brain drain and work collaboratively towards a more just and resilient healthcare system.