Abstract
Adequate nursing workforce is essential to ensure the delivery of effective and quality nursing care. However, the shortage of nurses accounts for more than half of the total shortage of healthcare professionals worldwide. Bhutan is one such country that reported an alarming 9.14% attrition of nursing workforce in 2022-2023. The average density of nurses in Bhutan has declined from 21.07 per 10,000 population in 2021 to 20.42 nurses by March 2023. Prior to the current high rate of attrition of nurses, the Ministry of Health had projected the need of additional 1595 nurses by 2026 to meet the minimum desired nurse to population ratio. With an increasing number of nurses leaving for developed countries seeking better economic opportunities, the numbers of nurses are expected to decline in Bhutan. As of 2025, nursing education in Bhutan is provided through one government and three private training colleges. Despite this, it is unlikely that the gap in nursing workforce requirement will be met as graduates prefer to migrate to developed countries. Some of the factors leading to attrition are poor remuneration, lack of clear job descriptions and lack of job satisfaction. Nurses who lack bachelor's degree face difficulties in career progression and advancement. We recommend the development of clear job description, introduction of nursing licensing examination for regulatory oversight and diversification of the roles of nurses into school and community-based programmes. With the reforms in the health system, health policymakers and health administrators need to develop a long-term plan for sustainable health human resource development. This Perspective presents a brief history of nursing profession, current situation of the nursing human resource, attrition and its contributing factors and the implications for Bhutan.