Florence Nightingale would not recognise the wards I trained in. As a second-year medical student in the early 1990s, my first serious lessons in medicine came not from doctors or surgeons, but from nurses. We had mandatory rotations under nurses before we were permitted anywhere near a physician or a scalpel. It was a wise system. If you wanted to understand how hospitals really worked, you began with the people who held the whole thing together- minute by minute, patient by patient. Those years left a mark. I watched nurses detect deterioration before any monitor sounded. I saw them catch medication errors, steady terrified families, and carry the burden of continuity while doctors cycled between rounds, clinics and theatres. Later, as a cardiothoracic surgeon, I understood that patient outcomes were never only about technical brilliance. They depended equally on the judgement and vigilance of the nurses around you. The best surgeons I knew never forgot that. That is why International Nurses Day matters to me, not as an abstract commemoration, but as a reminder of a professional truth that many doctors learn early and too many policymakers continue to ignore. Nurses are not peripheral to health care. They are its structural backbone. Yet in Nepal, as in so many countries, the people who hold the system together remain among the least recognised, least protected and least fairly paid. The pandemic made this undeniable. Nepali nurses worked through COVID-19 in overstretched hospitals, short of beds, oxygen, intensive care capacity and protective equipment, carrying the fear of infection home and sometimes facing social stigma in their own communities. They were called heroes. But praise is a poor substitute for pay, protection and power. When the emergency faded, the old pattern returned: recognition remained rhetorical, structural change remained elusive. Nepal today has roughly 3.5 nurses and midwives per 1,000 people. The country needs more than 65,000 nurses but employs around 50,500, a shortfall of 15,000. Meanwhile, approximately 25,000 of its 72,550 registered nurses are already working abroad. This is not a staffing problem. It is a crisis of political neglect dressed in administrative language. The departure of Nepali nurses is routinely framed as brain drain, as though the country is being abandoned by its own. But the research tells a different story. Low salaries, insecure contracts, absent career ladders and weak professional incentives push nurses out; better pay, training and basic dignity elsewhere pull them in. Many private hospitals in Nepal have been criticised for paying nurses below a living wage, overworking them and relying heavily on trainees to suppress labour costs. In that kind of system, leaving is not disloyalty. It is a rational and entirely justified decision. The deeper problem is how nursing is still imagined. Much of the public discourse remains trapped in an old Nightingale frame, nursing as vocation, as sacrifice, as feminised service. Modern nursing is none of those things alone. It is technical competence, clinical risk management and patient safety. It is the kind of professional knowledge that keeps people alive between a doctor's visits. Until policymakers internalise that distinction, their reform instincts will keep missing the point. This is why Nepal's current political moment is worth watching. Nisha Mehta, appointed Minister of Health and Population in March 2026, is a trained nurse who worked in clinical and teaching roles before entering politics. Her appointment matters symbolically. But symbolism without structural follow-through is just a better photo opportunity. For perhaps the first time, the Ministry of Health is led by someone who knows from lived professional experience what nursing costs, in skill, in risk, in daily sacrifice. Unusual openings do not stay open long. If this government is serious about social justice, the condition of its nurses is one of the clearest tests available. For too long, Nepal has pursued health sector expansion and privatisation without asking what that model has meant for the nursing workforce. That omission is not accidental. It reflects a policy hierarchy that has long normalised the invisibility of nursing labour. What Nepal needs now is not another round of speeches about respect. It needs a nursing strategy rooted in redistribution. Task shifting without compensation shifting is exploitation with better branding. If nurses are asked to shoulder greater responsibility in triage, chronic care, maternal health, community health and digital health, then salaries, career ladders and leadership must shift accordingly. That means enforcing fair wage standards across public and private facilities and linking hospital accreditation to staffing conditions, not just infrastructure checklists. Nepal cannot outbid richer countries on salary alone, and it should not pretend otherwise. But it can build a health system in which nurses see a professional future, are treated with dignity, and are rewarded in proportion to the responsibility they carry. That is not idealism. It is a precondition for any health system to actually function. I think back, on days like this, to the wards where I first understood what medicine really was. Not prestige. Not hierarchy. Not even diagnosis alone. It was attention, judgement and the discipline of staying with the patient. Nurses taught me that. Nepal now has a rare chance to build policy around that truth. The question is whether this government will take it. Dr Sunoor Verma is a cardiothoracic surgeon turned global health diplomat with 25 years of experience across low, middle and high-income settings, and Director of Partnerships and Advocacy at the World Innovation Summit for Health, Qatar Foundation. Views expressed are his own.