Migration intent, health, and higher education plans as determinants of professional identity and image of nursing among future nurses in resource-limited health systems: a cross-sectional study

Introduction: Nursing students often enter programs with idealistic perceptions shaped by personal experiences, family, and the media. However, in resource-limited healthcare systems, discrepancies between expectations and reality can adversely impact health and well-being, resulting in discontentment, absenteeism, and high attrition rates. This study explored undergraduate nursing students' perceptions of becoming registered nurses and the factors influencing these views. Methods: A quantitative cross-sectional survey was conducted using the 34-item Perceptions of Being a Registered Nurse (PRN) tool with a five-point Likert scale. The survey was conducted with a representative sample of 579 nursing students recruited from three universities in different regions of India. Data analysis was performed using SPSS version 27, with significance set at P < 0.05. Results: Students rated professionalism (M = 0.90), communication skills (M = 0.88), and patient advocacy (M = 0.85) highly, while work stress (M = 0.42) and unpredictability (M = 0.38) were notable concerns. Perceptions varied across academic years (H = 14.09, p < 0.01), with third-year students showing the highest scores. Having a disease negatively impacted perception (B = -8.33, p < 0.01), whereas aspirations to migrate (B = 4.53, p < 0.01) and higher education (B = 2.99, p < 0.05) were positive predictors. Conclusion: Proactively addressing nursing students’ perceptions throughout their education can inform targeted educational reforms, support sustainable workforce planning, and drive policy interventions that enhance retention and ensure a resilient nursing profession in India. Clinical trial registration number: Not applicable.