Nursing workforce in Southeast Asia: a scoping review of historical trends, contemporary issues, and regional solutions

BACKGROUND: The nursing workforce is pivotal to sustaining healthcare systems, yet Southeast Asia faces persistent challenges in recruitment, retention, and competency development. Historical legacies of workforce shortages, migration, and uneven training standards continue to shape the present, as rising demands from demographic transitions, pandemics, and evolving care needs have intensified pressures on the profession. OBJECTIVE: This scoping review aims to synthesize historical and current evidence on nursing workforce issues in Southeast Asia, with a focus on occupational competencies, workforce distribution, and policy responses. METHODS: Guided by established scoping review frameworks, literature was systematically mapped from regional and international databases, policy documents, and grey sources spanning the colonial era to 2025. Data were charted to capture temporal trends, thematic issues, and multilevel solutions. FINDINGS: Workforce issues include long-standing shortages, skill mix imbalances, migration to higher-income regions, limited continuing education, and uneven regulatory capacity. Emerging themes highlight the importance of advanced practice roles, digital health competencies, and resilience-building in crisis contexts. Regional solutions are evident at multiple levels: (i) Macro-level-policy harmonization, regional cooperation through ASEAN frameworks, and investment in nursing education infrastructure; (ii) Meso-level-institutional initiatives to strengthen workplace environments, interprofessional collaboration, and retention strategies; and (iii) Micro-level-competency-based training, mentorship, and leadership development programs tailored to local health system needs. CONCLUSION: Addressing nursing workforce issues in Southeast Asia requires historically informed, context-sensitive strategies that integrate regional collaboration with practical solutions across policy, institutional, and individual levels. Such approaches are essential for advancing occupational competency, strengthening health systems, and achieving universal health coverage in the region.