Rethinking internationalization in undergraduate nursing education: Beyond mobility as the gold standard

Introduction

Internationalization is no longer optional in undergraduate nursing education. Health systems are increasingly shaped by cultural diversity, global interdependence and persistent inequities. Nursing graduates must therefore be prepared to practice across cultural, social and geopolitical boundaries. Yet how internationalization is conceptualized and implemented remains deeply contested. Internationalization in nursing education continues to be narrowly defined by student mobility, such as study abroad and cross-border placements, despite clear evidence that this model is insufficient. This framing is problematic because these experiences remain accessible to only a limited proportion of students.

Financial constraints, rigid curricula, language requirements and caregiving duties all restrict participation. In practice, this model positions internationalization as a selective opportunity rather than a core educational responsibility. The continued reliance on mobility as the dominant indicator of internationalization is therefore both educationally insufficient and ethically flawed. It prioritizes physical movement over learning outcomes and excludes many students, particularly in nursing, where intensive clinical training and structural barriers limit access. This paper argues for a necessary reframing of internationalization in undergraduate nursing education. Drawing on the concept of Internationalization at Home (IaH), we contend that global and intercultural learning must be intentionally embedded within the curriculum and made accessible to all students. Rather than treating mobility as the gold standard, internationalization should be understood as a pedagogical and ethical commitment to equity, inclusion and global competence.

Reevaluating mobility-centric models

Despite growing recognition of alternative approaches, internationalization in undergraduate nursing education remains largely defined by mobility. Study abroad programs, cross-border internships and short-term placements are often treated as the primary pathways for developing intercultural competence and professional growth.^1–3 Such privileging of mobility is no longer defensible. Framing internationalization through mobility obscures structural barriers to participation. Financial costs, rigid clinical curricula, language requirements and caregiving duties all limit access. These barriers are amplified in low- and middle-income contexts and in feminized professions such as nursing and midwifery. ⁴ Mobility-based models reproduce inequity by reserving global learning experiences for a privileged minority. This limitation is not incidental but structural. Undergraduate nursing programs are highly sequenced and clinically intensive, leaving little flexibility for extended periods abroad. Many students also balance academic, professional and family responsibilities, further reducing their ability to participate in mobility. ⁴ In this context, treating mobility as the gold standard confuses travel with learning and risks equating educational quality with physical displacement rather than with meaningful intercultural competence. ⁵

IaH: expanding the field of practice

IaH shifts the focus from where students go to how they learn. Rather than equating international experience with physical travel, IaH defines internationalization as the intentional integration of global and intercultural dimensions into the curriculum for all students. This approach aligns closely with nursing education, where ethical practice, cultural responsiveness and social accountability are central commitments. Emerging evidence shows that well-designed IaH strategies can achieve meaningful intercultural outcomes, undermining the assumption that intercultural learning depends on physical mobility. Collaborative Online International Learning (COIL), for example, enables sustained interaction with international peers, ⁶ demonstrating that intercultural learning can be achieved without travel. Likewise, virtual simulation and digital projects support the development of culturally informed clinical reasoning across diverse contexts. ⁷

IaH should not be treated as a secondary or compensatory strategy. When intentionally designed and institutionally supported, it constitutes a robust and scalable approach to internationalization. Evidence shows that IaH enhances cultural intelligence, self-efficacy and intercultural awareness,^7–9 with outcomes comparable to those associated with mobility experiences. By embedding internationalization within the core curriculum, IaH ensures that global learning opportunities are accessible to all students, no longer contingent on financial capacity, personal circumstances or institutional resources. This model positions internationalization as a fundamental component of professional preparation.^5,10

Uneven global literatures and the visibility gap

Despite growing recognition of IaH, the knowledge base informing internationalization in nursing education remains unevenly distributed. Research is produced disproportionately in Europe and other high-income regions, while perspectives from Latin America, Africa and parts of Asia remain underrepresented. ⁴ This imbalance limits the development of contextually grounded models and normalizes approaches that are shaped by resource-rich settings. This absence of diverse geographic perspectives is not merely a representational concern. It has direct consequences for the learning process. When scholarship from underrepresented regions is marginalized, global hierarchies in knowledge production are reinforced. Students learning where mobility is least accessible remain overlooked. Addressing this visibility gap is therefore essential to building a more equitable and globally relevant understanding of internationalization in nursing education. This imbalance also shapes which educational models become normalized within global nursing education.

Toward a new conceptualization of internationalization

Internationalization in undergraduate nursing education must be reconceptualized as a core educational responsibility rather than an optional experience. Although cross-border mobility can support intercultural learning, its dominance is no longer defensible in contexts marked by persistent inequities and unequal access. ⁴ Continued reliance on mobility as the primary indicator risks reducing global engagement to physical displacement rather than meaningful outcomes. A more robust and equitable approach requires understanding internationalization as an ecosystem of complementary strategies, with IaH functioning as a central mechanism for developing intercultural competence. This shift aligns with longstanding calls to define internationalization in terms of learning outcomes rather than participation metrics. From this perspective, the value of internationalization lies not in where students go, but in how effectively educational experiences cultivate the intercultural and ethical capabilities required for culturally responsive nursing practice. ⁵

Indicators, institutional capacity and equity

Current indicators of internationalization, such as outbound mobility rates, are inadequate proxies for educational impact. They reflect institutional resources and prestige more than meaningful student learning. Continued dependence on such measures reinforces inequity by privileging institutions that can support mobility while obscuring those implementing inclusive, curriculum-based approaches. A redefined set of indicators is needed. These should prioritize the integration of international and intercultural content in core curricula, faculty engagement in intercultural pedagogy, and equitable learning opportunities for all students.^9,10 Such indicators shift the focus from participation to impact and better reflect the educational goals of nursing programs in a globalized context. Institutional capacity is central to this transformation. Without strategic leadership, curricular flexibility and sustained investment in faculty development, IaH initiatives will remain peripheral rather than embedded in core practice. Faculty preparedness in intercultural pedagogy, digital facilitation and reflective design is essential to the effectiveness of IaH initiatives.^6,9 This work must be recognized as core academic practice, with equity positioned as a guiding principle. Internationalization strategies must be designed with deliberate attention to structural barriers. These include financial obstacles, caregiving responsibilities and rigid program requirements. ⁴

Implications for research and practice

Advancing a more equitable and effective model of internationalization requires a stronger and more diverse evidence base. Future research should prioritize comparative evaluations of IaH and mobility-based strategies. These studies should use validated measures such as intercultural competence, cultural intelligence, self-efficacy and ethical reasoning.^5,8 Rigorous research focused on the effectiveness of IaH is long overdue to guide policy and curriculum design with confidence. Greater attention must also be given to the institutional and pedagogical conditions that enable successful implementation of IaH. This includes examining how faculty development, digital infrastructure and partnerships shape learning outcomes.^6,9 Without such analysis, the expansion of IaH will remain uneven and dependent on local capacity rather than guided by evidence-informed practice. Finally, expanding scholarship from underrepresented regions is essential for developing contextually relevant models and avoiding the uncritical transfer of approaches from high-income settings. ⁴

Conclusions and recommendations

Contemporary global health is shaped by migration, pandemics and persistent inequities. These conditions require nurses who can think and act across cultural and systemic boundaries. The limitations of traditional approaches are particularly visible in low- and middle-income regions, where financial, personal and academic constraints deter students from engaging in international mobility. Equating internationalization with physical travel excludes most nursing students from global learning while reinforcing existing inequities. Internationalization in undergraduate nursing education must therefore be reframed as an inclusive, curriculum-embedded process rather than a travel-based opportunity. IaH enables all students to develop intercultural competence through intentional pedagogical design.^7,9,10

This approach aligns closely with core nursing values such as equity, social responsibility and culturally responsive care. Such reframing is not only pedagogically sound, but also ethically necessary. A profession committed to equity in health cannot ignore inequities in access to global learning opportunities. Internationalization strategies should treat mobility and IaH as complementary, rather than continuing to privilege mobility as the primary indicator of success.^4,10 Greater attention must also be given to faculty development. Educators play a central role in shaping intercultural learning, and their capacity to design, facilitate and assess these experiences, particularly in digital and collaborative environments, is critical.^6,9

Finally, equity must function as a guiding principle rather than a secondary outcome. This requires the active removal of structural barriers and a commitment to ensuring that all students, regardless of socioeconomic context, have access to meaningful global learning opportunities.^4,7 By shifting the focus from mobility to learning, nursing education can advance a more equitable, context-responsive and globally relevant model of internationalization, one that is essential both for educational quality and for preparing a workforce capable of addressing contemporary global health challenges.