Background <p>The indispensable role of nurses in healthcare systems is widely recognized, as they contribute significantly to the effectiveness and continuity of healthcare delivery. However, nurse attrition has emerged as a growing concern in fragile and resource-limited settings such as Somalia, with serious consequences for health service provision.</p> Objective <p>This study aimed to explore the key factors contributing to nurse attrition in Somalia and to examine the perceived implications of nurse attrition for the healthcare system from the perspectives of former nurses and healthcare administrators.</p> Methodology <p>A qualitative descriptive study was conducted in the Benadir region, involving 42 former qualified nurses and 8 healthcare administrators, representing both genders. In-depth interviews were conducted with former nurses to explore their motivations for entering the nursing profession, their professional experiences, and the factors leading to their attrition. Semi-structured interviews with healthcare administrators focused on understanding the broader implications of nurse attrition within the healthcare system. Data were analyzed using reflexive thematic analysis to identify and interpret central themes.</p> Results <p>Nurses often enter the profession driven by compassion and the desire to impact patient lives positively. However, disparities between initial expectations and realities of nursing practice, including inadequate compensation, burnout, unfavorable working conditions, job dissatisfaction, strained nurse-doctor relationships, and community misconceptions about the nursing role, contribute to nurse attrition. These contributory factors have several negative consequences, including a shortage of nurses, reduced care quality, increased workload for remaining nurses, longer patient wait times, limited access to healthcare services, higher operational expenses, added responsibilities for doctors, and lasting effects on public health.</p> Conclusion &amp; recommendations <p>Nurse attrition is a complex process influenced by various factors. To mitigate its impact on healthcare systems, policymakers and healthcare administrators must allocate resources strategically, focus on comprehensive planning, and prioritize the recognition, support, and retention of nurses within the healthcare framework.</p>