Background <p>Stigmatizing attitudes toward mental illness among health professional students may influence future practice and contribute to workforce shortages in mental health services. Evidence from Nepal regarding nursing students’ attitudes and career intentions in mental health nursing remains limited. This study assessed attitudes toward people with mental illness and career intentions in mental health nursing, and examined associated factors.</p> Methods <p>A cross-sectional census study was conducted among all Bachelor of Science in Nursing (BSN) students (<i>n</i> = 287) from two institutions in Pokhara, Nepal. Data were collected using a modified Mental Health Nurse Education Survey. Construct validity was examined using exploratory factor analysis, and internal consistency was assessed using Cronbach’s alpha. Associations were analyzed using Mann–Whitney U tests and Spearman’s correlations. Multivariable linear regression identified independent predictors of career intentions.</p> Results <p>Students demonstrated generally positive perceptions of mental health nursing; however, only 24.0% intended to pursue a career in mental health nursing. Knowledge and preparedness (β = 0.36, <i>p</i> &lt; 0.001), clinical preparedness (β = 0.14, <i>p</i> = 0.01), and lower stigma toward mental illness (β = 0.19, <i>p</i> &lt; 0.001) were independently associated with career intentions. The model explained 25.6% of the variance (R² = 0.256, <i>p</i> &lt; 0.001). Knowledge and preparedness showed the strongest association with career intentions.</p> Conclusions <p>Although undergraduate nursing students expressed favorable attitudes toward mental health nursing, career intentions remained modest. Higher knowledge, clinical preparedness, and lower stigma were associated with stronger career intentions in mental health nursing; however, career intentions are likely influenced by additional unmeasured factors.</p>