Abstract
Purpose The current paper explores the use of equity theory in understanding the challenges of workforce localization of healthcare professionals in an international context. Design/methodology/approach Utilizing the Delphi method with a team of senior healthcare professionals, equity theory framed the discussions and aided in understanding the managerial challenges of recruiting and retaining Saudi nurses. Findings The article highlights how careful contextual considerations should be made when making referent choices to ensure the most effective and useful application of equity theory. Practical implications A series of managerial implications are outlined for improving the localization of the nursing workforce of Saudi Arabia and beyond. Originality/value Equity theory assists in addressing the decades old problem of localizing the Saudi nursing workforce, by proposing a hitherto unconsidered referent of public sector employees, rather than the conventional referent of expatriate nurses.