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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. [ABSTRACT FROM AUTHOR]