By Liz Nesladek, Chief Commercial Officer for Conexus MedStaff
How do you choose between two strong destinations like the UK and the U.S. as an internationally educated nurse?
It’s an important decision. From over 20 years of experience, we know it usually comes down to a few key factors, such as salary, career growth, and long-term opportunities.
That’s why we created the Global Nursing Destination Comparison Guide: a clear, practical guide to help you compare your options.
This blog is part of a series that explores those comparisons in more detail. Here, we focus on the UK and how it compares to the U.S.
But we don’t want you to rely on data alone. In this blog, we share the experience of Carlo, a nurse who has worked in both countries, to give you a real-world perspective.
Carlo’s Journey
Carlo’s journey began in the Philippines, where he qualified as a nurse before passing the NCLEX in 2008.
“I believed it was best to take the NCLEX as soon as possible after finishing college, while the knowledge was still fresh”, Carlo explains.
It was always Carlo’s goal to work in the U.S.
“Ever since I pursued a nursing career, I’ve always focused on going to the U.S.,” he says.
But Carlo’s journey to the U.S. was not straightforward. He first applied through Conexus in 2014 while working in the Philippines, but after a visa refusal in 2019, he continued building his experience and took an opportunity to work in the UK.
Throughout this time, Conexus remained involved in his US Journey. While working in the UK, Carlo was informed that his U.S. application had been approved, and he was guided through the next steps to complete his requirements, including returning to the Philippines for his medical examination.
“Conexus supported me through each stage of the process,” Carlo explains. “Even when things didn’t go as planned, they helped me stay on track.”
For Carlo, that support meant he could continue working towards his original goal. Moving to the U.S. gave him access to the career growth and opportunities he had been aiming for from the beginning.
What Nursing Looks Like in Practice
Drawing on his experience across both healthcare systems, Carlo describes differences in how nursing responsibilities are experienced on a day-to-day basis, particularly in relation to workload and patient care.
“In the UK, we were getting 1:12 during the day and 1:15 at night,” Carlo recalls, referring to the number of patients assigned to each nurse during a shift.
In the U.S., Carlo’s experience has involved fewer patients per nurse in certain settings. “I am currently working in a renal ward and the ratio is 1:4,” Carlo says, adding that this can vary depending on the hospital and department.
These differences affect both workload and how much time nurses can spend with each patient. Carlo explains: “In the U.S., we are expected to do a full head-to-toe assessment per shift. We take vital signs every four hours, we are expected to monitor laboratory values and update the physicians.”
In the UK, responsibilities were more closely linked to specific competencies and training. “We were only allowed to perform procedures of nursing that we had been signed off for. We could not start an IV cannula unless we got signed off through IV training,” Carlo explains.
For many nurses, these differences play a key role in how manageable and sustainable the role feels over time.
Overview:
UK = higher patient ratios, structured scope of practice
U.S. = lower patient ratios, broader clinical responsibility and autonomy
Earnings and Living Costs
Carlo highlights that earnings can vary depending on location, particularly in the U.S.
“Salary is individual, and it really depends on where you are working,” Carlo explains, noting that pay can differ from one state to another.
Living costs also vary by location, and the expenses you may need to plan for can differ depending on where you work. As Carlo puts it, “cost of living in both countries comes with different expenses to plan for.”
In the UK, costs are often linked to day-to-day living, including housing and transport, as well as taxes applied to goods and services. In the U.S., additional considerations may include car ownership and access to healthcare, alongside differences in how tax is applied at a state level.
Taking time to understand what expenses apply in each location can help you build a clearer picture of your overall financial position.
Overview:
UK = more predictable costs, but lower earning potential
U.S. = higher earning potential, with more variation depending on location and lifestyle
Career Direction
Working across different healthcare systems gave Carlo the opportunity to build his skills in a range of clinical settings and to reflect on how each environment aligned with his longer-term plans.
“I believed it would give me better opportunities and career growth,” Carlo says, describing his personal motivation for pursuing a career in the U.S.
Experience in both the UK and the U.S. gave Carlo a broader view of how a nursing career can evolve over time, particularly when considering future roles or areas of focus.
Overview:
UK = structured career path, but slower progression
U.S. = more opportunities, faster career growth
What Nurses May Want to Consider
Carlo’s experience shows how different each path can be in practice.
Understanding these differences is key to making the right decision for your future.
Workload and clinical responsibility can affect how a role feels in practice, alongside financial considerations. Personal priorities also play an important role in shaping what feels right at different stages of your career.
Taking time to understand how these factors relate to your own goals can help you assess which option feels right for you.
The Global Nursing Destination Comparison Guide explores these areas in more detail, helping nurses understand what different destinations offer in practice. Download the guide to compare 13 destinations side by side and understand which option offers the best long-term future for you.
