Chris, a nurse and healthcare administrator based in Manila, spent his shifts monitoring patients in intensive care units at U.S. hospitals. He checked vital signs, flagged drastic changes in blood pressure, and reminded on-site staff when medications hadn’t been logged. Sometimes he watched over as many as 10 patients at once — from an office thousands of miles away.
Between 2020 and 2023, Chris worked roughly a dozen remote nursing jobs for American hospitals. He asked to use a pseudonym because nondisclosure agreements prevent him from naming his employers. When he spotted a problem, he would alert the nurses’ station. “We’re not nurses — more like nursing aides,” said the 37-year-old, who now works full time in the Philippines. “We didn’t make the decisions for care, we just informed [on-site nurses] that the blood pressure was high. It was up to them to give the meds.”
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Chris is part of a growing workforce: virtual healthcare assistants in the Philippines who help U.S. hospitals cope with a shortfall of nearly 80,000 registered nurses. These workers, employed as independent contractors by American healthcare companies, handle tasks ranging from intensive care monitoring to filing medical records, checking insurance eligibility, and calling patients to remind them of appointments.
How remote nursing works across borders
Some U.S. employers hire through local third-party agencies in the Philippines. Others require American nursing licenses. For many roles, including telesitting — where workers watch patients remotely to prevent falls — a degree in any medical field is enough. The remote nurses typically work the graveyard shift from their homes or shared offices in the Philippines, earning between $5 and $10 per hour. That compares to an average of more than $45 an hour for registered nurses in the U.S.
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The Philippines has been a major source of nurses since the 1960s. Filipino nurses currently make up more than a quarter of all immigrant registered nurses in the United States. With visa restrictions tightening and artificial intelligence threatening the country’s business process outsourcing sector, more Filipinos are turning to virtual healthcare work instead.
For the American hospital, the savings are even starker: up to 70% in labor costs, according to JL Botor, president of the Healthcare Information Management Association of the Philippines (HIMAP). Botor expects the industry to keep expanding as hospitals automate easier tasks like note-taking and rely more heavily on human oversight for the rest. He declined to name the U.S. hospitals and clinics that outsource work to the Philippines, citing confidentiality agreements.
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The reality of working from a virtual clinic
Alice, a licensed Filipino nurse in Quezon City, used to earn about $100 per month at a Philippine hospital. In 2019, she started working as a care coordinator for a California-based telehealth company that provides mental health and substance abuse treatment in California and New Mexico. She also uses a pseudonym because she is not authorized to speak to the media.