For many Kenyan health workers, the promise of working as a registered nurse in the United States carries a near-mythical allure. Stories of million-shilling salaries circulate in WhatsApp groups and family gatherings, fuelling the exodus of trained nurses from Nairobi, Eldoret and Kisumu to hospitals in Texas, California and Washington state. But behind the headline numbers is a complex reality that blends long shifts, high costs, and the discipline of American professional culture.
A typical hospital nurse works 12-hour shifts, usually three per week. The day begins at 6.45am with a handover from the night team, followed by a flurry of morning assessments, medication rounds, and consultations with physicians. By mid-morning, the nurse is changing dressings, inserting IV lines, or preparing discharges. Lunch is a 30-minute luxury, squeezed between admissions and charting. The day ends at 7pm after detailed reporting to the night staff. It is a physically demanding rhythm, with standing, lifting, and constant decision-making forming the backbone of the role.
The financial reward is considerable by Kenyan standards. In Seattle, a nurse earns between Sh6,900 and Sh7,900 per hour (about $48–$55). Over a 12-hour shift, this amounts to roughly Sh83,000 before tax. A standard three-shift week delivers about Sh540,000 gross, translating to nearly Sh1.04 million per month, or over Sh12 million annually. With overtime, critical care specialisms, or seniority, pay can rise to the equivalent of Sh15 million per year.
Yet American taxation and social security contributions quickly narrow the margins. A Seattle nurse taking home Sh1.04 million gross can expect about Sh780,000 net after federal and state deductions, pension, and health insurance contributions. That is still a life-changing figure, but one that must withstand the weight of American living costs.
An illustrative monthly budget tells the story. Rent for a one-bedroom apartment in Seattle absorbs about Sh280,000. Health insurance premiums add another Sh70,000, with food averaging Sh60,000. Transport—whether car ownership or public options—takes around Sh75,000, while utilities, internet, and phone bills consume another Sh35,000. Add Sh40,000 for clothing, leisure and miscellaneous needs, and the monthly spend comes to Sh560,000. That leaves around Sh220,000 available for savings or remittances back to Kenya.
The contrast with Kenya is stark. A registered nurse in a public hospital at home typically earns Sh50,000 to Sh80,000 per month, barely enough to cover urban rent and family expenses. In the United States, even after high costs, a nurse can comfortably set aside two or three times that amount every month. It explains why recruitment agencies continue to attract large numbers of Kenyan applicants, despite the challenges of licensing exams, cultural adjustment, and the physical toll of American hospital work.
The arithmetic also exposes the trade-off. In America, nurses may be millionaires in gross earnings but quickly realise they are working in one of the world’s most expensive countries. The pay remains transformative, particularly when channelled into remittances, school fees, or investments back home. But it is a transformation built not on effortless riches, rather on long shifts, relentless paperwork, and the balancing act of life in the U.S.
