Purpose - One of the major challenges facing health systems in developing countries is the international migration of professional nurses, coupled with migration from rural to urban areas and gravitation to the private sector from the public sector. This study aims to determine what the future work plans of professional nurses in South Africa are and to determine appropriate, contextually relevant strategies to retain nurses where they are needed most. Design/methodology/approach - This is a cross-sectional survey of professional nurses conducted throughout South Africa using a pre-tested and self-administered questionnaire. A total of 569 professional nurses participated in the study. Findings - Of the respondents, 34.8 percent indicated an intention to change their sector of employment within the next five years while only 30.2 percent reported that they would most likely be still in their current positions as professional nurses in five years' time. Younger nurses, nurses in the public sector and nurses from the more rural provinces were also significantly less likely to be in their current positions within the next five years. Public sector nurses felt that employment security, workplace organisation and the working environment were the most important factors. Private sector nurses, however, rated workplace organisation, employment security and professional practice as being most important. Originality/value - The paper presents evidence that health provision in South Africa is facing an imminent crisis with the overwhelming majority of nurses planning to leave their current positions. The findings suggest that most nurses, irrespective of whether they intend to stay or leave, feel that the same issues need to be addressed if they are to be persuaded to remain in their current positions. This implies that a homogeneous approach could be adopted across sectors and geographic regions to promote health organisations in a more attractive way to nurses. © Emerald Group Publishing Limited.