For the last three decades, the Gulf Cooperation Council (GCC) states, comprising Bahrain, Kuwait, Sultanate of Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE) have relied heavily on doctors, nurses and allied health professionals recruited from other countries. Globally, there is a persistent shortage of doctors and nurses and the GCC countries are no longer able to meet their human resource requirements through international recruitment. They have thus pursued policies that aim to increase the supply of qualified indigenous health-care professionals - indigenization. This study aims to understand and examine why and how an indigenization policy has been formulated and implemented in a purposively selected sample of three Gulf States. Saudi Arabia, Bahrain and Oman have many commonalities and the structures of their health-care services, labour force and indigenization policies confront similar broad issues and challenges. However, they were selected to represent different social, cultural and policy environments in the region and different levels of success in creating an indigenous nursing workforce. This study employs a qualitative research approach to generate an in-depth understanding of the factors that facilitate or inhibit the implementation of indigenization policies in nursing. This includes semi-structured interviews with 78 stakeholders comprising current and former policy-makers, human resource managers, religious leaders and nursing officials living and working in one of the three Gulf States. Document analysis provided the historical and technical background for understanding the mechanism of the indigenization policy process and practices. Findings reveal that cultural, economic and political issues play important roles, as do society's views on education, the role of women and the image of nursing. The recommendations to address these issues, particularly in respect of increasing women's participation in the workforce, may contribute to the development of nursing in the Gulf.