AIM: To consider key aspects of the increasing substitution of legal private duty nurses by an illegal immigrant health-care workforce. BACKGROUND: Inadequate nursing care infrastructure and an oversupply of illegal immigrants, coupled with the current economic climate, favours the growth of an unofficial economy in hospital care. EVALUATION: Information gathered from literature, governmental and ministerial records, the media and the press are evaluated. KEY ISSUES: Increasing numbers of unauthorized immigrant health-care workers, facilitated by agencies, carry out undocumented private employment in hospitals for a considerably lower cost than their legal counterparts. Legal workers view their employment as being threatened and nurses have expressed concerns about quality of care and safety of patients, while at the same time health-care officials are unable to control this situation. CONCLUSIONS: It is anticipated that unless an appropriate care infrastructure is developed, this situation will persist and even escalate. The effects on patient care and the economy of the country, in general, need to be evaluated. IMPLICATIONS FOR NURSING MANAGEMENT: Managers ought to establish ways of improving the regulation and monitoring of illegal private duty nurses, in order to optimize the health, safety and wellbeing of patients.