Abstract Private recruitment agencies are increasingly central to the international migration of health workers, especially nurses, amid a global health workforce shortage. This paper examines how private recruitment practices align with the World Health Organization’s Global Code of Practice on the International Recruitment of Health Personnel (WHO Code) through comparative case studies from the United States, United Kingdom, and Germany—three major destination countries for migrant health professionals. It explores each country’s healthcare system, regulatory landscape, and mechanisms for ethical recruitment, with a special focus on voluntary certification schemes and national compliance programs. The paper also includes insights from the Philippines, a major source country, on its efforts to safeguard migrating health workers. Despite variations in governance, a common theme across these nations is the difficulty in monitoring and enforcing ethical standards, especially when participation in regulatory frameworks is voluntary. The U.S. faces challenges due to minimal federal oversight and legally permissible, yet ethically questionable, practices. The UK and Germany, by contrast, have incentivized adherence through funding mechanisms and legal frameworks. All three countries struggle to track the impact of active recruitment from WHO-designated vulnerable nations, raising concerns about the sustainability of source country health systems. The paper concludes that ethical recruitment is essential for maintaining both workforce integrity in destination countries and healthcare capacity in source countries. Strengthened multilateral oversight, transparency, and stakeholder cooperation are vital to advancing the WHO Code and protecting migrant health workers globally.