An understaffed hospital trust has hired 200 nurses from the Philippines having failed to recruit any from the UK.
Gloucestershire Hospitals - which serves 612,000 patients – is also aiming to appoint dozens of nurses from Spain, Portugal and India over the coming months.
The trust, comprising the Gloucestershire Royal and Cheltenham General Hospitals, is one of a growing number using overseas nurses to plug severe staffing shortages.
Figures show that three quarters of hospitals are recruiting nurses from abroad and nearly 5,700 were hired in the last 12 months.
Experts say that as many as one in 20 nursing posts in the NHS is currently vacant which is equivalent to 20,000 nurses.