Agency vs. Direct Hire – Guidance for International Nurses

When considering a career as an international nurse in the United States, two of the most common pathways to explore are working with a staffing agency like Conexus MedStaff or securing a direct hire position. Both models offer unique advantages, and while they share some similarities, they also have distinct differences that can impact your experience and long-term goals. Understanding how each model works, their benefits and risks, and how to decide which is the best fit for you is crucial as you make your decision.

How do staffing agencies work?

A staffing agency acts as an intermediary between you and the healthcare facility. These agencies specialize in helping international nurses find positions within U.S. healthcare systems. They handle much of the administrative work, including visa processing, securing licensing, and finding a hospital or healthcare facility that meets your qualifications and preferences.

In this model, you are employed by the staffing agency on a contractual basis. Your salary is determined by prevailing wages (same as if you were employed by the hospital directly) though your benefits would be provided by the agency. After the contract ends, there may be an option to renew with the agency, switch facilities, or transition to a permanent position with the facility, depending on the healthcare facility’s needs.

How does direct hire work?

Direct hire, on the other hand, involves securing employment directly with a hospital or healthcare facility without the involvement of a staffing agency. In this model, the facility handles the recruitment process, visa sponsorship, licensing, and onboarding.

With direct hire, you’re employed directly by the healthcare organization, often with a permanent position and benefits. The hiring process may take longer than through an agency, but it allows you to negotiate directly with the employer regarding salary, job responsibilities, and other employment terms.

There can be risk with the direct hire model particularly during periods of retrogression; when immigration wait times are longer, the facility may need to withdraw an offer as where an agency could find you a position at another hospital.

Learn about abandoned nurses and recapturing your Priority Date.

What are the similarities between the models?

1. Visa Sponsorship: Both routes typically provide visa sponsorship to help you legally work in the U.S., making them both viable options for international nurses.
2. Licensing Assistance: Whether through an agency or direct hire, both pathways often offer assistance with navigating the complex U.S. licensing process, including the NCLEX exam and state-specific requirements.
3. Job Placement: Both models ultimately aim to place you in a healthcare facility that matches your skills and qualifications, ensuring you find a role where you can succeed.

What are the differences between the models?

1. Flexibility: Direct Hire offers less flexibility as you are hired by the hospital directly and if the position is no longer available, your application may be abandoned. Conversely, an agency works with multiple hospitals and would be able to place you in a different facility should one previously selected fall through.
2. Job Security: Similar to above, if a hospital must make cuts to staff once you are working in the U.S., your position may be eliminated and your Permanent Residence status put at risk. An agency would be able to quickly find you a new role and help you maintain your status.
3. Salary: Direct Hire salaries may be slightly higher per hour though the contract length is usually longer than an agency contract, and in many cases, over time does not count towards your contract hours. At Conexus, all productive hours count toward your contract term.

Recommendations for International Nurses

Ultimately, the best choice depends on what’s most important to you. Take the time to weigh the benefits and challenges of both models and choose the path that aligns with your aspirations as an international nurse working in the U.S. By educating yourself and understanding both options thoroughly, you can make an informed decision that helps you achieve success and satisfaction in your nursing career in the United States.