Staffing Agency vs. Direct Hire – Guidance for International Nurses Working in the U.S.

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. So what is the difference between a staffing agency vs. direct hire? 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 does a staffing agency work?

A staffing agency acts as an intermediary between you and the healthcare facility that needs staff. Agencies, like Conexus MedStaff, specialize in helping international nurses find positions within U.S. healthcare systems. They handle much of the administrative work and hassle, 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 the U.S. Government’s prevailing wage determination (the same wage applies if you are employed by a hospital directly) though your benefits and all support services are provided by the staffing agency. After your contract ends, there will be options, that could include renewing with the agency, switching assignments or locations, or transitioning to a permanent position with your currently assigned facility.

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 and its support. In this model, the healthcare 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 risks with the direct hire model, particularly during periods of retrogression and immigration uncertainty; because when immigration wait times are longer, the facility may need to withdraw an offer to you because they can’t wait, where as an agency could find you a different position at another hospital based on your priority date. Unfortunately, in 2025, many healthcare professionals have been abandoned. Conexus MedStaff can help if you have been abandoned by your hospital sponsor or direct hire agency. And if your priority date is before June 2023, we are providing an additional bonus for a total earning potential of up to $15,000 in bonuses. Learn about abandoned nurses and recapturing your Priority Date.

How are Staffing Agencies and Direct Hire Similar?

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 is the Difference Between a Staffing Agency and Direct Hire?

1. Flexibility: Direct Hire offers less flexibility as you are hired by the hospital directly and if the position is no longer available, you may be abandoned by the sponsor. Conversely, an agency works with multiple hospitals and would be able to place you in a different facility if something happens with your assignment or the hospital’s staffing needs.
2. Job Security: Similar to above, if a hospital makes staffing cuts to staff once you are working in the U.S., with direct hire your position may be eliminated and your sponsorship abandoned, putting your Permanent Residence status at risk. A staffing agency would be able to quickly find you a new role and help you maintain your immigration status in the U.S.
3. Salary: Direct Hire salaries may be slightly higher per hour on surface, though the contract length is usually longer than an agency contract, and in many cases, overtime 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 your options thoroughly, you can make an informed decision that helps you achieve success and satisfaction in your nursing career in the United States.

If you would like to apply to Conexus MedStaff so we can support you not only in placing you at a U.S. healthcare facility, but for all your immigration, licensing, education and support needs once you have arrived in the U.S. and for your entire contract, apply with us today.