Contract vs. Direct Hire: Rethinking International Recruitment Strategies

By Liz Nesladek,  Chief Commercial Officer at Conexus MedStaff

What if your $80,000 international nurse leaves after only a few months?

Every year, hospitals across the U.S. spend millions of dollars on international direct hire recruitment to secure long-term talent. Yet, the reality is often far less certain and far more costly. 

In a climate where quality care, patient outcomes, retention, and financial predictability matter more than ever, the traditional international direct hire model is showing cracks. High attrition, visa complications, and workforce churn raise a critical question: Does international direct hire truly deliver ROI? 

International Direct hire: The hidden risks behind the upfront investment

At first glance, international direct hire seems like a straightforward solution. You pay a one-time fee, you get a permanent nurse, and your staffing issue is solved. Many hospital leaders are finding that a direct hire international nurse may be gone within the year.

The upfront costs for international direct hire are significant, with placement fees often ranging from $15,000 to $25,000 or more per nurse. Despite the investment, retention tends to be low. Industry data shows that many international direct hire nurses leave within six to twelve months, particularly those still adjusting to a new life and work in the U.S.

Even with replacement guarantees, timelines are vague. In our experience at Conexus, hospitals can often wait 12 to 24 months for a replacement — leaving critical roles unfilled for a year or more.  

And if the hire is on a visa like H-1B, there’s even more complexity. Who manages the EB3 visa process and the adjustment of status to a Green Card? Who pays the USCIS and legal fees, files the relevant applications, and ensures compliance with the relevant regulatory agencies? What happens if the nurse’s visa status is delayed or jeopardized? Too often, the answer is, you are.

The Conexus alternative: Stability with the long-term strategy

At Conexus MedStaff, we take a different approach, designed around long-term success through our temp-to-perm program. We deploy highly qualified and experienced international nurses who are committed to long-term growth, and we support them every step of the way.

Our results speak for themselves. 

96% of Conexus nurses complete their assignment, significantly reducing turnover and training costs

86% convert to permanent staff with zero conversion fee, helping hospitals build a more stable, reliable workforce

For our clients, we offer a hassle-free experience, where we handle the full immigration process, covering costs, ensuring compliance, managing EB-3 sponsorship, USCIS and legal filing fees, and staying on top of all deadlines to ensure a streamlined experience. It’s a level of support that removes the administrative burden from hospitals and ensures nurses can focus fully on delivering quality care.

In addition to immigration, licensing, and credentialing support, our nurses receive ongoing clinical education, cultural transition guidance, and career development resources throughout their assignment. This isn’t a short-term stopgap. It’s a strategic, scalable pipeline for long-term healthcare workforce stability.

Continuity of care, not just coverage

Turnover isn’t just an HR problem – it’s a continuity of care and patient safety problem. When an international nurse stays in a role for two to three years or more, they become more deeply embedded in the care team, familiar with hospital systems and protocols, trusted by patients and peers, and invested in achieving positive outcomes. The result is better quality of care and improved patient outcomes, which is undoubtedly a direct outcome of higher nurse retention.

Conexus international nurses aren’t just filling a shift; they’re becoming part of the hospital’s community, contributing meaningfully to patient care, clinical cohesion, and long-term outcomes. That level of integration is evident in the consistently high quality of care they deliver.

With Conexus, hospitals gain true continuity and not just temporary coverage. Our international nurses are placed with long-term success in mind, and our structured support doesn’t stop at the hospital doors. We help international nurses and their families integrate into the local community, easing the transition, reducing homesickness, and increasing the likelihood that they’ll stay for the long term. This community-first approach benefits both staff and the patients they serve.

Future-proof your workforce strategy

We’re not here to say that international direct hire is unviable; it remains a significant part of the recruitment strategy. But in today’s fast-changing healthcare landscape, it shouldn’t be your only strategy. Flexibility, diversity of sourcing, and long-term planning are essential for building a resilient workforce. A blended model that includes international temp-to-perm staffing offers stronger retention, lower total cost of hire, more predictable workforce planning, and, ultimately, better care for your patients.

At Conexus, we’re not a short-term fix; we’re a strategic complement to permanent hiring. We partner with leading hospitals to build stable, future-ready nursing teams that deliver consistent results. Our model is designed to grow with your needs. Now is the time to strengthen your workforce strategy with a blended model that delivers better outcomes, greater financial predictability, and long-term stability. 

Ready to reimagine your staffing strategy?

Speak to one of our staffing experts today – ‘Schedule an Initial Consultation’ HERE.