Staffing Agency vs. Direct Hire: Top Myths Debunked

Starting Your Journey to the USA

Once you've determined your dream is to become a US-RN, one of the biggest decisions happens right at the start of your journey. This is selecting an organization you trust to provide the support and US job access you'll need to land your dream career opportunity in the shortest amount of time.

In this article, we'll cover the two common types of organizations that support the journey of global nurses to the USA and dispel common myths regarding their services and capabilities along the way.

Understanding the Two US Immigration Support and Career Models*

When searching online, using social media, or at in-country events, you will generally see two types of organizations that you can sign on with to provide the assistance you'll need to navigate the route to the USA. These two options are:

Staffing Agencies, such as PassportUSA, provide US career opportunities wherein your professional services are contracted out to one of their healthcare facility clients while you remain an employee of the agency.

Direct Hire Recruitment that promotes career opportunities for their US client healthcare organizations at which you'll become a direct employee. Many global healthcare professionals call this "direct hire."

The staffing agency versus direct recruitment agency decision is a personal choice with good opportunities and organizations representing both options. It is important to do your research and ask the right questions before signing an agreement to make the best decision. Additionally, we've spoken with many nurses and read several social media posts indicating there are misconceptions concerning how PassportUSA compares to direct recruitment agencies. This article specifically aims to dispel these myths and give you a clear understanding of how we stand up to direct recruitment agencies.  

* NOTE: There is a third option where a U.S. healthcare organization recruits directly without help from a recruitment firm's assistance. In our experience, these opportunities are limited. A scenario where this commonly occurs is Canadian RNs being recruited to work in the US. It is much less common when recruiting nurses from overseas as the licensing and immigration process is more complex.

Now, let's dive into the common myths and misconceptions of contracting with PassportUSA, a staffing agency, versus a direct recruitment agency.

Myth #1: You do not have to sign a contract with a direct recruitment agency.

Myth Busted: This is incorrect. You may be required to sign an agreement with the direct recruitment agency for their support services. This contract will outline both your and the firm's obligations. It will also provide information on any money you may owe to the firm should you drop out of their program after they have extended effort to get you to the USA.

Secondly, and this is not commonly discussed, you will likely also have an employment contract with the US healthcare organization. While the content of these contracts can vary greatly, many of them have provisions in which you will be held accountable for certain expenses if you leave their employment before a certain period or fail to start your accepted position. You will not likely know the clauses contained within this contract until after you interview for a position or possibly accept an offer letter prepared by the direct recruitment agency on behalf of their US client. Many of these offer letters require a minimum amount of time worked (3 years), pay a very low starting hourly wage, don’t guarantee full-time hours and do not support your family coming with you.  

PassportUSA Benefit: With PassportUSA you sign one contract and an assignment confirmation letter that outlines all terms and conditions throughout the US readiness process and while working in the USA.

If a direct recruitment or staffing agency does not ask you to sign a contract, then you should be concerned since contracts provide individuals and businesses with a legal document stating the expectations of both parties and how processing your US visa filing will proceed. As with any contract, we advise you have a licensed attorney review the contract and verify that it is in your best interest.

Myth #2: You'll get to the U.S. faster with a direct recruitment agency.

Myth Busted: No, in fact, your immigration processing time could be slower with direct hire because they have to wait on the prevailing wage determination per healthcare facility client, which can take on average about 6-9 months before they could even file your visa petition after selection. Additionally, if the hospital that selected you, cancels your assignment/selection during the long immigration process, the direct hire company will need to secure you another assignment and the I-140 Petition process will have to start all over again. Health care facility staffing needs change daily and you could easily be unselected, Agencies like PassportUSA do not have this issue because of the abundance of our client facilities and their ongoing need for health care professionals makes it easy for us to find another assignment very quickly. Your petition is filed with Health Carousel as your US Employer so we can keep the immigration process moving forward seamlessly. In the best case, the process to arrive in the US through a direct recruitment agency cannot be faster than with PassportUSA. We both follow the same immigration and licensure rules. Simply put, direct recruitment agencies and the US healthcare organizations they represent do not receive any special consideration for faster immigration processing and visa issuance.

Additionally, it could take longer for them to secure you an assignment location since direct recruitment agencies oftentimes represent far fewer healthcare facility clients and US placement opportunities. This means you could be competing with many other nurses for a limited number of US job openings, thereby slowing down your US arrival. PassportUSA, on the other hand, has hundreds of clients in all 50 US states and our number of job openings consistently outpaces the number of nurses ready to interview with our clients.

Myth #3: You'll earn more as a direct employee of a US healthcare organization.

Myth Busted: According to data as of January 2022, the average pay for a nurse in the US is approximately $28.73 an hour.

Hourly pay at PassportUSA starts at over $30.69 per hour and we guarantee you'll get paid for full-time hours of 36 hours per week. Plus, you have the opportunity to earn one and a half times this for overtime hours. Combine this strong hourly wage with exam bonuses, US arrival stipends, annual merit-based pay increases, and bonuses of up to $15,000 at the end of your initial US assignment, and your compensation package is extremely competitive. At PassportUSA you will earn your full hourly rate at the start of your assignment, even during orientation.  

Myth #4:  You can’t bring your family with you.  

Myth Busted: PassportUSA encourages our candidates to bring their families because we know you will be most successful if you have your loved ones nearby. We'll do the legal work to file EB-3 visa petitions for your spouse and eligible children, just like you! We also have a dedicated team and resources to make sure you and your family have a successful experience settling here in the USA. Oftentimes, direct placement agencies will not offer support to bring your family with you, leaving all the legal work and logistics up to you.  

Myth #5: You'll be guaranteed full-time hours with a direct recruitment agency.

Myth Busted: As a direct hire employee, your weekly hours are dependent on the facility. Keep in mind, if a hospital's patient census is low, the hospital will start sending staff nurses home.

PassportUSA guarantees our nurses full-time hours each week. If the census drops low at the facility where you are working and you are sent home, you are still guaranteed full-time pay from PassportUSA and can always rely on a steady paycheck.

Myth #6: Direct recruitment agencies offer US arrival services  

Myth Busted: At PassportUSA, you are assigned an International Employee Supervisor (IES) who is focused on making sure you have all the tools necessary to succeed in not only your career but also in your life in the USA. An IES is often referred to as a "life coach” because they truly care about you living the best life possible here in America.  

PassportUSA also understands the complexity and resources it takes to relocate and resettle to the USA. We take great pride in the relocation and resettlement program we provide to our employees and their families. This includes:

• A PassportUSA Arrival Specialist to meet you and your family upon arrival to the USA to welcome you and help you get oriented within the first 24-48hrs of arrival  

A travel and housing team that arranges all travel and arrival logistics—including housing, transportation, etc.  

• Paid employee’s airfare to the USA

• A customized, in-person arrival experience which includes meeting the employee at the airport and ensuring they are settled in their transitional housing in their new community

• A $2,000 housing advance for transitional housing and  

• Support in securing long term housing

• A $1,500 arrival advance to help offset initial expenses in the USA

• Referrals to trusted vendors to buying or lease a car

• Instructing on how to obtain their US driver’s license and or referrals to driving schools if needed

• Education on setting up a US household and grocery shopping

• A free mobile phone and 30 days of paid service as well as access to a discounted corporate rate for service

• Visit to the healthcare facility where they will be working and a meet-and-greet onsite when possible  

• PassportUSA will assist with opening a bank account in the USA

• Guidance on how to obtain a US Social Security Number  

This level of support is rarely provided by direct recruitment agency due to their limited resources and because the responsibilities are pushed almost entirely onto the hospital’s own human resources and nursing leadership team, which may not fully understand the challenges you are facing as an international healthcare professional.

Myth #7: You'll receive ample training before your assignment with a direct recruitment agency.

Myth Busted: The depth of training provided is truly dependent on the direct hire facility. If you are considering direct hire, we strongly encourage you to research transition to practice programs to support your role as a US nurse. Many facilities are not equipped with the training resources that an established agency like PassportUSA offers, as we've been supporting foreign-educated healthcare professionals with transition to US practice training for over 13 years.  

We'll provide you with:

• An 8–12-week pre-departure transition-to-practice course that includes simulations or real-life patient situations  

• Post-arrival orientation and precepting once you're at your assignment location.  

• Ongoing access to our team of seasoned nurse managers for mentorship, tailored training programs, and clinical remediation when appropriate.

Myth #8: You're on your own to find a US-RN job at the end of your initial PassportUSA Assignment  

Myth Busted: This is simply not true at PassportUSA. PassportUSA and the whole Health Carousel organization can help you achieve your personal and career objectives whatever they may be and wherever they may take you

We offer many services to help you realize a lifetime of career satisfaction. With clients from coast-to-coast representing varied healthcare settings, Health Carousel can help you land an ideal position in your most desirable geographic location. Our clinical and account management teams can also champion a switch into your ideal nursing unit if you are not working there already.

During your assignment with PassportUSA, you will be assigned a Career Success Coach who will begin working with you to find out your goals and determine what type of path you would like to take at the completion of your initial assignment. We are one of the largest Healthcare Staffing Agencies in the USA and have many opportunities for you to pursue which could potentially include, supporting you in advancing your education and obtaining a Master’s Degree, Nurse Practitioner Degree, or Doctorate of Nursing Practice. It could also include taking an advance level assignment in a different geographic location or maybe you are interested in becoming a US Travel Nurse. The opportunities are endless!

With a direct recruitment agency, if you are let go from your job for any reason, you may be left stranded without support and your relative lack of US healthcare experience can be a barrier to winning your next opportunity.  

Myth #9: You'll have little worries about being terminated or losing your job with a direct hire.

Myth Busted: Did you know that 19% of all nurses in the USA change jobs annually? Some of this turnover is due to factors that have nothing to do with individual job performance such as hospital closure, downsizing, change in ownership, and more. In fact, it is not uncommon to find yourself out of a job due to no fault of your own.

If you’re contracted with a direct recruitment agency, make sure to check your agreement regarding obligations they may have to find you a new opportunity. It is likely they have no further obligation to you and leaving you stranded with no job, and no support from the facility.  

The uncertainty of not knowing whether your new US job will work out and not having a backup plan can be daunting — particularly if you have family who relies on your income.

In the very unlikely situation you were terminated from your assignment at a PassportUSA client facility, we immediately set to work on securing you another placement. Our goal is to keep you working and we do not abandon our nurses. In comparison, to a direct hire placement, a contract agency such as PassportUSA have a much higher vested interest in your long-term success.

The information provided in this document is believed to accurately portray the offerings and services of direct recruitment agencies and their client facilities, alike. However, there are numerous variations in how these companies operate. Therefore, the best thing you can do as a nurse is to ask smart questions before signing on.

We hope you've found the information we've provided to be useful in your journey to the USA.

January 18, 2023
Recent Blogs
This is some text inside of a div block.
October 16, 2023

Just Culture in Healthcare: A New Approach to Patient Safety

Embracing Just Culture in Healthcare: Fostering Accountability, Learning, and Safety. Health Carousel International Leads the Way.
This is some text inside of a div block.
This is some text inside of a div block.
September 27, 2023

Breaking Barriers: Navigating Limited NCLEX-RN Testing Spots for International Nurses

Explore the surge in global interest for the NCLEX-RN exam and the challenges foreign-educated nurses face in securing testing spots. Discover how Health Carousel International (HCI) provides vital support throughout the process.
This is some text inside of a div block.

How do I apply?

Click here to begin your US RN career the PassportUSA Way

Others also viewed

This is some text inside of a div block.
October 16, 2023

Just Culture in Healthcare: A New Approach to Patient Safety

Embracing Just Culture in Healthcare: Fostering Accountability, Learning, and Safety. Health Carousel International Leads the Way.
This is some text inside of a div block.
This is some text inside of a div block.
October 10, 2023

Understanding the US Visa Bulletin, Employment-Based Visa Supply, and Retrogression

Demystifying the US Visa Bulletin: Understanding Priority Dates, Retrogression, and Visa Availability. Discover crucial concepts shaping immigration to the United States.
This is some text inside of a div block.
This is some text inside of a div block.
September 27, 2023

Breaking Barriers: Navigating Limited NCLEX-RN Testing Spots for International Nurses

Explore the surge in global interest for the NCLEX-RN exam and the challenges foreign-educated nurses face in securing testing spots. Discover how Health Carousel International (HCI) provides vital support throughout the process.
This is some text inside of a div block.