Job Seeker Resources August 11, 2023

Grow your Career in the U.S. with a Staffing or Direct Hire Recruitment Agency

Amid a deepening shortage of nurses in the United States, opportunities for international nurses continue to grow in health systems across the country. Nurses from all over the world have opportunities to join top healthcare systems across the United States in a variety of different specialties, each offering these nurses the opportunity to reach their American Dream.

But where can nurses find the support, they need to realize their American dream? After all, the process is lengthy from recruitment, to immigration, to licensure, to credentialing, to onboarding and orientation.

International nurse staffing agencies and direct hire agencies are two of the most common options for nurses to use for their job search and relocation. Both types of agencies work in partnership with healthcare organizations to place nurses in their ideal positions. At AMN Healthcare, we're proud to both options of support! Through our sister companies, O’Grady Peyton International and Connetics USA, AMN Healthcare offers the most US-based job opportunities and the most comprehensive support to nurses interested in working in the U.S..

But what is “staffing”, and what is “direct hire”? How are they similar? How are they different? The following guide provides answers to these questions. It is designed to help nurses compare both staffing and direct hire opportunities.

Overview of Direct Hire and Staffing Agencies

To work as a registered nurse in the United States, nurses must obtain a valid visa. The preferred visa for nurses is a permanent residency visa, otherwise known as a Green Card. To obtain a Green Card, the registered nurse must be sponsored.

With a direct hire agency, like Connetics USA, the healthcare facility will be your employer and green card sponsor. On the other hand, with a staffing agency, like O’Grady Peyton International, the agency will be your employer and green card sponsor, though the nurse will work with one of the agency’s healthcare clients.

Job location options, length of employment contracts, compensation and benefits packages, and the amount of support provided will vary based on whether a nurse is employed by an international recruitment agency or hired directly by a healthcare system.

Working with an International Nurse Staffing Agency

International nurse staffing agencies like O’Grady Peyton International play a vital role in connecting nurses with leading hospitals and healthcare institutions across the United States. With more than 40 years of experience in the industry, our employment opportunities and expanding network are healthcare clients is second to none. Our recruitment team also has the resources and expertise to help nurses navigate the immigration and licensing processes and provide ongoing support and supervision.

International nurses who want to relocate to the United States can expect several advantages when choosing O’Grady Peyton International as their staffing agency including:

  • Shortest assignments in the industry at 2 years or 4,160 straight-time hours
  • Covered costs for expenses like English education, NCLEX exam fees, travel, and more
  • Clinical and social support for clinicians throughout their entire 2-year contract
  • Bonus opportunities are also available for post-NCLEX nurses and referrals

In addition, staffing agencies may file for a Green Card petition for multiple locations, versus a single location in a direct hire arrangement. This can provide more placement options and assurances for nurses that their visa application will not be slowed down due to issues with a single job cancellation.

Working with a Direct Hire Agency

International nurses who choose to work with direct hire agencies, like Connetics USA, will be employed by the healthcare system where they are placed. Direct hire agencies match registered nurses with nursing jobs at U.S. healthcare facilities via a direct hire, long-term contract.

International nurses will receive a Green Card along with the same salary and benefits as their American nurse colleagues. Direct-hire jobs are typically core staff permanent positions with salary and benefits based on experience and education. Key benefits of choosing Connetics USA as your direct hire agency include:

Placement directly at a healthcare facility across the U.S. in a full-time, permanent position earning the same salary and benefits as an American nurse

Competitive compensation packages to defray the cost of immigrating to the US (varies based on healthcare facility and may include relocation assistance, legal and government fees, bonuses and more)

Full-service support throughout the process including recruitment/job placement, immigration, licensing, credentialing, relocation, onboarding, orientation, clinical training and support

Referral bonuses for qualifying candidates

10 Key Factors to Consider When Deciding on a Recruitment Agency

Below are 10 key factors for nurses to consider when deciding between a staffing agency and a direct hire agency:

Key Factors

Staffing (O'Grady Peyton)

Direct Hire (Connetics USA)


Must be a registered nurse 

Must be a registered nurse 


Staffing agency 

Healthcare facility 

Visa Sponsor 

Staffing agency 

Healthcare facility 

Length of contract 

2-year full-time commitment 

3-year full time commitment  

*(TN visa nurses- 2 year full time commitment) 


AMN Healthcare benefits include vision, dental, 120 hours of PTO, 401K & more 

Benefits determined and administered by the healthcare facility; typically medical, vision, dental, PTO, 401K & more 

Salary rate 

Competitive pay rates based on location and prevailing wage 

Competitive pay rates based on education and experience. Rate is the same as what is being offered to similarly experienced domestic healthcare professionals employed by the healthcare facility 

NCLEX sponsorship 

NCLEX sponsorship available for all nurses who qualify 

NCLEX sponsorship available for all nurses who quality 

Job locations 

Wide variety of locations across the U.S. 

Wide variety of locations across the U.S. 

Document assistance 

Permanent EB-3 Green Card, TN, AOS 

Permanent EB-3 Green Card, TN, AOS 

Post-arrival support 

Available for 2 years 

Available for 6 months  


Nurses coming to America will want to consider the reputation and financial stability of both employment options, including a healthcare system’s budgetary constraints, staffing needs, geographic location, and regulatory requirements.

Explore Nursing Opportunities in America

The outlook is bright for international nurses who have dreams of working in America, and each person will need to evaluate the pros and cons of direct hire agencies versus staffing agencies based on their individual circumstances.

Your decision is a personal choice. Do your research, talk to nurses who have worked with both types of agencies, and be sure you understand the long-term benefits and opportunities before signing any contract.

Fortunately, international nurses are in good hands with either option when they decide to work with AMN Healthcare, the largest and most experienced recruitment agency in the United States. We know that everyone’s international nursing journey and desires are different, and the teams at our affiliate companies are dedicated to matching you with the right job, the right location, and the right pay and benefits for you and your family.

Nurses can rely on more than 40 years of international nurse recruitment expertise through O'Grady Peyton International and Connetics USA.

Apply for staffing     Apply for direct hire