For many international nurses coming to the United States for work, there are two common options: direct hire placement and sponsorship programs. While each has their advantage, direct hire is generally more convenient for both the international healthcare professional and the hiring hospital.
But what is direct hire placement, and why is it considered better than sponsorship programs? In this guide, we’ll break down what direct hire is, what its benefits are, and how to find direct hire nursing jobs in the U.S.
Direct hire is an international staffing permanent placement option, in which a hospital serves as both sponsor and employer of the immigrating healthcare professional. The hospital petitions for the healthcare professional’s visa and has them on payroll as an employee.
Unlike with a sponsorship program, in which an international recruitment agency sponsors and employs the healthcare professional, direct hire placement means the healthcare facility itself holds a direct commitment to the individual’s employment status.
“Many international nurses find direct hire preferable because of the high level of commitment from the hospital they’re placed with,” explains Lisa Taylor, Vice President of TRS International. “Since the hospital has a direct investment in them, immigrating nurses feel more part of the local culture as a full employee instead of simply a contractor.”
Typically, the first step for international nurses looking for direct hire placement in the U.S. is to connect with a direct hire agency that specializes in international recruitment.
Unlike an agency with sponsorship program, a direct hire agency’s goal is to get you employed directly by a U.S. hospital. This means they’ll facilitate the job search, immigration, and relocation processes, helping you to find work in the U.S. quicker and more efficiently.
After you’ve connected with the agency, you’ll be pre-screened by the agency to ensure you meet direct hire requirements.
In most cases, you’ll need at least two years of nursing experience, a nursing license, and nursing certifications before you can be employed. You’ll also be expected to pass the NCLEX registered nursing examination in English.
Be sure to check with your direct hire recruitment agency for details on what’s required in order for you to work as a nurse in the U.S., as some agencies and hospitals will have different expectations.
Once the prescreening requirements have been fulfilled, your resume and job application will be submitted by the direct hire agency to U.S. hospitals that have positions open for direct hire candidates, with consideration based on your qualifications and preferences.
Interested hospitals will then connect with the agency to set up job interviews with you. After the interview process, the hospital will determine whether or not they’ll extend a job offer. If a job is offered, you’ll begin the onboarding and immigration processes. If not, the agency will submit your application to other hospitals to find you the right position.
When you’re officially employed by a U.S. hospital, you’ll work with your direct hire agency and your new employer to begin the immigration process, with the hospital acting as your sponsor via either an H-1B, EB-3, TN, or E3 Visa. You can convert to a Green Card with all visas.
In many cases, the H-1B or EB-3 will be used. The H-1B is a quick yet complex temporary work visa for specialty occupations, and it’s often used by U.S. hospitals hiring international nurses. The EB-3 grants permanent residency from the start; however, it may have longer processing times.
Overall, the direct hire process takes approximately two years. Once you’re in the U.S., your direct hire agency should facilitate a smooth transition to help orient you with your new community and the hospital you’ll be working with. At this point, you’ll be able to begin work as a full-time employee.
From feelings of greater job security compared to agency sponsorship to having more control over your location, these are the top benefits of direct hire placement for international nurses
When you work through a sponsorship agency as an international nurse moving to the U.S., your contract is with that agency—not with the hospital or healthcare facility you work at. Meanwhile, non-U.S. based nurses who have been placed via direct hire are employees of the hospital from the start.
Also, unlike with a sponsorship program, direct hire contracts are not temporary positions. You’re permanently employed and sponsored by the healthcare facility where you work, giving you control and security over your nursing career. With direct hire, your employment is treated like any other staff member’s, rather than being limited to contractor status.
Direct hire nurses receive a salary and benefits in the same way a permanent staff member who happened to be hired domestically would. This means your pay rates, healthcare coverage, and other benefits are all determined by the hospital, rather than by the agency that placed you.
Of course, pay for direct hire nurses can vary by location, specialty, and other factors, but you can rest assured that you’re earning a fair rate relative to the market and facility’s typical rates.
Since job offers come directly from the hospital, direct hire international candidates are fully aware of where they’ll be living before coming to the U.S. This isn’t always the case for those with sponsorship program contracts, since the sponsorship agency may petition for citizenship using multiple job locations.
In other words, international nurses going the sponsorship program route may not know where they’ll work or live up until just a few months prior to immigration. With direct hire, you have clarity from the start of the process and will work hand-in-hand with the facility sponsoring you from the start.
Direct hire nurses are welcomed as permanent staff from the day they arrive at their employing hospital. Even before that, the healthcare facility employing them has direct involvement in the immigration process, so connections with various members of hospital leadership are likely well in place by the time an immigrating nurse starts working.
Also, since direct hire nurses are fully aware of where they’ll be living and working from the beginning, there’s ample time to research the area and become familiar with what to expect.
It’s a good idea to look for direct hire agencies that will also go the extra mile to help you get established in the community, including assistance with housing, obtaining social security cards, getting familiar with U.S. culture, and much more.
While an international healthcare professional employed through a sponsorship program will have an employment contract through their sponsorship agency that they must uphold throughout the immigration process, this isn’t the case for direct hire nurses.
Direct hire international nurses have the same opportunities as domestically hired staff to move within specialties or positions after they have fulfilled the necessary aspects of their sponsorship through the hospital. So, over time, if you decide to expand your professional horizons, you’re free to do so.
TRS International has a wealth of experience in assisting healthcare professionals immigrate to the U.S. and can help you find the international nursing jobs you’re looking for.
As a leading direct hire agency, TRS International helps nurses with job submissions, credentialing, immigration, and community orientation to ensure each nurse is well-acquainted with their environment and ready to start working prior to arrival.
Interested in working in the U.S. via direct hire? Apply with TRS International through our application page or contact us by emailing internationalinfo@trshealthcare.com.
