So, you’re considering a career change, and the US is the destination that you’ve selected. Congratulations, you’ve taken the first step! But hold on. You’re already at a crossroads—direct hire or contract placement are the options available to you. Okay, but what’s the difference? And which path is the right one for you? It’s okay to be confused. It’s the first big decision to make and the most important one. This step will define the rest of your journey in the US. So, it’s worth spending time on, and drilling down to compare the two options. Then you’ll be able to sit back, decide, and move forward with confidence. And that’s the experience we want for you. 

The Differences

The direct-hire model starts with a full-time staff position and recruits for that specific role. In contrast, the contract-placement model begins with general recruitment and confirms a worksite location later. Therefore, the main distinction is that direct hire offers a career choice from the outset, and contract placement ensures a job assignment in the future. 

That’s simple enough, but there are more specific differences to consider.


With direct hire, you are employed directly by a healthcare facility for a permanent position and become a staff member from day one. 

With contract placement, you are employed by a staffing agency and placed on assignment at one of their client facility locations.

Compensation Package

With direct hire, you receive the healthcare facility’s compensation package (salary, benefits, and perks) based on qualifications, experience, and the pay scale for the role.

With contract placement, you receive the staffing agency’s compensation package (hourly rate, benefits, and perks) based on their criteria.

It’s worth noting that a staffing agency’s compensation package may differ significantly from a healthcare facility’s compensation package. And the difference in cost for your health insurance coverage can be substantial.  

Job Details

With direct hire, you review the healthcare facility’s profile (culture and values), location, and compensation package as part of your interview selection process.

With contract placement, you sign a contractual agreement committing to the agency’s terms and conditions before knowing your placement’s details (actual salary and worksite location).

Also, staffing agencies reserve the right to move you from one assignment to another around the US. And depending on your needs, this could be fun and exciting or challenging and stressful. It’s truly a personal preference. 

Which One is Right for You?

That’s a question that only you can answer. And it will depend, in large part, on whether you favor certainty over ambiguity. But the good news is that time is on your side. The nursing shortage in the US is here to stay, and your professional skills are valued and in demand. So, don’t feel rushed. Take your time. Do your research. Check out our article on Nursing in the US: Direct Hire vs. Contract Placement and make a side-by-side comparison to help identify differences in important areas. Then use the information you’ve gathered to decide which employment option is best for you. 

Good luck! I hope your exploration brings clarity, and you choose a path that you will love and enjoy. 

Related Article: Nursing in the US: Direct Hire vs. Contract Placement