Choosing the Right Fit: Temp-to-Perm vs. Direct Hire for International Nurse Staffing
Healthcare facilities nationwide face rising nurse vacancies, creating staffing and financial strain. International nurses offer a reliable solution—and AMN Healthcare makes it easy. As an ethically certified partner, we offer two proven staffing models: Temp-to-Perm and Direct-Hire. Whether you are seeking rapid deployment or are planning for long-term workforce stability, we align global talent with your local workforce needs.
The Temp-to-Perm Model: Fast Track to Stability
How It Works
With our Temp-to-Perm model, we serve as the employer of record during a 2-3 year assignment period. These nurses have passed NCLEX and are already in the green card immigration process, which accelerates their timeline to start.
Key Benefits
Speed to Market: Deployment typically happens within 8-24 months, compared to three years for direct-hire positions. This speed advantage comes from our existing pipeline of qualified candidates already in the immigration process.
Financial Flexibility: No upfront cost means that you can secure talent without any pre-start investment. Your hourly bill rate starts only when the nurse begins working, providing immediate budget predictability.
Risk Mitigation: Cancel up to 90 days before the start date if your needs change. We also assume all employment liability during the assignment term, protecting your organization from unexpected legal complications.
Full-Service Support: We handle every detail—immigration paperwork, licensure requirements, relocation assistance, and comprehensive integration support managed by AMN, with 80% of nurses converting to perm roles. Your team can focus on patient care while we manage the complexities.
The Direct-Hire Model: Building Your Future Workforce
How It Works
In the Direct-Hire model, your healthcare facility becomes the employer and sponsor from day one. We assist with prevailing wage determinations, recruitment, and green card filings, but you own the employment relationship throughout the process.
Key Benefits
Permanent Integration: Nurses join as permanent employees immediately upon arrival, signing 3-year term letters with the health system to ensure deeper organizational commitment and culture alignment from the start.
Long-Term ROI: While requiring upfront investment, this model delivers a superior return on investment compared to contingent labor spend. You're building permanent capacity, not temporary coverage.
Cultural Ownership: You drive the integration process, ensuring international nurses align perfectly with your facility's values, protocols, and patient care philosophy.
Strategic Workforce Planning: Ideal for organizations with 3+ year planning horizons who want to systematically build their nursing workforce through international talent or replace experience to offset future retirements
Strategic Investment Structure: The Direct-Hire model has upfront costs, including recruitment fees, legal filings, and immigration expenses. However, these costs are structured over the immigration timeline, allowing for manageable budget planning. We provide detailed cost breakdowns, so you can plan accordingly.
Candidate Pipeline: The Foundation of Success
Sophisticated candidate pipeline management powers our dual-model approach. For Temp-to-Perm placements, we maintain a ready pool of qualified RNs already progressing through immigration processes. This head start reduces deployment timelines.
The Direct-Hire pipeline works differently. We initiate recruitment based on your specific requirements, then manage prevailing wage determinations and green card filings with precision timing.
Both pipelines draw from our global network of nursing talent, with rigorous screening processes that evaluate clinical competency, English proficiency, and cultural adaptability. Quality remains consistent regardless of which model you choose.
Making the Choice: When Each Model Works Best
Choose Temp-to-Perm When:
- You need nurses within 8-24 months
- Budget predictability is crucial
- Internal resources for immigration and integration management are limited
- You want flexibility to adjust numbers based on changing needs
- Risk mitigation is a priority
Choose Direct-Hire When:
- You have a 3+ year planning horizon
- Building permanent workforce capacity is the goal (e.g. growth planning)
- Internal HR and integration resources are strong
- Long-term ROI justifies upfront investment
- Cultural & clinical ownership during integration is important
Choose Both When:
Many successful facilities strategically use both models. Temp-to-Perm addresses immediate needs, while Direct-Hire builds long-term capacity. This hybrid approach provides ultimate flexibility and comprehensive workforce planning.
The AMN Advantage: Why Both Models Matter
Most staffing agencies specialize in one model or the other. Our unique dual capability means we can recommend the best solution that fits your needs, not just the one we happen to offer.
With over 40 years of experience, our track record speaks for itself: thousands of successful international nurse placements across both models. We've refined both approaches through real-world experience, ensuring optimal outcomes regardless of which path you choose.
Your Next Step: Discovering the Right Fit
Every healthcare facility is unique. The right staffing model may be Temp-to-Perm for immediate relief, Direct-Hire for strategic growth, or a combination of both.
