Job Placement · Healthcare · CNA Staffing Agency Alternative
Federal rule 42 CFR 483.35 puts registry verification on the facility, not the agency, for every nurse aide, including temporary, per diem and leased staff. BEG places permanent CNAs at a Tier I milestone fee of $4,680 to $5,616 and tells you honestly when a travel or temp agency is the better fit instead.
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A Scenario Worth Reading Before You Book Agency Coverage
You do. Not the agency, and not as a policy choice, as a federal rule that names your facility directly.
The Rule Most Buyers Do Not Read Closely
Under 42 CFR 483.35, a facility must not use any individual as a nurse aide, on a temporary, per diem, leased or any basis other than a permanent employee, unless it has received registry verification that competency requirements were met, with narrow exceptions. That sentence exists specifically to close the loophole of assuming a staffing agency's own vetting satisfies your obligation. It does not.
Where Joint Employment Adds A Second Layer
Separately, under EEOC guidance on contingent workers placed by staffing firms, either the agency or your organization can be held liable for discrimination against a placed worker, and sometimes both at once. Two different exposures, one common cause: assuming the agency relationship is a clean handoff of responsibility. It is not.
Four Ways To Fill The Seat
The compliance duty above applies no matter which column you pick. What changes is who employs the aide and how the bill arrives.
| Model | Who employs the CNA | How you pay | Right when |
|---|---|---|---|
| CNA staffing or travel agency | The agency | Hourly bill rate, pay rate plus a 20% to 75% markup, shift by shift | A real absence, a skill shortage, or a seasonal census spike, per NAPEO's own definition of legitimate temporary staffing. |
| DIY in-house posting | You, once someone is found | Job board spend and internal recruiter time, no placement fee, no set timeline | You can absorb an open line for weeks while you screen applicants yourself. |
| Contingency recruiter | You | Percentage of first-year pay, roughly $8,452 to $10,565 at the nursing assistant median | You want no invoice until someone starts and accept the fee tracking the offer. |
| BEG permanent placement | You | Tier I milestone fee, $4,680 to $5,616, fixed at the start | The line is permanent and budgeted, and you want one certified aide who stays, not a rotating bench. |
BEG does not employ aides, does not bill hourly and is not a staffing agency, a CNA employment agency or a CNA staffing company, so per diem or travel coverage is not a product we sell. See medical assistant and CNA placement for the full role page, or the healthcare staffing agency alternative hub.
The Instability Underneath The Vacancy
Because the pay is modest, the physical work is demanding, and the market has been treating the role as interchangeable for years. Agency coverage papers over that. It does not fix it.
The Checklist That Does Not Change By Channel
Four checks. None of them disappear because the aide arrived through a staffing agency rather than a direct hire.
| Check | What the rule requires | Who it catches out |
|---|---|---|
| Training and competency evaluation | A state-approved program meeting the federal 75-hour minimum, including 16 hours supervised practical training. | Facilities that assume an agency's internal vetting already covers this. The regulation names the facility, not the agency, as responsible. |
| Registry verification | Confirmation of competency before the individual serves, including checks against every state registry likely to hold a record, on every basis including temporary and leased staff. | Any team treating registry checks as a first-week task rather than a before-first-shift requirement. |
| The four month limit | No individual may work as a nurse aide more than four months full time without meeting competency requirements. | Buildings covering a vacancy with a string of short agency assignments and losing track of the cumulative clock. |
| The 24 month lapse rule | A candidate with a 24 month continuous gap in paid nursing-related work since training needs a new training and competency program. | Returning aides, whether sourced by an agency or applying directly. |
BEG verifies training completion and registry status before a CNA candidate reaches your shortlist, and confirms the same for any candidate coming off an agency assignment you are considering converting.
What A Rotating Bench Costs Beyond The Bill Rate
At a 32.5% annual turnover rate, a twenty-aide department is effectively replacing six or seven people every year regardless of channel. Agency coverage converts that churn into a recurring hourly line item instead of solving it. A permanent hire at BEG's Tier I fee of $4,680 to $5,616 is a fixed, one-time cost against a role where the alternative is an open-ended hourly bill.
The Honest Caveat
At this pay grade, the placement fee is a small number next to the cost of the churn underneath it. If the same line has emptied three times in two years, the next search will not be the one that sticks unless scheduling, onboarding or progression changes alongside it. We will tell you that directly rather than just book another search.
FAQ
No. Under 42 CFR 483.35, a facility must not use any individual as a nurse aide, on a temporary, per diem, leased or any basis other than a permanent employee, unless registry verification confirms the competency requirements were met. That obligation runs to the facility. An agency badge on the aide does not transfer it away from you.
Not in the strict legal sense. NAPEO describes true co-employment as the contractual arrangement a professional employer organization enters with a client, sharing employer responsibilities formally. A staffing agency is not a PEO. The more accurate term the staffing industry itself uses is joint employment, where the agency is the formal employer but the client can still carry real legal exposure for how that worker is treated.
Potentially both of you. Under EEOC guidance, either the staffing firm or the client can be held liable for discrimination against a placed worker if that business meets the legal definition of employer, and both can be liable at once, including when the client requests a discriminatory standard or knows about mistreatment and does not correct it. A BEG placement has no second employer in the chain to create that split liability question.
Reported markup on temporary and contract pay rates runs 20% to 75% generally, covering the agency’s FICA, unemployment tax and workers’ compensation costs as the aide’s legal employer, plus its own overhead, before any profit is left. That is an hourly number, not comparable to a one-time placement fee.
BEG prices CNA and nursing assistant placement as a Tier I search at $4,680 to $5,616, billed against milestones. A 20% to 25% contingency fee against the $42,260 BLS median for nursing assistants would run $8,452 to $10,565, roughly double BEG’s milestone fee. A staffing agency’s hourly rate is a different product entirely and is not a fair apples-to-apples comparison against either figure.
Yes, when the need is genuinely temporary. NAPEO frames legitimate temporary staffing as covering absences, a skill shortage, or seasonal volume, and travel CNA assignments usually fit that description directly. BEG does not run travel assignments and will tell you plainly when that is what you actually need instead of a permanent search.
Expect a conversion or buyout fee, commonly 15% to 25% of first-year salary, triggered by hiring inside an exclusivity window the agency set at six to twelve months from placement. It is framed as recovering the agency’s lost future billings, not a penalty on you specifically. A BEG search carries no such fee because the aide is never on an agency payroll first.
Because the churn rate is the highest in the building. NSI reports certified nursing assistant turnover at 32.5% for 2025, with CNAs and patient care technicians turning over virtually their entire staff every three years. A rotating cast of agency aides compounds that instability rather than fixing it, which is why a stable permanent core matters more here, not less.
A state-approved training and competency evaluation program of at least 75 clock hours, including a minimum of 16 hours of supervised practical training, under 42 CFR 483.152. States can require more. This floor applies whether the aide comes from a staffing agency, a direct application, or a BEG search, so verifying it is part of onboarding either way.
The regulation is explicit: no individual may be used as a nurse aide for more than four months on a full-time basis without meeting the competency requirements, with narrow exceptions. It is a hard compliance limit, not internal policy, and it applies regardless of which channel supplied the aide.
Yes, all three describe the same hourly bill rate model, an agency that employs the aide and bills your facility for the time worked. CNA employment agency and CNA recruitment agency are just the terms some buyers search instead of CNA staffing agency. None of them describe BEG. BEG is not a staffing agency, an employment agency or a recruitment agency. BEG places CNAs permanently on your payroll for a flat Tier I milestone fee, and the federal registry duty covered above applies the same way either route.
A 45-day replacement guarantee, plus 50% off a repeat search for the same line. Given a 32.5% national turnover rate on this role, read that clause closely in any agreement, including ours, and ask what happens on a second or third replacement rather than only the first.
Hiring elsewhere in the building? See medical assistant staffing alternatives, LPN and LVN placement and nurse manager recruiting, or all healthcare placement.
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