AGENCY VS HSE VS PRIVATE HOSPITALS: WHAT’S BEST FOR NURSES?

“Nursing in Ireland” is not one job market, it is three distinct employment models with different trade-offs: HSE/public service, private hospitals, and agency nursing. The “best” option depends on what you value most: predictable income and benefits, flexibility and control, or a particular working environment and pace.

This guide compares the three routes and highlights when each choice tends to suit nurses best.

The three options in plain terms

HSE (public service employment)

You are employed directly within the public health service, typically on structured grades with incremental pay scales and standardised conditions linked to Department of Health-approved rates.  

Private hospitals

You are employed by a private provider (for example, independent acute hospitals). Pay and benefits can be competitive, but terms vary by employer and are not automatically the same as public service conditions. The INMO provides private-sector rights/entitlements support, reflecting that conditions are employer- and contract-dependent.  

Agency nursing

You are employed by an agency and placed (“assigned”) to a “hirer” (which can be an HSE site or a private hospital). Irish law requires equal treatment in basic working and employment conditions for the duration of the assignment compared with direct recruits doing the same job.  

Quick comparison (what typically matters most)

1) Pay structure and predictability

HSE: Transparent, published pay scales with annual increments by grade (where applicable). This is a major advantage for predictability and long-term planning.  

Private hospitals: Pay varies by employer and role; some offer attractive packages, but you must compare like-for-like (base pay, premiums, pensions, overtime rules).  

Agency: Usually paid hourly; income can be strong when shifts are plentiful, but weekly totals can fluctuate with availability, cancellations, and your own scheduling choices. Equal-treatment rules apply to basic conditions during an assignment, but the overall package still depends on your agency contract and the assignment terms.  

2) Leave, sick pay, and employment protections

HSE: Operates formal leave and sick-leave arrangements; for example, HSE guidance notes self-certified sick leave provisions for staff.  

Private hospitals: At minimum, Irish statutory rights apply. Statutory sick pay is set out by Citizens Information (with additional provisions depending on employer policies).  

Agency: Under the Temporary Agency Work framework, agency workers must receive equal treatment in basicworking and employment conditions (commonly including pay, working time, rest periods, annual leave/public holidays) compared with direct hires in the same role during the assignment.  

3) Pension and long-term value

HSE: Public service pension coverage applies depending on your entry date/eligibility; HSE outlines the pension schemes and membership criteria, and the Single Public Service Pension Scheme applies generally to first-time entrants from 1 January 2013.  

Private hospitals: Typically provide occupational pension options, but the design and employer contribution levels vary, check the contract carefully.  

Agency: Pension arrangements depend on the agency. Even when equal-treatment rules apply to basic conditions during the assignment, a public-service-style pension is not automatically part of agency work.

4) Flexibility and control of your rota

HSE: More stable rosters but less individual control; leave is requested within service needs.

Private hospitals: Often more predictable elective activity patterns in some facilities, but this varies widely by hospital and unit.

Agency: Highest flexibility, you can accept or decline shifts and often choose sites but you trade off predictability and continuity.

5) Career progression and professional development

HSE: Strongest for structured progression (grade pathways), access to larger services, and broad internal mobility across specialties. Public pay agreements and scales provide a clearer long-term trajectory.  

Private hospitals: Can be excellent for focused clinical pathways (often in acute elective services) and may support development, but progression structures differ by organisation.

Agency: Best for building breadth of experience quickly, but harder to demonstrate sustained leadership/project work unless you deliberately create continuity (for example, long placements and documented competencies).

Which is “best” depends on your goal (practical scenarios)

Choose 

HSE

 if you want:

• A clear, published pay scale and increments you can plan around  
• Public service pension participation (where eligible)  
• Strong options for specialisation and promotion pathways
• Better alignment with longer-term stability (mortgage, family planning, predictable leave)

Watch-outs: bureaucracy, staffing pressures, and less rota control.

Choose 

Agency

 if you want:

• Maximum flexibility (location, nights/weekends, short-term blocks)
• The option to test different hospitals/units before committing
• Rapid exposure across services

Non-negotiables to verify before you start:

• Your equal-treatment entitlements during assignments (pay/leave/working-time basics)  
• Cancellation policies, travel expectations, and what counts as paid time
• How compliance and mandatory training are handled (and whether time is paid)

Choose 

Private hospitals

 if you want:

• A potentially different pace/culture and, in some facilities, a stronger elective focus
• A package that may be competitive, depending on the employer
• A more contained organisational environment (often fewer sites than the public system)

Watch-outs: terms vary widely, so you must compare total package (base pay + premiums + pension + leave + sick pay rules) and not assume it mirrors HSE conditions.  

A simple decision checklist (use this before you switch)

1. Do you prioritise stability (HSE) or control (agency)?
2. Do you need a pension pathway you can build on long-term (often easier in HSE)?  
3. Are you comparing total compensation, not just hourly/base pay (premiums, leave, sick pay, pension contributions)?
4. Do you want progression (CNM/ANP pathways) in a structured way (often stronger in HSE)?  
5. Do you need predictable leave windows for travel/family?
6. How important is continuity of team and unit to you (HSE/private) versus variety (agency)?
7. What is your tolerance for onboarding and compliance paperwork (higher with agency across multiple sites)?
8. What is the clinical setting you actually want (ED/ICU, theatre, mental health, community) and which employer type offers you the best access?

Bottom line

• HSE is typically “best” for nurses who value predictability, structured progression, and public service pension access.  
• Agency is typically “best” for nurses who value flexibility and autonomy, and who actively manage entitlement details under agency-work protections.  
• Private hospitals can be “best” when the specific employer offers the environment and package that match your priorities provided you confirm the full terms in writing.  

FAQs