A travel nurse's employer is almost always the agency, not the hospital. The agency pays the wage, withholds the taxes, carries the liability insurance and bills the facility an hourly rate that covers all of it plus a margin. Understanding who else is standing between the nurse and that hospital is the difference between a good rate and an average one.
The layer most nurses never see
Large hospital systems stopped managing relationships with a dozen agencies years ago. Instead they hand the whole staffing function to one vendor under a managed service provider arrangement, or run it through a vendor management system, and every agency that wants to supply nurses to that hospital goes through it.
The firm running that layer is often itself one of the largest staffing companies. AMN acquired the vendor management platform Shiftwise in 2013; HealthTrust Workforce Solutions grew out of Parallon, founded by HCA; other platforms include FocusOne and Medefis. See the history of travel nursing.
For a nurse the practical consequence is simple. The agency calling you may hold the contract directly, or it may be a subvendor placing you through another company's contract. The bill rate is the same either way; it is just divided among more parties. A rate that seems low for the market is sometimes a wide agency margin and sometimes a second company taking a share before the first one does. Asking whether the agency is the primary vendor for that facility is a fair question and a revealing one.
What the margin covers
Out of the hourly bill rate the agency pays the nurse's wage and stipends, employer payroll taxes, workers' compensation and professional liability cover, housing if it provides it, benefit costs, the recruiter's commission and its own overhead and profit.
The gap between the bill rate and what reaches the nurse is therefore not evidence of anything by itself. What makes it assessable is knowing the ceiling: the staffing survey hospitals benchmark against puts the average travel rate at $91.23 an hour on its 2026 figures, roughly $3,284 for a 36-hour week. A package far below that has an unusually wide cut behind it. See travel nurse pay packages.
Submissions, and how a nurse loses a job before applying
A recruiter cannot present a nurse to a facility without the nurse's profile. Two agencies submitting the same nurse for the same job creates a duplicate, and facilities usually resolve duplicates by rejecting the candidate entirely rather than adjudicating between agencies.
The rule that avoids it: never give blanket permission to submit. Give permission for a named facility, on a named date, once. Working with several agencies is normal and sensible, and keeping a written record of which agency was authorised for which job is what makes it safe.
A related question is exclusivity. If a recruiter is the only person working an opening, the nurse's odds are better. If a dozen agencies have it, the facility is looking at a stack of profiles, and speed matters more than persuasion.
Choosing between agencies
The differences that turn out to matter are rarely the ones in the marketing.
Benefits and when they start. Health cover from day one, or after 30 days, or not at all. Whether there is a retirement plan and any match. Whether licence, certification and physical costs are reimbursed.
Whether hours are guaranteed, and on what terms. See travel nursing contracts.
Housing: arranged, or a stipend, and how the stipend compares with the federal per diem rate for that locality. See travel nurse housing.
Cancellation terms, including what happens to housing and to any travel reimbursement already paid.
Whether the offer arrives in writing, complete, without being asked twice.
Reach. An agency with contracts in the states you want is more useful than a larger agency without them.
One credential worth checking
Staffing firms can be certified by the Joint Commission under its Health Care Staffing Services programme, which reviews on site how a firm verifies credentials, assesses competency, places clinicians and handles complaints. Certified firms must also collect standardised performance measures for their per diem and travel clinical staff and report them quarterly.
It is not a guarantee of a good rate or a good recruiter, and plenty of sound agencies do not hold it. What it does mean is that an outside body has looked at how the firm decides you are competent to be on that unit, which is more than can be said for an agency's own description of itself. Facilities often ask about it; nurses rarely do.
What a good recruiter is for
A recruiter knows things about a facility that are not in the job posting: why the post is open, how long it has been open, whether the unit has a reputation, how the interview process runs, and whether the rate has room in it. A recruiter who cannot answer those questions either does not know the client or is not close to it, and that is informative in itself.
The questions worth asking, in full, are set out in ten questions to ask a travel nurse recruiter. The condensed version: why is the job open, how long has it been open, do you have it exclusively, what are the ratios and the float practice, what is in the package besides the rate, what happens if it is cancelled, and can it be extended.
Compliance, and why it takes so long
The agency runs the credentialing: licence verification, certifications, a skills checklist, competency testing, background check, drug screen, immunisation records and titers, respirator fit testing and facility-specific paperwork. Employers can confirm a licence independently and at no cost through the national verification service, which shows whether a licence is current and whether it is multistate.
This is the part that most often moves a start date. See licensing a travel assignment.
Agencies are increasingly regulated
Since the pandemic, states have started registering staffing agencies, requiring contracts to be filed, and requiring bill rates to be reported by category of worker. Some prohibit contract terms that restrict where a nurse may work afterwards or that penalise a facility for hiring an agency nurse permanently. The regimes differ by state and change often. See nurse staffing agencies.
Reaching agencies without being buried
The usual complaint from nurses starting out is that one enquiry produces months of calls from firms they never contacted. Choosing which agencies receive a profile, rather than broadcasting it, is the practical fix; that is how the travel nursing job listings on this site work.
Related
- Travel nursing
- Travel nursing contracts
- Travel nurse pay packages
- Nurse staffing agencies
- History of travel nursing
Sources
- A Brief History of Travel Nursing. NurseRecruiter, 4 November 2019, on the rise of managed service provider and vendor management arrangements. Accessed September 9, 2026.
- National Health Care Retention and RN Staffing Report. NSI Nursing Solutions, 2026 edition, for bill rates. Accessed September 9, 2026.
- Health Care Staffing Services certification. The Joint Commission, on what the certification reviews. Accessed September 9, 2026.
- Health Care Staffing Services measures. The Joint Commission, on the performance measures certified firms report for per diem and travel staff. Accessed September 9, 2026.
- Ten questions you should ask your travel nurse recruiter. NurseRecruiter, 26 January 2017. Accessed September 9, 2026.
- Nursys licence verification. National Council of State Boards of Nursing. Accessed September 9, 2026.
- Temporary health care staffing agencies now required to register in New York. Garfunkel Wild. Accessed September 9, 2026.