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Using Travel Nurses: The Employer's Side

Travel and agency staffing is the most common answer to a short-staffed unit and the most expensive one. Both halves of that sentence have been true for years, and the gap between what hospitals say about it and what they do is the whole subject.

The cost, stated plainly

On the 2026 staffing survey figures, covering calendar year 2025, hospitals paid an average travel nurse fee of $91.23 an hour, or $189,758 a year. An employed registered nurse cost $59.46 an hour including a benefits load of 25.8 percent, or $123,676 a year. The difference is $66,081 per nurse per year, and replacing twenty travel contracts with employed nurses saves the average hospital roughly $1.32 million.

The trend is downward and it is not going to close the gap. Hospital-side travel rates peaked at $154 an hour in spring 2022 and have fallen every year since, while the hospital's hourly cost for an employed staff nurse went from $46 in 2020 to $56 in 2025. The pandemic transformed the price of a travel nurse and barely touched the price of a staff nurse. See the history of travel nursing.

This is the most favourable travel market since 2019 and it is still the costliest way to cover a shift.

Why the intention to cut it rarely survives

Around seven in ten hospitals, 70.7 percent on the current figures, say they want to reduce their reliance on travel and agency staff. They have said so for several years while agency staffing remained the first answer to an uncovered rota.

The reason is that cutting agency spend is not a decision. It is a hiring capability, and the current numbers describe a capability under strain. It takes 78 days to hire one experienced registered nurse, ranging from 56 to 102 days depending on specialty. The national vacancy rate is 8.6 percent, which still leaves the typical hospital with 43 unfilled registered nurse posts and puts the national shortage at 158,600 nurses. Turnover rose to 17.6 percent last year.

An employer stops paying travel rates only when it can reliably recruit and keep permanent staff. Announcing a reduction without changing recruiting or retention produces the same spend with more meetings. See nurse turnover and retention.

The arithmetic that usually settles it

Each registered nurse turnover costs the average hospital $60,090, and each percentage point of turnover is worth about $295,000 a year to the budget in either direction. The average hospital lost $5.19 million to nurse turnover in a year.

Set that against the travel premium of $66,081 per nurse per year and the conclusion is uncomfortable but simple: for most hospitals the cost of recruiting harder is smaller than the cost of not recruiting. Every dollar declined on filling a permanent post is spent roughly twice on covering it.

The other number worth putting in the same paper is first-year turnover: 22.7 percent of newly hired registered nurses leave within a year, and first-year departures account for 29 percent of all separations. A hire that does not last is a travel contract deferred by ten months rather than avoided.

Whether your market is unusual

Agency reliance varies by state more than most staffing conversations assume. In long-term care, where contract hours are reported to Medicare and published, contract staff were 25.1 percent of nurse hours in Vermont in mid-2025 and 13.4 percent in Pennsylvania and New Hampshire, against 1.0 percent in Alabama and 2.5 percent in Nevada.

Travel postings per employed nurse follow a similar pattern: heaviest in Idaho, Alaska, New Mexico, Maine, Vermont, New Hampshire, Montana, Washington and Wyoming, lightest in Mississippi, Utah, Minnesota, Delaware and Alabama. Thin local nurse supply, not state size, is what drives it, which is why California, Texas and New York sit mid-table once their own nursing workforces are counted.

Knowing which side you are on changes the diagnosis. In a high-reliance state, agency use is the market you are recruiting in, and your permanent staff are being offered contracts constantly. In a low-reliance state, heavy agency spend is usually a recruiting problem of your own making. See where the assignments are.

When travel staffing is the right tool

There are situations where it is straightforwardly correct: a unit opening or expanding before permanent hiring can complete, a seasonal surge in a resort or snowbird market, a leave of absence in a small specialty, a facility geographically unable to recruit locally, and a genuine crisis. See rural and frontier nursing and crisis and strike assignments.

It is the wrong tool when it is covering a vacancy caused by something the employer controls. A unit staffed by rotating thirteen-week contracts because nurses keep leaving is paying a premium for the consequences of its own turnover, indefinitely.

Benchmark against your own specialty and region rather than the national line before deciding which case you are in. Turnover runs from 22.5 percent in behavioural health and 20.7 percent in emergency down to 13.4 percent in paediatrics, and telemetry posts take 87 days to fill against 70 for emergency. A rate that is ordinary on one unit is a fire on another.

What it costs beyond the rate

A unit covered by a rotating series of short contracts is a different unit clinically. Continuity, familiarity with local practice and knowledge of the patients are part of what staffing buys, which is why staffing research measures skill mix and continuity rather than headcount alone. See nurse staffing and patient outcomes.

There is a staff effect too. Permanent nurses who orient a succession of travellers, and who know what those travellers are paid, are being asked to absorb both the work and the comparison. It is a recurring theme in why experienced nurses leave.

The contract terms that matter to a facility

Rate escalation during a crisis, and whether it is capped.

The definition of a cancelled shift, and the notice required.

Who verifies the licence and competency of the nurse who arrives. Verification is independent and free through the national licence verification service, which also shows whether a licence is multistate. Some staffing firms also hold Health Care Staffing Services certification from the Joint Commission, which requires them to report standardised performance measures for their per diem and travel clinical staff; asking whether a vendor holds it is a cheap question with a real answer.

Indemnity and insurance.

Conversion terms, if the facility might want to hire the nurse permanently. Some states now prohibit charges of this kind altogether, and several require agencies to register and report their bill rates. Massachusetts has gone further still and caps what temporary nursing agencies may charge long-term care facilities, by region and shift. See nurse staffing agencies.

Reducing the bill

Three levers actually move it.

Hire faster. Most of the agency spend in a hospital is time-to-fill converted into money, and the recruiting teams carrying that are not growing: 71.8 percent of hospitals expect to grow their nursing workforce this year, 26.7 percent expect a bigger recruitment budget, and 6.8 percent expect to add recruitment staff. What is left is reach: posting where the audience is nurses, searching a nurse database directly rather than waiting for applications, and having matching candidates arrive before the vacancy does.

Keep the nurses already employed, and protect the first year in particular. Every avoided resignation removes both a vacancy and the contract that covers it.

Build internal flexible capacity. A facility's own per diem roster and float pool cover the same gaps without the agency margin, and reach nurses who will not take a full-time post at all, including those stepping back towards retirement. See per diem nursing and float pools.

Sources

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