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2024 Travel Nurse Salary + Job Outlook

Travel nurses work in specific locations for limited and usually predetermined timeframes of anywhere from 13 to 16 weeks. Though they may work in any type of facility – hospitals, doctors’ offices, and long-term care facilities – they get to choose where they work, which helps prevent boredom. Travel nurses also earn handsome salaries that rival the average salaries of BSN-educated registered nurses (RNs). Here, you will learn more about the average travel nurse salary and what you can expect if you choose this exciting career path.

How Much Does a Travel Nurse Make?

Salary for different types of travel nurses, what other benefits will you receive as a travel nurse, how to boost your travel nurse salary, 10 best states to work for travel nurses + salary, travel nurse salary by state – highest to lowest, travel nurse salary by city, what are the 10 best travel nursing agencies to work for in the united states, what does the future look like for travel nursing jobs.

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How Travel Nurse Pay Works: A Comprehensive Guide

Table of Contents

Understanding travel nurse pay: your comprehensive guide.

Travel nursing is an exciting career option for registered nurses, offering the opportunity to explore new locations while helping patients in different healthcare facilities. As a travel nurse, understanding your pay is important to help you make informed decisions about your career and financial future. In this guide, we explore how travel nurse pay works, the factors that influence your earnings, and how to negotiate your contract to get the best pay package possible.

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How Does Travel Nurse Pay Work?

Travel nurse pay can be a complicated topic for many healthcare professionals. Unlike staff nurse positions, travel nursing contracts often come with multiple variables that can impact your take-home pay. This can include the bill rates at healthcare facilities, additional benefits like housing stipends, and vendor management fees that certain travel nursing companies apply to your pay. In this article, we will explore these various factors and dive deeper into how your pay works as a travel nurse.

Taxable Base Rates: What You Need to Know

First and foremost, it's essential to understand that your taxable base rate is the core component of your travel nursing pay package. As a travel nurse, this is the hourly wage that is taxed, similar to how a staff nurse is paid. This ensures you remain compliant with tax laws while working in your nursing position. Importantly, taxable base rates can vary between different travel nursing agencies, so it is essential to be aware of the rate you are receiving when comparing offers.

Tiered Bill Rates: How They Affect Your Earnings

Healthcare facilities typically pay travel nursing companies a bill rate for their services, which in turn covers your pay, benefits, and agency overhead costs. Some facilities use a tiered bill rate system, meaning the rates they pay to travel nursing companies can fluctuate based on specific factors. For example, a hospital may offer a higher bill rate for a nursing position in a hard-to-fill specialty or for an urgent need, which can sometimes result in increased pay for the travel nurse.

Being aware of tiered bill rates can be helpful when comparing travel nursing contracts and understanding the basis of your earnings. By exploring opportunities with higher bill rates, you could potentially maximize your earnings during your assignment.

Gross Profit Margin: Understanding Your Agency's Profit

Travel nursing companies make their profit by skimming some of the bill rates paid by healthcare facilities after covering the costs of your pay, benefits, and company overhead. This profit is referred to as the gross profit margin, and it's an important aspect to understand when examining the difference in pay between multiple agencies.

A transparent travel nursing agency should be able to provide a sample breakdown of how much from the bill rate is allocated towards your pay, benefits, payroll costs (e.g., taxes and Social Security), liability insurance, and company overhead. This understanding can empower you to ensure you're getting a fair deal and to potentially negotiate better pay and benefits if there's room for it within the bill rate.

Breaking Down the Travel Nursing Pay Package

Now that we have a grasp of taxable base rates, bill rates, and gross profit margin, let's dive into the other aspects of the travel nursing pay package, including travel stipends, housing reimbursements, and vendor management fees. These factors can have a profound effect on your final take-home pay, so it's essential to understand and compare them carefully when considering travel nursing contracts.

Travel Nursing Salary: Factors That Influence Your Earnings

Travel nursing agencies typically offer a benefits package on top of your taxable base rate, which can include housing stipends, travel reimbursements, and other tax-free reimbursements. It's important to understand how these factors work in addition to your base pay to get a full picture of your overall earnings on an assignment.

For instance, housing stipends might be offered based on the cost of living in your assignment area, while your travel stipend could cover any expenses related to commuting to and from your tax home. Some agencies may also offer shift differentials, overtime, certification reimbursement, or other bonuses that can influence your pay. Keep these factors in mind as you explore travel nursing contracts and compare offers.

Vendor Management Fees: What They Are and How They Affect Your Pay

Vendor management fees are another crucial aspect of the travel nursing pay package. Some healthcare facilities employ a Vendor Management System (VMS) to streamline the process of onboarding and managing temporary staff, including travel nurses. These VMS companies typically charge a small percentage of the bill rate as their fee, which is ultimately passed on to the travel nursing agency in the form of a reduced bill rate.

When a vendor management fee is taken into account, it can potentially influence the bottom line of your pay package. Agencies might have less flexibility in offering higher pay or better benefits given the reduced bill rates. Understanding this aspect of the system can help you set realistic expectations for pay when working with healthcare facilities that use a VMS.

Agencies Gross Profit: How It Affects Your Paycheck

Lastly, it's crucial to reiterate the connection between your travel nursing pay and the agency's gross profit. As mentioned earlier, travel nursing companies make their money by allocating a portion of the bill rate after covering your pay and benefits. Some agencies may have larger overhead costs or simply choose to retain more profit, resulting in lower pay and benefits for you. In contrast, other agencies that operate on a slimmer margin might be able to offer you better pay or additional benefits.

To ensure you get the best possible pay package and a fair deal from your agency, it's essential to ask questions and ensure transparency in their breakdown of the bill rate. Comparing your pay and benefits across multiple agencies can help you find the best fit for your needs and potentially increase your overall travel nurse earnings.

Understanding Your Total Pay Package as a Travel Nurse

When considering a travel nursing contract, it's essential to understand the various components that make up your total pay package. Unlike staff nurse positions, the travel nursing pay structure often comprises several components, including hourly wages, stipends, bonuses, and even liability insurance reimbursements. Travel nursing companies work with healthcare facilities to determine the bill rate for each nursing position - a figure that encompasses a travel nurse's wages, benefits, and vendor management fee paid to the agency.

To fully comprehend your travel nursing pay package, it's crucial to break down each element, such as the base pay, travel stipend, and housing stipend. Doing so will help you make informed decisions when comparing offers from different travel nursing agencies. Furthermore, understanding your pay package will help you negotiate more effectively with travel nursing companies, ensuring that you receive a fair deal for your services.

Travel Nursing Pay: Other Forms of Compensation to Consider

Beyond base pay, travel nursing agencies offer additional compensation to make their positions attractive and competitive. Recognizing these other forms of compensation is essential when comparing travel nursing pay packages:

1. Travel Stipend: Many travel nursing contracts include a travel stipend to cover the cost of transportation to and from your assignment. This amount varies depending on the distance of the assignment and the travel nursing agencies you choose.

2. Housing Stipend: A crucial aspect of a travel nursing pay package is the housing stipend. This stipend is intended to cover the cost of temporary housing during your assignment. It's essential to verify whether this housing stipend is sufficient to cover the entire cost of accommodation in your destination city.

3. Bonuses and Incentives: Travel nursing companies may also offer bonuses and incentives, such as completion bonuses or extension bonuses, to travel nurses who fulfill their contract obligations or extend their contracts beyond the initial term. These bonuses can enhance the travel nursing pay package and should be taken into consideration when evaluating offers.

4. Liability Insurance: Some travel nursing agencies provide liability insurance coverage for their nurses. This coverage is essential for travel nurses, as liability claims can be financially devastating. Ensure to inquire whether the travel nursing company includes this insurance in their pay package or if you need to secure it independently.

Travel Nurse Housing: Options and Costs

For many travel nurses, housing is one of the most critical considerations when accepting a traveling nursing position. Typically, travel nursing agencies offer two primary housing options - agency-provided housing or a housing stipend. Travel nurses can elect to use the stipend to arrange their accommodation, or they can choose to stay in housing organized and funded by the travel nursing company.

When evaluating housing options, travel nurses should account for factors such as location, convenience, safety, and cost-efficiency. If you decide to arrange your housing, research average rental rates in the assignment's city to ensure the housing stipend is sufficient to cover accommodation costs. Keep in mind that agency-provided housing is often move-in ready and may include furniture, utilities, and other conveniences that make transitions easier.

How to Negotiate Your Travel Nursing Contract

When negotiating your travel nursing pay package, it's essential to approach the process with a thorough understanding of the various components and industry norms. The following steps can help you negotiate effectively with travel nursing companies:

1. Research and compare: Gather information on travel nursing pay packages from multiple travel nursing agencies and identify the industry's standard rates for your specialty and experience. This knowledge will empower you when negotiating your desired pay package.

2. Determine your priorities: Before entering negotiations, identify which components of the pay package are most important to you, such as the housing stipend or travel reimbursement. This clarity will allow you to focus on those areas during the negotiation process.

3. Be assertive and confident: Don't be afraid to express your desires and concerns regarding the contract. Remember that travel nursing agencies' primary goal is to ensure your satisfaction so that you remain with the company. Your assertiveness may secure you a better pay package or assignment conditions.

4. Consult a mentor or colleague: If you have connections in the travel nursing industry, seek their advice on negotiating contracts and navigating conversations with recruiters. Gaining insight from experienced travel nurses can be invaluable during the negotiation process.

Sample Breakdown of a Travel Nursing Pay Package

Here's an example of a travel nursing pay package, with amounts allocated for various pay components:

• Base Pay (Hourly Wages): $25 per hour
• Overtime Pay: $37.50 per hour (1.5 times the base pay)
• Housing Stipend: $2000 per month
• Travel Stipend: $500 upon completion of the contract
• Completion Bonus: $1000 upon contract completion
• Extension Bonus: $500 for extending the contract past the initial date
• Liability Insurance: Included in the pay package

By understanding the various components and industry norms, a travel nurse can successfully evaluate and negotiate their travel nursing contract. Comparing offers, researching housing options, and effectively communicating your needs to travel nursing companies will ensure that you secure favorable travel nursing pay and assignment conditions.

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Travel nurse salaries are stabilizing in 2023 at about $3K per week

During the pandemic, hospitals, private practices, clinics, and other health care providers were hard-pressed for the resources they needed—and not just personal protective equipment (PPE) or masks. The demand for nurses and other health care professionals skyrocketed during the pandemic, which led to a greater need for travel nurses. And that unprecedented demand also helped drive extremely high salaries for travel nurses .

By December 2020, travel nursing salaries had reached nearly $3,500 per week, but the peak really came about a year later when that rate jumped to nearly $4,000 per week, according to data from health care recruitment platform Vivian Health . Between January 2020 and December 2021, average travel nurse pay had increased by more than 99%. As of December 2022, travel nursing salaries started to plateau at around $3,100 per week. 

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These rates reflect salaries for registered nurses (RNs), not nurse practitioners. Nurse practitioners typically must earn a master’s degree in nursing or have continuing education and be certified to practice. “Nurse practitioners generally earn higher wages due to their advanced schooling,” confirms Katelyn Harris, director of client development at Vivian Health. For reference, the median annual salary for nurse practitioners in 2021 was nearly $121,000, according to the U.S. Bureau of Labor Statistics.

While weekly travel nursing rates may fall slightly during the first couple of months of 2023, these new salary trends will be the “new floor” of travel pay, says Tim Needham, senior vice president of product at Vivian Health.

“Despite wages stabilizing, we expect that temporary nursing contracts will continue to account for a significant portion of the health care labor workforce,” Harris adds. “While health systems eye labor as one of their costliest line items, clinicians will continue to seek out the higher wages, greater flexibility, and reduced bureaucracy associated with temporary contracts.”

The 4 highest-paying travel nursing specialties—and 2023 trends

During the past two years, the highest-paying travel nursing jobs have been with intensive care units (ICU), the emergency department (ED), medical surgery, and home health. 

Pay for these specialties dipped during summer 2021 when COVID-19 vaccines first became available, but then surged again in late 2021 and early 2022 during the spread of the Omicron variant. However, maintaining hospital staff will become increasingly difficult due to their financial solvency and budgeting, Harris explains. Last year, more than half of hospitals were projected to have negative margins through 2022, according to a survey by the American Hospital Association .

“With the COVID Emergency Order coming to a close in May, this means that hospitals will not have the additional federal funds to support the steep labor costs that they incurred from short term contractors during 2020 and 2021,” Harris explains. “Despite wages stabilizing, we expect that temporary nursing contracts will continue to account for a significant portion of the health care labor workforce.”

Is travel nursing still worth it?

The average annual base salary for registered nurses in 2021 was $77,600, according to the BLS. Assuming a rate of $3,100 per week for 52 weeks in a year, theoretically travel RNs could make more than $161,000. However, because travel nurses participate in contract work, their salary does not come from a stable source. Travel nurses can be out of work for weeks or months at a time, depending on demand and contract availability.

“Pursuing a career in travel nursing is not as lucrative as it was in the height of the pandemic,” Harris tells Fortune. “While travel nurses do have higher gross wages than permanent staff nurses, their weekly pay includes stipends for housing, meals, and other contract-related expenses incurred on assignment.”

Travel RNs also have to pay for housing in their home location (where they’re based), as well as where they’re completing their short-term contract, she explains, which is why it’s critical to evaluate the cost of living for a prospective contract location.

“Travel nurses may receive higher wages than their full-time counterparts because health systems are paying a premium to fill critical staffing needs,” Harris says. “However, travel nursing is generally only more lucrative than full-time staff roles when local cost of living is low relative to pay.”

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Travel Nurse Pay Breakdown | Expenses & Tax 2022

I was originally drawn to the travel nursing field for the opportunity to travel the country while getting paid at the same time. I knew travel nurses were paid fairly well and had been bombarded with various emails advertising travel nursing pay scales as high as $40 an hour.

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I am typically not the type of person to do something just for the money. I tend to be more interested in the experience, but I also realize that I have bills to pay too. I didn’t really pay attention to the breakdown of my travel nursing pay, all I cared about was whether or not I had enough money to live and to get from point A to point B.

Fortunately, I had a wonderful travel experience but wish I took the time to really understand travel nursing pay scales, expenses and how to deal with taxes. Many of your recruiters don’t take the time to break these topics down for you so it is ultimately your responsibility to seek out the information and educate yourself.

Non-Taxable Travel Nurse Pay

The most alluring advertisement travel nursing agencies use to get you in the door is the infamous “tax advantage plan”.  This can also be referred to as per-diem, stipends, reimbursements or a combination of all three. What this basically means is that if you are traveling away from your home for work, there are certain expenses that are tax deductible and certain reimbursements that are non-taxable.

The most common types of stipends or reimbursements that you will hear about in the travel nursing world are referred to as meals and incidentals (incidentals include taxi/bus fares, parking, and tips), lodging or housing stipends, and travel reimbursements which cover your expenses to and from each assignment; other non-taxable items can include retirement plans, license reimbursements and health insurance. When travel nursing companies advertise pay rates, they will often tell you a blended rate. A blended rate combines an hourly taxable wage such as $20 an hour with your non-taxable reimbursements and stipends to give you a higher hourly rate. Here is an example of a typical pay package:

• $20 per hour – taxable base rate that is reported to the IRS
• $250 per week for meals and incidentals – non-taxable
• $2,000 a month for lodging – non-taxable
• $500 for travel reimbursement – non-taxable

Your blended rate is calculated by breaking down your non-taxable stipends into an hourly rate and adding it to your taxable base rate.   For instance, if you worked 36 hours per week on a 13 week assignment, your hourly rate would look something like this based on the above scenario:

Flex Pay and Rigid Pay

There are two different types of pay packages: flex pay and rigid pay.

Flex pay packages allow you to mix and match, add or subtract various non-taxable stipends such as healthcare, retirement, and license reimbursements to your pay package, while rigid pay packages are non-negotiable.  The benefit of flex pay is that you can decrease your hourly taxable base rate and increase your non-taxable earnings by adding more benefits such as 401K. Many travel agencies have to be careful not to enter the illegal realm of wage re-characterization when dealing with flex pay packages. To learn more about wage re-characterization visit traveltax.com .

Travel Nurse Overtime

There are some travel contracts offering overtime; for example, some agencies will ask you if you want to work 4 days a week instead of 3 days a week. Overtime by law has to be paid time and a half of your taxable base rate. So, if you make $20 and hour, then your overtime pay will be $30 an hour. In the world of nursing, $30 an hour isn’t really that much extra money for an extra shift; however, over the long run it does add up. If this is something you are considering doing than make sure you negotiate a higher taxable rate for lower non-taxable stipends if possible so that you really get more bang for your buck. I have never heard of a part-time travel contract so if you are looking to work part-time than it would be better to consider an agency job in your desired destination.

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Disadvantages of Non-taxable Stipend Pay

We also have to take into consideration retirement. I know many of you aren’t necessarily thinking about your social security check right now, but it is important to take into consideration that the social security payments are based on 35 of your highest income earning years. Non-taxable money is not considered income.

Last but not least, if you get injured on the job, you only receive 2/3 of your hourly taxable base rate. These are some scenarios to take into consideration when thinking about a travel nursing pay package.

Travel Nursing Pay: Things to Consider

With all things considered, a travel nurses pay rate, is very comparable to a staff nurse’s pay rate. However, there are some out of pocket expenses travel nurses have to be aware of that regular staff nurses don’t have to consider;

• Most travel nursing agencies do not offer paid time off. If you are thinking of taking a vacation or are taking time off in between assignments then you will not be paid
• Most travel nurses have to pay for their own certifications such as BLS and ACLS
• Sometimes travel nursing agencies will not pay for your annual physical and TB tests
• If you want to take an assignment that is across the country, your travel reimbursement might not cover the entire cost

Just like any of other profession, it is important to budget and prepare for the unknown. Take care of yourself make sure you are well organized.

What is an “IRS Tax Home”?

In order to qualify for these non-taxable stipends or reimbursements, one must maintain what the IRS calls a tax home. A tax home is your place of residence that you maintain and pay for while you are out on your travel assignment. Ideally, the IRS would like a travel nurse to take an assignment somewhere and then return to their tax home where they maintain a PRN or full-time nursing job.

Most travel nursing agencies will have you sign a form stating that you do have a tax home. If you do not have a residence that you are planning on maintaining when you are traveling, you will be referred to as an itinerant worker. As an itinerant worker, you will be required to pay taxes on all income earned including stipends and reimbursements. When applying with different travel agencies, make sure they are aware of your itinerant status. You can get more information about tax homes here .

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Tips to Make Traveling a Snap

All of this talk about taxes and the IRS can be a little scary. Here are a few easy tips to follow to make your traveling experience a little less complicated:

• Maintain a mileage log. You will have to write down you odometer reading the beginning of the year on January 1 and again at the end of the year on Dec 31. If you start traveling in the middle of the year you can look back at your maintenance records for previous odometer readings. You must also document your mileage to and from your place of employment.  Click here to print a mileage log.
• Return to your tax home in between assignments if possible or at a minimum of once per year. Document when you travel back to your tax home. Here is a travel log for your trips back home .
• Maintain a PRN or agency job in the same vicinity as your tax home. The IRS would like to know that you do business on a regular basis where you live.
• There is no need to keep track of meal or grocery receipts. The IRS gives you a set stipend for meals. If you exceed the stipend you are considered to be living above your means and will not be reimbursed.
• Keep a copy of all of your travel contracts. Make sure they have a beginning and ending date on them. This proves that you were really working on a temporary basis.
• Don’t work in a city more than 12 months in a 24 month period. The IRS will think you abandoned your tax home.
• There are tax people who specialize specifically in travel nursing. I recommend getting in contact with these people prior to starting your assignment. If you want to tackle this on your own then I recommend getting organized. Here is an organizer that helps you keep track of all your tax information;

Don’t let the IRS or financial aspects of travel nursing scare you.  Travel nursing should be an enjoyable experience not an accounting nightmare.

As with any tax issues, you should seek advice from a licensed tax professional before filing. This article only offers suggestions and isn’t meant to be tax advice. We leave that to the pros.

Professionals can help you through this experience in combination with educating yourself about nursing pay packages. It sounds complicated in the beginning, but the more you learn the lingo, the more prepared you will be to negotiate your next travel contract.

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The 8 Highest Paying Travel Nurse Jobs in 2024

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Higher earning potential is why many RNs chose to transition to travel nursing in the last few years. Other reasons you might consider making this transition yourself may include:  

• A change of work environment and an opportunity to learn new hospital cultures. 
• The ability to travel to and explore new places. 
• Job security, with options nationwide. 
• Broadened experience and skills. 

No matter your reason, a travel nurse salary can be extremely lucrative. However, it’s important to keep in mind that not  all  assignments and locations pay more than perm positions.   

Factors like the city/state of your assignment, your specialty, and even the shift you’re willing to work have a significant influence on your paycheck as a travel nurse. Here are a few key factors healthcare travelers should consider when seeking out the highest-paying travel nurse jobs.  

Travel Nurse Specialties  

As with perm nursing jobs,  your specialty  plays a big role in how much you get paid. Your travel nursing goals should always be taken into account, however, if you’re set on increasing your travel nurse salary, consider one of the following higher-paying specialties.   

• Oncology  Nurse  – Hospitals are consistently seeking travelers with hands-on experience caring for patients (both medical and surgical) with different varieties of cancer.   
• NICU  III Nurse  – NICU III travel nurses are always in high demand, as hospitals need people who can care for critically ill babies  and  support the needs of parents and family during this emotional time.   
• Pediatric Intensive Care Unit  (PICU) Nurse  – Qualifications for and experience working with young patients in the PICU of a children’s hospital will keep you in high demand, filling a need that hospitals consistently have.  
• Cardiovascular Intensive Care Unit  (CVICU) Nurse  – If you have specific experience in cardiac and neuro ICUs, you’ll most definitely have an edge over other critical care nurses when it comes to getting placed on assignment.  
• Cardiovascular Operating Room  (CVOR) Nurse  – As a part of the cardiovascular surgical team, CVOR nurses tend to make more per hour because surgeries bring in a large portion of hospital revenue.  
• C ardiac Catheterization Lab  Nurse  – Hospitals struggle to find nurses with experience in procedural areas like the cath lab—making these jobs in higher demand, with more lucrative hourly rates.  
• Certified Registered Nurse Anesthetist  (CRNA)  – CRNAs require more education than many other nurse specialties due to the added risk and accountability associated with anesthetics. Due to this requirement, CRNAs are often in short supply.

Highest Paying Travel Nurse Locations  

California – The most populous and geographically diverse state in the U.S., California is known for its vibrant culture and varied landscapes and climates.  

• Average Weekly Pay Range: $3,200 – $3,550  
• Average Monthly Pay Range: $12,800 – $14,200  
• Average Annual Pay Range: $166,400 – $184,600  

Alaska – The largest state in the U.S. is characterized by its extreme and diverse climate, with cold winters, long summer days, and vast wilderness expanses for outdoor lovers!  

• Average Weekly Pay Range: $2,600 – $2,875  
• Average Monthly Pay Range: $10,400 – $11,500  
• Average Annual Pay Range: $135,200 – $149,500    

Connecticut – This New England landmark is known for its subtropical summers, cold winters, charming coastal towns, and historical significance.   

• Average Weekly Pay Range: $2,375 – $2,750  
• Average Monthly Pay Range: $9,500 – $11,000  
• Average Annual Pay Range: $123,500 – $143,000  

New York – A bustling and iconic state, New York state is known for its cultural richness and diverse neighborhoods.   

• Average Weekly Pay Range: $2,100 – $2,745  
• Average Monthly Pay Range: $8,400 – $10,980  
• Average Annual Pay Range: $109,200 – $142,740  

Massachusetts – Massachusetts is a historic and intellectually vibrant state in the New England region, distinguished by prestigious universities and known for its gorgeous fall foliage as the weather cools for winter.   

• Average Weekly Pay Range: $2,400 – $2,740  
• Average Monthly Pay Range: $9,600 – $10,960  
• Average Annual Pay Range: $124,800 – $142,480  

Hawaii – Hawaii is a tropical paradise boasting a consistently mild climate with warm temperatures year-round.   

• Average Weekly Pay Range: $2,300 – $2,540  
• Average Monthly Pay Range: $9,200 – $10,160  
• Average Annual Pay Range: $119,600 – $132,080  

Washington – This rainy state comes along with vibrant urban areas, stunning natural beauty, and a diverse culture.   

• Average Weekly Pay Range: $2,290 – $2,500  
• Average Monthly Pay Range: $9,160 – $10,000  
• Average Annual Pay Range: $119,080 – $130,000  

New Jersey – Residents of New Jersey will boast about its suburban communities and bustling urban areas with a diverse landscape and climate.   

• Average Weekly Pay Range: $2,250 – $2,500  
• Average Monthly Pay Range: $9,000 – $10,000   
• Average Annual Pay Range: $117,000 – $130,000  

In addition to location, your hours may vary depending on your specific assignment and specialty, significantly influencing your wage*. For example, cities with a higher cost of living typically pay higher wages — but keep in mind that you do have to consider your other needs associated with that cost of living.   

It’s also common to see a trade-off between desirable locations and pay rates. For example, Hawaii is a highly desirable state for many travel nurses, so you may find pay rates there are inversely a bit lower. On the other hand, a less desirable location, like North Dakota in January, may inversely offer a higher pay rate.      

The big takeaway about the location of your travel nurse job is that your flexibility is key, and determining high-paying states for travel nurses is dependent on several factors beyond the base pay package . The more flexible you are regarding location, the more likely you are to go where current demand takes you—and that often means a higher paycheck.   

If you can be uber-flexible on location, it’s wise to maintain multiple state licenses and know your way around the  nurse licensure compact . That way, you can more swiftly apply for and accept high-demand jobs wherever they may be.  

* Estimated pay and benefits packages based on current job data. Bill rates can change frequently and without notice. Exact pay and benefits package may vary based on several factors, including, but not limited to, guaranteed hours, travel distance, demand, experience, eligibility, etc.

Highest Paying Travel Nurse Assignments  

Regardless of location and specialty, unexpected circumstances can also present financial opportunities for travel nurses. When you travel with  Medical Solutions , our expert team is always here to help you quickly acquire the licenses and certifications needed for rapid response, crisis, or  strike assignments. Plus, we offer  licensure and specialty certification reimbursement !    

• Crisis and Rapid Response Assignments   Hospitals and medical facilities are willing to pay travel nurses top dollar to fill roles when there’s an urgent need. If you have the flexibility to arrive quickly and stay as long as the need keeps you there — and if you’re open to traveling anywhere the need may take you — you can find yourself with assignments that are rewarding in pay  and  experience.     Crisis travel nurse jobs look fantastic on resumes, making these travelers even more appealing to employers, and increasing the likelihood of matching with high-demand roles in the future.   
• Strike Assignments   Strikes most often occur when a hospital and union cannot come to an agreement on a labor contract that’s up for renewal or when workers face unsafe conditions. Despite the reason for a strike, continuity of care is crucial for patients in affected facilities and travel nurses can make a good sum of money in  strike assignments  because of the urgent need.

Travel Nurse Qualifications  

Any travel nurse with the proper certifications and experience deserves a high-paying travel nursing job if that’s what they want. The basic requirements to become a travel nurse include:  

• Earning your ADN or BSN degree.
• Passing the NCLEX.
• 1-2 years of recent, in-hospital experience as a nurse. 
• Earning your appropriate licensure and certifications per location and chosen specialty.

Meeting these requirements will put you well on your way to accessing the highest paying travel nursing jobs.

To check out if Medical Solutions currently has any high-paying assignments for travel nurses or allied health professionals, contact your recruiter or call our 24-hour customer care line at 1.866.633.3548 . We’re always hard at work placing talented travel nurses and negotiating to get them the highest travel nurse pay possible.   

Original post created by Sarah Wengert Nov. 5, 2020.

• What is a Travel Nurse Salary
• How Much is a Travel Nurse Salary
• What is the Average Salary for a Travel Nurse

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The Ultimate Travel Nurse Salary Guide: 4 Million+ Jobs Analyzed (February 2024)

We aggregated more than 4 million travel nursing salaries from the past 4+ years. Now we're revealing pay rates and job trends nationwide in our interactive pay explorer!

Average Pay (per week) $2,169.13 Based on 2,386,114 jobs analyzed across all travel nurse specialties , nationwide

Travel nursing by month (pay and count), best travel nursing agencies 🚀.

• Highest Paying
• Access Healthcare Staffing 20,000+ jobs $155.90 above average
• Host Healthcare 50,000+ jobs $106.53 above average
• Aureus Medical Group 50,000+ jobs $75.58 above average
• Epic Travel Staffing (formerly Emerald Health) 50,000+ jobs $64.39 above average
• MedPro Healthcare Staffing 50,000+ jobs -$12.71 below average
• TotalMed 50,000+ jobs -$12.76 below average
• Healthcare Staffing - IDR, Inc 20,000+ jobs -$62.15 below average
• Job Availability
• Aequor Healthcare 50,000+ jobs -$88.38 below average

Top Locations Nationwide

• New York 50,000+ jobs $236.59 above average
• California 50,000+ jobs $226.24 above average
• Massachusetts 50,000+ jobs $201.51 above average
• Illinois 50,000+ jobs $50.19 above average
• Ohio 50,000+ jobs $47.14 above average
• Washington 50,000+ jobs $39.62 above average
• Virginia 50,000+ jobs -$40.38 below average
• Texas 50,000+ jobs -$159.23 below average
• Pay is standarized to 36 hour per week.
• For agency and metropolitan area ratings, results are compared against average for specialty and state. Nationwide average pay used if no state is selected. Top paying agencies and metro areas with less than the median job count for the category are excluded.
• View all footnotes

Want to see how your travel nurse salary stacks up in this unpredictable travel nurse job market?

How about making sure you're getting the higher compensation you should be in our challenging career?

You're in the right place to get all your questions answered about travel nurse pay.

Welcome to our  interactive pay explorer - with auto-updates every month!

Since September 2019 , we've been continuously tracking travel nurse pay packages.

View our full history of pay insights using the toggle in the right-hand corner of any of our graphs in this article.

More than four million jobs analyzed and four years later, we're proud to bring you objective overviews on the travel RN job market you can't find anywhere else.

Get the full scoop in this ultimate guide:

How Much Do Travel Nurses Make?

• What Is An Average Travel Nurse Salary?

Why Do Travel Nurses Make So Much?

Is travel nursing worth it, get a travel nurse pay breakdown.

• The Highest Paying States for Travel Nurses
• The Highest Paying Travel Nurse Specialties
• How to Find the Highest Paying Travel Nursing Jobs

How To Find The Best Paying Travel Nurse Agencies

Do travel nurses earn more money than full-time registered nurses? Overall, definitely!

Keep in mind: Travel nurses make higher salaries on average.

Your potential average annual income will depend on demand for your nursing specialty and where you work.

The averages you see below are measured across all specialties and locations nationwide for a general comparison.

Average Travel Nurse Salary vs Staff Nurse Salary

The average hourly pay for full-time staff RN's in the U.S. is $39.05, or $1,561.92 per week, according to the most recent 2022 US Bureau of Labor Statistics registered nurse occupational outlook .

The average hourly rate for travel nurses is $64.58, or $2,324.92 per week, according to our Ultimate Travel Nurse Salary Guide in September 2023.

The average hourly wage for a travel RN is $25.53 higher than staff nurse pay, and the average salary per week is $736 more .

Extrapolating to compare the average annual salary of a staff nurse vs travel rn pay, the difference is significant, with travel nurses' average annual salary reaching upwards to $30,000 more.

We calculated the average annual salary for travel nurses for only 48 weeks a year. Travel nurses need time off to organize and move to new assignments.

In short, high demand = higher compensation.

We're all aware many healthcare facilities nationwide are experiencing "nursing shortages". Registered nurses are retiring and/or leaving the bedside altogether, a trend sped up by the pandemic.

It's estimated that by 2025 the US will have a staffing gap of 200,000-450,000 nurses . In other words, 10-20% of direct-patient care nursing jobs will be unfilled.

With nursing skills like ours in high demand, we deserve higher pay. Not to mention the inherent stress we put up with in our challenging career.

Travel nurses earn more competitive wages by having the adaptable skills necessary to fill critical staffing needs and provide meaningful patient care in a pinch with minimal to no orientation.

These critical needs are often on less desirable shifts, so preparing yourself to work night shift would open up more travel nurse job possibilities.

Healthcare facilities entice nurses with more competitive wages due to the extra hardships we take on with the lack of job stability while searching for new jobs every 13 weeks. There's also the lack of a consistent job benefits package and the inconveniences of travel costs and time.

If you're looking to get more satisfaction in your nursing career, it could definitely be worth it.

It turns out it really is better to be a travel nurse than a staff nurse. A sweeping study analyzing feedback straight from our fellow nurses confirms it.

Nurses working in travel nurse jobs are more satisfied than permanent staff nurses in key areas:

• better job satisfaction
• less work-related stress
• feeling safer on the job
• more employer support
• higher compensation

Working in a travel nurse job isn't easy, but it could elevate your bedside nursing practice and give you more control in your nursing career.

You'll have to decide if the pros outweigh the cons for yourself. The standard contract is only 13 weeks, so I recommend every nurse give it a try.

Pro tip: You should definitely take the time to research what to expect before you commit to a travel nurse job.

Understanding how travel nurses' higher wages breakdown will help you compare pay offers and spot the jobs that are worth your relocation.

Travel nurses are typically hired as contracted temporary employees of travel nursing agencies, getting paid on a weekly basis to work in a variety of healthcare facilities.

The most common travel nurse contracts offered are for hospital inpatient units in a healthcare facility. These contracts usually commit you to work:

• 12 hours/shift
• 3 shifts/week
• 36 hours/week
• 13 weeks total
• 468 work hours total per contract

Our  interactive pay explorer  above standardizes all travel nurse wage data around the average 36-hour weekly pay packages.

See A Pay Package Example

Here's an average travel nurse pay package offer for a Medical-Surgical Nurse working 36 hours/week:

• $400 M&IE (Meals & Incidental Expenses) - per Week
• $3,200 Housing Stipend - per Month
• $750 Travel Reimbursement - One Time payment
• $30 Base Rate - Hourly pay rate

It's confusing!  ¯\_(ツ)_/¯

Let's break this offer down to view your pay per week and per hour. Convert all parts of your travel nurse wages to a standardized hourly rate, then combine to calculate.

Your "M&IE" (meals & incidental expenses) payment is meant to cover your living expenses and daily (diem) meal costs on assignment.

Your housing stipend covers your temporary housing in your assignment location. Remember you should be maintaining housing in your permanent tax home, as well.

Many travel nursing offer travel reimbursements to help offset the higher cost of life on the road.

Be aware you may have more living expenses coming out of your travel nursing paycheck, based on what employment benefits package you accept:

• Taxes based on your permanent tax home rates
• Agency health insurance - health benefits can start at $20/week
• Agency 401k retirement plans

Ask your agency what other benefits they provide and how those affect your pay package.

Taxable vs Tax Free Pay

Following on from our pay example above, your travel nurse pay is made up of a taxable hourly wage and tax free income.

Notice that more than half of this pay package is tax free pay. Ka-ching!

Your tax free stipends, or "Per Diem" pay, are based on daily maximum rates set by the government.  Check  gsa.gov's Per Diem rates  for your next contract location.

Travel nurses are eligible for Per Diem tax free stipends when working away from your permanent tax home. When receiving tax free pay you MUST duplicate living/housing expenses, required per IRS rules.

This means paying fair market prices for both your accommodation at your travel nursing assignment, AND maintaining your own housing at your permanent tax home.

Many agencies also offer travel reimbursements to help you get money back you spent on travel expenses moving between assignments.

Pro tip: You can still "travel nurse" while living in your own housing at your permanent tax home. The difference is your income will be fully taxed, and you won't be eligible for the the tax free travel nursing pay.

Highest Paying States for Travel Nurses

Which states are really worth the higher cost license fees? Our map shows the highest paying states for travel nurses over the past 12 months.

To view the highest paying states averages since  September 2019 , use the toggle in the right-hand corner of any of our graphs.

These averages would include crisis rate market fluctuations.

Highest paying states for travel nurses. Standardized to 36/hour week contracts to compare data accurately.

For more specific travel nurse salary by state, see our table below with detailed pay trends and job availability.

We've included the  standard deviation . This shows you how 68% of pay offers spread above and below the average travel RN rates.  Picture a bell curve.

For example, 68% of California travel nurse salaries are $2,537.01 +/- $681.08 = pay range of $1,855.93 - $3,218.09.

The 'job count' column gives you a snapshot of each state's job availability.

Curious what the market looked like pre-COVID19?

Below is a compilation of the states that offered the higher pay from  September 2019 - March 2020 . Compare this list to our above map and table to see what difference crisis rates made.

Top 5 Highest Paying States for Travel Nurses (Pre - Covid19)

• California Consistently has the best pay and the most jobs by a long shot. Both inside and outside of the pandemic.
• New Jersey Solid opportunities for both pay and job availability.
• Washington D.C. Great income, but fewer job openings.
• Alaska Decent pay and lots of jobs, despite reputation for low rates. Current rates lower than pre-covid19.
• Connecticut Regularly pays above average with frequent job openings.

Highest Travel Nurse Salaries by Metropolitan Area

Not sure which areas of the country pay great for travel nurses?

We've got a summary here to get you started. Get even more location-specific data on high paying opportunities using our interactive pay explorer .

Top 5 Highest Travel Nurse Salaries by Metropolitan Area

Go after high pay AND lots of job openings in these locations:

• California Holds 9 of our top 10 spots for highest-paying metro areas
• East Coast New York City-Newark, Boston, Philadelphia, Washington DC
• Pacific Northwest Seattle-Tacoma, Portland
• Midwest St Louis, Chicago
• Arizona Phoenix, Tuscon

Pro Tip: Investing in a California license is worth your time and money if you're looking for LOTS of high-paying job options.

Highest Paying Travel Nurse Specialties

Feast your eyes on the largest travel nursing specialty comparison available including more than  130 specialties . Our interactive table shows nationwide pay averages including  standard deviation  for you to get an accurate overview of the highest paying specialties.

We removed specialties with very low job counts and supervisory roles. This keeps our data relevant to the travel nursing specialties with high pay AND regular job availability.

For a different view, we've got an interactive bubble chart displaying the highest paying travel nurse specialties by their job availability. Hover over the bubbles to identify the specialties.

Not all nursing specialties have a regular high need for travel nurses. For example, RN's in Electrophysiology Lab (EP Lab) regularly have higher pay offerings, but don't have the plentiful job options that ICU or L&D nurses have.

Pro tip: If you aspire to work consistently as a travel nurse, gain experience in a specialty with higher job availability.

I repeat: Higher demand = Higher compensation.

How To Find the Highest Paying Travel Nursing Jobs

How can you cut through the lowball offers to find and land the best paying travel nurse salaries? We started StellarNurse to help you.

After analyzing the market for 4+ years, here's our best advice:

• Use our interactive pay explorer to check pay trends, job availability and best agencies for your specialty
• Check out the newest & highest-paying travel nursing jobs to get an objective overview on your best current opportunities
• Message agencies anonymously on our StellarNurse jobs marketplace, focus on agencies that pay best and have lots of jobs for your specialty
• Keep current state licenses for the locations that have your specialty's best pay and highest job availability
• Breakdown pay packages to weekly or hourly income to accurately compare job offers
• Prioritize high pay - above personal convenience, best locations, nicest recruiter or agency loyalty
• Move fast for Crisis or Rapid Response rate offers

In a nutshell, stay flexible. The best offers are competitive and often need help fast. Be ready to adjust plans quickly, coordinate with a new agency or arrange travel to an unexpected location.

Bonus tip: If you like your agency, tell fellow travel nurses. Make an easy $500-$1,000. Every agency offers referral bonuses if a nurse you referred works with them too.

With more than 500 agencies posting travel nursing jobs daily it’s overwhelming to find which ones might be the best travel nurse companies for you.

After analyzing 4 million jobs over the past 4 years, we’ve organized our data to help you make informed decisions on which agencies to prioritize contacting first.

Find the best paying travel nurse agencies for your specialty and preferred locations. Use the filters to see which agencies have the most jobs available.

Refer back to our interactive pay explorer for in-depth pay trends on the best travel nursing agencies for your specialty and locations.

StellarNurse answers three important questions you should consider in your travel nurse agency choices.

Which travel nurse agencies have:

• The highest paying jobs for your specialty?
• The most jobs available for your locations?
• The benefits you’re looking for?

More questions you should consider when choosing a travel nurse agency are:

• What sets this agency apart?
• What agency resources are available if you have issues?
• How responsive is this agency?

Furthermore, find unbiased reviews to guide your choices.

Since I prefer to read reviews directly from my fellow nurses, here's where I look:

Bonus tip: You can message recruiters anonymously on the StellarNurse jobs marketplace totally risk-free. Get all your questions answered before giving up your contact info.

Our Data Sources

All our data is publicly available on the named travel nursing agency's website or Google jobs listings.

Methodology

We'll be publishing more technical details on our GitHub in the near future.

Dropping the Mic 🖐🎤

We can't wait to hear your success stories - Tell us how our travel nurse salary interactive pay explorer has helped you.

Did we miss any questions you have about finding how much travel nurses can make?

Connect with us on Instagram and Facebook so we can add your requests to future updates.

Share with your registered nurse friends so they can see their earning potential too!

Your days of being underpaid are over.

Bring evidence-based practice to your job search. Land the highest paying travel nursing jobs based on objective market overviews.

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Travel Nurse Salaries In 2024: What To Expect

The role of travel nurses has become increasingly pivotal. In the role they offer flexibility, adventure, and the opportunity to make a tangible difference in various healthcare settings, travel nursing has captured the attention of many aspiring and seasoned nurses alike.

As we navigate through 2024, understanding the financial aspects of this dynamic profession is paramount for both newcomers and seasoned professionals. This article delves into the projected salary landscape for travel nurses in the USA this year, shedding light on key factors that shape compensation and offering insights to help you navigate this rewarding career path.

Table of Contents

What is a travel nurse? 

A travel nurse is a registered nurse (RN) who takes on temporary assignments, typically ranging from a few weeks to several months, in various healthcare facilities across different locations.

Unlike permanent staff nurses who remain in one facility or location, travel nurses have the flexibility to work in diverse settings, including hospitals, clinics, rehabilitation centers, and other healthcare environments.

Key characteristics of travel nurses

• Temporary assignments: Travel nurses are contracted for specific periods, allowing healthcare facilities to fill staffing gaps due to seasonal fluctuations, staff shortages, or increased patient demand.
• Flexibility: One of the primary attractions of travel nursing is the flexibility it offers. Nurses can choose assignments based on location, facility type, duration, and specialty, allowing them to explore different parts of the country while gaining diverse clinical experiences.
• Competitive compensation: Due to the temporary nature of their assignments and the often urgent need for their specialized skills, travel nurses typically receive competitive compensation packages. These packages may include higher hourly rates, signing bonuses, housing stipends, and travel allowances.
• Specialized skills: Travel nurses often possess specialized skills or certifications in high-demand areas such as critical care, emergency room, labor and delivery, and other specialties. Their expertise allows them to seamlessly integrate into various healthcare settings, providing quality patient care.

Benefits of becoming a travel nurse

• Adventure and exploration: Travel nursing offers the opportunity to explore new cities, cultures, and healthcare environments, making it an ideal choice for those with a sense of adventure.
• Professional growth: By working in diverse settings and encountering a wide range of clinical scenarios, travel nurses can enhance their skills, expand their knowledge base, and build a robust professional network.
• Financial incentives: Beyond competitive salaries, travel nurses often receive additional financial incentives such as bonuses, housing allowances, and reimbursement for licensing and continuing education.

A brief look back of travel nurse job

Travel nursing, rooted in addressing healthcare staffing shortages, has undergone significant transformation over the years. Understanding its evolution provides context for the current landscape in 2024.

Early beginnings

The concept emerged from periodic nursing shortages, leading to the need for a flexible, temporary nursing workforce to meet fluctuating demands in healthcare settings.

Rise in demand

Several factors fueled the demand for travel nurses:

• Healthcare dynamics: Mergers, expansions, and shifts in patient demographics created fluctuating staffing needs, emphasizing the role of travel nurses.
• Specialized expertise: Advanced healthcare technologies and specialized services necessitated nurses with specific skills, boosting opportunities for travel nurses with specialized certifications.
• Geographical disparities: Nursing shortages in rural and underserved areas highlighted the importance of travel nurses in bridging healthcare gaps and ensuring equitable access to care.

Professional recognition

Recognition of travel nursing’s value led to streamlined licensing processes, credentialing initiatives, and investment in training programs, facilitating seamless integration into various healthcare settings.

Future outlook

Today, travel nursing is a dynamic component of healthcare, shaped by technological advancements and diverse opportunities across specialties and locations. The modern landscape reflects a harmonious blend of addressing healthcare challenges, advancing professional opportunities, and embracing innovation, setting the stage for the resilient and transformative impact of travel nursing in 2024 and beyond.

Factors influencing travel nurse salaries in 2024

Several key factors play a pivotal role in determining salary structures and compensation packages for travel nurses across the USA. Understanding these factors provides valuable insights for both aspiring and seasoned travel nurses seeking to optimize their earning potential and career growth.

1. Geographic location

• Cost of living: Salaries often correlate with the cost of living in a particular geographic location. Metropolitan areas or regions with higher living expenses typically offer more competitive compensation packages to attract and retain travel nurses.
• Demand-supply dynamics: Nursing shortages or high demand for specialized skills in certain regions may drive up salaries as facilities compete for qualified travel nurses to fill staffing gaps.

2. Specialized skills and certifications

• High-demand specialties: Travel nurses with specialized certifications or skills in high-demand areas such as critical care, emergency room, labor and delivery, and oncology often command higher salaries due to the specialized nature of their expertise.
• Continuing education: Investing in additional certifications, training, or advanced degrees can enhance marketability and leverage for negotiating higher salaries and premium assignments.

3. Facility type and size

• Facility reputation: Working in prestigious or specialized healthcare facilities, such as trauma centers, teaching hospitals, or renowned healthcare systems, may offer higher compensation packages to travel nurses due to the facility’s reputation and patient care standards.
• Location type: Rural clinics or undeserved areas experiencing significant nursing shortages may offer competitive incentives, including higher salaries, signing bonuses, or housing stipends, to attract travel nurses and ensure access to quality care.

4. Experience and track record

• Years of experience: Seasoned travel nurses with a proven track record, positive references, and extensive experience in various healthcare settings may negotiate higher salaries, bonuses, or premium assignments based on their expertise and reliability.
• Performance metrics: Demonstrating excellence in patient care, adaptability, teamwork, and leadership skills can enhance marketability and leverage for negotiating competitive compensation packages and long-term assignments.

5. Contractual agreements and benefits

• Negotiation skills: Effective negotiation of contractual terms, including base salary, signing bonuses, completion bonuses, housing, and travel stipends, and benefits such as healthcare, retirement plans, and continuing education allowances, can significantly impact travel nurse salaries and overall compensation packages.

Multiple factors influence travel nurse salaries in 2024, including geographic location, specialized skills and certifications, facility type and size, experience and track record, and contractual agreements and benefits. By understanding these factors, leveraging opportunities in high-demand specialties and regions, and partnering with reputable agencies, travel nurses can optimize their earning potential, professional growth, and overall satisfaction in this dynamic and rewarding career path.

Travel Nurse projected salary range for 2024

Understanding the projected salary range for travel nurses in the USA for 2024 is crucial for those considering this rewarding career path. Below is a table outlining the anticipated salary range, complemented by key insights into factors influencing compensation.

Key insights:

• Location impact: Salaries can vary significantly based on geographic location, with metropolitan areas or regions with a higher cost of living often offering more competitive compensation packages.
• Specialized skills: Nurses with specialized certifications or skills in high-demand areas such as critical care, labor and delivery, or oncology may command higher salaries due to their expertise.
• Facility type: The type of healthcare facility, whether a large metropolitan hospital, rural clinic, or specialized facility, can influence salary ranges, with larger facilities often offering more competitive compensation packages.
• Bonuses and incentives: Travel nurses can leverage signing bonuses, completion bonuses, and housing and travel stipends to maximize earning potential and enhance overall compensation packages.

The projected salary range for travel nurses in the USA for 2024 varies based on specialty, location, experience, and facility type. By understanding these factors and leveraging opportunities in high-demand areas, travel nurses can navigate the competitive landscape and embark on a rewarding career path that aligns with their professional goals and financial aspirations.

Highest paying states for travel nurses in the USA

When considering a career as a travel nurse in the USA, understanding the geographical variations in compensation is crucial. Several states offer competitive salaries and benefits to attract travel nurses due to factors such as demand-supply dynamics, cost of living, and healthcare infrastructure. Below are some of the highest-paying states for travel nurses based on available data and trends up to 2024:

1. California

• Why it’s high-paying: California consistently ranks among the top-paying states for travel nurses due to its high cost of living, robust healthcare infrastructure, and nursing shortages in specialized areas.
• Specialties in demand: Critical care, labor and delivery, emergency room, and oncology are among the specialties in high demand, offering competitive compensation packages to travel nurses.

2. New York

• Why it’s high-paying: New York, particularly metropolitan areas like New York City, offers competitive salaries to travel nurses to address staffing shortages, maintain quality patient care, and accommodate the high cost of living.
• Specialties in demand:  Medical-surgical, ICU, pediatric, and psychiatric specialties are in high demand, with travel nurses commanding premium compensation packages and incentives.

3. Massachusetts

• Why it’s high-paying: Massachusetts ranks among the highest-paying states for travel nurses due to its prestigious healthcare facilities, nursing shortages, and high cost of living in metropolitan areas like Boston.
• Specialties in demand: Cardiac care, neurology, orthopedics, and emergency room specialties are particularly in demand, offering travel nurses competitive salaries and benefits.

4. Washington

• Why it’s high-paying: Washington State offers competitive compensation packages to travel nurses to address nursing shortages, accommodate the cost of living, and maintain quality healthcare services.
• Specialties in demand: Critical care, labor and delivery, oncology, and emergency room specialties are among the high-demand areas, with travel nurses receiving attractive salary offers and incentives.
• Why it’s high-paying: Texas ranks among the top-paying states for travel nurses due to its diverse healthcare landscape, rapid population growth, and nursing shortages in various specialties and regions.
• Specialties in demand:  Emergency room, ICU, labor and delivery, and medical-surgical specialties are particularly in demand, with travel nurses benefiting from competitive compensation packages and incentives.

Read more : Highest Paying States for Travel Nurses in the USA

Travel Nurse benefits and perks beyond salary

While competitive salaries play a crucial role in attracting travel nurses, the industry also offers a plethora of benefits and perks that enhance the overall compensation package. Here’s a concise overview of the additional advantages that travel nurses can leverage:

1. Housing stipends: Many travel nursing contracts include housing stipends or allowances, enabling nurses to secure comfortable accommodations near their assignments without incurring out-of-pocket expenses.

2. Travel reimbursements: Travel nurses often receive reimbursements for travel expenses, including airfare, mileage, or other transportation costs, reducing financial burdens associated with relocation or commuting between assignments.

3. Signing and completion bonuses: To attract experienced travel nurses, facilities may offer signing bonuses as incentives to secure long-term commitments. Additionally, completion bonuses reward nurses for successfully fulfilling contract terms, enhancing overall compensation.

4. Healthcare and retirement benefits: Many travel nursing agencies provide access to comprehensive healthcare benefits, including medical, dental, and vision coverage. Additionally, retirement planning options such as 401(k) contributions or pension plans offer long-term financial security.

5. Continuing education opportunities: Travel nurses can access continuing education resources, workshops, and certification programs to enhance their skills, expand their knowledge base, and advance their careers, often at discounted rates or sponsored by agencies.

6. Professional development and mentorship: Collaborating with reputable staffing agencies and healthcare facilities provides travel nurses with opportunities for mentorship, skill development, and career advancement, fostering professional growth and networking.

7. Flexibility and work-life balance: The flexibility of travel nursing allows nurses to create customized schedules, explore diverse locations, and maintain a healthy work-life balance, accommodating personal preferences, family commitments, and lifestyle choices.

Travel Nurse Vs Permanent Nurse

Travel nursing and permanent nursing positions each offer distinct advantages and considerations for healthcare professionals. Here’s a concise comparison highlighting key differences:

Potential challenges and considerations in travel nursing

While travel nursing offers a myriad of opportunities and benefits, it’s essential to recognize potential challenges and considerations that healthcare professionals may encounter in this dynamic career path. Here’s a concise overview:

1. Adjustment to new environments

• Challenge: Adapting to new healthcare settings, team dynamics, and community cultures can be challenging initially, requiring flexibility, resilience, and effective communication skills.
• Consideration: Prioritize orientation sessions, seek mentorship opportunities, and leverage support from staffing agencies to facilitate smoother transitions between assignments.

2. Licensing and credentialing:

• Challenge: Navigating state-specific licensing requirements, credential verifications, and compliance regulations can be time-consuming and complex.
• Consideration: Collaborate with reputable staffing agencies, maintain up-to-date certifications, and research state licensing requirements in advance to streamline the credentialing process and ensure compliance.

3. Work-life balance

• Challenge: Balancing professional commitments, travel logistics, and personal life can be demanding, leading to potential burnout or fatigue.
• Consideration: Establish boundaries, prioritize self-care, and leverage scheduling flexibility to create a sustainable work-life balance aligned with personal preferences and lifestyle choices.

4. Job security and stability

• Challenge: Relying on short-term contracts and market demand can create uncertainty regarding future assignments, financial stability, and long-term career planning.
• Consideration: Diversify skills, maintain a strong professional network, and collaborate with reputable agencies to access exclusive assignments, negotiate favorable contract terms, and enhance job security.

5. Continuity of care:

• Challenge: Transitioning between assignments and healthcare settings may impact the continuity of patient care, relationships with multidisciplinary teams, and clinical outcomes.
• Consideration: Prioritize effective communication, documentation, and collaboration with healthcare teams to ensure seamless transitions, maintain quality care standards, and foster patient trust and satisfaction.

6. Financial considerations:

• Challenge: Managing expenses, understanding tax implications, and navigating compensation structures, such as housing stipends and travel reimbursements, can be complex.
• Consideration: Consult financial advisors, research tax laws and regulations, and maintain organized records to optimize financial planning, maximize deductions, and ensure compliance with regulatory requirements.

Conclusion 

Travel nursing is a captivating and rewarding career path that offers healthcare professionals a unique blend of adventure, professional growth, and competitive compensation. However, navigating this dynamic area requires careful planning, adaptability, and access to the right resources and opportunities.

This is where MedCadre comes into play. As a leading recruitment platform specializing in the travel nurse sector and other healthcare industries, we are dedicated to helping professionals like you land your next career opportunity seamlessly. Our experienced recruitment team meticulously analyzes your profile, skills, and aspirations to match you with suitable job opportunities tailored to your expertise and career goals.

Don’t miss out on your next career opportunity in the travel nurse sector or other healthcare industries. Whether you’re exploring new horizons, seeking growth opportunities, or looking to leverage your skills in diverse settings, MedCadre is your trusted partner in connecting you with top employers and exclusive job opportunities related to the healthcare industry.

Drop us your CV, and then our recruitment team will analyze your profile and skills, after analyzing carefully they will connect with you for the job that will fit your skills. 

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Application deadline for pre-licensure programs: June 30th, 2024.

Travel Nurse Salary by State: How Much Do Travel Nurses Make Across the US in 2024?

Posted on: May 20, 2021; Updated on: Jan 17, 2024

Traveling nurse is a profession fit for those who like to combine work and leisure. It requires nurses to go to healthcare facilities that struggle with personnel shortage and work there for a specific amount of time. These assignments usually last from 4 to 13 weeks, during which most travel nurses perform tasks similar to those of a regular RN.

The travel nurse profession is one of the most sought out nurse professions out there, not only for the benefit of traveling the world but also because of the competitive wages it offers.

If you’re interested in becoming a travel nurse you need to either earn an Associate’s Degree in Nursing (ADN) or earn a Bachelor of Science in Nursing (BSN), which might soon become the norm for registered nurses in many states.

Become a learner in our accredited BSN Program and embark on your traveling nurse journey today!

Is a Travel Nurse Salary Really That Good?

Travel nurses typically earn far more than regular nurses and their contracts include different base pays and benefits such as paid housing and travel costs reimbursement.

This is why calculating the annual salary of a travel nurse is a bit tricky. However, ZipRecruiter , one of the top job platforms out there, managed to collect data on travel nurse salaries across all 50 states of the USA.

In January 2024, ZipRecruiter reported that the average annual pay for a Travel Nurse in the United States is $121,710 , with a monthly wage of $10,142 , and an hourly wage of $59 .

The travel nurse salary you may expect will vary depending on the percentile you find yourself in, with top earners in the field taking home around $66,000 more than travel nurses in the bottom percentile .   

Here is a breakdown of the expected traveling nurse salary based on performance percentiles:

A travel nurse’s salary will also be affected by the place of employment and state they reside and work in. Next, we will look at the variation in salaries for travel nurses based across the 50 US states.

How Much Do Travel Nurses Make By State?

The highest paying state for travel nurses is New York , with a $135,031 travel nurse annual salary with an hourly wage of $64.92 . This may be the case because the Big Apple is one of the most expensive US states to live in. Since travel nurses' wages include both housing and travel expenses , it makes sense that the most expensive states to live in are the ones that offer the highest pay for travel nurses.

On the opposite end, Florida has a $91,074 travel nurse annual salary (with a $43.79 hourly wage), which makes it the lowest paying state in America.

Here is a list with the best and worst paying states for travel nurses, ranked from highest to lowest pay:

• Annual salary: $64.92
• Monthly pay: $11,252
• Hourly wage: $135,031
• Annual salary: $63.80
• Monthly pay: $11,058
• Hourly wage: $132,707
• Annual salary: $130,341
• Monthly pay: $10,861
• Hourly wage: $62.66
• Annual salary: $126,575
• Monthly pay: $10,547
• Hourly wage: $60.85
• Annual salary: $125,217
• Monthly pay: $10,434
• Hourly wage: $60.20
• Annual salary: $124,240
• Monthly pay: $10,353
• Hourly wage: $59.73

Pennsylvania

• Annual salary: $123,669
• Monthly pay: $10,305
• Hourly wage: $59.46

Massachusetts

• Annual salary: $122,156
• Monthly pay: $10,179
• Hourly wage: $58.73
• Annual salary: $121,382
• Monthly pay: $10,115
• Hourly wage: $58.36
• Annual salary: $120,934
• Monthly pay: $10,077
• Hourly wage: $58.14

New Hampshire

• Annual salary: $120,647
• Monthly pay: $10,053
• Hourly wage: $58.00
• Annual salary: $119,997
• Monthly pay: $9,999
• Hourly wage: $57.69

North Dakota

• Annual salary: $119,877
• Monthly pay: $9,989
• Hourly wage: $57.63
• Annual salary: $119,111
• Monthly pay: $9,925
• Hourly wage: $57.27
• Annual salary: $118,043
• Monthly pay: $9,836
• Hourly wage: $56.75
• Annual salary: $117,602
• Monthly pay: $9,800
• Hourly wage: $56.54
• Annual salary: $116,968
• Monthly pay: $9,747
• Hourly wage: $56.23
• Annual salary: $115,975
• Monthly pay: $9,664
• Hourly wage: $55.76
• Annual salary: $114,771
• Monthly pay: $9,564
• Hourly wage: $55.18
• Annual salary: $114,453
• Monthly pay: $9,537
• Hourly wage: $55.03
• Annual salary: $114,294
• Monthly pay: $9,524
• Hourly wage: $54.95
• Annual salary: $113,577
• Monthly pay: $9,464
• Hourly wage: $54.60

South Dakota

• Annual salary: $113,297
• Monthly pay: $9,441
• Hourly wage: $54.47
• Annual salary: $111,865
• Monthly pay: $9,322
• Hourly wage: $53.78
• Annual salary: $111,315
• Monthly pay: $9,276
• Hourly wage: $53.52

Rhode Island

• Annual salary: $111,146
• Monthly pay: $9,262
• Hourly wage: $53.44
• Annual salary: $110,939
• Monthly pay: $9,244
• Hourly wage: $53.34
• Annual salary: $110,469
• Monthly pay: $9,205
• Hourly wage: $53.11
• Annual salary: $109,735
• Monthly pay: $9,144
• Hourly wage: $52.76

Connecticut

• Annual salary: $108,976
• Monthly pay: $9,081
• Hourly wage: $52.39
• Annual salary: $108,771
• Monthly pay: $9,064
• Hourly wage: $52.29
• Annual salary: $107,945
• Monthly pay: $8,995
• Hourly wage: $51.90

Mississippi

• Annual salary: $107,802
• Monthly pay: $8,983
• Hourly wage: $51.83
• Annual salary: $107,540
• Monthly pay: $8,961
• Hourly wage: $51.70
• Annual salary: $106,277
• Monthly pay: $8,856
• Hourly wage: $51.09
• Annual salary: $106,005
• Monthly pay: $8,833
• Hourly wage: $50.96
• Annual salary: $105,533
• Monthly pay: $8,794
• Hourly wage: $50.74
• Annual salary: $104,121
• Monthly pay: $8,676
• Hourly wage: $50.06

South Carolina

• Annual salary: $103,067
• Monthly pay: $8,588
• Hourly wage: $49.55
• Annual salary: $102,909
• Monthly pay: $8,575
• Hourly wage: $49.48
• Annual salary: $102,199
• Monthly pay: $8,516
• Hourly wage: $49.13
• Annual salary: $102,065
• Monthly pay: $8,505
• Hourly wage: $49.07
• Annual salary: $101,486
• Monthly pay: $8,457
• Hourly wage: $48.79

North Carolina

• Annual salary: $100,940
• Monthly pay: $8,411
• Hourly wage: $48.53
• Annual salary: $99,788
• Monthly pay: $8,315
• Hourly wage: $47.98
• Annual salary: $96,957
• Monthly pay: $8,079
• Hourly wage: $46.61
• Annual salary: $96,919
• Monthly pay: $8,076
• Hourly wage: $46.60

West Virginia

• Annual salary: $95,511
• Monthly pay: $7,959
• Hourly wage: $45.92
• Annual salary: $92,113
• Monthly pay: $7,676
• Hourly wage: $44.29
• Annual salary: $91,074
• Monthly pay: $7,589
• Hourly wage: $43.79

What Are the Highest Travel Nursing Jobs in 2024?

According to ZipRecruiter , the highest paying jobs in traveling nursing are received by NICU and PACU travel nurses , with annual salaries reaching $154,500 and $147,500, respectively. At the other end of the spectrum, the salary for a visiting nurse ranges from $70,000 and $105,500 per year, being the lowest in the industry.

Here is an overview of the travel nurse salary ranges, based on the specialization and role they occupy:

If you want to discover the 20 best-paying positions as a travel nurse, read our Highest Paying Travel Nursing Jobs in the US article and orient yourself towards the best career choice, from a financial perspective.

Is the Travel Nurse Salary Better Than for Other Nursing Staff?

Travel nurses take home $32,700 more annually, compared to registered nursing staff, the difference being equivalent to making $16.2 more per hour. Additionally, traveling nurses make on average $740 less per year than nurse midwives, and $2,970 less per year than nurse practitioners.

So, is it better to be a travel nurse or staff nurse? From an economic standpoint, the answer is a clear yes , as travel nurses can win considerably more on average and have greater opportunities for advancement than staff RNs. And, since both job positions have similar academic requirements, you can simply earn a lot more with your ADN .

The downsides to a higher travel nurse salary are a lack of flexibility in working hours, less job security and varying pay, lack of paid leave, and many other benefits that come with a stabler nursing staff position. The choice between these options will depend on your priorities and ability to adapt to a more dynamic work environment.

If you’re interested in the average annual income for Registered Nurses of all career specialties, check out our Nurse Salaries in the US study and find out which are the happiest states for RNs, from a financial point of view.

Travel Nurse Salary Guide: How Much Travel Nurses Make In 2023?

• Last Updated: July 28, 2023

Travel nursing is a popular career path for registered nurses looking for flexibility, adventure, and higher pay rates. Travel nurses work on temporary assignments in healthcare facilities across the country, filling in gaps in staffing and providing patient care. 

One of the key benefits of travel nursing is the potential for higher salaries than permanent nursing positions, with many travel nursing assignments offering additional incentives such as travel reimbursement and housing allowances. However, the pay rates for travel nurses can vary significantly depending on various factors, including specialty, location, and experience level. 

This article will provide a comprehensive guide to travel nurse salaries, including average pay rates across different specialties, top-paying states, and ways to increase your salary. If you are interested to learn more specifics as to how much a travel nurse makes an hour, follow the guide below.

Table of contents

What is a travel nurse, lowest- and highest-paying states for travel nurses, salary based on the different types of travel nurses, salary based on experience, career outlook for travel nurses, benefits you will receive as a travel nurse, ways you can increase your travel nurse salary, what’s the bottom line.

A travel nurse is a healthcare professional who works on a temporary basis in various healthcare facilities across different locations. Travel nurses are highly skilled and experienced, often working in critical care units or other specialized areas of nursing. 

The role of a travel nurse is to provide temporary staffing support in hospitals, clinics, and other medical facilities, usually for a period of 13 weeks or longer. The facility may hire them directly or work through an agency specializing in travel nursing assignments. 

Travel nurses enjoy a high degree of flexibility, as they can choose their assignments based on location, specialty, and contract length. In addition to competitive salaries, travel nurses often receive benefits such as housing, travel expenses, and health insurance. 

This career path is ideal for those who love to travel and want to gain experience working in different healthcare settings.

Travel Nurse Salary in 2023

The salary of a travel nurse may vary depending on a few factors, such as location, experience, and specialty. According to recent data, the average annual salary for travel nurses in the U.S. is $106,030 or $51/hr . However, the salary range can vary widely on the factors mentioned above, with the lowest salary reported at $31,000 and the highest at $179,500.

Location plays a significant role in a travel nurse’s salary. The cost of living and demand for healthcare services vary significantly from state to state and even within cities, which can substantially impact a travel nurse’s compensation. But how much do travel nurses make in each state?

Below you can find the list of states with the lowest travel nurse salaries . The list goes as follows: 

• Texas $87,843
• Nebraska $85,776
• Idaho $85,262
• Kentucky $82,639
• North Carolina $81,884
• Arkansas $81,209

Conversely, the average travel nurse salary in some states exceeds $100,000. More specifically, New York is the highest paying state for travel nurses, reaching up to $104,675, followed by Idago with $102,559, and California with $100,323.

Now that we have covered the highest and lowest paying states for travel nurses, let’s see what city travel nurses make the most money in. The first in the list of the best cities for travel nurses to make the most money is Barrow, AK, with $137,200, followed by San Jose, CA, with $133,873, and Oakland, CA, and Antioch, CA, with $132,042 and $129,387 respectively. 

Travel nurse salaries can vary based on their specialty, as some specialties require more experience, skill, and demand, resulting in higher pay rates. To provide an idea of the highest-paying travel nurse specialties, we have listed the average annual salary for each specialty in 2023:

Experience plays a crucial role in determining the salary of a travel nurse. In most cases, the more experience a travel nurse has, the higher their pay will be. 

Experienced travel nurses possess valuable skills and knowledge which can benefit the healthcare facilities they work for. As a result, many employers are willing to pay a higher salary to attract and retain experienced travel nurses.

In addition, experienced travel nurses often have a deeper understanding of their specialties and can handle complex cases with greater ease. This means they can work more independently, which is particularly valuable in rural or remote locations where staffing may be limited. Moreover, experienced travel nurses have often worked in various healthcare settings, making them adaptable and able to easily handle new situations. 

According to Zippia , travel nurses with entry-level experience earn an average annual salary of $66,600, whereas mid-level experienced travel nurses have an average annual salary of $83,700. Lastly, senior-level travel nurses can expect to earn an average annual salary of over $115,000.

The career outlook for travel nurses is positive, with increasing demand for their services in various healthcare settings. The Bureau of Labor Statistics (BLS) projects that the employment of registered nurses, including travel nurses, will grow by 6% from 2021 to 2031. 

This growth is due to an aging population that requires more healthcare services, a greater emphasis on preventive care, and advances in medical technology that allow patients to receive care outside of traditional hospital settings. 

The COVID-19 pandemic has also highlighted the need for more healthcare workers, including travel nurses, to assist with sudden surges in patient volume. Overall, travel nursing offers an exciting and rewarding career path with considerable growth and professional development opportunities.

Travel nursing comes with a range of benefits that make it an attractive career choice:

• Travel nurses have the opportunity to work in different healthcare settings, which allows them to broaden their skills and experience.
• Travel nurses typically earn higher salaries than their permanent counterparts, and many travel nursing assignments offer additional incentives, such as sign-on bonuses, travel reimbursements, and housing allowances.
• Travel nurses often have greater flexibility in their work schedule, allowing them to take time off between assignments to pursue personal interests or spend time with family. Travel nursing also enables nurses to explore new cities and regions, providing a unique cultural experience.

Overall, travel nursing offers numerous benefits, making it an appealing career path for many nurses.

There are several ways that a travel nurse can increase their salary, such as:

• Specializing in a high-demand area: Consider specializing in an area with a high demand for travel nurses, such as intensive care or emergency departments. Specializing in a high-demand area can increase your value as a travel nurse, leading to higher-paying job offers.
• Gaining more experience in their specialty: They can achieve this by taking on challenging assignments and pursuing advanced certifications.
• Negotiating higher pay rates when signing on for new assignments: This may involve researching typical salaries for their specialty in the location they will be working and negotiating with their agency or employer.
• Taking on additional responsibilities: More responsibilities at work, such as precepting new staff or taking on leadership roles, can lead to increased compensation.
• Traveling to higher-paying locations: Travel nurses can seek assignments in high-demand areas where pay rates may be higher due to a staff shortage.

In conclusion, travel nursing can be a rewarding and lucrative career path for registered nurses who enjoy new challenges and experiences. While the pay rates for travel nurses can vary depending on multiple factors, including expertise and location, there are many ways to increase your salary as a travel nurse, such as gaining experience in your specialty, negotiating for higher pay rates, taking on additional responsibilities, and more. 

It’s essential to do your research on typical pay rates for your specialty in different locations and to work with a reputable travel nursing agency that can provide you with competitive pay rates and additional benefits. With the right approach, travel nursing can offer you a fulfilling career and a comfortable lifestyle while exploring new places and meeting new people. 

Don’t wait any longer to start living your best life as a travel nurse. Take charge of your career and find your next high-paying placement in a desirable location today! 

Nurse Luke is a CRNA who specializes in Nursing content and still enjoys a very busy career with Locum, Per Diem and Travel nursing in the greater midwest. He has over 25 years of experience in the healthcare field and received his CRNA masters degree from the Mayo Clinic School of Healthcare. He is passionate about helping nurses explore the options of becoming a travel nurse as well as spending time with his Family. 

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Travel Nurse Salaries in 2024: What To Expect

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Travel nurse pay by state

From February to March, Montana saw the sharpest decrease to average weekly travel nurse pay, and Idaho saw the sharpest increase, according to data shared with Becker's from Vivian, a healthcare career marketplace.

Here is the average weekly travel nurse pay for each state for March, alongside the percentage difference between March and February. 

Note: As of April 1, there are 171,486 open jobs and 73,353 new this week on the Vivian platform.

March: $2,328.69

Month-over-month decrease: 4.01%

North Dakota

March: $2,374.86

Month-over-month decrease: 2.41%

March: $2,441.55

Month-over-month decrease: 2.31%

March: $2,436.33

Month-over-month decrease: 2%

Connecticut

March: $2,379.35

Month-over-month decrease: 1.78%

Massachusetts

March: $2,631.19

Month-over-month decrease: 1.69%

March: $2,594.90

Month-over-month decrease: 1.57%

March: $2,327.87

Month-over-month decrease: 1.52%

South Dakota  

March: $2,337.45

Month-over-month decrease: 1.43%

Pennsylvania

March: $2,243.53

Month-over-month decrease: 1.42%

West Virginia

March: $2,339.60

Month-over-month decrease: 1.30%

March: $2,313.12

Month-over-month decrease: 1.29%

March: $2,096.67

Month-over-month decrease: 1.28%

Rhode Island

March: $2,336.95

Month-over-month decrease: 1.17%

March: $2,142.66

Month-over-month decrease: 1.05%

March: $2,265.29

Month-over-month decrease: 0.95%

March: $2,254.71

Month-over-month decrease: 0.75%

March: $2,259.29

Month-over-month decrease: 0.51%

North Carolina

March: $2,187.99

March: $2,467.94

Month-over-month decrease: 0.49%

March: $2,061.39

Month-over-month decrease: 0.24%

March: $2,554.61

Month-over-month decrease: 0.23%

March: $2,251.87

Mississippi

March: $1,937

Month-over-month decrease: 0.22%

March: $2,249.45

Month-over-month decrease: 0.13%

March: $2,409.12

Month-over-month decrease: 0.07%

March: $2,413.62

March: $2,602.97

Month-over-month increase: 0.05%

March: $2,165.72

Month-over-month increase: 0.18%

March: $2,515.58

Month-over-month increase: 0.20%

March: $2,127.19

Month-over-month increase: 0.21%

March: $2,317.40

Month-over-month increase: 0.34%

March: $2,228.42

Month-over-month increase: 0.43%

March: $2,121.76

Month-over-month increase: 0.50%

March: $2,536.74

Month-over-month increase: 0.53%

March: $2,091.65

Month-over-month increase: 0.69%

New Hampshire

March: $2,386.20

Month-over-month increase: 0.76%

March: $2,477.53

Month-over-month increase: 0.81%

March: $2,258.79

Month-over-month increase: 0.89%

March: $2,433.89

Month-over-month increase: 0.94%

March: $2,304.70

Month-over-month increase: 0.95%

March: $2,325.06

Month-over-month increase: 1.14%

March: $2,456.99

Month-over-month increase: 1.16%

March: $2,552.12

Month-over-month increase: 1.19%

March: $2,344.52

Month-over-month increase: 1.69%

March: $2,856.17

Month-over-month increase: 1.71%

March: $3,045.44

Month-over-month increase: 2.63%

March: $2,574.88

Month-over-month increase: 2.88%

South Carolina

March: $2,161.60

Month-over-month increase: 3.64%

March: $2,382.11

Month-over-month increase: 4.98%

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Iowa nursing homes rely too heavily on temporary staff. Is capping their pay the solution?

Long-term reliance on contract staffing to care for vulnerable patients in Iowa's nursing homes is a big expense and threatens the quality of care, many industry officials agree.

In recent years, nursing homes across the state say they have had to increasingly rely on travel nurses and other temporary staff to fill workforce gaps. While travel staffing helps temporarily fill those holes, they say it is not a viable solution to the chronic staffing shortages plaguing many of the state's long-term care facilities.

Some worry about the repercussions that Iowa's most vulnerable population face as a result.

“If they're using agencies' staff more than trying to recruit and retain permanent staff, that becomes a consistency issue that affects quality," said Angela Van Pelt, Iowa's state long-term care ombudsman.

However, recent legislative efforts have highlighted a split in the search for solutions.

Earlier in the legislative session, Iowa lawmakers considered a proposal from the nursing home industry to cap payment rates that staffing agencies could charge for their temporary nursing services, limiting those costs to no more than 150% of the statewide average wage paid the previous year for staff professionals.

Other states have considered similar legislation after COVID-19 dramatically changed the industry.

House File 2391 was approved by the Iowa House in February. However, a Senate committee did not advance the bill before a key legislative deadline earlier this month.

Still, it may not be the last time the Iowa Legislature considers such a proposal, particularly as the nursing home industry in Iowa continues to struggle with staffing challenges.

“Iowa House Republicans are listening to the concerns of nursing homes across the state," Melissa Saitz, spokeswoman for the Iowa House Republican caucus, said in a statement. "One of the top concerns we’ve heard is the need to address temporary staffing agencies. The current system has created budget crises for our health care facilities, increased costs on the state and resulted in lower quality of care for patients."

"Our bill would have a big impact to help nursing homes provide quality, consistent care at a reasonable cost to the Iowa taxpayers," Saitz said. "We believe this is important legislation, and we are not done fighting to see it passed into law this session.”

But even as those on each side of this issue continue to debate the merits of such a measure, other advocates have emphasized that many factors have led to the larger issue of nursing shortages in health care facilities in the state.

They contend that addressing an overreliance on temporary staffing must be part of a broader conversation about health care workforce shortages — highlighting how complicated the search for solutions can be.

Low wages drive high turnover among direct care staff, advocates say

Today, 125 staffing agencies based in Iowa and 325 total agencies provide staffing services to the state, according to the American Staffing Association , which represents 1,200 agencies across the country.

Demand for travel nurses and other temporary medical staff soared during the pandemic as health care facilities struggled first with surges in COVID-19 infections, then increases in patients returning for medical care they had put off for months.

The reliance on travel staffing has continued in recent years as the supply of available hires for permanent nursing jobs has dwindled.

Alan Faith of Hinton and Savonda Petersen of Sioux City are registered nurses who left full-time bedside jobs to work for travel agencies.

Faith initially started taking per diem shifts in 2020 at drive-through COVID-19 testing sites, and eventually left his management position in a hospital emergency room for travel nursing. Faith said he wanted the flexibility to build his own schedule and have more time to travel and be with family.

“To be honest, I just grew tired of the demand," said Faith, who mainly works per diem shifts at rural hospitals in northwest Iowa. "You’re always one phone call away from having to put a set of scrubs on and drive to work. That was 24 hours a day, seven days a week. So I decided to give myself a break.”

For Petersen, the major driver into travel nursing was the pay. She said in the 10 years she worked in a hospital, her wages did not significantly increase.

She saw a major pay bump only when she switched to travel nursing, she said. Petersen now works as a travel nurse in an internal float pool for a large Iowa health system, and takes per diem shifts for Highland Medical Group.

“After COVID, I became highly aware of what I was making and what my wage was, because this is time that I'm spending away from my family," Petersen said. "I want to be compensated appropriately and not have to work a kazillion hours of overtime to make a living wage for my family to be able to afford to pay our bills.”

Di Findley, executive director of the direct care worker advocacy organization Iowa Caregivers, noted that chronic low wages — which persist even as inflation and the cost of living are rising — is a prominent driver for high turnover among direct care workers.

A recent wage brief from her organization found that nearly 80% of direct care workers in Iowa who were seeking new jobs were doing so for better wages.

In 2022, the estimated median hourly wage was $14.42 for nursing assistants and $13.89 for home health aides.

“You can't blame the workers who are making $14.42 as a median hourly wage to try to find higher paying employment,” Findley said.

Low wages are also a prominent factor for registered nurses, certified nursing assistants and other health care staff, Findley said, contributing to turnover rates for those professionals.

Iowa nursing homes reported a 72% turnover rate among certified nursing assistants in 2023, according to the brief published earlier this month by Iowa CareGivers. That turnover rate is estimated to have cost Iowa nursing homes more than $123 million, the report states.

Fran Mancl is a former certified nursing assistant who left the profession after working more than 30 years in Iowa nursing homes, including 25 years at a Dubuque nursing home. Before his retirement in 2021, he said his nursing home increasingly relied on temporary staffing as the pandemic ramped up in Iowa.

Mancl said those temporary certified nursing assistants and nurses could not provide the same level of care as permanent staff because they lacked institutional knowledge of residents and their care plans. Despite this, those short-term workers were paid much more than even the more tenured full-time staff at the nursing home, he said.

"There were shifts I would have rather worked short staffed," said Mancl, who is now a member of the Iowa CareGivers direct care council.

Why do officials disagree over caps on travel nursing costs?

Statewide, the average bill rate to hire traveling nurses almost doubled at nursing homes and hospitals during the "pandemic peak," or when demand was at its highest in mid- to late 2022, according to data provided to state lawmakers by the American Staffing Association.

The report compiled data from Iowa staffing agencies on their average bill rates, which include the pay rate to that traveling staff member as well as any additional costs, such as administrative fees and transportation stipends.

The cost to hire a nurse traveler at a nursing home during peak demand was $130 per hour, the data shows. That compares with the $75 per hour average in 2019.

The certified nursing assistant traveler rate for nursing homes was $78 per hour at peak demand in 2022, an increase from $38 in 2019.

In total, nursing homes in Iowa spent $49 million on agency staffing in 2019, according to Brent Willett, president and chief executive officer of the Iowa Health Care Association. By 2022, those total costs rose to $184 million, he said.

Agency bill rates are returning to pre-pandemic levels, according to the report from the American Staffing Association. As of 2024, the average cost to nursing homes is $75 for a traveling nurse and $40 for a traveling certified nursing assistant.

Despite the recent drop in costs, nursing home officials say the price tag imposed by staffing agencies is still a major burden on nursing homes in Iowa, which have been struggling financially for years, Willett said. Because of these increasing costs, administrators have struggled to afford higher wages and better benefits for permanent staffing.

If the cap on staffing agency bill rates was approved by the Iowa Legislature and signed into law, it would have saved Iowa nursing homes $22 million in overhead costs.

“We need to find ways to pay our direct care workers even more, and we need to find ways to recruit more," Willett said. "In order to do that we've got to have the cash to do it. … That $22 million would go a really long way to bolster the permanent workforce.”

However, travel agencies have pushed back on nursing home officials' argument, stating legislation imposing caps could have the opposite effect. Instead of encouraging travel nurses to seek full-time jobs at nursing homes or hospitals in Iowa, they will opt to leave the state in search of travel contracts that will continue to pay them higher wages.

“We know that we’re not a permanent solution, but we do want to be there when times become difficult," said Greg Opseth, chief operating officer at Highland Medical Group, a staffing agency in Gowrie.

Approximately 65% of agency nurses in Iowa already work a full-time job, according to Bob Livonius with the American Staffing Association. He said these individuals opt to take additional contract work “to pay for the broken refrigerator or to pay for a family vacation or to simply make ends meet.”

“The management of their facilities oftentimes creates great turnover," Livonius said. "If you’re a nursing home running more than 5-10% contract labor … there’s a management problem that has to do with their hiring and retention. It's likely the management and the work environment that they're working in that's causing that particular facility to use many more contractors than others.”

Willett said the effort to address costs of temporary health care staff is just the first step to address the long-term need within nursing homes for better recruitment and retention of nursing staff, but that it’s an "important piece."

"We can’t leave anything on the cutting room floor when it comes to the inflated costs of care delivery. Health care employment agencies, in our viewpoint, largely represent that category," Willett said. "By no means is this a singular solution to the nursing shortage, but it’s an important step to take and we can all take collectively.”

Officials at Iowa's travel agencies say they want a seat at the table when it comes to crafting meaningful, long-term solutions to the nursing shortage.

“It's unfortunate to hear that when organizations are relying heavily on contingent staffing that it becomes a blame game," Opseth said. "I think there also has to be some accountability and there has to be some evaluation about what’s contributing to that high utilization.”

“I don’t think a cap would be a solution. I think we have to look more broadly at this situation," he said.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at  [email protected] , at (319) 339-7354 or on Twitter at  @Michaela_Ramm

Motivations for travel nurses accepting temporary assignments go beyond the big pay boost

Travel nurses take short-term contracts that can require long commutes or temporarily living away from home. Time and again, they have to get used to new co-workers, new protocols and new workplaces.

So why would staff nurses quit their stable jobs to become travel nurses?

Well, for one, they get bigger paychecks . But U.S. nurses have other rationales besides making more money, according to a study I conducted .

To do this research, I interviewed 27 registered nurses based in different places.

Many of the people I interviewed disclosed that they left permanent positions to combat burnout. Although they welcomed the bump in pay, travel nursing also gave them the autonomy to decide when and where to work. That autonomy allowed them to pursue personal and professional interests that were meaningful to them, and it made some of the other hassles, such as long commutes, worth it.

On top of earning more money, travel nursing "gives you an opportunity to explore different areas," said a nurse I'll call Cynthia, because research rules require anonymity. "When you actually live there for three months, it gives you a chance to really immerse yourself in the area and really get to know not just the touristy stuff, but really hang out with the locals and really be exposed to that area."

Other study participants said they enjoyed the novelty and educational opportunities.

"You don't get bored or stuck in a routine," Michelle said. "You're always trying to learn new policies at the new hospital that you're in, learning about the new doctors, nursing staff, new ways of doing things, where things are located. That helps keep me from feeling burned out so quickly."

Said Patricia: "I want to see how other operating rooms across the country do things and how they do things differently. I do learn a lot of things going from place to place."

Why it matters

A growing number of U.S. nurses were obtaining temporary assignments before the COVID-19 pandemic began.

But travel nursing became much more widespread in 2020, when hospitals were scrambling to keep their staffing levels high enough as millions of Americans were becoming infected with the coronavirus, straining capacity in many communities.

While compensation varies widely, the median pay of registered nurses in 2022 was US$81,220 , about 35% less than the $110,000 that registered nurses who traveled earned .

At the height of the COVID-19 pandemic, travel nurses could earn an even bigger premium . Many were paid twice as much as staff nurses.

Once the number of Americans with severe symptoms fell, that premium declined too . But there are still over 1.7 million travel nurses in the U.S. Hiring them is one of the main ways that hospitals cope with a long-term shortage of nurses .

But nurses with permanent jobs can get aggravated by this arrangement when they learn how much more travel nurses earn for doing the same work, as I found through another research project .

What other research is being done

Research supports a widely reported trend: More Americans have temporary jobs and freelance employment than in the past.

While travel nurses can help hospitals, nursing homes and doctors' offices meet staffing needs, there are signs that patients don't always fare as well with their care.

And a Canadian study found that when hospitals let staff nurses work part time and offer other alternative arrangements, their retention rates may rise .

This article is republished from The Conversation under a Creative Commons license. Read the original article .

Provided by The Conversation

Bachelor of Science in Nursing (BSN) Overview

• BSN Specialties
• Admission Requirements
• Core Concepts
• What To Expect
• Should I Get A BSN

Are you ready to earn your online nursing degree?

average BSN program length

Average credits required for a bsn, bsn average earning potential.

According to the American Association of Colleges of Nursing , healthcare settings see a difference in nursing practice based on a nurse’s education level. Employers have a strong preference for bachelor of science in nursing (BSN)-prepared nurses, as they are linked to better patient outcomes. Hospitals seeking Magnet status also prefer to hire graduates of BSN programs.

Nurses benefit from BSN programs for the comprehensive curriculum that teaches more than clinical skills. Students learn critical thinking, decision making, leadership, evidence-based practice, and nursing informatics.

Although salaries depend on many factors, BSN-prepared nurses routinely average more per year than nurses from associate degree in nursing (ADN) programs. Additionally, a BSN prepares the nurse for graduate school and career advancement, factors that contribute to higher earning potential.

A BSN degree may soon become mandatory to practice . In December 2017, New York became the first state to mandate nurses earn a BSN within 10 years of initial licensure.

Earning a BSN increases your credibility with patients and administration. It can also open doors to greater opportunities outside of patient care, including working as an analyst, consultant, case manager, leader, or in sales.

Opportunities With a Bachelor of Science in Nursing

Good career mobility, path to advancement, job potential, skills learned.

Featured BSN Specialties

Beyond working in hospitals as RNs, individuals with a BSN degree find careers as geriatric nurses, OBGYN nurses, and neonatal nurses. Check out the descriptions below to learn more about these specialty occupations.

Registered Nurse

RNs lead teams of nurses to care for patients in clinics, hospitals, and nursing homes. They work the day or night shift to monitor and treat caseloads of patients, including infants, adults, and the elderly. In 16 states, RNs also prescribe medications. An ADN or BSN degree is required to become a registered nurse.

• Salary: $73,300
• Job Outlook: 7% growth from 2019-29

Geriatric Nurse

Geriatric nurses work in nursing care facilities and hospitals to provide medical help to seniors. These professionals have worked as RN nurses and gained clinical experience working with elderly individuals. They have a unique understanding of diseases such as osteoporosis, Alzheimer’s, and dementia.

• Salary: $64,870
• Job Outlook: Positive growth in coming years

OBGYN Nurse

OBGYN nurses provide medical services to women and infants. Under the direction of obstetricians and gynecologists, they deliver care in clinics, private doctor’s offices, and hospitals. They may focus on helping women in various stages of reproduction, including pregnancy, labor, or postpartum.

• Salary: $60,000

Travel Nurse

Travel nurses work on a contract basis. High demand areas such as operating rooms, intensive care units (ICU), and emergency rooms need travel nurses across the country. Their assignments last for weeks or months. International work may run as long as two years.

• Salary: $79,000

Neonatal Nurse

Neonatal nurses administer care to sick or critically ill infants in the ICU or neonatal intensive care unit. The job includes working with pediatricians and nursing staff, while also providing instructions to parents. Most hold years of experience as RNs, and neonatal nursing certificates.

• Salary: $60,797

How Much Will I Make With a Bachelor’s Degree in Nursing?

$32.64 Hourly Salary

$7,123 Monthly Salary

$85,539 Annual Salary

Source: PayScale

How to Get a BSN

1. decide type of bsn program.

There are several types of BSN programs, including traditional, bridge, and online. Figure out what works best for you.

2. Find BSN Program

After deciding which factors are important to you in a school, use our degree finder to find programs that fit your criteria.

3. Apply to BSN Programs

Common application requirements include GPA, essay, references, CV or resume, volunteer experience, and prior coursework.

4. Secure funding for BSN programs

There are many ways to finance your degree, including financial aid, grants, scholarships, and loans .

5. Attend BSN classes

Complete the required courses and obtain clinical hours to get hands-on experience. Learn how to work independently with your own patients.

6. Graduate with a BSN

Congrats on earning your degree! Now you can take the NCLEX-RN and become a registered nurse (RN), or continue your education and get your MSN.

Types of Bachelor’s Degrees in Nursing

Admission requirements for a bsn program.

A BSN applicant’s admission requirements depend on their status as a student. Schools set different criteria and credit requirements for freshmen, transfer students, and international students. However, most BSN degree programs maintain the following common admissions requirements for all students:

• High school or college transcripts
• SAT or ACT scores
• A CV or resume
• A GPA of at least a 2.5 or 3.0

Schools often expect applicants to have completed classes in microbiology, physiology, chemistry, and anatomy. Some institutions may give preference to candidates with volunteer service experience.

Core Concepts in a BSN Program

Bachelor’s of science in nursing programs include two phases: a didactic portion, which is taught in classrooms, and a clinical learning experience. Through lectures and reading assignments, students learn to promote safe solutions and good health, prevent and manage disease, reduce risks, and improve patient outcomes. Candidates gain foundational knowledge through core courses such as:

• Community health nursing
• Pharmacology
• Leadership and management
• Nursing informatics
• Research and statistics
• Pathophysiology

Upper division courses explore speciality areas such as gerontology, global public health, maternal-child care, and pediatrics.

Clinical & Lab Components in a BSN Program

BSN programs may require students to spend time in a hospital, clinic, or lab stimulation setting in which they work an actual shift. During clinical experiences, candidates work under licensed RN mentors as they deliver medications, assess and diagnose patients, plan interventions, and monitor outcomes. By the end of the program, students can work independently with their own patients. Clinicals offer the opportunity to:

• Shadow working RNs
• Apply classroom skills on patients
• Network with future employers
• Build confidence

What to Expect From an Online RN-to-BSN Program

Students earning their RN-to-BSN or second degree BSN have the option of attending an online program instead of traditional face-to-face classes. Online RN-to-BSN degrees let students take core classes in anatomy, pharmacology, and psychology remotely. While distance learners do not have to meet on campus for their foundational courses, they must complete clinicals or labs in their local communities. During a program’s clinical component , students work in labs or at their local hospitals, clinics, or nursing care facilities. Students are often required to find their own clinical experiences.

Nothing, aside from the format, differentiates online degrees from traditional programs. Online learners receive the same degree and education, learning from professors who work on campus. Instructors use online learning platforms to meet live with students or assign online work.

Learn more on this page about how online programs work.

Should I Get a Bachelor’s Degree in Nursing?

Your personal financial situation, time constraints, and family obligations may impact your decision to pursue a 4-year degree. Take a look at the pros and cons of pursuing a bachelor’s degree in nursing:

Advantages to a BSN

Disadvantages to a bsn, explore bsn programs.

The Best Online BSN Programs

Pursuing a BSN online provides academic freedom and flexibility for aspiring nurses. Check out this guide for a list of the best online BSN programs.

The Best Online ABSN Programs

ABSN programs are a great option for aspiring nurses who already hold a bachelor’s degree in another field. Learn more about fast-track BSN degrees and find the top online programs.

The Best Online RN-to-BSN Programs of 2024

Are you an RN interested in completing your undergraduate nursing education? These top RN-to-BSN programs can be completed in just 12-24 months.

Four-Year Bachelor of Science in Nursing (BSN) Programs

The traditional route to a bachelor of science in nursing (BSN) spans four years and admits high school graduates. Read on for details about four-year BSN programs.

The Best Online LPN-to-BSN Programs

Are you an LPN ready to move up in your career? Explore our rankings of the best online LPN-to-BSN programs to find the best fit for your professional goals.

Whether you’re looking to get your pre-licensure degree or taking the next step in your career, the education you need could be more affordable than you think. Find the right nursing program for you.

You might be interested in

HESI vs. TEAS Exam: The Differences Explained

Nursing schools use entrance exams to make admissions decisions. Learn about the differences between the HESI vs. TEAS exams.

10 Nursing Schools That Don’t Require TEAS or HESI Exam

For Chiefs’ RB Clyde Edwards-Helaire, Nursing Runs in the Family

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Maine’s nurses cannot comfortably do their jobs because of a chronic staffing crisis. Juggling too much work and too many patients, they urgently need support. The way to intervene, however, is not by mandating nurse-to-patient ratios that hospitals will almost invariably fail to meet.

“The groundswell of support for nurse-to-patient ratios among bedside nurses makes it painfully clear that radical change is overdue in our state’s units and wards,” this editorial board wrote back in June of last year , when the proposal was first circulating in Augusta. “If we could dependably legislate against staffing shortages, however, it could conceivably also be done for teachers, bus drivers, public defenders and more.”

A drive for better staffing is a no-brainer. The sticking point with the proposal moving through the Legislature, however, is the same now as it was then: that applying and enforcing the ratios risks driving hospital departments out of operation. Warnings that the move could have the effect of further threatening patient care need to be taken seriously. Already, hospitals’ poor financial positions have a pernicious effect. Patients should not have to be exposed to risk in an attempt to force change.

Where else can effort to improve working conditions be channeled? Legislators interested in helping nurses should take it upon themselves to come up with effective means of supporting violence prevention, going above and beyond existing federal requirements. They should make Maine the most attractive state in the U.S. in which to train, qualify and work as a nurse, using financial support of schools (nursing programs are notoriously costly to run), student debt forgiveness and complementary incentives. They should explore means of transferring hospitals’ ballooning traveling nurse budgets to staff nurse pay.

The ongoing nursing challenge is an unacceptable symptom of the failure of our health care system, where costs and services too often don’t match and relentless, commercially driven belt-tightening has made hospitals very difficult workplaces. Recruitment is best achieved by supporting prospective recruits. Would that it were any simpler than that.

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Fact Sheets FY 25 Skilled Nursing Facility Prospective Payment System Proposed Rule (CMS 1802-P)

• Nursing facilities

On March 28, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2025. CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for SNFs annually. This fact sheet discusses the major provisions of the proposed rule.

FY 2025 Proposed Updates to the SNF Payment Rates

For FY 2025, CMS proposes updating SNF PPS rates by 4.1% based on the proposed SNF market basket of 2.8%, plus a 1.7% market basket forecast error adjustment, and a negative 0.4% productivity adjustment. Note that these impact figures do not incorporate the SNF VBP reductions for certain SNFs subject to the net reduction in payments under the SNF VBP; those adjustments are estimated to total $196.5 million in FY 2025. 

In this proposed rule, CMS proposes to update the SNF market basket base year from the current 2018 base year to a new base year of 2022 and to update the payment rates used under the SNF PPS based on the FY 2025 SNF market basket increase factor, as adjusted by the productivity adjustment and forecast error correction. CMS proposes updates to the SNF Quality Reporting Program (QRP) to better account for adverse social conditions that negatively impact individuals’ health or health care. Additionally, this proposed rule would make changes to CMS’ enforcement policies to impose more equitable and consistent civil monetary penalties (CMP) for SNFs for health and safety violations. CMS also proposes to update the SNF PPS wage index using the Core-Based Statistical Areas (CBSAs) defined within the new OMB Bulletin 23-01 [1]   to improve the accuracy of wages and wage-related costs for the area in which the facility is located. 

Proposed Changes in Patient-Driven Payment Model (PDPM) ICD-10 Code Mappings 

The PDPM utilizes the International Classification of Diseases, 10 th Revision, Clinical Modification (ICD‑10) codes in several ways, including using the person’s primary diagnosis to assign patients to clinical categories. CMS is proposing several changes to the PDPM ICD-10 code mappings to allow providers to provide more accurate, consistent, and appropriate primary diagnoses that meet the criteria for skilled intervention during a Part A SNF stay. The proposed changes to the ICD-10 code mappings and lists used under PDPM are available on the PDPM website at https://www.cms.gov/Medicare/MedicareFee-for-Service-Payment/SNFPPS/PDPM. The proposed rule also includes a Request for Information (RFI) seeking input from commenters on potential future updates to the Non-Therapy Ancillary (NTA) component of PDPM.

Nursing Home Enforcement

The proposed rule includes revisions to CMS’ existing nursing home enforcement authority to enhance the safety and quality of care provided in the nation’s nursing homes. In February 2022, the Biden-Harris Administration signaled a commitment to ensure that all residents living in nursing homes receive safe, quality care. [2] CMS is proposing to expand its ability to impose financial penalties to drive sustained correction of health and safety deficiencies. These revisions will allow CMS to expand the mix and number of penalties in response to situations that put residents’ health and safety at risk and, therefore, encourage facilities to promptly correct and maintain lasting compliance with CMS’s health and safety requirements.

CMS’ current enforcement authority allows imposition of civil money penalties (CMPs) for noncompliance. Penalties can currently be imposed per day (PD) or per instance (PI) depending on the health and safety deficiencies identified, with PD CMPs applied until the noncompliance is corrected and PI CMPs for isolated instances. However, PD and PI penalties may not be imposed during the same survey, and PI penalties may not be imposed concurrently for the same deficiency. The severity of enforcement sanctions is based on the harm or potential harm to residents caused by non-compliance. This regulatory limitation prevents CMS and the State from imposing CMPs commensurate with the identified noncompliance by restricting the use of multiple penalties for one deficiency, which prevents full use of CMPs to encourage faster correction and sustain compliance with health and safety requirements. 

In this proposed rule, CMS proposes to expand the penalties that can be imposed through regulatory revision to allow for more per instance and per day CMPs to be imposed. The proposals in this rule will permit both types of penalties to be imposed, not to exceed the statutory daily limits, providing CMS with greater flexibility to impose penalties in a manner that more directly reflects the health and safety impact to residents and incentivizes permanent correction. We look forward to receiving comments on how to use this proposed flexibility to better hold nursing homes accountable for failing to provide safe, quality care for their residents. 

Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)

CMS proposes adding four new social determinants of health (SDOH) items and modifying one SDOH assessment item for the SNF QRP. Additionally, CMS proposes that SNFs included in the SNF QRP participate in a process to validate data submitted under the SNF QRP through the Minimum Data Set (MDS) beginning with the FY 2027 SNF QRP. Finally, CMS is also seeking feedback on future measure concepts for the SNF QRP with a Request for Information (RFI) on quality measure concepts under consideration for future SNF QRP years.

The SNF QRP is a pay-for-reporting program. SNFs that do not meet reporting requirements are subject to a two-percentage-point reduction in their Annual Payment Update (APU) in accordance with section 1886(e)(6)(A) of the Act. Additionally, CMS publicly reports each SNF’s performance on measures adopted into the SNF QRP on the Care Compare website.

Proposed Updates to the SNF QRP:

• Beginning with the FY 2027 SNF QRP (beginning with residents admitted on October 1, 2025), we are proposing the adoption of four new items in the MDS under the following SDOH categories: (1) Living Situation, (2) Food (2 items), and (3) Utilities. Among other reasons, screening for SDOH via collecting these items may assist SNFs in better addressing those identified needs with the residents, their caregivers, and community partners during the discharge planning process, if indicated.
• Beginning with the FY 2027 SNF QRP (beginning with residents admitted on and after October 1, 2025), we propose modifying the Transportation item under the SDOH category. As part of our routine item and measure monitoring work, we have identified an opportunity to improve the data collection for this item. Specifically, the proposed Transportation item modification would improve and align data collection in three ways: (1) the guidance would clarify the look-back period for when a patient experienced a lack of reliable transportation, (2) the response options would be simplified for the resident, and (3) the revised assessment item would be collected at admission only, which would decrease provider burden since the current assessment item is collected at both admission and discharge.
• Beginning with the FY 2027 SNF QRP, we propose requiring SNFs participating in the SNF QRP to participate in an MDS validation process. Specifically, we propose adopting the same validation process for the SNF QRP that we have adopted for the SNF Value-Based Purchasing Program in the FY 2024 SNF PPS final rule (88 FR 53323 through 53325). We are required by section 1888(h)(12)(A) of the Act (as added by section 111(a)(4) of Division CC of the Consolidated Appropriations Act, 2021 (Pub. L. 116–260)) to apply a process to validate data submitted under the SNF QRP.

Skilled Nursing Facility (SNF) Value-Based Purchasing Program VBP

For the SNF VBP program, CMS is proposing several operational and administrative proposals as part of this year’s rule. Operationally, this includes adopting a measure retention and removal policy to the SNF VBP program, as well as updating the case-mix methodology for the Total Nurse Staffing measure and a review and correction policy update. 

The SNF VBP program is a pay-for-performance program. As required by statute, CMS withholds 2% of SNFs’ Medicare fee-for-service (FFS) Part A payments to fund the SNF VBP Program. This 2% is referred to as the “withhold”. CMS is then required to redistribute between 50% and 70% of this withhold to SNFs as incentive payments depending on their performance in the program. 

Proposed Updates to the SNF VBP

• We are proposing adopting a measure retention and removal policy to help ensure that the SNF VBP Program’s measure set remains focused on the best and most appropriate metrics for assessing care quality in the SNF setting. We are also proposing adopting a measure removal policy that aligns with the measure and retention and removal policy currently in place in the SNF QRP program. 
• We are proposing an update to the case-mix methodology utilized as part of the Total Nurse Staffing measure. 
• We are proposing administrative policy updates, including an update of the Review and Correction policy that we previously finalized for the Program, to ensure that SNFs can review and correct Payroll-Based Journal (PBJ) data beginning with the FY 2026 program year and MDS data beginning with the FY 2027 program year.

To view the proposed rule, visit the Federal Register: https://www.federalregister.gov/public-inspection/2024-06812/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities  

[1] https://www.whitehouse.gov/wp-content/uploads/2023/07/OMB-Bulletin-23-01.pdf

[2] https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/

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CMS News and Media Group Catherine Howden, Director Media Inquiries Form 202-690-6145