travel nursing salary cap

This Legislation Could Cap Travel Nurse Pay, Staffing Agencies Accused of "Price Gouging"

State and federal moves.

• What the Legislation Says

What Nurses Think

Updated 2/3/2022

It’s no secret that there has been a disparity in agency nurse and staff nurse wages over the past year and a half. And the disparity is becoming increasingly bigger as the weeks pass by. Travel nurse pay has never been higher since the pandemic started, with August numbers showing a weekly average rate of over $2.5K, compared to a December 2019 average weekly pay of just over $1K. And as staffing issues continue to plague the entire country, they show no signs of slowing down. 

However, in an attempt to stop the ballooning wages—and perhaps better balance the gap between staff and travel nurse pay—some states have introduced legislation to cap agency nurse pay. As you can imagine, the idea has a lot of people talking, so here’s more on what the legislation is proposing, and how nurses are responding. 

During the pandemic, there have been both state and federal moves towards enacting legislation specifically aimed towards more regulation for staffing agencies and limiting travel nurse pay rates. Most recently, the American Health Care Association/National Center for Assisted Living, LeadingAge and a coalition of long-term care and senior living organizations sent a letter to White House officials warning against the “price gouging” happening in staffing agencies and how the practice is harmful to both patients and providers, who receive fixed reimbursement primarily through Medicare and Medicaid. 

That letter was followed by another one , signed by 200 supporters, urging Congress to enlist federal agencies with competition and consumer protection authority to investigate the conduct of nurse staffing agencies to determine if it is the product of anticompetitive activity and/or violates consumer protection laws. The letter cited that nursing staffing agencies are sometimes taking as much as 40% of the fee collected from hospitals, adding that continuing to pay the high fees to staffing agencies is “ simply unsustainable.”

Supporters behind the movement to cap travel nurses’ pay say that the pandemic has thrust the need for more requirements for staffing agencies into a major spotlight and that ignoring the financial and regulatory issues brought on could lead to long-term impacts. 

Nationally, the American Health Care Association (AHCA) sent a letter to the Federal Trade Commission (FTC), urging the FTC to use its authority to protect consumers from anti-competitive and unfair practices regarding agency staffing. Statewide, Massachusetts and Minnesota are the only two states to already have agency wage caps in place, but some states did make initial moves to address high wages during the pandemic. (Although, notably, Massachusetts raised its caps by 35% for the amount agency staff for nursing homes could be paid during the pandemic.) In Minnesota, wages were also raised , but only slightly: agency RNs can make a max of $58.08/hour at regular pay and up to $99.90/hour for holiday pay. 

Other states have tried to make some kind of moves towards regulating staffing agencies. For instance, with the advent of the pandemic, Connecticut prohibited profiteering during emergencies, with violators subject to fines by the state Department of Consumer Protection and the Office of the Attorney General. The New York State Health Care Facilities Association has also tried to introduce legislation but has not been successful yet. So far, Pennsylvania is the only state that appears to have the most concrete plan in place for moving forward with legislation specifically aimed at regulating staffing agencies. 

What the Legislation Says 

Although the legislation in Pennsylvania hasn’t been formally introduced yet, Pennsylvania Representative Timothy R. Bonner wrote a memorandum on November 5, 2021, that he plans to introduce Pennsylvania Health Care Association (PHCA)-supported legislation that will “require Contract Health Care Service Agencies who provide temporary employment in nursing homes, assisted living residences and personal care homes to register with the Department of Human Services (DHS) as a condition of their operations in Pennsylvania.”

As part of the requirements, the proposed legislation would establish maximum rates on agency health care personnel. Bonner noted that nursing homes in Pennsylvania lost 18% of their workforce, with 68% of the state’s facilities struggling to meet minimum staffing requirements. As a result—like many other healthcare facilities in the nation—agency staff filled those needs. However, in his memo, Bonner cited a statistic that 39% of the surveyed facilities said that they would not be able to afford to keep their facilities open for more than one year. 

Part of that, he added, was the added cost of paying staffing agencies. In some cases, wages have ballooned to over 400% above the median wage rate for long-term care facility staff. Additionally, some of the facilities themselves have lost their own staff to travel agencies. And because long-term care facilities are funded primarily through Medicare (70% of all care in the state’s facilities are through the Medicare program), paying high agency staff wages has significantly drained Medicare funds as well.  

Although the legislation would incorporate a cap on agency pay, it also aims to allow state agencies oversight of supplemental health care service agencies, which they currently do not have. That would include everything from registration requirements to an established system for reporting and penalties. 

“Recognizing the increased role that these agencies play in the day-to-day operations of nearly 700 nursing homes and 1200 assisted living residences and personal care homes, we must ensure they are operating in a manner that supports the long-term care sector and high-quality resident care,” Bonner wrote. 

As you can imagine, travel nurses have something to say about this legislation. In a travel nursing group on Facebook , over 270 comments poured in during a discussion on travel nurse wage caps. 

Some nurses hinted that they would strike if legislation capping pay came to pass, while others warned that there would be no need for a formal strike--travel nurses could simply not pick up new assignments, making staffing shortages even worse. 

“I have just had my best year ever. I could easily sit out for 6 months or change careers,” wrote one nurse. “They do not want to screw around with nurses right now. It is curious that people making legal policy don't possess the professional credentials to do our jobs but believe that they know better than us anyway,” this nurse added. 

Other nurses pointed out that a wage cap could potentially put both patients and healthcare facilities at risk amidst another COVID-19 surge or even another health emergency. “If they try to cap RN pay, what will happen if there’s another COVID surge,” commented another nurse. “Let’s say they cap our rate at 5K, if there’s another surge they will most likely not get much RN’s wanting to help. So they better tread lightly otherwise they will have bigger problems in their hands. A severe nursing shortage.” 

Another commenter chimed in to agree with Celne: “Right?” wrote a nurse. “If they cap, why would anyone want to go help with surges. I’m not going into a hot mess doing more work when I can stay capped right where I am for less work.” 

There is also a Change.org petition circulating online as a result of the letter to Congress that aims to stop the efforts to cap travel nurses pay. “We all know that wage caps are going to have a detrimental effect on staffing, forcing even more nurses to give up working at the bedside and further worsening the problem at hand,” the petition reads. “What about encouraging legislation to protect the safety and rights of nurses? What about legislation to nationalize safe nurse-to-patient ratios? What about legislation to set a fair, competitive minimum pay for nursing? Reach out to your elected officials and voice your concerns. There are many solutions out there, but this isn't one of them.”  

It’s left to be determined exactly if the legislation will pass and what the possible ramifications could be for both the travel nursing industry as well as the ongoing nursing shortage.  

Chaunie Brusie , BSN, RN is a nurse-turned-writer with experience in critical care, long-term care, and labor and delivery. Her work has appeared everywhere from Glamor to The New York Times to The Washington Post. Chaunie lives with her husband and five kids in the middle of a hay field in Michigan and you can find more of her work here . 

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Registered traveling nurse Patricia Carrete, of El Paso, Texas, reads a book during a quiet moment on a night shift at a field hospital set up to handle a surge of COVID-19 patients, Wednesday, Feb. 10, 2021, in Cranston, R.I. (AP)

Congress hasn't proposed traveling nurse pay cap, but asked for staffing agencies probe

If your time is short.

There has been no legislation proposed in Congress to cap pay for traveling nurses.

A letter signed by nearly 200 legislators called for an investigation into high pricing by staffing agencies, but its authors insist they do not want to cap wages for traveling nurses.

Some states are considering capping how much staffing agencies can charge healthcare facilities. This could lead to lower salaries for traveling nurses, one expert said.

A letter sent to a White House official and signed by nearly 200 members of Congress from both parties has sparked concern among traveling nurses that legislators want to cap their pay.

"According to Congress, travel nurses need a pay cap," read a Feb.  7 Facebook post from one nurse, who added, "Staff nurses aren’t paid enough, and the ones who left to travel and help are now being told they make too much. We were once heroic and now it’s back to reality."

The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about our partnership with Facebook .)

There’s no evidence that these lawmakers are advocating a cap on nursing pay. But a group of lawmakers did ask federal officials to inspect the way staffing agencies charge healthcare facilities. And some states are considering capping what staffing agencies charge hospitals, which one industry expert said could lead to reductions in nursing pay.

Traveling nurses have been in high demand during the COVID-19 pandemic. The job often comes with higher than average pay — sometimes two to three times higher — as an incentive to attract nurses to temporarily live and work in areas where there aren’t enough qualified nurses. 

Two congressmen, Reps. Peter Welch, a Democrat from Vermont and Morgan Griffith, a Republican from Virginia, spearheaded the Jan. 24 letter to Jeff Zients, the White House’s COVID-19 response team coordinator, expressing concern that some staffing agencies are taking advantage of the pandemic to inflate their prices for profit. The lawmakers called for a federal investigation into the agencies’ pricing practices.

The American Hospital Association, American Health Care Association and the National Center for Assisted Living sent a similar letter to Zients on Jan. 27, saying the staffing agencies are "exploiting" the facilities’ "desperate" needs for personnel. 

" The AHA and AHCA/NCAL have each urged the Federal Trade Commission to investigate this conduct as a violation of our antitrust or consumer protection laws but we have not yet received any response," the letter said, urging Zients to see that the matter "gets the attention it merits from the federal government."

While both letters complained of the high rates staffing agencies are charging health care facilities to supply workers, neither mentioned capping pay for nurses or proposed any federal legislation that would cap pay.

Griffith issued a statement on Feb. 5 to address what he called "disinformation" about the letter, saying that he has not introduced legislation to cap nurses’ pay, nor would he support any.

"The bipartisan letter I sent to the White House asks about potential illegal practices by staffing agencies that charge high rates and then keep that money for themselves, not nurses. Rumors are that middleman staffing agencies keep as much as 40% of the money they charge for nurses instead of giving more of the money to the nurses," he said. "I do not and will not support legislation to cap nurses’ pay. Anything to the contrary is fake news."

Emily Becker, a spokesperson for Welch, said the congressman also is "categorically opposed to pay caps for nurses, including travel nurses." His office is "not aware" of any federal legislation proposed or in the works that would cap nurse pay and he "would oppose such legislation," she said.

Welch wants an investigation "to determine whether there has been any improper behavior on the part of staffing agencies and the private equity firms that own them," said Becker, who pointed to an article by the health news publication STAT, with a headline about private equity firms cashing in on the traveling nursing business. An analysis by STAT showed that since early 2021, "at least eight private equity firms have bought at least seven staffing agencies."

Welch has not heard back from the White House about the letter, Becker said.

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The American Health Care Association/National Center for Assisted Living said in a statement to PolitiFact that it also was not advocating for a pay cap for traveling nurses, but rather an investigation into "potential anticompetitive practices" by staffing agencies, who may be taking advantage of the pandemic and labor shortages, while only giving the nurses "a fraction of what the agency is charging the facility."

The American Nurses Association, meanwhile, earlier this month issued a statement calling on Congress to address the root causes of nurse shortages. It applauded efforts to address any price gouging, as long as "travel nurses are not negatively impacted in the process."

The median pay for registered nurses in 2020, the last year data was available, was about $75,000 per year, according to the U.S. Bureau of Labor Statistics. Salaries have risen for staff nurses as hospitals tried to attract workers and compete with staffing agencies, The Wall Street Journal reported .

High demand has translated into higher pay from staffing agencies, which in turn pass their higher costs on to hospitals and nursing homes, said Toby Malara, the vice president of government relations for the American Staffing Association , a trade group for the U.S. staffing and recruiting industry.

Malara said the higher prices are simply "a matter of supply and demand driving the rates up." Staffing agencies trying to attract nurses to high-demand areas must factor in higher costs of living in big cities and the risk for nurses working in COVID-19 hot spots, which he called "akin to hazard pay."

He said that 75% of the rates staffing agencies charge hospitals help cover expenses like nurses’ wages, federal and state taxes, workers compensation and unemployment insurance, and benefits. 

Malara said the ASA has not heard from the White House or the FTC about an investigation. An FTC spokesperson told PolitiFact that the agency does not comment on or confirm the existence of investigations.

Malara said that he does not expect to see any federal legislation as a result of the letter from the legislators.

But some states are considering rate caps on what staffing agencies can charge hospitals, which is in essence "a salary cap on nurses because you're limiting what nurses can be paid," Malara said. 

In Pennsylvania, Rep. Timothy Bonner introduced legislation in January that he said in a November memo "would establish maximum rates on agency health care personnel to end the practice of ‘gouging’ the Medicaid program and Pennsylvania taxpayers."

Currently, only Massachusetts and Minnesota have state caps on what staffing agencies can charge healthcare facilities for nurses or other professionals, MedPage Today reported . Malara said staffing agencies struggle to recruit nurses in those states because they can go elsewhere for higher pay if the market demands it.

A Facebook post said that "according to Congress, travel nurses need a pay cap."

A group of nearly 200 legislators sent a letter to the White House asking for a federal investigation into what it called "inflated" prices that staffing agencies are charging hospitals to supply nurses. A similar letter was sent by hospital and nursing home groups. No investigation has been announced by the White House or FTC.

However, the letters did not call for pay caps on what travel nurses make, nor has any legislation been proposed in Congress. The two main authors of the letter said they do not want to see lower pay for travel nurses as a result and would not support any legislation that proposes that.

Some states are considering rate caps on what staffing agencies can charge hospitals and that could ultimately result in lowered salaries for nurses, an industry expert said. But that’s not what the Facebook post is claiming.

We rate this claim False.

CORRECTION, Feb. 17, 2022: U.S. Rep. Peter Welch is a Democrat. An earlier version of this post listed the wrong party affiliation. 

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Facebook post ; Archived: here

Statement from ​​the American Health Care Association/National Center for Assisted Living, Feb. 14, 2022

Email exchange with Emily Becker, spokesperson for Vermont U.S. Rep. Peter Welch, Feb. 15, 2022

Interview with Toby Malara, vice president, government relations, for the American Staffing Association, Feb. 15, 2022

Rep. Morgan Griffith, " Griffith statement on disinformation about nurses’ pay ," Feb. 5, 2022

Letter from U.S. Reps. Peter Welch and Morgan Griffith, to Jeffrey Zients, White House COVID-19 response coordinator," Jan. 27, 2022

Letter from the American Hospital Association, the American Health Care Association and the National Center for Assisted Living to Jeffrey Zients, Jan. 27, 2022 

Associated Press, " AG looks at high rates nursing home staffing agencies charge, " Jan. 13, 2022

American Nurses Association, " ANA Calls on Congress and the Administration to Investigate and Mitigate the Root Causes of Nurse Shortages ," Feb. 1, 2022

American Staffing Association, " What's Really Driving the Cost of Temporary Nurses ," February 2022 

First Coast News, " No, Congress is not considering a salary cap for nurses ," Feb. 14, 2022

Nurse.org, " This Legislation Could Cap Travel Nurse Pay, Staffing Agencies Accused of "Price Gouging ," Feb. 3, 2022

The Wall Street Journal, " Travel Nurses Make Twice as Much as They Did Pre-Covid-19 ," Feb. 8, 2022

The Wall Street Journal, " Nurse Salaries Rise as Demand for Their Services Soars During Covid-19 Pandemic ," Nov. 22, 2021

The New York Times, " ‘Nursing Is in Crisis’: Staff Shortages Put Patients at Risk ," Aug. 21, 2021

NPR, " For travel nurses, jobs at home can't come close to pay they get on the road ," Feb. 11, 2022

U.S. Bureau of Labor Statistics, " Registered Nurses, 2020 " 

MedPage Today, " Will States Rein in Nurse Staffing Agencies? " Feb. 5, 2022

Massachusetts Executive Office of Health and Human Services, " Rates for temporary nurses ," May 8, 2020

Massachusetts Executive Office of Health and Human Services, " Addendum to Massachusetts Secretary of State Regulation Filing Form 940 CMR 3:18, Price Gouging ," 

Massachusetts Executive Office of Health and Human Services, " Memo to temporary nursing agencies executive officers ," Feb. 16, 2021

Minnesota Department of Human Services, " SNSA Maximum charges

Minnesota Department of Human Services, " Application Process for Waiver of SNSA Maximum Charges Request Form for MN Medicaid Certified Nursing Facilities ," Oct. 16, 2020

Minnesota Department of Health, " Supplemental Nursing Services Agency, Minnesota statute 2000, section 144.057 - 144A.74 ," July 2001

Pennsylvania Rep. Timothy Bonner, " Registration and Oversight of Contract Health Care Service ," Nov. 5, 2021

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Congress hasn't proposed traveling nurse pay cap, but asked for staffing agencies probe

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Health Care

Hospitals ask biden administration to help lower the soaring cost of travel nurses.

Shalina Chatlani

It's now been a year since the American Hospital Association alleged price gouging and asked the White House to investigate and act. Bidding wars among states have only escalated.

ARI SHAPIRO, HOST:

The American Hospital Association says health care staffing agencies are exploiting the pandemic, forcing them to pay astronomical wages for temporary nurses and other staff. Nurses who sign on with the agencies and who are willing to travel can more than double their salaries. That's because of the large sums of federal COVID relief money given to states. Shalina Chatlani, with the Gulf States Newsroom, reports hospitals are asking the White House to do something.

SHALINA CHATLANI, BYLINE: Last year, Kimberly Carson got tired of the nursing job she'd had for eight years at a hospital in Illinois. She didn't think she was being paid well enough to compensate for the pandemic workload.

KIMBERLY CARSON: I feel like you should be able to afford to pay your staff more money and better wages.

CHATLANI: Carson says, by the time the hospital started offering bonuses, it was too late.

CARSON: Like, where were you at, at the beginning when we really needed you? Where were you?

CHATLANI: So she quit and since December has worked as a traveling nurse, making twice her old salary on a temporary contract with a Mississippi hospital.

Demand for travel nurses has soared. Before the pandemic, hospitals sought to hire about 7,000 traveling nurses at any one time. By 2021, they were looking for 28,000. That's in part because of COVID relief money Congress sent states. Most are using it to hire travel nurses. Texas alone has spent $7 billion on temporary medical staff.

ROBYN BEGLEY: It's just not sustainable.

CHATLANI: Robyn Begley is with the American Hospital Association.

BEGLEY: Some hospitals that really struggle to break even at - year after year, we are really in a crisis.

CHATLANI: Nurse wages have also gone up because there are now far fewer nurses than before the pandemic. The 100,000 open positions then has now doubled.

BEGLEY: Some nurse staffing agencies, we believe, are exploiting the severe workforce shortages and charging exorbitant fees.

CHATLANI: Toby Malara of the American Staffing Association, a trade group, says staffing companies are just responding to the current labor market.

TOBY MALARA: And their prices are being driven by the wages and the cost of labor that have come about by the pandemic.

CHATLANI: He says some hospitals and governments are actually making things worse by not being good stewards of COVID relief money.

MALARA: If the federal money is used to pay and retain nurses and pay them bonuses, that could be helpful. But also, it gives them a chance to push out money and pay those higher rates without thinking about it as much.

CHATLANI: Some states, like Massachusetts, are trying to create rate caps, but Malara says that could drive nurses away. Better, he says, would be increasing nurse numbers overall and Medicaid payments to hospitals.

MALARA: Increase federal funding for nursing schools. You have to increase the Medicaid reimbursements.

CHATLANI: The hospital association asked the Federal Trade Commission to investigate staffing agencies a year ago. The FTC won't confirm whether it's doing so. The association has sent multiple letters to the White House, too.

A Biden administration official declined to speak publicly about a complaint to the FTC, an independent agency, but said that the White House has deployed federal search teams, and it's helped cover costs for National Guard deployments to hospitals with staffing shortages. It's also trying to accelerate visa processing for 5,000 foreign health care workers.

JAMIE HEARD: It all boils down to, I'm doing this for my family. It boils down to money.

CHATLANI: Jamie Heard, an ICU manager in Mississippi, says for now, nurses know the labor market has changed, and there's a lot less incentive to stay at a given hospital.

HEARD: I can bounce within my career and make more money. Staying long at places is, I think, a thing of the past.

CHATLANI: Last week, nearly 200 members of Congress signed on to a letter to the White House, urging quick action to rein in high travel nurse costs.

For NPR News, I'm Shalina Chatlani in Jackson, Miss.

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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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Hospitals desperately need staff. But capping travel nurses’ pay won’t help.

The travel nursing boom is just a symptom of a much larger, self-inflicted problem.

An earlier version of this article stated that a letter by Rep. Peter Welch (D-Vt.) and Rep. H. Morgan Griffith (R-Va.) called for regulating the pay of travel nurses. In fact, the letter calls for federal agencies to investigate the prices charged by nurse staffing agencies. This article has been corrected.

Across the country, travel nursing has been making headlines , most of them focusing on how much money these short-term contract workers can make — double or triple what their staff counterparts earn. But compensation, while important, is often not the main reason nurses leave hospitals for these contracts.

In interviews, nurses from across the country have told me many variations of a shared story: Working conditions, which had never been ideal in the first place — due to lack of support staff and high patient-to-staff ratios, among other factors — have dramatically deteriorated. Nurses have been asked to work to the edge of their abilities; they fear for patient safety. For many, travel contracts present a way out they never thought they’d have to take. Some nurses say that a travel contract limited to 8- or 13-week bursts protects their physical and mental health. They know that no matter how bad conditions get, for them the situation is finite. Others are using the money as a bridge to get out of nursing altogether.

Nearly 1 in 5 health-care workers has quit since the pandemic began. A recent survey by the American Association of Critical-Care Nurses found that 92 percent felt that the pandemic had “depleted nurses in their hospital, and that their career would be shorter than they had intended as a result.”

Their capacities stretched to the breaking point, hospitals have turned to the temporary fix of hiring short-term travel nurses, further alienating staff nurses, who are then incentivized to quit and take a travel contract themselves. Demand for travel nursing grew by at least 35 percent in 2020 and has driven up salaries: Travel nurses can command an average of about $3,500 per week and sometimes even more. By the end of 2020, average weekly pay for travel nurses was more than double what it had been the year before. Nurses report being bombarded with recruiting offers; unfilled travel nurse openings hover around 40,000 .

Five myths about nurses

Yet the problematic explosion of traveling nursing is only a symptom of a longer-running, self-inflicted disaster: Over the long-term , hospitals have failed to hire and support enough nurses to weather crises.

Hospitals often say there simply aren’t enough nurses to hire. It’s true that in some parts of the country, particularly in low-income rural areas , there aren’t always enough nurses to go around. And because the majority of nurses are older than age 50, as the baby boomer generation ages into needing more medical care, there has been a surge in demand for nursing alongside a surge in retirements from nursing. Still, this is a deceptively narrow assessment of a complex problem — and it lets hospitals themselves off the hook.

The devaluing of nurses starts early in the pipeline. Though nursing schools are graduating an increasing number of nurses, they are also rejecting tens of thousands of qualified candidates because there aren’t enough instructors to teach them. Nurse educators are paid a fraction of what they could make working clinically. For those that do graduate, hospitals rarely provide the support that would allow new nurses to grow into veterans. “Some of the new grads get culture shock when they first come, and they quit because of the lack of training, preceptorship and mentorship that these hospitals are offering,” said Zenei Triunfo-Cortez, a nurse and president of National Nurses United, the country’s largest nurse labor organization. Newly graduated nurses quit their jobs in their first and second years of work by rates of 30 to 57 percent.

Hospitals also contribute to the problem by keeping their nursing staff as lean as possible, treating the nursing workforce like a tap they can turn on and off to maximize profits. At the beginning of the coronavirus pandemic , hospitals furloughed or laid off nurses when lucrative elective procedures were suspended, only to frantically try to hire them back as covid-19 hospitalizations rose. Ping-ponging from furloughs and layoffs to cutting hours and then to mandatory overtime is not a recipe for retention. The understaffing crisis is a circular problem: Not hiring enough nurses makes working conditions unbearable, leading to more nurses leaving their jobs.

The undervaluing of nursing has deep roots. From the dawn of modern American hospitals in the 19th century, hospitals have treated nursing care like something they should get for free. The first American training schools of nursing were located inside hospitals. There, students lived on-site to provide free care and received little formal education and support. When they graduated and expected salaries, their training hospitals generally didn’t hire them. Many graduates turned to private nursing, hired by individuals who could afford them. After World War I, despite a surplus of graduate nurses, hospitals nevertheless complained of a “shortage,” which was really a shortage of nurses who would work for free.

By the 1940s, as hospital care became more complex and labor-intensive, hospitals finally started to hire and pay graduate nurses in large numbers. But administrators never changed the way they thought about nursing, argues nurse historian Jean C. Whelan — that is, as a line item to be cut, not a resource to invest in. “Hospitals failed to question whether improving the working lives of nurses could make a positive impact on nurses’ decisions to enter and stay in the workforce,” Whelan wrote in her book “Nursing the Nation.”

Social workers are the unsung heroes of the pandemic

The way today’s hospitals make money reinforces this notion. Revenue mainly flows into hospitals through physicians, who perform billable services. Meanwhile, the costs of nursing care are wrapped up into the fee for room and board. If you were admitted to the general medical floor of a hospital, your nurse could have eight patients, or she might have four patients. Either way, the room and board bill the hospital sends to your insurance company will usually be the same. From a hospital administrator’s point of view, fewer nurses taking care of more patients is much more profitable. But from a patient’s perspective, this might mean you don’t see your nurse for hours.

In the end, this is not only inhumane but extremely ineffective in terms of health outcomes. Numerous studies over decades have shown that assigning nurses too many patients is associated with all kinds of bad outcomes for patients, from more hospital-acquired infections to more deaths. A 2018 meta-analysis found that the higher the level of nurse staffing in a hospital, the fewer patient deaths there were.

Employing more nurses per patient is safer for patients, and it makes nurses less likely to burn-out and quit . But hiring and supporting a large nursing staff is expensive, and many hospitals have been unwilling to do it. Travel nurses are expensive, too, but they are a short-term expense; they don’t get benefits or job security.

Amid this ongoing disaster, that rarest of things has emerged: bipartisan action. Earlier this year, Rep. Peter Welch (D-Vt.) and Rep. H. Morgan Griffith (R-Va.) proposed that federal agencies investigate the prices charged by nurse staffing agencies, citing concern that the high rates for travelers amounted to price gouging, and was contributing to the destabilization of the health system. The proposal , sent to the White House covid-19 response team, was signed by 200 members of Congress, an ideologically disparate group including Ilhan Omar (D-Minn.) and Nicole Malliotakis (R-NY). Pennsylvania and Oregon , among other states, are considering similar proposals. Meanwhile, the American Health Care Association and the American Hospital Association have asked the Federal Trade Commission to curb what they call “price-gouging” by agencies. Though the AHA denies it has advocated for nurse pay caps, some nurses reasonably fear that caps are the logical end result.

Incredibly, given Congress’s inability to come together to curb prescription drug costs or pass paid family leave, they have found common ground on one issue: cracking down on nurses’ pay. Meanwhile, rising hospital administrator pay has escaped political scrutiny — though there is no correlation between those salaries and hospital mortality or readmission rates. This is not only deeply unfair and shortsighted, it may make the problem worse. Capping the relatively high wages currently commanded by nurses willing to leave home and provide crisis care could decrease the number of nurses willing to work in those environments.

As historian Susan M. Reverby has observed , American nursing’s central problem is “the order to care in a society that refuses to value caring”: In this context, care is often impossible. In my conversations with nurses, this painful reality comes up again and again. It is a nightmare to know that your patients need the best care you can provide and to also know that your working conditions prevent you from providing it. Can anyone blame nurses for turning the tables, for working within the system’s own flawed, profit-driven logic, for charging what the market will bear? Can we really look at the state of our health-care system and conclude that travel nurse salaries are the problem? Isn’t it telling that the industry has only asked the government to step in now, when nurses are the ones wielding their market power?

If the industry — and our lawmakers — truly want to address the staffing crises, they will need to start at the root of the problem: our collective failure to value caring.

Contract Nurse Agencies Are Making Big Money in the Age of COVID-19. Are They ‘Exploiting’ the Pandemic?

I n the 40 years that Jennie Kahn has worked as a registered nurse, the last two have been by far the most grueling.

A lot of that is due to COVID-19, which transformed health care facilities, including Thomas Health’s hospital system in Charleston, West Virginia, where Kahn works, into triage centers and forced nurses to take on an extraordinary amount of personal risk and heartache. It’s no mystery why some 18% of health care workers quit their jobs between Feb 2020 and Sept 2021, according to a Morning Consult poll.

But another reason these past two years have been so punishing, Kahn says, is that hospital nursing staffs have been subject to extraordinary churn as thousands of nurses have quit their staff positions to become contract travel nurses, where the pay is often two to four times higher. This rapid turnover has triggered a costly feedback loop: hospital administrators, facing shortages in staff nurses, spend a mint hiring contract nurses, which makes them less able or willing to increase their staff nurses’ pay. So more staff nurses quit to become contract nurses, thus further lowering nurse supply and driving demand for contract nurses. “It is a vicious cycle,” says Kahn, the hospital system’s chief nursing officer.

Meanwhile, contract nursing agencies have increased their prices. The advertised pay rate for travel nurses has surged 67% from January 2020 to January 2022, according to Prolucent Health, a workforce management tool for healthcare companies, while some staffing agencies such as AMN Healthcare, told TIME that pay rates for travel nurses at facilities they work with rose by 164% from the fourth quarter of 2019 to the fourth quarter of 2021. Some of these agencies’ profit margins top 20%.

Some hospital administrators, many of which saw their facilities’ profits shrivel during COVID, say they’ve reached a crisis point and are calling on Congress and the Biden Administration to step in. They argue that contract nursing agencies are exploiting circumstances resulting from COVID-19 to pad their own pockets. The agencies say their prices are merely a reflection of growing demand. Nurses, meanwhile, argue that hospital administrators, who are somehow finding a way to pay premium rates for contract nurses, could have avoided the mass nurse exodus by paying their staff nurses better and improving working conditions from the start, and that a fragmented nursing force with quick turnover is bad for patients’ health.

The solution is not straight-forward. Health care facilities, desperate to keep nurses on staff, may have to improve salaries and working conditions, but at many facilities, that’s easier said than done. At long-term care centers, bottom lines are dictated by Medicare and Medicaid reimbursement, and at many small and medium-sized hospitals, the cost of personal protective equipment and patient loads have fluctuated dramatically since March 2020.

“This is not anything that any health system can sustain for a long period of time,” says Kahn. “If the rates do not decrease or if travel nursing is not reduced somewhat, hospital systems are going to have to find alternative ways to provide patient care.”

An explosion of temporary staffing

Travel nurses have been around for decades and became more widespread in the 1980s, as nursing shortages grew, but it’s really the pandemic that changed the landscape of the profession. In some healthcare settings, contract nurses are now almost as prevalent as staff nurses.

Jeffrey Tieman, president and CEO of Vermont Association of Hospitals and Health Systems (VAHHS), says that prior to COVID-19, his system used travel nurses “as a stop gap”; now he says they’re “in every department of the hospital every day of the week.” The same is true of Thomas Health, Kahn says. When she first became the hospital system’s chief nursing officer in 2019, the acute care team didn’t rely on traveling nurses at all; these days, about 40% of her acute care nurses are on temporary contracts.

The financial fallout of this trend for hospitals’ and nursing homes is staggering. Due largely to the increase in contract nurses, Thomas Health is now roughly 100% over its previous staffing budget, the hospital system tells TIME. Between Fiscal Years 2020 and 2021, VAHHS’s outlay for contract nurses increased $29 million, or 35%, the group says. “As the pandemic picked up and dragged on, the need for nurses intensified when the supply of nurses diminished,” Tieman says.

Depending on contract nurses also creates logistical problems, says Deb Snell, a registered nurse and the president of the Vermont Federation of Nurses & Health Professionals. “It is difficult when you have new people coming in every 12-13 weeks, and orienting them to your floor, making sure they know where equipment is, where meds are, who to call for a problem,” she says. “It’s constant turnover.”

Struggling to fill empty roles and way over budget on staffing, VAHHS reached out to Vermont Congressman Peter Welch for help coming up with a solution, and on Jan. 24, Welch and Morgan Griffith of Virginia wrote a letter to the White House, cosigned by nearly 200 other members of Congress. The letter urges the Biden Administration to investigate the extent to which contract nursing agencies are exploiting the pandemic to drive their profits by engaging in anticompetitive activity. “We are writing because of our concerns that certain nurse-staffing agencies are taking advantage of these difficult circumstances to increase their profits at the expense of patients and the hospitals that treat them,” the letter says.

Days later, the American Hospital Association and the American Health Care Association/National Center for Assisted Living, the major nursing home trade group, threw their support behind Welch and Griffith, calling on the Administration to help prevent the travel agencies “from exploiting our organizations’ desperate need for health care personnel.”

Travel nurses, meanwhile, were incensed. On social media and message boards, they begged supporters to call their members of Congress to defend them and their pay schedules. “Wait, what? They want to cap travel nurse pay but they won’t cap CEO and executive pay? Well… I guess they know who their true masters are, and it sure as hell ain’t the voters,” wrote one Reddit user.

“It’s just because they can get away with it”

Welch says capping contract nurses’ take-home pay was never the intention of his letter. “I never have and never would propose a cap on nursing pay,” he says. “Nurses are the frontline, and they’re overworked, they’re underpaid, and they legitimately point out how the executives get fat salaries while they have to do all this work.”

Instead, he says, one big reason for the financial burden on hospitals is the fees that nurse staffing agencies charge to assign travel nurses to health care settings that need them. Proculent Health, the workforce management tool used by healthcare companies, estimates that hospitals and other healthcare facilities are billed an additional 28% to 32% above the wages the agencies pay contract nurses.

Welch argues these agencies may be exploiting the pandemic’s circumstances at the expense of hospitals, health centers, and the patients who seek care at them. “The fee that the agency charges is not related to any additional work they do, or any value added,” Welch tells TIME. “It’s just because they can get away with it.”

AMN Healthcare Services reported its gross profits were $434 million in the fourth quarter of 2021, up 109% from a year prior, according to an annual earnings report . Its net income, which takes into account all business related expenses and taxes it had to pay, was $116 million, an 1100% increase. Another healthcare staffing agency, Cross Country Healthcare, saw its revenue increase 93% between the third quarters of 2020 and 2021. It also reached $1 billion in annual revenue for the first time in the company’s history in 2021.

In recent months, private equity firms have begun acquiring contract healthcare staff agencies at a rapid clip, signaling to Welch that investors believe there is even more money to be made off the travel nurse industry in years to come—which would put hospitals under even greater strain. One of the largest healthcare staffing agencies, Medical Solutions, was purchased by two private investment firms in August. Favorite Healthcare, another large staffing group, was bought by a private equity-owned staffing firm in January.

“Three of the 10 largest staffing agencies—and probably more—were purchased by private equity right around the time that the pandemic began,” Welch says.

Staffing agencies argue that the higher prices health care facilities are paying are driven primarily by the higher wages the agencies pay nurses to meet the demand. In 2020, 75% of revenue nurse staffing agencies made went to wages and the costs of employing nurses, including payroll taxes, worker’s compensation and unemployment insurance payments, and other benefits, says Toby Malara, vice president of government relations for the American Staffing Association (ASA), a trade group for the staffing industry. He adds that most of the association’s nurse staffing agencies have seen their profits remain “relatively stable” during the pandemic.

Nurses worry about pay cuts — for good reason

Many nurses are worried that heightened government scrutiny will result in lower take-home pay for them — and that anxiety is not necessarily unfounded. Some states already cap nurse pay under certain situations, or are considering legislative action to do so. Minnesota, for example, caps contract nurses who work in nursing homes. The most that an RN can earn per hour during non-holidays is $62.36, according to documentation provided by the state’s Department of Health. Massachusetts caps pay for RNs at hospitals around $120 per hour. At nursing home facilities, the state caps an RN’s pay around $79 per hour, the state’s Executive Office of Health and Human Services says .

Other states including Kansas, Ohio, Oregon, Illinois and Pennsylvania are now considering legislation to cap nurse pay in some cases. Pennsylvania state Rep. Timothy Bonner has introduced a bill to establish maximum rates for employees of travel nursing agencies in his state that would be no higher than 150% of the average statewide pay rate for similar jobs. “[Staffing] agencies have seized on the pandemic and the critical need for workers,” he wrote in a letter to his statehouse colleagues, according to the Lewistown Sentinel , “and have raised their hourly rates to 100 percent, 200 percent or even 400 percent above the current median wage rate.”

The White House referred TIME’s questions about how regulatory action against the contract nursing industry would work to the Federal Trade Commission, which did not return a request for comment.

Many nurses say arbitrary pay caps are unfair. The problem is not high pay, they say; it is that there aren’t enough nurses to do an increasingly challenging job for relatively low wages. And while the pandemic exacerbated nurse shortages nationwide, the problem long preceded COVID-19’s added pressures. “Things were already getting tight even prior to the pandemic,” says Snell in Vermont. “Nurses have known and seen this coming for a while. We just couldn’t get people to listen.”

Part of the issue is demographics. The median age of RNs in 2020 was 52, according to a recent survey from the National Council of State Boards of Nursing, and with baby boomers retiring, more nurses will need replacing. But there’s no lack of interest. Enrollment in baccalaureate and higher-degree nursing programs increased in 2020, according to the American Association of Colleges of Nursing, and nurse practitioner graduates have swelled in recent years too. Nursing schools could be training even more graduates, experts say, but the cost of nursing school can be a barrier for students, and schools are also experiencing a shortage of nursing instructors.

But the largest factor, according to nurses unions and professional groups, is how low the pay is compared to how difficult the work environment is. “There is no nursing shortage in the United States. There is a shortage of nurses who are willing to work in these conditions,” says Michelle Mahon, a registered nurse who is assistant director of nursing practice at National Nurses United (NNU), the largest nurses union in the country. “This is something that’s been created by health care employers over a very long period of time.”

NNU has frequently criticized hospitals for adopting what it says are policies of chronic understaffing in order to help their bottom line. High patient-to-nurse ratios deteriorated patient care and put nurses at increased risk of workplace injuries and infections before COVID-19, Mahon says. Then when the pandemic swept in, hospitals that had prioritized cutting costs were unprepared.

Health care doesn’t operate like a free market

While some nurse unions have been able to demand raises from large hospital systems during the pandemic, health facilities that see primarily patients who have government health insurance are often more limited in what they can pay. Nursing homes are overwhelmingly paid by Medicaid and Medicare, so they say the rates they can pay nursing staff are largely determined by how much the government programs reimburse per patient, and hospitals in low-income areas can face similar situations.

About 70% of the costs of operating a nursing home are related to labor, according to Clif Porter, senior vice president of government relations at AHCA/NCAL. But even as facilities have had to pay two to three times normal wages to hire temporary nurses during the pandemic, their reimbursement rates have not kept pace. “I can’t pass on inflation to my customer,” he says. “This creates a situation where our expenses exceed our revenue. It’s just that simple. And that’s just not sustainable.”

Porter says that he doesn’t want maximums for what nurses can make, but floats the idea of a cap on agency profits or regulations that stipulate how much of what a staffing agency charges it must pass on to its workers.

“If the legislation were to directly impact the [agency] overhead, we don’t believe that nurses salaries would be impacted,” says Ernest Grant, president of the American Nurses Association. But the ANA does not support any effort to lower nurse wages, and Grant added that the concern over price gouging has “become quite a distraction.”

Mahon agrees, saying the idea of investigating these staffing agencies will not solve the staffing crisis. Even if the health care facilities are not happy about the rates these staffing agencies are charging, she notes, they have found the money to pay them. “If there was serious reflection and introspection and desire to solve [the nursing shortage], it would be focused inward by this industry,” Mahon says.

More nurses, better treatment

Nurses groups’ say there are other solutions that could retain and attract a larger workforce. NNU would like to see minimum staffing ratios, enhanced workplace safety measures, and increased funding for nursing education, for example. The ANA has also promoted ideas including improving nurse hours and mental health support, adjusting the Centers for Medicare and Medicaid Services payment methods, and removing barriers that make it difficult for nurses to practice. “We really need to address it once and for all, and not just cap it off at this particular time,” Grant says.

Desperate to retain staff, Thomas Health, where Jennie Kahn works, has increased bonus pay, instituted recruitment bonuses, expanded its tuition repayment programs and started offering its staff free meals at hospital cafeterias.

The University of Vermont Medical Center, meanwhile, just agreed to raise its nurse’s wages by 20% over two years, with 10% being implemented now and an additional 5% coming in October 2022 and an additional 5% coming in October 2023.

Though Snell says the raises are a positive step toward retaining staff, she’s not certain it is sufficient to stop the bleeding. A study released in October by the American Nurses Foundation reports 21% of nurses nationwide said they planned to resign from their jobs within the next six months. Another 29% said they were considering leaving. University of Vermont Medical Center is not immune.

“We have a lot of nurses leaving our hospital to go travel,” she says. “I’m hoping the 10% right now will be enough to maybe keep some of them in place.”

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Write to Abby Vesoulis at [email protected] and Abigail Abrams at [email protected]

What You Need to Know About a Travel Nurse Pay Cap

August 15, 2022

Fusion Medical Staffing

Here’s what you need to know about what travel nurse pay caps are, the legislation on them, and what happens next.

What is the travel nurse pay cap?

• Why cap travel nurse pay?
• Is Congress trying to cap travel nurses pay?

What states are trying to cap travel nurse pay?

What happens next with the cap on travel nurse pay.

Note: The following information was up to date at the time of publication, but changes after the time of publication may impact the accuracy of the information.   What You Need to Know About a Travel Nurse Pay Cap

There are some healthcare facilities, hospital lobbies, and legislators that want to limit how much travel nurse agencies can charge hospitals and healthcare facilities, or in other words, put a cap on their bill rate. A bill rate is the total amount a healthcare staffing agency charges a hospital or healthcare facility for each traveler they place.

The bill rate goes toward paying the traveler as well as travel nursing agency costs like recruiting, HR, benefits, travel reimbursements, payroll taxes, worker’s compensation, unemployment insurance payments, and more. Additionally, Toby Malara , vice president of government relations for the American Staffing Association (ASA), a trade group for the staffing industry, maintains most of the association’s nursing staffing agencies have seen their profits remain “relatively stable” during the pandemic.

It's important to note that a lot of the legislation or calls to investigate agencies doesn’t explicitly call for travel nurse pay caps. However, it’s understandable why some healthcare professionals are nervous caps on agencies’ rates could translate to caps on what travel nurses and agency health care personnel who travel can earn. Hence, the worry about travel nurse pay caps.

Why cap travel nurses pay?

But why do these organizations want to put a max on bill rates? Well, travel nurse agencies are being accused of price gouging during COVID-19 or requesting higher rates for travel nurses than needed. So, let’s take a step back and investigate what was going on in the market at the time.

Why were travel nurse staffing agencies' pay rates higher during COVID?

At the highest end of the spectrum, crisis pay rates reached $10,000 a week during the peak of the pandemic. Compare that to today’s rates of about $3,000 a week and it seems steep. However, there are a lot of factors that go into why rates got that high.

For starters, a healthcare staffing shortage, particularly a nursing shortage, existed well before COVID arrived, and the pandemic has only exacerbated it. When hospitals are short-staffed due to an inability to find or hire talent, staff-to-patient ratios become dangerous. Existing staff must work harder and face burnout, all while likely being underpaid. Add COVID to the mix and the situation became much worse.

One solution is to fill this shortage by hiring more nurses. Employing more nurses is safer for patients and makes it less likely for staff to burn out and quit. However, hiring more staff nurses isn’t always an expense a hospital wants to take on, especially during an uncertain time like COVID. Enter travel nurses. While bringing on travel nurses is expensive too, it’s a short-term expense that hospitals are more comfortable making.

So, hospitals utilized travel nurses to meet the demands of COVID. However, for travelers to drop everything and travel to remote areas, work long, grueling hours, and constantly risk COVID infection, they needed higher pay, meaning agencies needed to charge higher bill rates.

The American Staffing Association also points out that while travel nurse pay has increased, so have the demands of the job. Over the past two years, healthcare workers have dealt with stress, burnout, overwork, physical danger, and animosity from coworkers, patients, and hospital visitors.

Is Congress trying to cap travel nurse pay?

Yes and no. Price gouging accusations have stirred up heightened government scrutiny and action taken by legislators and hospital lobbyists, but they haven’t explicitly called for a cap on traveler pay. Here’s a timeline of what’s been happening:

Feb. 4, 2021: The American Health Association (AHA) sent a letter to Acting Chairwoman Rebecca Slaughter

• Asked Slaughter to employ the Federal Trade Commission (FTC) to “investigate reports of anticompetitive pricing by nurse-staffing agencies.”

Oct. 8, 2021: LeadingAge, a network of non-profit aging services, sent a letter to the Chairwoman of the FTC, Lina Khan

• Asked the FTC to “protect consumers and taxpayers from anti-competitive and unfair practices to investigate these activities and take appropriate action to protect long-term care providers and the seniors they serve.”

Nov. 15, 2021: Sen. Mark Kelly, Sen. Bill Cassidy, Rep. Doris Matsui, and Rep. David McKinley sent a letter to COVID-19 Response Team Coordinator Jeffrey Zients

• Asked Zients to enlist a federal agency to investigate "the extreme prices being reported for nurse staffing agencies from hospitals in our states, and the concern that certain staffing agencies may be taking advantage of these difficult circumstances to increase their profits at the expense of patients and the hospitals that treat them."

Jan. 24, 2022: 200 members of Congress sent a similar letter to Zients

• Asked Zients to ask the FTC to determine if the rates agencies were charging are “the product of anticompetitive activity and/or violates consumer protection laws.”

Jan. 27, 2022: The AHA, along with the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) sent another letter to Zients

• Reiterated the same concerns but added that their “concerns focus directly on the agencies and not the personnel they represent.”

Feb. 2, 2022: The AHA made a statement

• Continued to “urge the FTC to investigate these reports of anticompetitive conduct from staffing agencies that are exacerbating workforce shortages and straining the health care system,” and “ask that Congress look into this pressing matter and coordinate with the FTC and other agencies where appropriate.”

Feb. 10, 2022: U.S. Senate Committee on Health, Education, Labor & Pensions held a hearing on Pandemic-Related Workforce Shortage in Health Care

• Discussed healthcare staffing shortages and agencies potentially "taking advantage of a very dangerous situation." 

Jun. 6, 2022: U.S. Sen. Kevin Cramer of North Dakota introduced the Travel Nursing Agency Transparency Study Act

• If passed, this bill would require the Government Accountability Office (GAO) to conduct a study on the business practices of staffing agencies, including potential price gouging, and taking of excessive profits. It would also look at the difference between how much agencies charged health care institutions and how much they paid contracted nurses as well as investigate how states that imposed caps to contract nurse pay were affected by such caps.

The FTC has not responded to whether they’re investigating this issue.

While the matter is slow moving at the federal level, states have been passing legislation restricting healthcare staffing agencies and the rates they can charge while trying to establish maximum rates, even before the pandemic. Here’s what legislation has been introduced and the status of that legislation by state. Some legislation may be deemed as a “grey area” because the language of the bill is vague and/or it’s not clear if the legislation will affect travel registered nurse salaries.

California - bill failed, grey area

Requires healthcare staffing agencies to report billing information to the state and makes increasing "nonlabor costs, as defined, for health care personnel by more than 10%" during a state of emergency.

Colorado - law, grey area

Calls for a task force to discuss “recommendations for determining caps and other limitations on service rates and the amount that supplemental health care staffing agencies may charge for each category of health care workers providing services to health care facilities."

Connecticut - law

Requires Department of Social Services to set maximum rates healthcare staffing agencies can charge in nursing home settings.

Idaho - bill failed

Doesn’t allow a healthcare staffing agency to charge an “exorbitant or excessive increased price” during a declared emergency.

Illinois - law, grey area

Healthcare staffing agencies must report rates and fees they charge and restricts non-competes.

Indiana - bill failed

A healthcare staffing agency commits price gouging if an agency's charge is more than three times the fair market value of the healthcare services of a healthcare employee or temporary worker. 

Iowa - law, grey area

Requires healthcare staffing agencies to register, report bill rates and travel pay rates, and limits non-competes.

Kansas - bill failed

A healthcare staffing agency can’t bill or receive payments from an adult care home or a hospital long-term care unit at a rate higher than 200% of the sum of the weighted average wage rate, plus a factor determined by the secretary to incorporate payroll taxes for the applicable employee classification for the geographic group.

Kentucky - law

Healthcare staffing agencies can’t solicit or recruit current staff, must report pay rates, limit non-competes, and can’t charge more than 10% of what prices were before during a declared emergency unless they can prove an additional cost is related as imposed by a supplier or additional cost of labor.

Louisiana - law, grey area

Provides for licensure and regulation of healthcare staffing agencies including limiting non-competes and the ability to investigate as necessary.

Maryland - bill failed

HB 800 & SB 565

Prohibits healthcare staffing agencies from charging 10% more of the price charged prior to the state of emergency during a state of emergency and for the 90 days following the end of an emergency.

Massachusetts - law

101 CMR 345

Travel nurse rates are capped based on area, day of the week, and type of nurse.

Note: During the pandemic, Massachusetts raised its caps by  35 percent .

Minnesota - law

Statute 144A

The most that a travel RN in a nursing home can earn per hour during non-holidays is $62.36, according to the documentation provided by the state’s Department of Health.

Note: They allowed changes to the max rates on a case-by-case basis during the pandemic.

Missouri - bill failed

A healthcare staffing agency can’t bill or receive two payments from a health care facility at a rate higher than 150 percent of the sum of the average wage rate, plus a factor to incorporate payroll taxes for the applicable employee, if necessary.

There can’t be a “gross disparity” between the price charged or offered for the services and either the price at which the same service was sold or offered by the agency in its usual course of business immediately prior to the onset of a declared emergency, or the price at which the same or similar service is readily obtainable from other health care staffing agencies.

New York - bill failed

Imposes criminal penalties for price gouging of an unconscionably excessive price during periods of “abnormal disruption” including medical services.

A price will be deemed excessive if the price exceeds, by at least 10%, the price at which the service was sold immediately prior to the state of emergency unless the price charged is because of additional costs imposed by the supplier or other costs of providing the good. In such situations, the price will be excessive if it represents a 10% increase in the amount of markup from cost, compared to the markup customarily applied by the seller in the usual course of business immediately prior to the state of emergency.

Ohio - in progress

HB 466  

Healthcare staffing agencies are prohibited from billing or receiving payments from health care providers for any category of health care personnel listed in the Medicaid cost reports submitted under existing law at a rate that is higher than 150% of the statewide direct care median hourly wage for that category of personnel. The agency may charge the provider an additional hourly amount of not more than 10% of the maximum rate for the individual if providing care to patients with an infectious disease for which a declared public health emergency is in effect.

Oregon - law

Requires temporary staffing agencies to apply for a license to operate in the state, as well as annually evaluate and implement maximum rates agencies may charge.

Pennsylvania - in progress

A healthcare staffing agency can’t bill or receive payments from a healthcare facility at a rate higher than 150 percent of the sum of the average rate…determined by the department and reported on an annual basis. The maximum rate includes all administrative fees, contract fees, or other special charges, in addition to the hourly rate for the healthcare personnel supplied to a healthcare facility.

Rhode Island - bill failed

Prohibits healthcare staffing agencies from charging more than "two hundred percent (200%) of the regional average hourly wage of each position" and requires them to report to the department of health. Also prohibits agencies from charging conversion fees or recruiting permanent staff who work for their clients.

Tennessee - law, grey area

A study of the use of temporary staffing provided by healthcare staffing agencies in long-term care facilities. Investigates costs paid by nursing homes for temporary staff provided by healthcare staffing agencies, the effect those costs may have on the TennCare program, the impact any increases in charges for temporary healthcare staffing have on assisted care living facilities, and practices that would improve the quality of long-term care facility resident care while reducing costs to the TennCare program.

When it comes to this legislation, there may be unintentional consequences or consequences that may not seem obvious. For instance, any time legislation limits travel nurse agencies' bill rates, that may in turn limit a traveler's pay rate, as that’s part of the total bill rate. Additionally, limits on what agencies can charge during a declared emergency may seem logical, but in cases like the pandemic, higher rates were necessary to supply the demand hospitals needed.

Capping the amount of money a travel nursing staffing agency can charge a hospital or healthcare facility could worsen healthcare shortages, driving registered nurses to work in other states or leave the profession entirely. States that have passed such legislation may feel the impact of greater nursing shortages in their hospitals if travelers decide to take assignments in areas with better pay.

This change and heightened scrutiny may cause you to worry, but travelers don’t need to panic. One of the ways you can take back control as a healthcare traveler is to work with a trusted recruiter at Fusion Medical Staffing. On our platform, you can keep tabs on the market and observe how different states are being affected. We work hard to ensure our rates are accurate and transparent, so you know what’s going on and can make the best choice for yourself.

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Some States Are Trying to Cap Travel Nurses’ Pay

This is why that is a bad idea.

Kirsten Newcomb  worked  in Virginia as a nurse for ten years. Her job was grueling. She’d work four 10 hour shifts each week. In 2020, she decided to make a change and start travel nursing—an arrangement where hospitals and other healthcare providers hire nurses for short-term contracts. As part of the arrangement, nurses are not only paid much higher wages, they also are usually given generous stipends for food and housing.

“Once I start looking for a new contract, it typically takes about a week,” says Newcomb. “I can pretty much pick wherever I want to go next.” Lately, Newcomb has been spending her time in Hawaii. Not a bad place to ride out a pandemic, even for healthcare workers.

Kirsten’s experience is one shared by a growing number of nurses who are participating in the booming travel nursing industry. As you are probably aware, there is a healthcare provider shortage in the US. The shortage existed even before the pandemic (and largely  stems from government , which creates barriers to entry in the field), but the pinch has really been felt since COVID-19 hit our shores.

Due to that, the pay for travel nurses has ballooned, as one might expect when demand surges and supply is constricted. August numbers show a weekly average rate of over $2,500, compared to a December 2019 average weekly pay of just over $1,000.

But some lawmakers have decided that they want to make the situation worse and are considering  legislation that would cap travel nurses’ pay.

In Pennsylvania, for instance, Representative Timothy R. Bonner wrote a  memorandum  on November 5, 2021 where he stated his intention to introduce a bill that would “establish maximum rates on agency health care personnel,” specifically in “nursing homes, assisted living residences and personal care homes.” So basically, he wants to set price caps for the agencies that act as middlemen between travel nurses and healthcare facilities.

In his memo, Bonner also referred to some efforts to the same effect at the national level. “…the American Health Care Association recently sent a letter to the Federal Trade Commission (FTC), requesting that the FTC use its authority to protect consumers from anti-competitive and unfair practices regarding agency staffing.”

As news of this broke in online nursing channels, some nurses, nurse.org  reported , hinted they would strike if price control legislation came to pass. Others pointed out the price caps would almost certainly make the shortages worse since travel nurses would simply not pick up new assignments.

“I sure as heck won’t take any assignments in any states that cap my wages,” one nurse  commented on a Facebook page for travel nurses. “I leave my family and home to go into hot zones to help out. I have marketable skills … you want my skills in your [hospital], then compete for me.”

Why This Is Misguided

Travel nursing is actually a beautiful example of the free market at work (it still manages to find a way, even in fields overrun with regulations and cronyism like our healthcare industry). This structure ensures demand is still met despite shortages—and in this case, shortages can be deadly.

Travel nurses are paid more for a reason. The higher wage incentivizes them to leave their families and their homes to live in unfamiliar locations for extended periods of time. The higher pay ensures that demand is met when the need is urgent. Leaving family and traveling for long periods of time reflects the fact that traveling nurses experience high opportunity costs. So, in order to incentivize nurses to supply more, they must be compensated with higher wages to make up for large opportunity costs. Economists call this the law of supply.

We don’t have to wonder or even rely on economic theory alone to know what would happen should politicians implement price caps on travel nursing. The  online  nursing community is making it known loud and clear—they’ll stop showing up.

“There are some professions you can play with, nursing is not one of them!” one nurse responded,noting the economy’s high demand for nurses.

Price caps would ultimately spell disaster for patients, who would not be able to get healthcare when they need it, particularly those who live on the margins or live in rural areas.

The Economic Theory

Price is merely a signal that represents the amount of resources available. Those who wish to implement price caps really just wish to ignore the reality of  scarcity . But while they may wish to bury their head in the sand, it won’t shield them from the results of the policy. Price caps  cause shortages , it’s basic supply and demand.

As economist Thomas Sowell has  said , “Why do price controls cause shortages? There are basically two reasons: supply and demand. People will not supply as much at a lower price as they will at a higher price.”

We don’t have to look very far back in history to find numerous examples of price caps causing shortages. It’s time we learn from past mistakes. What politicians really need to do is remove barriers to entry in the healthcare field so we can increase the number of providers. Allowing markets to function freely is the only thing that will actually bring the price of healthcare down.

This piece was originally published on FEE.org under the title, Some States Are Trying to Cap Travel Nurses’ Pay. Here’s Why That’s a Bad Idea

How Much Do Travel Nurses Make?

Average Pay for Travel Nurses

Travel nursing pay explained, highest and lowest paying states for travel nurses.

• Highest Paying Travel Nurse Specialties
• Ways to Increase Pay

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Travel nursing offers a unique work experience with the opportunity to earn above-average hourly wages. These wages may even exceed those of other registered nurses (RNs) with the same education and credentials.

Travel nurses are typically employed by travel nursing agencies and work assignments across the country wherever nurses are needed. Because each assignment is different, the total annual income for travel nurses can vary significantly. Factors include the details of the pay package, where the assignment is located, and nursing specialty.

On this page you will find the most recent information about travel RN salaries, benefits, specialties, and the states with a high demand for travel nurses.

Fast Facts About Travel Nurses

• Travel nurses generally earn as much or more than staff nurses with the same experience and qualifications.
• Lodging reimbursement and tax advantages impact travel nursing salaries.
• The most in-demand travel nursing specialties include labor and delivery, emergency room, and medical-surgical/telemetry.

The average travel nurse salary varies greatly depending on the work assignment. Depending on travel location, these practitioners can earn between $3,000 and $7,000 per week, averaging a 36-hour work week. According to Vivian , a healthcare jobs marketplace, and the U.S. Bureau of Labor and Statistics (BLS), travel nurses earn jan average of $2,183 per week, while RNs earn a mean hourly wage of $42.80. However, aspiring travel nurses should note that living on the road leads to additional personal expenses, so the increase in pay accounts for living accommodations.

Max Weekly Pay

Average Total Weekly Pay

Source: Vivian , September 2023

Travel nurse pay differs from full-time nursing positions because agencies offer hourly rates for each assignment, meaning RNs can shop around and find opportunities with ideal pay. In contrast, RNs working full time at hospitals, physicians’ offices, and other facilities usually rely on raises or additional education to increase their earning potential.

Practitioners considering this role also need to explore what take-home pay looks like for travel nurses . Nursing agencies set their own conditions, so pay packages vary. For instance, organizations may offer an hourly base pay with additional stipends to cover housing or meals, while other companies may offer a higher hourly rate to account for additional expenses.

Travel nurse salaries vary by state and region. Locations in need of RNs typically offer more competitive wages. In fact, the popularity of a particular region can influence travel nurses’ earning potential. Less popular locations may pay more, while desirable locations may pay less. Likewise, states with a higher cost of living offer higher wages relative to living costs.

According to 2023 data from Vivian, the top-paying states for travel RNs included New Jersey , California, and Alaska. Practitioners also want to consider the highest-paying specialties to determine earning potential which may vary by state. The following section includes the top specialties in demand.

Highest Paying Travel Nurse Specialities

Typically, nursing specialties that lack licensed practitioners offer more pay than other specialties, which further increases earning potential for travel nurses. Higher acuity facilities also offer higher pay, as they need skilled practitioners who can meet their patients’ needs. Here are five in-demand specialties for travel nurses.

Labor and Delivery

Emergency room, medical-surgical/telemetry, critical care – intensive care unit, operating room registered nurse, 4 ways to increase pay as a travel nurse.

While travel nurse pay may exceed traditional full-time RN salaries, travel nurses can additionally increase their earning potential by considering factors like demand for specialties, understaffed or unpopular shifts, and locations in need of skilled RNs.

Travel nurses should examine the full benefits package to determine if jobs can provide sufficient take-home pay. For instance, regions with a high cost of living may impact how much practitioners actually earn if stipends do not cover all costs.

Frequently Asked Questions: Travel Nursing Salaries

How much does a traveling nurse make per year.

Travel nurse salaries vary significantly, especially since the outbreak of COVID-19. Factors that can influence earning potential include geographic location and specialty. However, travel RNs should anticipate working 46 weeks a year and earning about $2,183 on a weekly basis .

Do travel nurses get paid more?

Travel nurses typically earn more than full-time salaried RNs because they often take job assignments where there is a nursing shortage. Travel nurse agencies also pay practitioners by the hour and offer additional benefits, including housing and meal stipends.

Is travel nursing worth the money?

Travel nurses generally earn more than salaried RNs. However, practitioners should consider their lifestyle as well. For instance, an RN with a family may not feel the additional pay outweighs time at home, while another practitioner may find the pay suitable and enjoy the travel opportunities.

Do travel nurses get time off?

Travel nurses often do not receive time off since they work hourly and take temporary job assignments. While assignments vary, travel nurses should plan to work for 8-26 weeks at a time. Most travel nurses schedule time off between job assignments.

Learn More About Travel Nurses

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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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Senate moves forward with proposal capping what traveling nurse agencies can charge

by Skylar Tallal

Iowa Senators advanced a proposal that some say would help Iowa's nurse shortage, but others think it will push traveling nurses out of state.

"I will say nurses feel very targeted by this," Amy Campbell with the Iowa Nurses Association said. "There was a very negative reaction to this legislation."

Senators weighed a proposal that would cap how much traveling nurse agencies could charge healthcare facilities.

Supporters of the bill said these agencies charge too much, and lowering the costs could help fill permanent nursing positions.

"Today in 2024, we estimate it would create savings of more than $22 million for nursing homes alone," Brent Willett the president and CEO of the Iowa Healthcare Association said. "Those dollars could be reinvested in increasing wages for permanent director of staff, hiring more people."

While the bill aims to protect traveling nurses' wages from being impacted by this change, Bob Livonius with GrapeTree Medical Staffing Agency said agencies like his wouldn't be profitable and would have to move services out of the state.

"Of course, we will try to move as many persons as we possibly can to other states so that we can fill jobs in other states," Livonius said. " We'll simply abandon the work that's being done here in Iowa with the idea that they'll, they're just not going to make any money on it."

The bill has already passed the House and GOP Senator Jason Schultz manages it in the Senate.

He said there is a need to address the current problem and plans to do more research to ensure this bill is the solution.

Full Time Nurse

By Nurses, For Nurses.

Travel Nurse Pay Cap: Why Pay Is Getting Cut

This post may contain affiliate links. If you use these links to buy something we may earn a commission. Read our full disclaimer here . Our opinions are our own.

Additionally, we are proud to not use any AI within our content. Our content is 100%   for nurses, by nurses .

What is the travel nurse pay cap? What is going on with travel nurse agencies, and why pay is getting cut?

Travel nursing has been quite lucrative over the past few years ( How Much Money Do Travel Nurses Make ).

If you haven’t heard, recently there has a been a huge push to cut travel nurse pay. Well, more specifically the travel nurse agencies pay. Later, we’ll go into detail a bit more, but it’s a big topic right now. In addition, nurses are marching for equal pay, no more pay cuts, and workplace safety ( read more ).

So, with that being said, let’s get into why they want to cap travel nurse pay, what it means for the industry, and why staffing agencies are not happy about it!

What is the Travel Nurse Pay Cap?

Why do hospitals want to cap nurse pay, how are hospitals responding, how are travel agencies responding, final thoughts.

A travel nurse pay cap would effectively put a ceiling on the amount of money a staffing agency could bill for a nurse. Or, put a limit how much money a nurse could make.

While it might not be directed towards the nurse, they are directly effected. Staffing agencies are supposed to cover the differences when a hospital changes a contracts terms. However, this has not been the case recently.

For example, if a hospital changed a travel nurses pay from $3,500/wk to $3,000/wk, the agency should make up the different. But, again, this is not happening and is causing nurses to lose out.

While hospitals aren’t directly trying to cap nurse pay ( or at least not yet ), they are trying to cut out staffing agency markups. Because, travel nurse agencies bill a lot more than what the nurses are actually paid, hospitals are forced to pay ( in some cases double ) higher costs for nurses. Additionally, hospitals also lost a lot of the government funding provided during the pandemic.

For example, a travel nurse might have a pay rate of $75 an hour, while the actual bill rate to the hospital for that nurse can be as high as $150-180 an hour. Even though agencies have to pay for things like housing stipends and insurance they still can make a hefty profit.

The agency is basically a brokerage for travel nurses and hospitals don’t want to pay the premiums. According to an article by Nurse.org , Cross Country Healthcare who specializes primarily in travel nursing, made $132 million in profit in 2021.

In addition to the pay, travel nursing has significantly impacted hospital retention rates. A lot of nurses have either retired earlier or left their respective hospitals in order to take a travel nursing assignment ( for more money ).

Hospitals are attempting to improve retention and avoid costs by creating their own internal travel agencies. Basically the concept is instead of paying $150-180 an hour for the same travel nurse in the example before, they only pay the nurses $75 an hour ( no markup from a travel agency ).

In addition, some hospitals are even creating certain bonuses for existing staff. These bonuses might include an extra $100 per hour for any additional 12-hour shift taken. While these are welcome bonuses for existing staff, there is still a call to increase nurse pay.

Nursing staffing agencies are attempting to respond the best they can to pay cuts. Unfortunately for travel nurses, it is a tough and unprecedented situation. Travel agencies are going to have to figure out creative ways to keep nursing pay up!

In conclusion, while there are massive highs and lows for travel nurses, there should be more focus on the greater issue. The great issue being the staffing problems at a lot of hospital systems ( and medical field in general ). There most likely will be a call for change, not only for the patient’s safety, but the staff’s safety as well.

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Why a cap on travel nurse salaries is a big mistake, particularly for patients

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The American Hospital Association (AHA) and over 200 bipartisan, high ranking U.S. House and Senate members , including Adam Schiff, Tim Ryan, Rick Scott, Liz Cheney, and Jackie Speier — fearless fighter of women’s rights — are calling for an investigation into the high nursing staffing fees . They request the White House COVID-19 Response Team Coordinator to determine why nurse staffing fees have skyrocketed during the pandemic and protect consumers from anti-competitive and unfair agency staffing.

Everyone involved agrees that the COVID-19 crisis has placed unprecedented stresses on healthcare workers and accompanying burdens on hospital systems to maintain safe staffing levels to care for patient demands. But the AHA and this large group of lawmakers are bent on focusing on why nurse staffing agencies have collectively raised fees to hospitals as much as three times the pre-pandemic rate, with 40 percent going to the agency’s profits.

This may sound bad by the numbers. But in my opinion, as a nurse for over 38 years, who has worked for nurse staffing agencies, I believe that AHA and lawmakers are errantly accusing these agencies of wholesale extortion. Because it is easier than paying travel nurses and the agencies that field their services based on emergency needs by hospitals dealing with a staffing crisis amid a pandemic. Don’t we pay police and firefighters premium rates when they work overtime or when called upon for emergency duties?

Meanwhile, travel nurses and agencies are becoming national targets.

During the pandemic, Massachusetts and Minnesota have capped fees to address the high cost of the nursing staffing agencies. Massachusetts raised its caps by 35 percent , whereas Minnesota increased the cap to $58.08/hour for regular pay and up to $99.90/hour for holiday pay. Connecticut enacted a statute prohibiting profiteering during emergencies, and violators will incur fines. In Pennsylvania, a bill was introduced in January to cap the rates at $150/hour for workers sent by staffing agencies to long-term facilities. Still, this would include administrative costs incurred by the agencies.

Hospitals must offer competitive salaries to attract the best and brightest Registered Nurses. Unfortunately, labor can cost a business up to 70 percent of their profits, so it makes sense that it would be the first place the health organizations would start to impose salary caps on traveling nurses to trim costs.

Not all businesses are the same

To be sure, salary caps are essential for many industries , particularly in large organizations where the compensation structure is more defined. However, smaller businesses may give their managers latitude in determining salary increases for employees, raising salary levels, and pricing employees closer to the salary cap sooner than is possible with a large company. 

When it comes to nursing salary caps, there may be unintentional consequences, starting with potentially exacerbating the current chronic nurse shortage that has taken root across the country. In response to cap salaries, nurses may move to areas with better compensation, leaving some hospitals with a limited supply of nurses.

The truth is, traveling nurses are essential during a pandemic, and the agencies that supply traveling nurses have not been more crucial than presently due to the pandemic.  

When it comes to nursing salary caps, there may be unintentional consequences, starting with potentially exacerbating the current chronic nurse shortage that has taken root across the country.

Like most healthcare professionals, nurses are not in it just for the money. For example, when New York City needed nurses during the pandemic, traveling nurses came to the rescue . Nurses are highly skilled workers whose roles can’t be easily duplicated, and they are the most prominent frontline healthcare workers in the health industry. Limiting access to traveling nurses is not a way to ensure patient safety. Nurses are tired, burned out, and welcome relief that the travel nurses can bring. 

To be sure, hospital costs have increased very steeply and rapidly.  According to a study conducted in 2020, hospitals increased patient charges up to 18 times, which doubled in the last 20 years. Could this concern for high nurse agency fees be more about cutting into their profits than patient safety?  

Doctors are expensive; the most expensive employees at most hospitals. Why not cap their salaries? Cap the CEOs too. 

If we don’t do that then leave traveling nurses alone, too. These nurses are being paid their worth for the premium service and patient care they administered during the ongoing pandemic and beyond. 

About the author

Denise Dawkins is an assistant professor of nursing at San Jose State University with more than 38 years of nursing experience and 15 years as a nurse educator. She is also a Public Voices Fellow with The OpEd Project .

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Travel Nurse Salary Guide | 2023

What is a travel nurse.

Travel nurses are registered nurses that work short-term contracts to fill the needs of hospitals, clinics, long-term facilities, and other healthcare institutions. Travel nurses can help when there are nursing shortages. However, it is not always a long-term solution.

Travel nursing is very enticing to those who want increased flexibility within the nursing sector that traditional bedside nursing might not offer.

Looking for open travel nurse assignments? Speak with a recruiter today!

How Much Do Travel Nurses Make?

Travel nurse salaries vary depending on the location and specialty. Most recently travel nurses have seen a decline in salaries as compared to several years ago. The COVID-19 pandemic dramatically increased wages for travel nurses, and many left the bedside in order to travel the country but also cash in on the big paychecks. While now the salaries are not as large for contracts, there are still a plethora of contracts available at a competitive wage across the country.

ZipRecruiter.com reports the national average for travel nurses is $118,400 per year. The highest-paying states are New York, California , and Idaho while the lowest reported salaries are in Louisiana and North Carolina. Even though North Carolina has the lowest travel nurse salary, the annual travel nurse salary is still more than the $77,600 national average for staff nurses according to the BLS .

But don’t forget other ways to make money as a travel nurse, such as earning points or miles on all the travel that you already have to do. We now have travel nursing credit cards just for nurses to earn while they travel.

Travel Nurse Salary by State

Salaries and stipends vary by state and city , as do housing and cost of living. Here’s a breakdown of travel nurse salaries and hourly wage for all fifty states, going from highest to lowest.

Source: ZipRecruiter.com

Find available, high-paying travel nurse opportunities.

Wages for travel nurses involve more than a straight hourly rate. Travel nurses can receive non-taxed stipends for housing and living expenses, and those stipends are paid on top of your hourly rate. Other benefits may include, depending on the staffing agency:

• Medical, dental, and vision insurance
• 401K investment options
• Sign-on, completion, and referral bonuses
• Free continuing education courses
• License Reimbursement
• Weekly/Bi-weekly Pay
• Tax Advantage Plan
• Life Insurance
• Liability Insurance, Disability Insurance, and Worker’s Compensation
• 24/7 Support

It’s important to remember that travel nurses are paid (and taxed) differently than staff nurses . Travel nurses are paid through agencies, not the hospital, so you have to look at your total pay. This includes your hourly base pay + your non-taxable stipends, which is what things like housing and meals are considered.

What Does a Travel Nurse Package Include?

Travel nurse packages will vary depending on the company as well as the individual. For example, one travel nurse may take a housing stipend while another might take the company-provided houses. These small differences are important to remember when investigating travel nurse contracts and also speaking to your peers. Furthermore, some travel nurse companies will have exclusive contracts with healthcare institutions, and packages will look different based on the exclusivity.

There are three major components to all pay packages:

• Taxable hourly pay
• Housing Stipend
• Meal and Incidentals Stipend

Taxable Hourly Rate

The hourly pay is the dollar per-hour amount for each hour worked. It is the taxable portion of the pay package, which is important to remember. The actual amount you are paid will vary depending on the agency. Travel nurse agencies will want to pay you the least amount possible in order to make packages look the most attractive to travel nurses. The larger the hourly wage, the more taxes are taken out and as a result less weekly income.

Housing, Meal, and Incidental Stipends

This portion of the pay package is tax-exempt since non-taxable money is not considered income. This is the most alluring part of a travel nurse pay package and where travel nurses will make the most money. This money is directly determined by the travel nurse company .

These stipends will also vary depending if you decide to take housing provided by the company or find your own. If you decide to take company-provided housing then you would not receive a housing stipend. Many travel nurses decide to take the housing stipend and then find their own living arrangements. This can help nurses take home extra non-taxable pay. But be careful, it also can be harmful.

For example, if the housing stipend is $1,200 and you find an apartment for $1,000 then you will get to keep the extra $200. Unfortunately, if housing is more than the housing stipend provided by the company then you are responsible for the difference.

Pro tip: Look at housing costs before signing your contract!

As an example, a standard total pay package could look something like this:

*Assumes $20 per hour at 40 hours per week, minus taxes

Understanding Your “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 (either by rent or mortgage) 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.

Travel nurses that have a tax home will need to maintain proof of this. It’s important to keep all receipts that prove you are paying to maintain your primary residence (e.g., house sitters, utilities, home maintenance expenses).

Per IRS Publication 463 , three factors are used to determine if a location/residence qualifies as a tax home. These are:

• You perform part of your business in the area of your main home and use that home for lodging while doing business in the area.
• You have living expenses at your main home that you duplicate because your business requires you to be away from that home.
• You have not abandoned the area in which both your historical place of lodging and your claimed main home are located; you have a member(s) of your family living at your main home; or you often use that home for lodging.

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 .

Itinerant status is not ideal and will cause a big difference in take-home pay. It can be confusing to navigate the difference between tax home and itinerant status. Speaking to a financial planner and/or accountant specializing in travel nurse pay is helpful. As a best practice, travel nurses are encouraged to return to their permanent residence between contracts.

What Factors Affect Travel Nursing Pay?

There are numerous factors that can affect travel nursing pay. Some will be in your control and others will not. These include

The specific location of the assignment most heavily influences travel nurse pay. Simply put, pay rates often reflect the cost of living in the area and also regional trends. Historically speaking, the highest-paying states for travel nurses include California , Texas , Massachusetts, Washington , and New York .

Southern states, like Mississippi and Alabama, typically have lower living costs and in turn, lower travel nurse pay. Destination locations, like Hawaii, typically do not have the most desirable pay packages because the locations are highly sought after. Companies know that there are many travel nurses who are excited about the surf and sand of Hawaii, so pay packages are reflective of that.

The travel nurse’s specialty also impacts pay. Medical surgical nurses, long-term care nurses, and clinic nurses will see significantly lower rates than other specialties, but this is generally the case even for staff nurses. Increased certifications, credentials, and skills will command higher pay. Historically speaking, the top-paying travel nurse specialties are:

• Intensive Care Unit (ICU)
• Labor & Delivery
• Neonatal Intensive Care Unit (NICU)
• Operating Room (OR)
• Post-anesthesia Care Unit (PACU)

Night shift assignments are generally more prevalent in the world of travel nursing. The increased need and the less desirable shift means that many hospitals offer higher rates for their night shift assignments. If you want to make the most money as a travel nurse, flexibility is key.

Ready to start your adventure? Sign up today and start traveling next week.

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Politics latest: Scottish first minister Yousaf resigns after 'biggest political miscalculation of his career'

Humza Yousaf has announced his resignation as SNP leader and Scotland's first minister following the fallout from his decision to end the SNP's powersharing agreement with the Scottish Greens.

Monday 29 April 2024 15:28, UK

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• Yousaf quits as Scottish FM after ending powersharing deal
• Outgoing SNP leader admits he 'underestimated' hurt caused
• The contenders who could replace him in Scotland's top job
• Analysis: The biggest political miscalculation of Yousaf's career
• Explained: How did we get here - and what happens next?
• Tap here to follow Politics At Jack And Sam's
• Live reporting by Samuel Osborne

The issue of asylum seekers crossing from the UK into the Republic of Ireland is an indication Rishi Sunak's Rwanda scheme is already working as a deterrent, the Northern Ireland secretary has said.

Speaking at a joint press conference with Irish deputy prime minister Michael Martin in Westminster, Chris Heaton-Harris said: "The UK's new deterrent is clearly working and having some impact already.

"An impact that will obviously increase as the first flights take off for Rwanda."

He added: "We will obviously monitor all this very closely and continue to work with the Irish government on these matters."

The cabinet minister said while the deterrent effect of the Rwanda scheme was anticipated "we are slightly surprised that it manifested itself so quickly after the act became law".

The SNP's Westminster leader has praised Humza Yousaf's "integrity, compassion and commitment" during his time as Scotland's first minister.

Posting on X Stephen Flynn, the MP for Aberdeen South, said: "Humza Yousaf has served Scotland with integrity, compassion and commitment.

"The challenges he has faced have been huge, yet at every turn he has led from the front.

"There can be no doubt that he has now laid the groundwork required to take our country forward. I wish him well."

Nicola Sturgeon has praised Humza Yousaf's "grace, dignity and integrity" after he announced he is stepping down as Scotland's first minister.

In a post on X, Mr Yousaf's predecessor said: "I know how big a privilege being first minister is, but also the toll it can take.

"I also know what a wrench it is to step aside, even when sure it is the right thing to do.

"Humza has conducted himself with grace, dignity, and integrity - both as FM and in the manner of his leaving. 

"I am and always will be proud to call him a friend."

Humza Yousaf has quit as Scotland's first minister and leader of the SNP.

We take a look back at how the 39-year-old rose through the ranks to become Scotland's top politician.

Mr Yousaf - the MSP for Glasgow Pollok - was born in the city on 7 April 1985 to a Pakistani father and Kenyan mother.

He was privately educated at Hutchesons' Grammar School in Glasgow and became interested in politics during his youth.

He went on to study the topic at the University of Glasgow, graduating in 2007 with an MA.

During his time at university, he joined the SNP. He was also president of the Muslim Students Association and was involved in the Students' Representative Council.

It was straight to Holyrood for Mr Yousaf, taking a job as a parliamentary assistant to the SNP's Bashir Ahmad - Scotland's first Muslim MSP.

After Mr Ahmad's death two years later, he carried on the role and worked as an assistant for a number of MSPs, including Nicola Sturgeon and the then-first minister Alex Salmond, solidifying his place in the party.

Read more about Mr Yousaf's life in politics from our Scotland reporter Jenness Mitchell here:

Labour has made hay with the chaos surrounding the Tory party in Westminster, and could do the same with the SNP in Scotland, says our deputy political editor Sam Coates .

Given Humza Yousaf's resignation today, after just 13 months in office, Sir Keir Starmer could consider himself "quite a lucky general".

"He watched in many ways the collapse of the Conservative Party, and saw the Tory poll rating crash, and now more problems for the SNP which has such a hold on Scottish politics," said Sam.

"That grip seems to be loosening.

"Many in Labour will be quite happy about what they're seeing."

It's been pointed out many times that a path to power for Labour at the next general election will likely require some form of recovery in Scotland, where the SNP has been dominant since the 2014 independence referendum.

The leader of the Scottish Conservatives, Douglas Ross, has said the outgoing first minister "decided to jump before he was pushed" by announcing his resignation today.

Humza Yousaf "knew his future was on a knife edge" as he faced up to two confidence votes this week, Mr Ross said, adding he had quit "because of the pressure we had put on as the main opposition party".

But there was no sign of Mr Ross and the Scottish Tories looking to offer their backing for a new SNP first minister.

Having seen off Mr Yousaf, Mr Ross said his party was now focused on "seeking to replace this tired, failing, nationalist government who have prioritised independence above everything else".

Holyrood is in a "terrible situation" following the resignation of Scotland's first minister, one of Humza Yousaf's predecessors has said.

Henry McLeish, who was first minister under Labour from 2000 until 2001, said while Mr Yousaf had shown "a bit of grace" and "humility" by quitting today - there was "no way he could continue in office".

He told Sky News his decision to end the SNP's powersharing deal with the Scottish Greens was more evidence of how "politically divided" Scotland had become.

Mr McLeish told Sky News his homeland is in desperate need of some "unity" and called for all parties to start thinking like a "coalition", even if not in practice.

Labour's call for an immediate election at Holyrood is - like their demand for one at Westminster - not likely to go anywhere, he added.

Humza Yousaf has announced he is standing down as Scotland's first minister and SNP leader.

Our Scotland reporter Jenness Mitchell reports on some of the potential contenders who could step up to lead the country:

Former SNP leader John Swinney has said he is giving "very careful consideration" to standing to replace Humza Yousaf after he announced his resignation as first minister of Scotland.

Mr Swinney said: "I've been somewhat overwhelmed by the requests that have been made of me to do that, with many messages from many colleagues across the party.

"So I'm giving that issue very active consideration. And it's likely I'll have more to say about that in the days to come."

He added: "I'm very sorry that the first minister has decided to stand down.

"He's been a pioneer as first minister, the first person of colour to hold the office of first minister of Scotland.

"He's led our country with empathy, with care and with an emphasis always on bringing people together, so I very much regret the fact he's felt it necessary today to stand down."

 It is "bizarre" that some SNP MSPs would rather see Humza Yousaf resign as Scotland's first minister than do a deal with the pro-independence Alba Party, Ash Regan has said.

Ms Regan's support may have been needed to get Mr Yousaf over the line in a confidence vote.

The former SNP politician, who leads Alba in Holyrood and is the party's first MSP, said: "The irony will not be lost on many that the event that has cost Humza Yousaf his job was removing the Greens from government - something most people in Scotland agreed with.

"Alba Party were willing to work in the best interests of Scotland to put independence back at the heart of government, protect the rights of women and girls, and to get the government back on to a competent footing.

"The Greens were willing to vote with the Tories and bizarrely some forces in Humza Yousaf's own party would rather see him resign than deal with a party who really want to advance independence."

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