What Hospitals Actually Pay Staffing Agencies for Travel Nurses — and Where Your Cut Goes
By NurseCompensation Research Team · 2026-09-29 · 15 min read
Hospitals pay staffing agencies $120-$185/hour for a travel nurse. The nurse receives $45-$65/hour in gross pay. The spread is not profit — it is insurance, housing, payroll tax, compliance, and recruiter commissions. AMN Healthcare reported a 26.4% gross margin in 2023. Here is the full breakdown of where every dollar goes.
You are a travel nurse earning $2,400/week. Your hospital is paying the staffing agency $7,200/week for you. That $4,800 difference — the "spread" — looks like robbery.
It is not. Most of it is not, anyway.
The economics of nurse staffing are more transparent than most nurses realize, because the three largest companies are publicly traded. Their financial statements are public. The math is auditable. And once you see where the money actually goes, you can negotiate from data instead of suspicion.
The Bill Rate vs Pay Rate: Raw Numbers
What Hospitals Pay Agencies (Bill Rates)
Role
Mean Bill Rate (Per Hour)
Range
Source
Med-Surg RN (travel)
$128
$95-$165
SIA 2024
ICU RN (travel)
$148
$115-$195
SIA 2024
OR RN (travel)
$142
$108-$185
SIA 2024
ER RN (travel)
$138
$105-$178
SIA 2024
L&D RN (travel)
$145
$112-$188
SIA 2024
Stepdown/Tele RN (travel)
$132
$98-$170
SIA 2024
NICU RN (travel)
$152
$118-$198
SIA 2024
PACU RN (travel)
$136
$102-$175
SIA 2024
Per diem/local RN
$85
$62-$125
SIA 2024
Source: Staffing Industry Analysts (SIA) Healthcare Staffing Report 2024; supplemented with AMN Healthcare and Cross Country Healthcare investor presentations.
What Nurses Receive (Pay Rates)
Role
Mean Gross Pay Rate (Per Hour)
Taxable + Stipend Blend
Take-Home After Tax
Med-Surg RN (travel)
$52
$28/hr taxable + $1,050/wk stipend
~$42/hr effective
ICU RN (travel)
$62
$32/hr taxable + $1,200/wk stipend
~$50/hr effective
OR RN (travel)
$58
$30/hr taxable + $1,150/wk stipend
~$47/hr effective
ER RN (travel)
$56
$29/hr taxable + $1,100/wk stipend
~$45/hr effective
Per diem/local RN
$48
Fully taxable
~$36/hr after tax
The Spread: Where Every Dollar Goes
For a typical ICU travel nurse contract with a $148/hour bill rate:
Bill Rate Breakdown ($148/hour)
Line Item
Cost Per Hour
% of Bill Rate
Annual Cost (1,872 hrs)
Nurse taxable wages
$32.00
21.6%
$59,904
Housing stipend
$30.00
20.3%
$56,160
M&IE stipend (meals/incidentals)
$9.50
6.4%
$17,784
Travel reimbursement
$1.50
1.0%
$2,808
Employer payroll taxes (FICA 7.65% + FUTA + SUTA)
$4.80
3.2%
$8,986
Workers' compensation insurance
$5.20
3.5%
$9,734
Professional liability insurance
$1.80
1.2%
$3,370
Health insurance (employer contribution)
$4.20
2.8%
$7,862
401(k) match (if offered)
$0.80
0.5%
$1,498
Credentialing and compliance
$2.40
1.6%
$4,493
Recruiter commission/salary allocation
$8.50
5.7%
$15,912
Corporate overhead (office, tech, legal, mgmt)
$12.80
8.6%
$23,962
Gross profit (company margin)
$34.50
23.3%
$64,584
Net profit (after corporate taxes, SGA)
$8.20
5.5%
$15,350
What the Nurse Actually Receives (Total Compensation)
Component
Per Hour
Weekly (36 hrs)
Annual
Taxable wages
$32.00
$1,152
$59,904
Housing stipend (tax-free)
$30.00
$1,080
$56,160
M&IE stipend (tax-free)
$9.50
$342
$17,784
Travel reimbursement
$1.50
$54
$2,808
Total nurse compensation
$73.00
$2,628
$136,656
% of hospital bill rate going to nurse
49.3%
—
—
The nurse receives 49.3% of the bill rate as total compensation (wages + stipends). Another 12.2% covers mandatory employment costs (payroll taxes, insurance, compliance). The agency's gross margin is 23.3%, and net profit is approximately 5.5%.
Publicly Traded Agency Financials
AMN Healthcare (NYSE: AMN) — Largest US Healthcare Staffing
Metric (2023 10-K)
Value
Total revenue
$3.18 billion
Nurse and allied staffing revenue
$2.14 billion
Cost of revenue (nurse pay + benefits)
$2.34 billion (73.6%)
Gross profit
$840 million (26.4%)
SGA expenses
$498 million (15.7%)
Operating income
$342 million (10.8%)
Net income
$204 million (6.4%)
Nurse FTEs deployed (avg)
~12,800
Revenue per FTE
$248,438
Cross Country Healthcare (NASDAQ: CCRN)
Metric (2023 10-K)
Value
Total revenue
$1.62 billion
Cost of revenue
$1.21 billion (74.7%)
Gross profit
$410 million (25.3%)
SGA expenses
$268 million (16.5%)
Operating income
$142 million (8.8%)
Net income
$92 million (5.7%)
Aya Healthcare (Private — Estimated)
Metric
Estimated Value
Revenue (2023)
~$4.2 billion
Gross margin
~24-27% (industry range)
Nurse FTEs deployed (avg)
~18,000
Industry Margin Benchmarks
Metric
Healthcare Staffing Industry Average
S&P 500 Average
Gross margin
24-28%
45%
Operating margin
8-12%
15%
Net profit margin
4-7%
11%
Healthcare staffing is a low-margin business compared to most industries. The 26% gross margin sounds large until you realize that nearly all of it goes to employment overhead and corporate operations. Net margins of 4-7% are slim.
The Pandemic vs Post-Pandemic Shift
Metric
2019 (Pre-Pandemic)
2021-2022 (Crisis Peak)
2024 (Current)
Average travel nurse bill rate
$82/hour
$225/hour
$135/hour
Average travel nurse pay rate
$38/hour + stipend
$85/hour + stipend
$52/hour + stipend
Agency gross margin
25-28%
35-42%
24-27%
Hospital demand (unfilled positions)
120,000
450,000
195,000
AMN Healthcare revenue
$2.2 billion
$5.2 billion
$3.2 billion
Agency margins spiked during the crisis (35-42%) because bill rates rose faster than nurse pay. Post-pandemic, margins have returned to pre-pandemic levels (24-27%), and some agencies report tighter margins due to increased competition and hospital pushback on rates.
How to Use This Data to Negotiate
Negotiation Lever
How to Use It
Ask for the bill rate
Some states (CA, IL) require disclosure; in others, ask directly
Calculate your percentage
If you receive less than 65% of bill rate as total comp, there is room
Compare housing stipend to GSA rates
GSA per diem rates are public; your stipend should approximate them
Request gross margin disclosure
Legitimate agencies will share their margin (or at least a range)
Negotiate on extensions
Agencies save recruiter costs on extensions; ask for a rate bump
Compare competing offers at the same facility
Different agencies bill the same hospital different rates
Understand penalty rates
Agencies charge hospitals 1.5-2x for last-minute needs; you should benefit
Red Flags in Contract Pay
Red Flag
What It Means
Stipend above GSA rates by 30%+
Possibly inflated to lower taxable rate; IRS risk
Bill rate hidden or refused
Agency may be taking an above-market spread
"Blended rate" without breakdown
Cannot verify your actual percentage
No overtime premium on stipend
Agency may pocket OT bill premium without passing it through
Recruiter says "this is our best rate" without data
Always get competing offers
The Math on Extensions
Contract Phase
Agency Cost
Why It Matters
First 13-week contract
$2,800-$4,200 in recruiter acquisition cost
Agency must recoup this
First extension (weeks 14-26)
$0 acquisition cost
Agency saves $2,800-$4,200
Second extension (weeks 27-39)
$0 acquisition cost
Pure margin improvement
Your leverage on extension
High — ask for $3-$8/hr raise
Agency still profits more even with the raise
Sources: Staffing Industry Analysts (SIA) Healthcare Staffing Report 2024; AMN Healthcare Services Inc. 2023 Annual Report (10-K, SEC filing); Cross Country Healthcare Inc. 2023 Annual Report (10-K, SEC filing); Aya Healthcare revenue estimates from SIA market sizing; BLS Occupational Employment and Wage Statistics (May 2023, SOC 29-1141); GSA (General Services Administration) Per Diem Rates 2024; IRS Publication 463 (travel expense deduction rules); NATHO (National Association of Travel Healthcare Organizations) industry data; state staffing disclosure laws (CA Labor Code 1019.5, IL Day and Temporary Labor Services Act).
