How to Choose a Nurse Staffing Agency: A Buyer’s Checklist for Facilities

Most facilities don't choose a nurse staffing agency in a calm, deliberate way. They choose one at 4 p.m. on a Thursday, when two nurses have called out for the weekend and the schedule has holes that nobody on staff can fill. That's understandable, and it's also how facilities end up locked into contracts with surprise fees, nurses who aren't ready for the unit, and an agency that stops answering the phone after the first invoice.

This guide is for directors of nursing, administrators, staffing coordinators and HR teams at hospitals, skilled nursing facilities, assisted living communities and home health agencies. It covers what a good staffing partner should do for you, what to check before you sign, how pricing really works, and the warning signs that tell you to keep looking.

First, be clear about what you need

Agencies specialize, even when their websites say they do everything. Before you call anyone, write down:

• Roles: RNs, LPNs/LVNs, CNAs, or a mix? Which specialties: Med-Surg, ICU, memory care, wound care?
• Type of coverage: per diem shifts to cover call-outs, 8- to 26-week contracts, or temp-to-hire placements that may become permanent staff?
• Volume and timing: how many shifts or positions, which shifts, and for how long?
• Your onboarding requirements: orientation length, EHR training, facility-specific competencies and any state-mandated training.
• Budget: what you can realistically pay per hour, and where premium rates make sense, such as nights, weekends and holidays.

An agency that's excellent at placing ICU travelers in large hospitals may be mediocre at filling CNA shifts in a 90-bed nursing home, and the reverse is just as true. Ask each agency what percentage of their placements look like your request.

Credentialing and compliance: the non-negotiables

When an agency nurse walks onto your unit, your facility's name is on the door. You need confidence that every clinician is who they say they are and is qualified for the assignment. Ask each agency to walk you through their credentialing process step by step, and to show you a sample credential file with personal information removed.

What a solid credential file should include

• Primary-source license verification in the state of practice. For nurses that typically means checking Nursys or the state board directly, not relying on a photocopy of a license card.
• Exclusion screening against the HHS Office of Inspector General's List of Excluded Individuals/Entities (LEIE) and any state Medicaid exclusion lists. Hiring an excluded individual can put your federal program funding at risk.
• Background checks and drug screening that meet your state's requirements for healthcare workers.
• Health records: TB screening, immunizations and any vaccinations your facility requires.
• Current certifications such as BLS, ACLS and PALS, with expiry dates tracked.
• Skills checklists and competency testing relevant to the assignment.
• Professional references, ideally from recent clinical supervisors.
• For CNAs, verification of active status on the state nurse aide registry.

Ask how the agency tracks expiring items, and what happens if a license or certification lapses mid-assignment. The right answer is that they catch it before you do.

Certification and accreditation

The Joint Commission offers a Health Care Staffing Services certification for staffing firms. It's not mandatory, but it shows the agency has had its processes reviewed by an outside body. If your organization is Joint Commission accredited, a certified staffing partner can make your own survey preparation easier. Either way, ask how the agency would support you during a survey or audit, such as producing credential files on short notice.

Who is the employer?

In most arrangements the agency is the employer of record. It pays the clinician's wages and payroll taxes and carries workers' compensation coverage. Confirm this in writing, along with:

• Proof of workers' compensation and general and professional liability insurance, with limits that meet your requirements, and whether your facility can be named as an additional insured.
• How the agency classifies its clinicians, as W-2 employees or 1099 contractors. Misclassification can create legal and tax risk that may reach your facility, so W-2 employment is generally the safer arrangement for clinical staff.
• Responsibility for I-9 employment eligibility verification.

Understanding pricing: bill rates, pay rates and fees

Agencies charge you a bill rate per hour worked. Out of that they pay the clinician's wage and cover payroll taxes, insurance, benefits, recruiting, credentialing, travel and housing for contract staff, plus their margin. A lower bill rate isn't automatically better value. If it's too low to attract good clinicians, your shifts simply won't get filled.

Ask for the full rate card

Get every number in writing before you sign:

• Base bill rates by role and shift
• Overtime, holiday and on-call rates, and exactly how overtime is triggered
• Premiums for orientation hours, charge duty or floating
• Travel, housing or per diem charges for contract staff, and whether they're bundled into the rate
• Rate increases: when they apply and how much notice you get

Watch the fees that hide in the contract

• Conversion or buyout fees. These apply if you hire an agency clinician permanently. They're reasonable in principle, but check the amount and how long the restriction lasts.
• Minimum hours guarantees. These commit you to paying for a set number of hours even if you no longer need the nurse.
• Cancellation terms. How much notice must you give to cancel a shift without paying for it?
• Exclusivity clauses that stop you from using other agencies.
• Automatic renewal of the master agreement.

Measuring performance: what to ask for

Good agencies track their own performance and share it without being pushed. Ask for:

• Fill rate: the percentage of requested shifts they actually fill
• Time to fill for per diem shifts and for contracts
• Cancellation rate: how often their clinicians cancel or fail to show
• Contract completion and extension rates for longer assignments
• References from current clients similar to you in size and setting, and actually call them

Agree on how you'll review these numbers together, for example in a short monthly or quarterly check-in.

Quality on the unit

Credentials get a nurse in the door. Fit decides whether the shift goes well. Ask the agency:

• How do you match clinicians to our setting? A strong ICU nurse may struggle in long-term care, and the reverse is true too.
• Do you send profiles for us to approve, or do we just see whoever shows up?
• Can we interview contract candidates before they start?
• How do we give feedback, and how fast do you act on it?
• What is your "do not return" process if a clinician isn't a good fit?
• Do you try to send the same clinicians back to us so they get to know our unit?

Consistency matters more than most facilities realize. A per diem nurse who has worked your unit ten times is far safer and more efficient than ten different nurses who have each worked it once.

Start with a trial period

Even after all the due diligence, the best test of an agency is how it performs on your actual schedule. Where you can, start with a limited trial. That might mean a set number of per diem shifts or a single contract position over 60 to 90 days, before you sign anything long-term or exclusive.

During the trial, track a few simple things:

• How quickly they confirm shifts
• Whether clinicians arrive on time with complete credentials
• How your charge nurses rate each clinician
• Whether invoices match the agreed rates

Ask your staff for honest feedback. They'll tell you quickly whether agency nurses are pulling their weight. At the end of the trial, sit down with the agency to review the results. A good partner will welcome the conversation and come with ideas to improve.

Red flags

• They can't explain their credentialing process, or won't show a sample file.
• Every answer is "yes, we can do that," including for specialties and locations they've never staffed.
• They pressure you to sign a long or exclusive contract before a trial period.
• Rates are vague, or important terms only come out after you ask several times.
• They can't give you references from facilities like yours.
• Their clinicians are paid as 1099 contractors without a clear legal reason.
• They're hard to reach outside business hours, which is when you'll need them most.

Use more than one source of staff

The facilities that handle staffing gaps best rarely rely on a single agency. They build an internal float or PRN pool first. They use one or two primary agencies for most outside coverage, keep a backup for emergencies, and work steadily on permanent hiring so agency use stays a tool rather than a habit. Our guide on how to hire nurses fast covers the permanent side of that plan.

Posting your openings where nurses are actively looking also cuts how often you need outside help. You can register your facility on TheNurs.com and post RN, LPN and CNA jobs for free. You'll get an email the moment someone applies, and you can review every applicant from your dashboard. When you need staff quickly, request RNs, LPNs or CNAs and we'll respond with matched candidates.