How to Cut Agency Contract and Conversion Fees From Nurse Staffing Budgets

By Sarah Knight, ShiftMed Content Manager//Healthcare Industry, Healthcare Staffing Solutions
A nurse manager sits at his desk and looks at a computer.

Hospitals often struggle with budget challenges caused by hidden agency fees surrounding staffing contracts and nurse conversion costs. From inflated base rates to overlooked administrative charges to buyout clauses, these fees add up quickly, making temporary staffing solutions far more expensive than they appear at first glance.

Removing these hidden fees from your nurse staffing budget and leveraging innovative workforce management solutions are critical for hospital financial efficiency—and we're here to help you identify healthcare cost reduction strategies and shift toward a more sustainable workforce model.

Hospital and health system operating costs are soaring, with labor costs leading the charge. Labor makes up about half of a hospital's operating budget, and according to the Healthcare Financial Management Association (HFMA), 96% of CFOs now cite labor expenses as one of their biggest challenges to maintaining margins.

A Breakdown of Nurse Agency Contract Fees

Contract fees are notorious for draining nurse staffing budgets. Understanding the specific components of these costs—such as compliance charges, housing allowances, and travel reimbursements—can help your hospital drive significant healthcare workforce savings.

Base Rate Premiums

Traditional staffing agencies often charge significant markups above the base pay rates for nurses. These premiums cover agency profits and the convenience of quick shift fulfillment. For hospitals, inflated costs have them spending significantly more than they would on hiring local talent or utilizing internal float pools. Over time, this excessive spending contributes to unsustainable labor budgets.

Administrative Fees

Often overlooked in contract negotiations, traditional staffing agencies typically charge administrative fees for scheduling, credential verification, and account management. While these fees might seem minor as individual line items on an invoice, they can quickly add up, consuming a significant portion of your nurse staffing budget. These hidden costs can impose considerable financial strain on hospitals already operating on tight margins.

Compliance Charges

Compliance-related expenses, such as background checks, drug screenings, and ongoing credential monitoring, are essential for ensuring patient safety and meeting regulatory standards. However, traditional staffing agencies often inflate these costs, leaving hospitals with unnecessary financial burdens. By leveraging workforce platforms like ShiftMed, you can optimize your hospital budget and minimize compliance risks.

Housing Allowances

Travel nurse contracts often include housing stipends or direct accommodation costs, amounting to thousands of dollars per month per nurse. While necessary for out-of-town staff, these expenses become unnecessary when leveraging a local, credentialed workforce. By sourcing nurses within the community, facilities can avoid these extraneous costs altogether.

Travel Reimbursements

Transportation expenses and meal reimbursements further inflate the cost of using travel nurses to cover shift vacancies. While seemingly minor per shift, these charges add up significantly over time, making travel nurses one of the most expensive healthcare staffing options.

A Breakdown of Nurse Conversion Costs

When hospitals want to transition temporary nurses into permanent roles, staffing agencies often impose various fees that can strain budgets and hinder workforce stability. Usually buried in contracts, these costs discourage permanent hires and perpetuate reliance on expensive temporary staffing solutions.

Percentage-Based Fees

Agencies often charge a percentage of the nurse's annual salary as a fee when a facility wants to hire a temporary nurse permanently. For instance, a 20% fee on a $90,000 yearly salary results in an $18,000 expense to transition one staff member. This model discourages facilities from making permanent hires, continuing a reliance on costly temporary contracts.

Flat-Rate Charges

Flat-rate fees for conversion range from $5,000 to $15,000, depending on the agency. While predictable, these costs still represent a significant hurdle for hospitals seeking to stabilize their workforce through permanent staffing.

Time-Based Variables

Some agencies tie conversion fees to the duration of the nurse’s contract. The shorter the contract, the higher the cost, penalizing facilities for wanting to hire talent quickly. This structure forces organizations into prolonged temporary arrangements, which are less cost-efficient over time.

Buyout Clauses

Contract buyout clauses allow agencies to charge exorbitant fees for releasing a nurse from their contract so that the facility can hire them directly. These clauses significantly deter the development of a robust internal workforce.

A chart comparing ShiftMed nurses with contract and travel nurses.

Cost Benefits of Eliminating Contract and Conversion Fees

Eliminating the contract and conversion fees imposed by traditional nurse staffing agencies allows hospitals to save on labor and boost operational efficiency.

Contract Fee Reduction

Eliminating inflated base rates, housing stipends, and travel reimbursements can save facilities hundreds of thousands to millions annually. For example, removing a $1,000 housing stipend for 20 nurses can lead to $240,000 in annual savings. Scaling these reductions yields dramatic financial improvements.

Conversion Fee Elimination

Transitioning away from percentage-based or flat-rate conversion fees allows hospitals to reinvest savings directly into their workforce. For example, a hospital that hires 50 nurses annually can save up to $750,000 by eliminating $15,000-per-nurse buyout fees.

Administrative Cost Savings

By reducing reliance on external agencies, facilities can streamline administrative operations, cutting costs tied to contract negotiations, scheduling, and billing oversight. Automated platforms like ShiftMed further reduce these burdens by integrating staffing processes into a single interface.

Processing Time Recovery

Eliminating unnecessary fee negotiations and billing complexities allows HR teams to focus on strategic initiatives, such as retention programs and employee development, rather than paperwork and dispute resolution.

SSM Health partnered with ShiftMed to eliminate conversion fees and transform its workforce strategy. In 2023, 12% of on-demand workers transitioned to permanent roles, enabling the hiring of 30-40 full-time employees per quarter. This reduced reliance on travel nurses, improved care quality, and led to a 73% drop in patient falls, higher satisfaction scores, and better safety ratings.

Cost Benefits of Reducing Agency Dependence

Hospitals can free up valuable time and resources across HR, payroll, contract management, and compliance by minimizing the administrative complexities of working with multiple staffing agencies and reducing reliance on travel nurses.

HR Productivity

By removing the need for buyout negotiations, HR teams can dedicate more time to improving employee satisfaction, streamlining hiring processes, and building long-term workforce plans.

Payroll Processing

Simplified staffing models reduce the administrative burden of calculating and processing variable fees, resulting in faster payroll cycles and fewer errors.

Contract Management

Transitioning to a platform-based staffing solution like ShiftMed eliminates the need to oversee multiple agency contracts, reducing time spent on negotiations and compliance management.

Compliance Oversight

Access to pre-vetted, local talent minimizes the need for extensive compliance checks, saving time and money while ensuring regulatory adherence.

LCMC Health improved staffing efficiency at its West Jefferson Medical Center using ShiftMed workforce solutions. In nine months, the medical center converted 18% of ShiftMed on-demand nurses to permanent staff, avoiding buyout fees, cutting labor costs, and boosting nurse engagement and patient care.

Ready to Boost Your Nurse Staffing Budget?

ShiftMed redefines healthcare staffing by eliminating contract fees and nurse conversion costs and fostering internal workforce growth. ShiftMed allows facilities to evaluate the job performance of its on-demand nurses before making permanent hiring decisions. This “try before you buy” model eliminates financial risk and ensures optimal staff fit. Facilities can seamlessly transition on-demand workers into full-time roles without incurring buyout fees, building a reliable and flexible workforce.

Schedule a free workforce consultation today!