Permanent healthcare recruitment in the United States
Permanent healthcare recruitment in the United States
Registered nurses, licensed practical nurses, certified nursing assistants, physical therapists and clinical leadership. A flat fee per hire, not a percentage of salary — so agreeing a competitive wage no longer increases your recruitment bill.
Our standard fees are $15,500 for a registered nurse or physical therapist, $9,500 for an LPN or LVN and $4,500 for a certified nursing assistant. Subscription clients pay about a third less. Leadership and senior clinical appointments are charged as a percentage of first-year salary. All figures in US dollars.
Who this page is for
Two audiences, one team. Pick the one that describes you.
US healthcare employers →
Hospitals, health systems, ambulatory surgery centers, skilled nursing and rehabilitation. What turnover actually costs you, what we charge, and the point at which our own subscription stops being worth buying.
Nurses and therapists →
Permanent roles, never travel contracts, and never a fee to you. Plus what a US license opens up abroad, if Australia or New Zealand has ever crossed your mind.
The number that moves is turnover, not headcount
A vacancy you fill in 78 days and lose again in eleven months is not a filled vacancy. It is the same vacancy, twice, with the cost of both.
Among the 527 hospitals in NSI’s 2026 national survey — 262,405 registered nurses across 40 states — RN turnover rose to 17.6%, up 1.2 percentage points on the year, while the RN vacancy rate fell to 8.6%.1 Those two lines moving in opposite directions is the whole problem in one sentence: hospitals are filling roles and not holding people.
The cost is not abstract. NSI puts the cost of turnover at $60,090 per bedside RN, and calculates that each single percentage point of RN turnover is worth $294,976 a year to the average hospital.1 Nearly a quarter of newly hired RNs — 22.7% — leave inside twelve months, and that first year accounts for 29.0% of all RN separations.1
Source: NSI Nursing Solutions, 2026 National Health Care Retention & RN Staffing Report, March 2026. A survey of participating hospitals, not a whole-of-sector census.
What that does to your contract labor line
The same survey prices a travel RN at $91.23 an hour, or $189,758 a year, against a staff RN at $59.46 an hour including a 25.8% benefits load, or $123,676 a year — a differential of $66,081 per nurse per year.1 Removing twenty travel RNs from the schedule is worth around $1.32 million annually. It is unsurprising that 70.7% of the hospitals surveyed said they were working to reduce their reliance on travel and agency labor.1
Independently, Staffing Industry Analysts put the aggregate travel nurse bill rate at $90.54 an hour for 2025, essentially flat on 2024 — the market has contracted on volume, not on price.5 The premium is not going away on its own.
Agency shifts are a symptom, not a strategy
Contract labor is bought at a premium, it is hard to forecast, and it puts a different face in front of the same patients every few weeks. None of that is an argument that agency is wrong — sometimes it is the only thing that covers a shift this Friday. It is an argument that the permanent pipeline behind it is what determines how much of it you have to buy.
Where the shortage actually is
It is worth being precise about this, because a great deal of recruitment marketing is still quoting a national RN shortage number that has been superseded.
HRSA’s current projection — Nurse Workforce Projections, 2023–2038, published December 2025 — puts the national RN shortfall in 2038 at 108,960 full-time equivalents, or 3%.2 The previous edition had projected 207,980 for 2037. On the national aggregate, the picture improved.
The distribution did not. The same projection puts the RN shortage at 11% in non-metro areas against 2% in metro areas, and at 22% in California, 20% in North Carolina and 20% in Georgia — while Wyoming is projected to be in substantial oversupply.2 And the licensed practical nurse position is materially worse than the RN position: HRSA projects LPN supply at 70% of demand in 2038, a shortfall of 245,950 FTEs.2
It is a distribution problem
Non-metro 11% short against metro 2%. If your facility is rural, exurban or in one of the three worst-projected states, the national average is not describing your market.2
LPN is the harder gap
70% adequacy projected for 2038 against 97% for RNs. Where your model depends on LPNs, that is the line to plan against.2
Replacement, not growth
BLS projects roughly 189,100 RN openings a year through 2034 against only 5% net growth — the demand is overwhelmingly people leaving, not new posts.4
The Nurse Licensure Compact changes the search radius
43 jurisdictions have enacted the NLC and roughly 40 are currently issuing multistate licenses.6 For permanent recruitment that removes a four-to-twelve week licensure step across most of the country and widens the realistic search radius for a hard-to-fill specialty well beyond your own state. It does not help everywhere — California, New York, Michigan, Oregon, Minnesota, Nevada, Hawaii and Alaska are not compact states — and knowing which of your target markets are in and out is part of how a brief gets scoped.
One correction worth making, because it affects post-acute planning
The federal minimum staffing standards for long-term care facilities — the 24/7 registered nurse requirement and the 3.48 total nurse hours per resident day — were repealed. CMS published the repeal on 3 December 2025, effective 2 February 2026, after two federal district courts vacated parts of the 2024 rule and section 71111 of Public Law 119-21 barred enforcement until 30 September 2034.8 The standard reverts to registered nurse services for at least 8 consecutive hours a day, 7 days a week, plus a full-time director of nursing.
If a recruiter is selling you on a federal staffing mandate in 2026, they are working from last year’s deck. The drivers in post-acute are acuity, occupancy, payer mix and state staffing law — several states retain their own ratios, and those are untouched by the federal repeal.
Roles we recruit
Permanent appointments across acute care hospitals, health systems, ambulatory surgery centers, skilled nursing and long-term care, inpatient and outpatient rehabilitation, and home health.
- Operating Room / Perioperative
- PACU & Pre-Op
- Critical Care / ICU
- Emergency
- Medical-Surgical
- Telemetry / Progressive Care
- Cardiac & Cath Lab
- Oncology
- Labor & Delivery
- NICU
- Pediatrics / PICU
- Behavioral Health
- Case Management
- Physical Therapist
- Physical Therapist Assistant
- Occupational Therapist
- Licensed Practical / Vocational Nurse
- Certified Nursing Assistant
- Charge Nurse
- Nurse Educator
- Clinical Nurse Specialist
- Nurse Manager
- Director of Nursing
- Chief Nursing Officer
Your people team keeps every hiring decision, salary authority, the employer brand and the relationship with each unit manager. What we add is market reach, screening throughput, and someone whose whole week is the pipeline.
Where we recruit
Permanent appointments nationwide — acute care, ambulatory surgery, post-acute and home health — with the deepest candidate coverage in the markets where the shortage is sharpest.
Because 43 jurisdictions have enacted the Nurse Licensure Compact and around 40 are currently issuing multistate licenses,6 a hard-to-fill specialty does not have to be recruited from inside your own state. Where your state sits outside the compact, we build the licensure lead time into the plan rather than discovering it after an offer.
United States
Two ways to buy, and what committing gets you
Both are available and both stay available. The difference is $5,000 on every registered nurse appointment and 4.3 percentage points on every leadership appointment — which is what the subscription buys you, on top of the pipeline it builds.
No subscription — pay per placement
No upfront cost and no monthly fee. You brief a role, we fill it, and you are invoiced on the nurse’s start date. If nobody starts, there is no fee at all. Our standard fees apply: $15,500 per registered nurse and 18.3% of first-year salary on leadership appointments.
Best if you make fewer than six permanent nursing appointments a year, or you want to test us on a single role first.
Subscription — the reduced fees
A fixed monthly fee, and $10,500 per registered nurse instead of $15,500. The monthly fee builds and holds a pipeline of nurses for your facilities — screened and in contact before a vacancy exists — rather than starting a fresh campaign each time a role opens. It is payable whether or not anyone starts that month. Leadership appointments drop from 18.3% of first-year salary to 14%.
Best if you make six or more permanent nursing appointments a year at the entry tier, or you are carrying contract labor you want to convert into permanent staff. The reduced fees are available to subscription clients only.
What the subscription buys: a pipeline, not a campaign
Paying per placement buys a campaign. A role opens, we advertise, we source, we screen, we shortlist — and when the role is filled, that work stops. The next vacancy starts from zero. Given that the average RN vacancy already takes 78 days to fill,1 starting from zero is expensive.
We keep talking to nurses when you have no vacancy
Most of the nurses worth hiring are not applying for anything. They are in a job, open to the right move, and they take months of contact before they make it. That contact is what the monthly fee pays for — and it cannot be bought retrospectively once a resignation lands.
The pool is built for your facilities
Screened against your specialties, your locations and your salary bands. License verified through Nursys or the state board, right to work verified, and referenced before a vacancy exists rather than after one opens.
You can see it before you need it
Pipeline reporting by specialty and site shows you where the depth is thin. That turns a looming staffing gap into a recruitment plan a quarter early, instead of a travel booking on the day someone resigns.
What it costs
Our standard fees are $15,500 for a registered nurse, $9,500 for an LPN or LVN, $4,500 for a certified nursing assistant and 18.3% of first-year salary on leadership appointments. With a subscription they are $10,500, $6,500, $3,000 and 14% — about a third less across the board.
| No subscription | With a subscription | |
|---|---|---|
| Monthly fee | None | From $1,950 |
| Registered nurse | $15,500 per appointment | $10,500 per appointment |
| Physical therapist | $15,500 per appointment | $10,500 per appointment |
| Licensed practical / vocational nurse | $9,500 per appointment | $6,500 per appointment |
| Leadership and senior clinical | 18.3% of first-year salary | 14% of first-year salary |
| Certified nursing assistant | $4,500 per appointment | $3,000 per appointment |
| Do the fees rise with the salary? | No — flat, except leadership | No — flat, except leadership |
$5,000 on every registered nurse and physical therapist, $3,000 on every LPN or LVN, $1,500 on every CNA appointment, and 4.3 percentage points on leadership — $6,020 on a $140,000 nurse manager and $6,880 on a $160,000 director of nursing.
Each tier publishes its own break-even and we hold ourselves to it: 5 registered nurse appointments a year at Single Site, 11 at Group, 29 at National. If your volume sits under the figure for your tier, our standard fee is cheaper and we will tell you so rather than sell you a subscription.
What other agencies charge, and what we charge
There is no published benchmark specific to healthcare permanent placement, so we use the general direct-hire benchmark and label it honestly rather than dress it up as a nursing number. Staffing Industry Analysts put the median direct-hire fee at 20% of first-year salary, with 42% of staffing firms charging exactly 20%; professional staffing sits at 18% to 22% and dedicated direct-hire firms at 20% to 25%.5 Healthcare staffing sources put the same range at 15% to 25%, and some recruiters quote up to 30% on hard-to-fill and senior clinical roles.5
The important difference is not the percentage. It is that a percentage moves and a flat fee does not.
| RN salary | Agency at 20% | IHR standard | IHR subscription |
|---|---|---|---|
| $85,000 | $17,000 | $15,500 | $10,500 |
| $97,550 | $19,510 | $15,500 | $10,500 |
| $110,000 | $22,000 | $15,500 | $10,500 |
| $125,000 | $25,000 | $15,500 | $10,500 |
Against a 20% fee, our standard fee saves you from $1,500 at an $85,000 salary to $9,500 at $125,000, and a subscription saves from $6,500 to $14,500. At the top of the market range — 25% — a $110,000 nurse costs $27,500 to recruit. Ours costs $15,500, or $10,500 on a subscription, and it does not matter what you agree to pay.
Put another way: our standard fee is 15.9% of the national median RN salary and our subscription fee is 10.8%. We are not the cheapest number anyone will quote you — there are firms that will undercut this and staff the brief with a job-board search. We are priced inside the market and structured so that we do not make more money when you pay a nurse more.
Because our nursing fee is flat rather than a percentage, it does not rise when you agree a competitive wage. That matters more than it used to: the AHA reports that advertised RN salaries have grown 5.5% a year over the last two years, more than double the rate of inflation.7 On a percentage model, every dollar of that wage growth is also a dollar on your recruitment invoice.
Subscription tiers
The reduced fees above apply to subscription clients only, and are the same on all three tiers. What changes between tiers is how many sites are in scope and how much service sits behind them — you do not buy a better fee by moving up. You should be able to work out roughly what this costs before you spend an hour on a call. Final pricing depends on site count, specialties in scope and term.
Single Site
One hospital, facility or center, or a group of up to 4 sites. Pays for itself from 5 registered nurse appointments a year.
- No cap on the number of permanent briefs you can raise. Delivery capacity for each tier is set out in your agreement
- One named consultant, direct line, no call center
- Domestic-first sourcing: US-licensed nurses with existing work authorization presented before any sponsored candidate
- Monthly pipeline report
3, 6 or 12-month term, then month to month.
Group
5 to 20 sites under one group or system. Pays for itself from 11 registered nurse appointments a year.
- Everything in Single Site, plus:
- Account team with named cover, so work continues when someone is on leave
- Quarterly workforce review against your staffing position and turnover data
- Salary and fee benchmarking for your markets
- Multistate sourcing across NLC jurisdictions, with a licensure plan for the states that are not in the compact
3, 6 or 12-month term, then month to month.
National
21 or more sites, multiple states. Pays for itself from 29 registered nurse appointments a year.
- Everything in Group, plus:
- All US sites in scope under one agreement
- Reporting formatted for board and executive papers
- 12-month rolling workforce plan by state and specialty
- International program managed end to end, if you use it
3, 6 or 12-month term, then month to month.
Prices shown are the 12-month rate, which is the lowest. Three and six month terms are also available — see below. Subscription fees are payable monthly and are not refundable. Placement fees can be refunded under the 90-day guarantee. All figures in US dollars.
Choose a term: three, six or twelve months
Nobody should sign a year of something they have not seen work. So the shortest commitment is three months.
| 3-month term | 6-month term | 12-month term | |
|---|---|---|---|
| Single Site — up to 4 sites | $2,750 / mo | $2,350 / mo | $1,950 / mo |
| Group — 5 to 20 sites | $6,300 / mo | $5,400 / mo | $4,500 / mo |
| National — 21 sites or more | from $16,800 / mo | from $14,400 / mo | from $12,000 / mo |
The twelve-month rate is 29% lower, and here is why
The set-up work is the same whether you stay three months or twelve: the scoping, the salary banding, the approval chain, and the first weeks of pipeline building before it produces anything. Over three months we have to recover that in the monthly fee. Over twelve we do not, so the rate is 29% lower on every tier — $9,600 a year less at Single Site, $21,600 at Group, $57,600 at National — and we hold it for the whole term.
If you are unsure, take three months. It costs more per month, but it costs a great deal less to be wrong. If it works, you move onto the twelve-month rate at the end of it.
At the end of any term the subscription continues month to month — 30 days’ notice on a three or six month term, 60 days on a twelve-month term. Nothing rolls into a new fixed term automatically.
What committing is worth: the arithmetic
Rather than leave you to model it, here it is. Registered nurse appointments only, at the entry subscription of $1,950 a month. LPN and leadership appointments improve every row further.
| RN hires a year | No subscription | With subscription | You save |
|---|---|---|---|
| 3 | $46,500 | $54,900 | −$8,400 |
| 4 | $62,000 | $65,400 | −$3,400 |
| 5 | $77,500 | $75,900 | $1,600 |
| 10 | $155,000 | $128,400 | $26,600 |
| 15 | $232,500 | $180,900 | $51,600 |
| 20 | $310,000 | $233,400 | $76,600 |
| 30 | $465,000 | $338,400 | $126,600 |
Effective cost per hire falls from $16,350 at four appointments to $15,180 at five, $12,840 at ten and $11,280 at thirty. For context, twenty registered nurse appointments bought at the SIA median of 20% of a $97,550 salary would cost $390,200.3,5 The same twenty on our entry subscription cost $233,400.
Every tier publishes its own break-even
| Tier | Monthly | A year | Pays for itself at |
|---|---|---|---|
| Single Site — up to 4 sites | $1,950 | $23,400 | 5 RN appointments |
| Group — 5 to 20 sites | $4,500 | $54,000 | 11 RN appointments |
| National — 21 sites or more | from $12,000 | $144,000 | 29 RN appointments |
Those figures count registered nurse appointments, which carry the largest saving. An LPN saves $3,000 rather than $5,000 and a CNA appointment $1,500, so a hiring mix weighted toward LPNs and CNAs needs more volume to reach the same point. Leadership appointments bring every figure down: each one saves 4.3 percentage points, so a single $140,000 nurse manager is worth about one and a quarter nursing appointments against the break-even. Tell us your actual mix and we will give you your own figure in writing.
If your volume sits below the figure for your tier, our standard fee is cheaper, and we will tell you that. We have not seen another agency publish the point at which its own offer stops being worth buying. We do, because the alternative is selling a subscription that a client works out was a mistake in month seven.
Nursing fees are flat either way, so they never rise because you agreed a competitive salary. Placement fees are invoiced in full on the nurse’s start date. No retainers, no instalments, no staged payments.
Our 90-day replacement guarantee
Clock one — the nurse
If a nurse we place resigns or is terminated for performance within their first 90 days, and the original invoice has been paid, we recruit a replacement at no further placement fee.
Clock two — us
From the day we receive your replacement brief, IHR has 90 days to present at least three candidates who meet the written brief. If we do not, the original placement fee is refunded in full.
The two clocks are deliberately kept separate. A free replacement that never arrives is not a guarantee, so the second clock runs on us. The only current benchmark we could find puts typical US guarantee periods at 30 to 90 days,5 and none of them carry a delivery deadline on the agency. Ours does.
This matters more in the United States than the raw number suggests, because 22.7% of newly hired RNs leave within twelve months.1 A guarantee is the only part of a recruitment contract that puts the agency’s fee at risk when a placement does not hold.
The guarantee applies to registered nurse, physical therapist, LPN/LVN and leadership appointments. It does not apply where the position is made redundant, withdrawn or materially changed, or where candidates meeting the written brief are not interviewed within 10 working days of presentation. Refunds apply to placement fees only, never to subscription fees. Full terms are in your agreement.
We would rather send you three nurses than thirty resumes
Quality is easy to claim and hard to prove, so here is what it means in practice — and why our fee structure is built to enforce it rather than to reward the opposite.
Nobody reaches you unscreened
Every candidate we present has been interviewed by us, had their license verified through Nursys or the issuing state board, their work authorization verified and their references checked — before you see them, not after you have shortlisted them. Each comes with a written summary a hiring manager can read in two minutes.
Short shortlists, on purpose
Three or four candidates we would stand behind, not everyone who answered the ad. If only two genuinely fit the brief, you get two and an honest explanation, rather than a longer list padded out to look like effort.
We turn work down
If a role cannot be filled well at the salary, the shift pattern or the location on offer, we will say so and tell you what would need to change. Taking a brief we cannot deliver wastes a quarter of your hiring year and costs us the relationship.
Our fee structure removes the incentives that damage quality
A flat fee means we do not earn more when you pay more. A recruiter on a percentage of salary is paid more for talking you into a higher offer. Our registered nurse fee is the same on a $110,000 nurse as on an $85,000 one, so the salary conversation is about what the market requires rather than about our invoice.
The guarantee puts our fee at risk on a bad placement. If a nurse we place leaves in their first 90 days we replace them at no further placement fee, and if we cannot deliver that replacement inside 90 days we refund the fee. Pushing a marginal candidate through to trigger an invoice is a good way for us to lose the invoice.
And the subscription pays us to build a pipeline, not to close a vacancy this week. When the monthly fee covers the work between vacancies, there is no reason to rush a shortlist so a placement lands inside the month.
International recruitment: the honest version
We do international nurse recruitment. We will not sell it to you as a solution to a staffing gap this year, because on the current numbers it is not one.
Schedule A, Group I at 20 CFR 656.5 lists exactly two occupations: professional nurses and physical therapists.11 Both are pre-certified, which means no PERM labor certification and no test of the labor market — the employer files the Schedule A application directly with USCIS alongside the I-140. That removes roughly twelve to twenty-four months against a standard employment case and is the single biggest structural advantage either occupation has.
It does not remove the queue. On the August 2026 Visa Bulletin, EB-3 final action dates sit at 1 September 2024 for Worldwide chargeability, 1 August 2023 for the Philippines and 1 January 2014 for India.9 In plain terms, that is a backlog of roughly 23 months, 36 months and 12.6 years respectively, and only the Worldwide queue is closing. Chargeability is by country of birth, not citizenship or where the nurse trained.
Worldwide chargeability
UK, Ireland, Kenya, Ghana, Nepal, South Korea and most others. Plan on two to four years end to end. Do not plan on less.
Philippines
The queue is advancing roughly six months per calendar year against a 36-month backlog. Realistically five to eight years.
Canada and Mexico
TN status under USMCA. No cap, no priority date, no visa bulletin. Six to twelve months is achievable. This is the one fast international route.
There is a second number people do not mention. In 2025, the NCLEX-RN first-time pass rate for internationally educated candidates was 47.3% across 52,827 candidates — down from 53.8% the year before — and the repeat pass rate was 30.5%.10 Any international pipeline model that assumes one attempt per nurse is wrong for the majority of candidates.
So our order of work is domestic first: US-licensed nurses with existing work authorization, sourced across compact jurisdictions where your target market allows it. International sits behind that pipeline, on a realistic timetable, for the roles that genuinely cannot be filled domestically. If a competitor is quoting you overseas nurses on the floor within six months and they are not talking about Canada or Mexico, ask them which chargeability and which visa bulletin date they are working from.
Opening a new unit? Volume recruitment against a fixed date
A new surgical suite, an additional floor, an ambulatory surgery center or a service line coming back online: each needs a full complement of specialty nurses credentialed and scheduled before the first case runs, and OR and PACU are the hardest of those to recruit.
Commissioning is a different job from filling a vacancy. You are not recruiting one nurse, you are building a schedule that has to be complete, credentialed and oriented on a date already sitting in a board paper — and every week of slippage carries full overheads.
We work backwards from the opening date
A cohort plan by specialty and shift, with offer dates set against your credentialing and orientation lead times rather than ours. You see the whole schedule as one plan, not as a queue of separate vacancies.
Cohorts run in parallel, start dates staggered
Clinical leadership first, because they interview and orient the rest. Then the nursing cohort in overlapping waves, so onboarding is not swamped in one week and there are experienced hands on the floor before the last group arrives.
We plan for the withdrawals
On any cohort of thirty, some accept and then do not resign from their current job. We build that in from the start rather than discovering it a fortnight out — which is the difference between opening on time and opening short.
Example. A four-OR suite opening with 30 registered nurses, 10 LPNs and four leadership appointments at $140,000: about $662,000 at our standard fees, or about $512,000 on a Group 12-month subscription — a difference of around $150,000 in the year your hiring volume peaks.
Volume is also where recruitment quality usually collapses: the pressure of a date is exactly what produces a stack of unscreened resumes. Everything above about screening and short shortlists applies harder at thirty appointments than at one, and the 90-day guarantee applies to every nurse in the cohort.
If you have a commissioning date, tell us the date first and the numbers second. The date determines whether the plan is achievable, and we would rather say so early than take the brief and miss it.
Recruitment fees: questions from CFOs and procurement
How much do nursing recruitment agencies charge in the US?
There is no current healthcare-specific published benchmark. The best available figure is Staffing Industry Analysts’ all-industry direct-hire benchmark: a median of 20% of first-year salary, with 42% of firms charging exactly 20% and dedicated direct-hire firms at 20% to 25%.5 Against the BLS national median RN wage of $97,550,3 20% is $19,510. Our standard fee is a flat $15,500 per registered nurse appointment — flat rather than a percentage, so it does not rise with the salary you agree — and 18.3% of first-year salary on leadership appointments. Subscription clients pay $10,500 and 14%. The reduced fees are available to subscription clients only.
Do we pay anything upfront?
Not without a subscription — no upfront cost, no monthly fee, and you are invoiced only when a nurse starts. A subscription carries a fixed monthly fee and reduces the placement fees to $10,500, $6,500, $3,000 and 14%. The entry tier pays for itself from five registered nurse appointments a year.
Is this RPO? Procurement will want to benchmark it against RPO rates.
No, and that benchmark is the wrong one. RPO is typically sold per recruiter per month and buys embedded headcount running your process. This buys outcomes: a fixed monthly fee plus a fixed fee on each nurse who starts. The correct comparator is the percentage-of-salary placement fee you pay today, and the arithmetic is set out above.
What happens if we hire nobody in a month?
On the subscription you pay the monthly fee and no placement fees. It buys continuous pipeline work — sourcing, screening and talent-pool building carry on whether or not a role closes that month, which is what stops the next vacancy becoming a travel booking. Assess it over the year, not the month. Without a subscription there is no monthly fee at all, and you pay only when a nurse starts.
What if we hire far more than expected?
The subscription does not change, so your effective cost per appointment falls. There is no cap on the number of briefs you can raise; delivery capacity for each tier is set out in your agreement, and if your volume moves you to a larger tier we will tell you before it does.
Do we have to commit to a year?
No. Subscriptions run on a 3, 6 or 12-month term. The 12-month rate is 29% lower on every tier because the set-up work is the same whichever you choose, but three months is a real option and it is the one we suggest if you have not worked with us before.
Can you recruit across state lines?
Yes, and the compact makes it materially easier. 43 jurisdictions have enacted the Nurse Licensure Compact and around 40 are currently issuing multistate licenses,6 so for most of the country a nurse holding a multistate license from their primary state of residence can practice in your state without a fresh application. Where your state is outside the compact — California, New York, Michigan, Oregon, Minnesota, Nevada, Hawaii and Alaska among them — we build the licensure lead time into the plan rather than discovering it after an offer.
Does this replace our contract labor spend or sit on top of it?
It is designed to reduce it. On NSI’s figures a travel RN costs $189,758 a year against $123,676 for a staff RN including benefits — $66,081 a difference, per nurse, per year.1 If you want a defensible business case, model the subscription against your contract labor invoices for the last 12 months as well as your placement fees. That comparison is usually the larger number.
Who owns the candidate relationship and the data?
You own the records of every candidate we introduce to you, and they are handed over in full if the agreement ends. IHR retains its own records as required by law and by the candidates’ consent.
How do you keep quality up on a large volume brief?
The screening does not change: every candidate is interviewed by us, license verified, work authorization verified and referenced before you see them, whether it is one appointment or thirty. Shortlists stay short, and the 90-day guarantee applies to every nurse in a cohort — which is what makes it expensive for us to lower the bar under date pressure.
For US-licensed nurses and therapists
Permanent roles, not travel contracts. Free to you, always — we are paid by the employer, never by the clinician.
Most of the nurses and therapists we place are not applying for anything when we first speak to them. They are in a job, doing it well, and open to the right move if it turns up. That is the conversation we are set up for: not a stack of applications, but a working relationship with someone who knows what is actually open in your specialty and your market, and who will tell you when nothing worth moving for is.
You are never charged
Our fee is paid by the hospital, health system or facility that hires you. There is no fee to you at any stage, and no contract that recovers costs from your paycheck.
Your resume does not move without you
We ask before we send you anywhere, every time. No blanket submissions, no finding out your resume reached your current employer’s competitor by accident.
We tell you the parts recruiters skip
Shift pattern, typical ratio, float expectations, call requirement, orientation length, and what the unit is actually like. Nearly a quarter of newly hired RNs leave inside a year1 — usually because none of that was said out loud before they started.
The compact is worth understanding before you decide where to look
43 jurisdictions have enacted the Nurse Licensure Compact and roughly 40 are currently issuing multistate licenses.6 If your primary state of residence is one of them and you hold a multistate license, you can practice in every other compact jurisdiction without applying for a new license — which makes a much wider set of roles available to you at short notice than most nurses assume.
The exceptions matter too. California, New York, Michigan, Oregon, Minnesota, Nevada, Hawaii and Alaska are not compact states, so a move there means a licensure application and a lead time to plan for. If you move your primary state of residence to another compact state, you need to apply for licensure in the new state within 60 days.
What the market pays
The BLS national figures for May 2025 put registered nurse pay at a median of $97,550 a year and a mean of $101,420, across 3,379,720 RNs.3 LPNs and LVNs sit at a median of $64,400 and nursing assistants at $42,260.3 Those are national numbers and the spread by state, setting and specialty is wide — hospital employment generally pays above the national median, and non-metro and specialty premiums vary enormously.
Two things are worth knowing when you negotiate. Advertised RN salaries have risen about 5.5% a year for the last two years, more than double inflation.7 And because our fee to the employer is flat rather than a percentage of your salary, we have no financial interest in where your offer lands. A recruiter paid a percentage does.
What we will ask you for
- Your license and specialty history. Which states, single-state or multistate, your primary state of residence, and the units you have actually worked — not the ones on your resume from six years ago.
- What you are looking for, specifically. Shift, commute, ratio tolerance, call, whether you want charge or education track, and the number below which you will not move.
- Certifications and dates. BLS, ACLS, PALS, NRP, CNOR, CCRN and anything else current, with expiry dates, so nothing stalls at credentialing.
- Two references we can actually reach. A charge nurse or manager who has seen you work. We check them before you are presented, not after.
- Permission, each time. We tell you who we want to send you to and why, and we do not send anything until you say yes.
Thinking about Australia or New Zealand?
This is the part of our business we have been doing longest — IHR Group has placed permanent nurses into Australian and New Zealand healthcare since 2013 — and US-trained nurses are in an unusually good position on both pathways.
Australia
The United States is on the NMBA’s approved list of comparable international regulatory jurisdictions, alongside the UK, Ireland, Singapore, Spain and the Canadian provinces of British Columbia and Ontario.12 Under the registration standard for internationally qualified registered nurses, in effect since 23 April 2025, a nurse with a qualifying nursing degree from a comparable jurisdiction and at least 1,800 practice hours since 1 January 2017 — roughly one year full time — uses a streamlined route. The NMBA indicates this can complete in one to six months, against nine to twelve previously.12
You are also almost certainly exempt from English language testing: US schooling and a US nursing qualification taught in English satisfy the recognised-country pathway in the NMBA English language skills standard.13
One caveat worth checking early: the streamlined route is written around a degree-level qualification. If you hold an ADN rather than a BSN, complete the Ahpra self-check before assuming it applies to you — an associate degree can be assessed at a level that requires the outcomes-based assessment instead.
New Zealand
The Nursing Council of New Zealand also recognises US-educated nurses. With a qualification equivalent to a New Zealand Bachelor of Nursing or higher and 1,800 hours of RN practice in the last ten years, you can be exempted from the competence assessment programme, and US nursing education conducted in English exempts you from English testing.15
Registered Nurse sits on New Zealand’s Green List at Tier 1, which is the straight-to-residence tier.16 With a job offer from an accredited employer you can apply for residence from the outset rather than serving time on a work visa first. Immigration New Zealand decides 80% of those applications within three months.16
New Zealand also treats you better on healthcare: publicly funded health services are available to work visa holders whose visa allows a consecutive stay of two or more years.16
The money conversation, honestly
For an experienced US registered nurse, both Australia and New Zealand are a pay cut in US dollar terms. We would rather say that here than let you discover it at offer stage.
A New South Wales registered nurse earns AUD $81,468 in year one and AUD $114,379 at year eight on the rates effective 1 July 2026;14 a Queensland Grade 5 nurse starts at AUD $87,790.14 At an exchange rate of about 0.71, year eight plus 12% superannuation comes to roughly US$90,700 against a US mean of $101,420.3,18 New Zealand is further behind: the ratified scale runs from NZD $77,667 to NZD $109,407, which at about 0.59 is roughly US$45,700 to US$64,400.17,18
What you gain is not salary. It is five to six weeks of annual leave with a 17.5% loading, penalty rates of 150% Saturday, 175% Sunday and 200% on public holidays, a 12% employer superannuation contribution on top of salary, legislated nurse-to-patient ratios in several Australian states, and a defined route to permanent residence — two years with a sponsoring employer in Australia, or immediately in New Zealand on the Green List. Whether that is worth a dollar pay cut is a decision only you can make, and it is not one we will make for you.
One practical warning for Americans specifically: the United States does not hold a Reciprocal Health Care Agreement with Australia, so on a subclass 482 visa you will not have Medicare and must hold Overseas Visitors Health Cover for the whole stay. Medicare comes with permanent residence. Anyone advertising “free healthcare in Australia” to a US nurse on a work visa is wrong.
Registration requirements, in detail
The Nurse Pathway course
The Nurse Pathway is our education arm for internationally qualified nurses — a self-paced course covering registration, documents, exams and job readiness for Australia and New Zealand. It is education only; placement is a separate, employer-paid service and carries no visa or job guarantee.
Who you are dealing with
IHR Group has been placing permanent healthcare staff since 2013. Thirteen years of doing one thing.
We are not a general staffing firm with a healthcare desk. Permanent clinical recruitment is the whole business and has been since it started — registered nurses, specialty and operating room nursing, midwifery, therapy and clinical leadership, placed into hospitals, private hospital groups and long-term care providers under agreements that run year after year rather than placement by placement.
What that buys you is not a brand you have heard of. It is a consultant who has taken several thousand briefs, knows the difference between a hard role and an impossible one, and will tell you which of the two yours is before you commit a quarter of your hiring year to it. It is screening done properly the first time, because we have seen what happens when it is not. And it is a fee structure published on a public page, which very few recruiters are willing to do.
Permanent only
We do not run a travel or per-diem book. There is no internal incentive to keep a role unfilled so a contract keeps billing — the only way we get paid is somebody starting and staying.
Specialty-led sourcing
OR, PACU, critical care, ED, med-surg, cardiac, oncology, L&D, NICU and therapy — sourced by discipline and by who is actually working in it, not by job-board keyword.
Published fees, published break-evens
Every number on this page is public, including the point at which our own subscription stops being worth buying. If a recruiter will not put a fee in writing before a call, that is information too.
The United States is a newer market for us than Australia and New Zealand, and we would rather say so than imply a US client list we have not built yet. What is not new is the work itself. Ask us for references and we will give you the people whose schedules we have been filling for years.
Book a call
Send Chris Bailey a short email and he will call you back.
Employers: bring your last 12 months of placement fees and contract labor invoices, and we will model your actual volume against both options — and tell you plainly if you are better off staying as you are. Tell us your hardest specialty to fill and roughly how many permanent nursing hires you make a year.
Nurses: tell us your license states, your specialty and what you are looking for. There is never a fee to you.
Email Chris Bailey to book a call
Or write to chris.bailey@ihrgroup.com.au directly, or call +61 (0)2 9231 8481.
Sources
- NSI Nursing Solutions, 2026 National Health Care Retention & RN Staffing Report, March 2026. Survey of 527 hospitals in 40 states covering 262,405 registered nurses, data period January–December 2025. A survey of participating hospitals, not a whole-of-sector census.
- HRSA National Center for Health Workforce Analysis, Nurse Workforce Projections, 2023–2038, December 2025. Modelled projections assuming historical patterns of attrition, graduation and labor force participation continue.
- US Bureau of Labor Statistics, Occupational Employment and Wage Statistics, national data, May 2025. Annual figures assume year-round full-time work and exclude the self-employed.
- US Bureau of Labor Statistics, Occupational Outlook Handbook, Registered Nurses, projections 2024–2034. Annual openings are predominantly replacement demand, not net new positions.
- Fee benchmarks: Staffing Industry Analysts, direct-hire fee benchmarks, April 2022, from the North America Staffing Company Survey 2021; corroborated by SpectraForce (May 2025, updated January 2026) and Nursa (September 2025), which put the healthcare range at 15% to 25%. These are all-industry or agency-published figures; no current healthcare-specific fee survey exists. Travel nurse bill rate from the SIA/NATHO Travel Nurse Benchmarking Survey, May 2026.
- Nurse Licensure Compact, nursecompact.com, accessed August 2026. Implementation counts vary slightly by source and date.
- American Hospital Association, Costs of Caring 2026, March 2026. Published by a hospital trade association; salary growth derived from Lightcast data.
- CMS/HHS, Repeal of Minimum Staffing Standards for Long-Term Care Facilities, Federal Register, 3 December 2025, effective 2 February 2026; enforcement barred to 30 September 2034 by section 71111 of Public Law 119-21.
- US Department of State, Visa Bulletin for August 2026. Backlog durations are our arithmetic from the published final action dates, not official forecasts; bulletin movement is not linear.
- NCSBN, 2025 NCLEX Examination Statistics, Research Brief Volume 96, June 2026.
- 20 CFR 656.5 (Schedule A, Group I) and 8 CFR 212.15 (health care worker certification).
- Ahpra and the Nursing and Midwifery Board of Australia, Registration standard: general registration for internationally qualified registered nurses, in effect 23 April 2025, and the Approved list of comparable international regulatory jurisdictions, April 2025.
- Nursing and Midwifery Board of Australia, English language skills registration standard, April 2025.
- NSW Health Information Bulletin IB2026_018 (rates effective 1 July 2026); Queensland Health nursing stream wage rates effective 1 April 2026.
- Nursing Council of New Zealand, internationally qualified nurse requirements and fee schedule, 2026.
- Immigration New Zealand, Green List Appendix 13 (version effective 9 March 2026) and Straight to Residence Visa; Health New Zealand | Te Whatu Ora eligibility guidance.
- New Zealand Nurses Organisation and Health New Zealand terms of settlement signed 23 April 2026, ratified May 2026; scale effective 2 March 2026.
- Exchange rates as at 14 August 2026: AUD 1 = USD 0.7078; NZD 1 = USD 0.5892. Rates move; conversions are indicative only.
Figures on this page are indicative and were current at the date of publication. Nothing here is legal, financial, tax, immigration or procurement advice.
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