Why America's Largest Nurse Staffing Agencies Still Leave 158,600 Jobs Unfilled

AMN Healthcare and Aya Healthcare are the two largest travel nursing agencies in the US, and between them they place a large share of the nurses who move between facilities every year. Neither is the reason 158,600 RN positions sit unfilled nationally. That number, from the 2026 NSI National Health Care Retention and RN Staffing Report, reflects a structural gap agencies were never built to close, because agencies staff temporary and travel roles well. Permanent hiring is a different problem.

Agencies are built for temporary coverage, not permanent pipeline building. AMN's own site states 61% of nurses plan to make a career change within a year, including switching jobs, roles or retiring, and 58% feel burned out most days. Agencies exist partly because that churn is constant. They solve the immediate coverage gap. They do not reduce how often a facility has to hire again.
The fee structure rewards filling a shift, not owning a pipeline. Staffing agency pricing runs on a markup over the placement's pay rate for temporary roles, or a percentage of first-year salary for permanent placements. That model works well when a facility genuinely cannot staff itself. It becomes expensive fast when it substitutes for building an in-house sourcing capability that would otherwise reduce how often an agency is needed at all.
Verification happens, but it happens inside the agency's process, not in the facility's own system. Agencies do credential and licence verification as part of their service, which is real value. The facility does not own that capability afterward. Every future hire outside the agency relationship starts from zero again.

What our client says

"By leveraging HireQuotient's AI agents, we cut our time-to-hire nearly in half, a 45 to 50% reduction, while taking complete control of our recruitment pipeline without relying on expensive staffing agencies."

Yale Smith, Director of Talent Acquisition & Recruiting, Stern at Home Therapy Source: HireQuotient's EasySource Delivers $60,000 Cost Savings for Stern at Home Therapy

"Without relying on expensive staffing agencies" is the specific claim worth sitting with. It is not an argument that agencies are bad at their job. AMN and Aya are large because they are good at temporary coverage at scale. It is an argument that a facility building its own verified sourcing capability stops needing to rent that capability every time a role opens.

Where each is the right choice

	EasySource	AMN / Aya
Best for	Permanent hiring where you want to own the pipeline	Temporary, travel and crisis coverage, filled fast
Fee model	Software cost, no per-placement fee	Markup on pay rate, or percentage of salary
Verification ownership	Owned by your team, reusable on every future hire	Handled by the agency, per engagement
Speed for urgent gaps	Not built for same-week crisis coverage	Very strong; this is the core service
Cost over many hires	Fixed, regardless of volume	Recurring per placement

Facilities with genuine crisis or travel coverage needs should keep using agencies for that. The gap is permanent hiring done repeatedly through an agency relationship that never reduces the underlying need.

FAQ

Are healthcare staffing agencies bad?

No. AMN and Aya are strong at temporary and travel coverage, which is a genuinely different problem from building a permanent, in-house pipeline.

Why do facilities still pay agency fees if permanent hiring tools exist?

Often because building in-house sourcing and verification takes a deliberate decision to invest, while calling an agency is the path of least resistance for an urgent gap. Both are valid depending on the situation.

Does using a sourcing tool replace credentialing entirely?

No. It verifies licence status before contact. Ongoing credentialing, payer enrolment and privileging remain separate processes.