Hospital CFOs celebrated when travel nurse pay rates began their long decline from pandemic-era highs. But the normalization of travel nurse rates has not translated into sustainable ER staffing pipelines. Staff nurse vacancy rates in emergency departments remain at a historically high 17% nationally — and in some markets, the situation is getting worse.
In the spring of 2022, a travel nurse working a 13-week emergency department contract could earn $8,000 to $12,000 per week — rates that seemed to defy gravity and that hospital finance departments viewed as an existential threat to their operating margins. Four years later, those rates have fallen to $3,200 to $4,800 per week, a decline of roughly 41%. Hospital leaders declared victory. The staffing crisis, they suggested, was over.
It was not over. It had simply changed form.
The pandemic-era travel nurse rate spike was driven by a specific set of conditions: a sudden, massive increase in hospital patient volume, a simultaneous wave of staff nurse resignations driven by burnout and COVID-19 exposure risk, and a travel nurse supply that could not scale fast enough to meet demand. Staffing agencies, operating in a seller's market, extracted premium rates that hospitals — flush with federal pandemic relief funding — were willing to pay.
The normalization began in late 2023 as several of those conditions reversed. Federal pandemic relief funding expired, forcing hospitals to scrutinize labor costs more aggressively. Patient volume growth slowed from its 2021–2022 peak. And the travel nurse workforce itself had expanded significantly during the pandemic, as nurses who had never considered travel work were drawn in by the extraordinary pay. As supply caught up with demand, rates fell.
By the first quarter of 2026, the average travel ER nurse weekly rate had settled at approximately $4,100 — still well above pre-pandemic levels of $2,200 to $2,800, but no longer the budget-breaking figure of 2022. Hospital systems that had been spending 30–40% of their nursing labor budgets on travel staff reported that figure falling to 12–18%.
The assumption embedded in the "crisis is over" narrative was that lower travel rates would translate into higher staff nurse retention — that nurses who had left for travel work would return to permanent positions as the pay differential narrowed. That assumption has proven largely incorrect.
A 2026 survey of 3,800 emergency nurses conducted by the Emergency Nurses Association found that only 19% of nurses who had transitioned to travel work during the pandemic had returned to permanent staff positions. The majority — 61% — remained in travel or per-diem work, citing scheduling flexibility as the primary reason. Another 14% had left bedside nursing entirely, moving into education, administration, or non-clinical roles.
The result is a structural vacancy problem that travel rate normalization has not addressed. Emergency department staff nurse vacancy rates nationally stand at 17% — meaning that roughly 1 in 6 budgeted ER nursing positions is unfilled. In rural markets, the figure is 24%. In safety-net urban hospitals, it is 21%.
The pandemic fundamentally altered emergency nurses' relationship with their employers. Having experienced the autonomy and financial rewards of travel work, many nurses are unwilling to return to the constraints of permanent employment — fixed schedules, mandatory overtime, limited ability to decline assignments — even at competitive pay rates.
Hospital systems that have successfully reduced their travel nurse dependence have generally done so not by cutting travel rates but by redesigning their permanent employment models to incorporate flexibility features that were previously associated only with travel work. These include self-scheduling systems that allow nurses to build their own schedules within defined parameters, premium pay for high-demand shifts rather than mandatory overtime, and internal float pools that allow nurses to work across multiple units or facilities.
HCA Healthcare, which operates 186 hospitals, reported in its 2025 annual report that its "internal travel" program — which allows staff nurses to take temporary assignments at other HCA facilities at enhanced pay rates — had reduced its external travel nurse spend by 34% while improving staff nurse retention by 11 percentage points. Several other large health systems have implemented similar programs with comparable results.
Compounding the retention problem is an accelerating attrition rate among new emergency nurses. The ENA survey found that 43% of emergency nurses with fewer than three years of experience planned to leave emergency nursing within two years — a figure that has increased from 31% in 2022 and 38% in 2024.
The drivers of early-career attrition are well-documented: inadequate orientation and mentorship, exposure to traumatic events without adequate psychological support, high patient-to-nurse ratios that make it impossible to provide the level of care nurses feel their patients deserve, and workplace violence. The last factor has emerged as a particularly significant driver of early departure, with 67% of nurses who planned to leave emergency nursing citing a violent incident as a contributing factor.
Emergency medicine nursing leaders argue that sustainable staffing requires addressing the root causes of attrition rather than managing the symptoms through travel nurse utilization. The ENA has called for federal minimum nurse-to-patient ratio standards for emergency departments — a policy that California adopted in 2023 and that several other states are considering.
Proponents argue that minimum ratio standards reduce burnout by ensuring nurses are not overwhelmed, improve patient outcomes, and make emergency nursing more attractive as a career. Opponents, primarily hospital associations, argue that ratio mandates are inflexible, increase labor costs, and can force ERs to go on diversion when they cannot staff to the required ratio.
The evidence from California's experience is mixed. A 2025 RAND Corporation study found that California ERs operating under the ratio mandate had lower nurse turnover rates and higher patient satisfaction scores than comparable ERs in states without mandates, but also had higher rates of ambulance diversion during peak demand periods.
ER Times will continue tracking emergency nursing workforce data through 2026. The next ENA workforce survey is scheduled for publication in September 2026.
Weekly data on ER vacancy rates, travel nurse markets, and workforce trends.