Staffing shortages are leaving fewer nurses to cover increasingly demanding hospital workloads.
The U.S. is short roughly 158,600 registered nurses in 2026, according to NSI Nursing Solutions’ latest national retention survey. The Health Resources and Services Administration projects the gap will widen to a 10% national RN shortage by 2027. For hospital administrators, that’s not just a hiring headache. It’s a line item that keeps growing.
A single unfilled overnight shift doesn’t stay contained. It triggers overtime pay, forces a scramble for agency coverage, and in enough cases, caps how many beds a unit can safely staff. Facility operators are starting to treat nurse staffing the way they’d treat any other operational risk: with a dollar figure attached.
The Real Cost of an Empty Shift
A hospital staffing board reflects the daily pressure facility managers face when shifts go unfilled.
Losing a single bedside RN now costs a hospital an average of $60,090. Multiply that across a typical facility’s turnover rate and the number climbs to $4.2 million to $6.2 million a year, just from replacing nurses who leave. Management Sciences for Health puts the systemwide cost of the nursing shortage at $55 billion by 2025, building on the American Hospital Association’s earlier estimate of $37 billion a year in overtime and temporary staffing spend alone.
It gets worse for units that stay understaffed the longest. Modern Healthcare found those units pay 41% more in locum tenens fees than adequately staffed ones, since agencies charge a premium when a facility has no leverage and no time to negotiate.
That math is pushing operators toward tools built specifically to close gaps without the markup. Nursa’s healthcare staffing solution connects facilities directly with credentialed per diem clinicians, cutting out the agency middleman and the contract lock-in that comes with it. Instead of paying a premium to a staffing firm for a nurse who might show up, facilities post the open shift and fill it directly, often within hours.
Why Traditional Staffing Agencies Are Losing Ground
A per diem clinician picks up an open shift directly from her phone, bypassing the agency booking process entirely.
Persistent workforce shortages continue to drive up hospital labor costs across the U.S. healthcare sector. That pressure is also forcing facilities to take a closer look at how they source and pay for temporary staff.
Agencies built their business model on markup and multi-month contracts. That model is harder to justify when 65% of hospitals and health systems report operating below full capacity at some point due to staffing shortages, and 81% of healthcare leaders say care delays are now a substantial problem.
Nearly 96% of healthcare leaders expect gig-style roles, including per diem and float pool positions, to be core to their staffing strategy by 2026, and more than 92% are already piloting flexible or contingent staffing models, per MedCerts’ 2026 workforce data. That trend mirrors what’s happening in other labor-strapped sectors. Fleet operators facing driver shortages have moved toward similar flexible staffing solutions, trading rigid long-term contracts for on-demand labor pools that flex with demand instead of against it.
What Facility Operators Should Look For in a Flexible Staffing Model
Staffing decisions also have a direct impact on patient safety, making the way facilities fill workforce gaps about more than cost alone. That makes choosing the right staffing model especially important for facility operators.
Not every per diem platform solves the underlying problem. Facility leaders evaluating a switch should look for a few specific things: automated credential verification so compliance doesn’t become a manual burden, transparent per-shift pricing instead of buried agency fees, and a fill time measured in minutes rather than days.
Just as important is a clear path to convert a per diem clinician into a full-time hire without a placement fee attached. Locking facilities into buyout penalties defeats the point of flexibility. The efficiency case here isn’t isolated to staffing, either. It echoes a broader shift toward reducing administrative overhead across healthcare operations, where digital tools are replacing manual processes that used to eat into margins.
Conclusion
The nursing shortage isn’t resolving on its own, and the World Health Organization’s projected global health worker shortfall suggests the pressure will continue. Facilities that rely on agency markups and overtime to fill staffing gaps will keep absorbing higher costs.
Operators that prioritize staffing flexibility can better control these costs while maintaining the workforce they need.
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