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In 2024, ReyAnn Moya signed a 3-month contract to work the day shift as a registered nurse (RN) at a hospital in California. One week before her first shift, the hospital alerted Moya that there was no longer a need for nurses on the day shift.
“They said, ‘We still have needs for nurses on the night shift. Either you keep the contract, or we cut you,’” she recalled.
Moya’s new, unplanned contract changes were one of the risks of working as a travel nurse when she accepted her first gig 5 years ago. Despite the unpredictable nature of contract work, she has no regrets about trading a salaried position for short-term contracts in different hospitals.
“The things that really contributed to that transition were financial gain…and learning different hospital systems and…building different communities in different areas, living in different states, and really just wanting something new,” she told Medscape Medical News.
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape APRN Job Market Report 2025 found that
- 47% of nurses surveyed said that the demand for jobs was about the same compared with 3 years prior.
- Nurse respondents said many employers are only willing to consider local candidates, which shrinks the talent pool.
- 51% of nurses think the South has had the most growth in advanced practice registered nurse job postings.
Hospitals are reporting an increased demand for flexible work options, including float pools, per diem positions, and travel contracts with, almost half reporting plans to increase contingent labor roles by at least 50% in the next year. Working as independent contractors — also called 1099 workers due to the Internal Revenue Service form 1099 that independent contractors use to report their wages — often offers RNs more flexibility, higher pay, and more control over their work than salaried nurses, but the benefits come with trade-offs.
“Independent contracting offers flexibility, but it also shifts financial responsibility to the nurse,” said Molly Kokenge, PhD, RN, associate dean for strategic partnerships and practice at the Orvis School of Nursing at the University of Nevada, Reno. “[It] can be financially rewarding, but it requires disciplined planning, budgeting, and recordkeeping.”
Same Roles, More Responsibilities
The extra effort was worth it for Zac Shepherd. In 2017, Shepherd traded a salaried position in Texas for travel nursing assignments that have taken him to New Jersey, New York, California, Washington, and Colorado. Although his duties as an ICU nurse are similar in each hospital, independent contractor status has helped alleviate burnout.
“The reward for being a good bedside nurse in the inpatient setting is more responsibility and more expectations,” he said. “I thought [working as a travel nurse] might be a way to breathe some life back into my career.”
Nurse burnout is on the rise with, some studies estimating that it affects up to 56% of nurses. The ability to choose flexible work arrangements, preferred shifts, and more manageable workloads can help. But Shepherd admits that it also can be “very scary” to work as an independent contractor accepting at-will assignments with fewer benefits and less support than traditional staff nursing roles.
“There’s always the risk that you take a contract and reshuffle your whole life and drive across the country and commit to housing and get settled in, and all of a sudden, all of that falls through,” he warned.
In addition, independent contractors are responsible for taxes, health insurance, retirement contributions, liability coverage, continuing education, and travel expenses. RNs who work across state lines must also follow state-specific tax obligations. Kokenge notes that income can fluctuate between contracts, and maintaining a financial cushion is essential.
Stagnant or shrinking pay rates for travel nurses in some regions mean that RNs assume more financial risks. In the past year, Moya has found it “more difficult” to pick up contracts and has seen fewer postings for higher-paying travel nursing roles. At the same time, costs have gone up.
“Things are progressively getting more expensive, but travel nurses are getting paid pre-COVID rates,” Moya added. “[Temporary housing] can be more expensive because people…see the word ‘travel nurse’ and think, ‘They make a lot of money; let’s upcharge.’”
Working through agencies can alleviate some of the financial stressors. Shepherd contracts through Aya Healthcare, where he has access to perks like health insurance benefits and a 401(k), but still maintains the power to pick assignments and control his schedule. He believes being nimble and flexible can also help overcome some of the hurdles of working as an independent contractor.
“There is always going to be need on a national level,” he said. “If you go in with the attitude, ‘I want to learn, and I’m here to help,’ then it opens a lot more doors, and you have a lot better experience.”
Charting Compliance
Supplementing a salaried RN workforce with independent contractors allows hospitals to be responsive to staffing gaps and nursing shortages, support retention, and improve job satisfaction, but that flexibility comes at a cost. The American Hospital Association found that contract labor expenses for hospitals and health systems jumped 258% from 2019 to 2022, and the median wage paid to contract staffing firms increased 57%.
Maintaining compliance is also essential. The US Department of Labor has different rules for independent contractors and salaried workers and levies steep penalties for noncompliance. Megan Hicks, compliance specialist and strategic partnerships at GigSafe, notes RNs working as independent contractors can dictate their work schedules and have the option to contract to multiple hospitals or health systems.
“Hospitals have to be aware of everything from how they communicate with travel nurses, request certifications and documentation all the way down to how compensation is received,” Hicks said. “A misstep in doing so could mean a misclassification suit or state and federal fines.”
For RNs working as independent contractors, Kokenge advises purchasing liability and malpractice insurance to limit personal risk.
“Legally and professionally, contracting can provide greater autonomy. Nurses can negotiate terms that protect clinical judgment and ensure safe practice conditions,” she added. “For many nurses, this model offers flexibility to choose assignments that align with their expertise and values, which reinforces a nurse’s role as a practice expert rather than simply a labor resource.”
Just make sure to tick all the boxes when it comes to taxes, health insurance, travel expenses, and your contract. It doesn’t hurt to have a contract attorney or employment lawyer have a look at your contract before signing.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.
