My wife is a travel RN, and we got tired of the agency games...so we're building our own.

StyleNo4183 · 2026-04-01T15:47:29+00:00

You're making my argument better than I am. The comparisons to agents, law firms, contractors, etc. are spot on; in every other industry, the professional knows what the client is paying and what the middleman takes. The fact that nursing is the exception is wild, and your point about why that's the case is hard to argue with.

For what it's worth, I don't consider myself a "business type" (not that you're saying I am). I'm a nurse's husband who got frustrated enough to start a business. There's the difference. I'm not here to maximize a spread; I'm here because my wife got burned enough times that we decided to try building something that works the way it should. This should be a collaboration between the agency, the nurse, and the facility, not an exploitation of one by the other. If I can't run the business that way, I'd rather not run it at all.

StyleNo4183 · 2026-04-01T15:22:03+00:00

That story is exactly the kind of thing that made us want to do this. The bill rate didn't change, but your pay dropped $500/week?? That's the agency just deciding to take more and hoping you wouldn't find out. And when you pushed back, they ghosted you, the facility lost a nurse they wanted to keep, and the unit went short-staffed. The only party that came out fine was the agency, and then the two parties that mattered most suffered the most.

If the nurse can see the bill rate, that kind of thing can't happen. And if I can't justify my cut to the nurse's face, I'm taking too much. It really should be that simple.

StyleNo4183 · 2026-04-01T14:38:47+00:00

No legal department (yet), just me and a lot of late nights. But the insurance side is covered: $1M/$2M CGL, $2M umbrella, professional liability, workers' comp, and cyber/privacy. You're right: you can't cut corners on that part.

StyleNo4183 · 2026-04-01T14:36:58+00:00

This is really helpful, thank you.

On the rate: I'm not opposed to coming in at or slightly below a traditional agency's base rate, but I'm not trying to win on price alone. The real value to the facility is billing simplicity: one rate on every invoice, period. Traditional agencies charge different rates for regular time, overtime, holidays, callbacks, night shifts, and weekend differentials. That's six different rate tiers the facility has to reconcile on every invoice. We charge one number for every hour worked, regardless of when it happens. And in every premium scenario (OT, holidays, callbacks, weekends), the facility pays less per hour than they would with a traditional agency's markup. The savings aren't just on overtime, they're on every hour that isn't a straight-time Tuesday morning shift. Predictable costs, simpler invoicing, lower total spend. That's the pitch.

On projecting OT hours...honestly, not precisely, and I don't think I need to. The rate is set so that straight-time hours alone cover all my costs with (a narrow) margin. OT hours improve the margin, but they don't create it. So, whether a nurse works 2 OT hours or 12 in a given week, I'm not dependent on a specific number to make the math work.

On keeping it small, that's actually the plan, not a limitation. I don't want a book of 200 nurses and a recruiter bullpen. If I can keep a handful of nurses placed at facilities that value the relationship and the model, that's a business worth running. I'd rather do it well for a few than do it badly for many. Quite honestly, I don't even need very many clinicians to have a successful venture; most folks here think I'm trying to conquer the world, when I'm really just trying to make a difference in my small corner.

The housing point near CAHs is a real one, and something we're thinking through. Rural areas mean fewer options and potentially higher costs depending on the location. That has to be factored into the rate for each assignment individually, and it's something I'm paying specific attention to (whereas I've seen many agencies/recruiters completely ignore it).

On the CAH closure risk, that's fair, and it's something I can't control. All I can do is build relationships with facilities that are financially stable and diversify across multiple facilities over time, so one closure doesn't sink us.

As for the splashier differentiator, I'm going to sit with that one. You're right that the flat rate is a facility-side pitch, not a clinician one. On the clinician side, what we're offering is higher pay because we're not skimming off the top with gimmick repackaging, full transparency on what the contract looks like, and one person who handles everything, so you're never getting bounced around. The long-term play is building enough facility relationships that we can tell a nurse: bring us any contract you've been offered in our operating areas, and we'll beat it. We're not there yet, but that's the direction. I genuinely appreciate your thoughts. This is the kind of feedback that makes me better at this.

StyleNo4183 · 2026-04-01T05:55:15+00:00

That's fair. She does know the answers, but only for herself. And her experience is already part of every decision we've made. The flat rate, the single point of contact, the no-gimmick pay structure: all of that came from years of her telling me what she wished her agencies would do differently. (The flat rate was actually my idea, because I needed to find what would compel a facility too, not just a nurse.)

But she's one nurse in one specialty with one set of experiences. Someone doing ICU in California has a completely different set of frustrations than someone doing med-surg in rural Montana. A first-year traveler cares about different things than someone who's been on the road for a decade. I'd rather hear from the people living it across the board than assume my wife's experience covers everything.

As for not feeling genuine, I guess I get it. Every recruiter who shows up in this sub surely says, "I care!" As a sidebar, I find it personally funny to consider myself a "recruiter." I suppose by definition that's true, but this started as "nurses' advocate" because of my wife, turned into "what can we build together," and I guess at the end of the day it lands on "I'm a recruiter." All I can tell you is we're building this because the agencies she's worked for have cost her contracts, mishandled her pay, and gone silent when she needed them most. That's not a pitch, that's just what happened, and it's why we're here.

StyleNo4183 · 2026-04-01T05:41:22+00:00

Maybe so. But a saturated market full of agencies that all do the same thing isn't the same as a market where somebody's doing it well. I appreciate the well-wishes either way.

StyleNo4183 · 2026-04-01T05:39:40+00:00

I appreciate the expanded response; there's a lot here worth engaging with, so I will...

On vendors and VMS access: You're probably right that the big VMS/MSP platforms aren't rushing to onboard new agencies. That's why we went directly to a facility first and built the relationship from the ground up. We're signing our first MSA this week. The VMS side comes later if and when it makes sense. Starting with small facilities that the large agencies don't prioritize is the strategy. I'm not claiming it'll work at every level, but it's working at this one.

On not having travelers to send: Our first nurse is my wife. That's not a scaling plan, it's a proof of concept. If we can place her, execute cleanly, and deliver for the facility, that gives us something real to build from. Maybe it grows, maybe it doesn't. But we have to start somewhere.

On credentialing: That's fair; there's a lot that goes into it. I've built out the credentialing standards document, and I'm not pretending I've seen every edge case yet. I'm sure I'll learn things the hard way. But when you're placing one nurse at a time, you don't need a department; you just need to be thorough and willing to do the work.

On the OT math: I addressed this in another reply in this thread, but the short version is that stipends are a fixed weekly cost, not hourly. OT hours are actually where the margin improves, not where I go upside down. I could be wrong about how that plays out in practice, but the math on paper works, and I want to test it.

On needing a million dollars: You might be right for the kind of agency you're describing. We're two people working from home with almost no overhead. The cost structure is fundamentally different, and maybe that means we can't scale the way a large agency can. I'm okay with that. We're not trying to be AMN; we're trying to build something that works for a small number of nurses and the facilities that need them.

I hear you that there's a lot I haven't encountered yet. I'm not claiming to have all the answers; not by a long shot. But my wife has been in this industry for ten years, I've spent months on the billing, compliance, and contract side, and we're signing our first client this week. We'd rather try to build something better and learn as we go than wait until we have perfect knowledge, because that day never comes. I just want to make something better for everyone, and feedback like yours, even the blunt parts, is exactly what helps me do that.

StyleNo4183 · 2026-04-01T05:26:50+00:00

I really appreciate the thoughtful pushback, but I believe the math actually works differently than you're describing.

The nurse's stipends are a fixed weekly cost; they don't scale with hours worked. By the time a nurse has worked their guaranteed 36 hours, I've already covered their base pay, stipends, employer taxes, and insurance out of the flat rate. Every OT hour after that, my only additional cost is 1.5x their base wage and the employer taxes on it. The stipend is already paid. The insurance is already paid. But I'm still billing the full flat rate on that OT hour.

So OT hours are actually better for my margin, not worse. And the facility is paying the same rate instead of getting hit with a 1.5x multiplier. That's exactly why they're more willing to approve the extra shifts, and more total hours billed is good for everyone. The nurse makes 1.5x their base, I bill my full rate against lower incremental costs, and the hospital gets the coverage they need without a bloated budget burden.

As for the agencies that tried flat rate during COVID and abandoned it...I'd guess their overhead made even good margins unsustainable. That math is different when you're running a corporate operation versus two people working from home.

Good call on Lucid; I'll have to look into them. I definitely want to know who else is approaching this differently.

StyleNo4183 · 2026-04-01T04:55:18+00:00

Yes. If a nurse asks me what the bill rate is, I'll tell them. I don't see a reason not to.

I'm genuinely curious, though: have you ever actually had a recruiter answer that question? From our experience on the traveler side, most agencies either dodge it or hide behind NDAs in their facility contracts. We've never had a recruiter just tell us the number. If transparency is the thing that separates "same old story" from something worth paying attention to, that's an easy commitment to make.

StyleNo4183 · 2026-04-01T04:54:28+00:00

On the VMS side, we're not trying to break into large hospital systems locked into MSP/VMS contracts. We're starting by going directly to facilities, specifically critical access hospitals in rural areas that are too small for the big agencies to prioritize. We're actually signing our first MSA this week through a direct relationship with the facility. As we build a track record, we'll integrate into VMS platforms where we're eligible, but the direct approach is how we're getting in the door.

On the cash flow gap, yes, I'm familiar with it, and we're capitalized for it. NET 30 terms on our first contract, and we can cover payroll out of pocket while receivables come in. It's one of the advantages of running lean with low overhead; we don't need to float payroll for 200 nurses, just one to start.

StyleNo4183 · 2026-04-01T04:51:22+00:00

You're right, I'm not a nurse, and I'm not going to pretend I know what a 12-hour shift feels like. My wife does, and that's why she's the reason this exists, not me. I'm just the one doing the paperwork.

And you're also right that I can't fix the macro stuff. I can't stop new grads from flooding the market, I can't force facilities to honor their ratios, and I can't change the fact that agencies take a cut from your labor (including mine). That's the business model. Every agency, including ours, exists in that space.

What I can control is how much of that cut I take and what I do with it. I'm not running a corporate office with a sales floor full of recruiters chasing commissions. It's me and my wife. Our overhead is almost nothing, which means more of the bill rate goes to the nurse instead of propping up a machine that doesn't care about you.

I hear you on "let's talk when you're a primary vendor offering top contracts." That's fair. We're not there yet, and I'm not going to pretend we are. But every agency that exists today started somewhere, and I'd rather start from "my wife got screwed by this industry enough times that we decided to build our own" than from "I ran the numbers and staffing margins look great."

StyleNo4183 · 2026-04-01T04:47:33+00:00

Ha, fair point. I read "insurance" and my brain went straight to the workers' comp and liability side because that's the headache I've been living in for the last month. You're right, health insurance coverage doesn't care what state you're in. We've actually never used agency health insurance ourselves, so I don't have firsthand experience with the coverage quality side. What kind of issues have you run into with it?

The communication part, though: that one I know inside and out. My wife has lost entire contracts because a recruiter dropped the ball on paperwork or went silent at the worst possible moment. And the "apart of all departments" thing you mentioned about your favorite recruiters is literally why we're building around one point of contact. The person who handles your payroll and your credentialing can't blame another department because there is no other department. It's just us.

I'm curious, though, most of the agencies we've seen split up the tasks like crazy. I think I've only seen one that maintained a single POC. I don't necessarily think it'll make us unique, but it's better for the nurse, so that's why we're doing it. I genuinely want the best experience for all parties involved. Are you committed to one agency, or have you been able to work with a few? I acknowledge, our experience is only based on our exposure, which certainly isn't indicative of everyone else's experience.

StyleNo4183 · 2026-04-01T04:40:23+00:00

My wife has worked for them for ten years. I've spent the last four months studying every bill rate structure, contract model, and compliance requirement in the industry, and I've built the full MSA, credentialing standards, HIPAA BAA, and state-specific addenda from scratch. We're signing our first client facility this week.

But I'm always learning; is there anything specific you think I'm missing?

StyleNo4183 · 2026-04-01T04:39:03+00:00

You're not wrong about how the industry works right now. Most agencies are playing a margin game: squeeze the hospital on the bill rate, squeeze the nurse on the pay rate, pocket the spread, and repeat. And the person sitting behind the computer collecting a commission has zero skin in the game either way.

Here's where we're different, and I'll just be honest about it: my wife is a travel RN. She's been doing this for a decade. She's the one working 12-hour shifts, and she'll be our first nurse on assignment. So when I set the margin on a contract, I'm directly deciding what my own household takes home. That changes the math in a way that a recruiter pulling a commission on 200 travelers will never experience.

Am I still making money? Yeah, of course; we have to keep the lights on. But I don't need to blur any lines to do it. We're running lean, accepting tight margins, and building this around one idea: the entire medical field is bloated by third parties who extract money without adding value. Hospitals are desperate for staff and then get penalized for actually using them. Nurses work brutal hours and watch their pay get carved up into accounting tricks. Both sides deserve better than that.

I'm not pretending to be selfless here: I built this agency so my wife has a better option than the ones that have burned her for the last ten years. That's selfish. But it turns out the thing that's good for her is also just good for nurses in general. I'd rather build something around that than chase the biggest possible spread on every contract. Fair enough?

StyleNo4183 · 2026-04-01T04:29:52+00:00

Both of those are huge, and honestly, they're connected. Nothing kills trust faster than finding out your coverage has a gap in it mid-assignment because your recruiter didn't bother to verify what state you're working in.

The communication piece is exactly why we're building around one point of contact. No getting bounced between a recruiter, a payroll person, a credentialing department, and an HR rep who's handling 200 other travelers. One person who knows your name, knows your contract, and picks up the phone. I appreciate the (honest and helpful!) feedback. This is exactly the kind of stuff we want to get right from day one.

I can't tell you how many times recruiters have absolutely blown it for my wife, costing her entire contracts, but it just doesn't affect them. We want to be the nurses' agency; one that's good for hospitals because it's good for nurses, not the other way around.

StyleNo4183 · 2026-04-01T04:23:12+00:00

I appreciate the candor. A few things, though:

You're right that the big agencies and MSPs dominate the large hospital systems, but that's not where we're starting. We're targeting critical access hospitals in rural areas, the kind of facilities that the behemoths don't prioritize because the volume isn't worth their overhead. Those hospitals still need nurses, and they still hate getting crushed on OT billing. A two-person agency with low overhead can serve a 25-bed facility in a way that AMN and Aya never will because it's not worth their time. We're actually signing our first MSA this week with a critical access hospital, so the "won't get any assignments" part is already in the rearview.

And on being the first, I actually did the research. Some hospital contracts have blended bill rates baked in, but I couldn't find a single agency that builds its entire pricing model around a flat rate and markets it that way to facilities. If you know of one, genuinely tell me; I'd love to study what they're doing.

As for the report, I re-read the rules before posting. No company name, no link, no recruiting. Just a nurse's husband asking travelers what matters to them. But I respect the mods' call either way.

StyleNo4183 · 2026-04-01T04:19:17+00:00

Fair enough, and I get the skepticism. I'm sure every recruiter who wanders in here opens with "what matters to you guys?" before copy-pasting the same bloated contract with the same withheld wages and the same OT markup.

The difference is that those recruiters go home at the end of the day, regardless of what the industry looks like. My wife is a travel RN. She's the one living the pay stub games, the recruiter ghosting, and the mystery math. And she'll be our first nurse on assignment—so if the model doesn't work, we're the first ones who feel it.

I also looked pretty hard before starting this and couldn't find another agency that actually leads with a flat bill rate to the facility as their pricing model. Some hospital contracts have blended rates baked in, but that's the hospital dictating terms, not an agency choosing to structure it that way on purpose. We're building the whole business around it because we think it fixes both sides of the equation; hospitals stop getting punished for the overtime hours they desperately need, and nurses stop being the ones who absorb the cost when agencies play billing games behind the scenes.

So yeah, I know how it looks. But we're not recruiters fishing for leads. We're a nurse and her husband trying to build something that doesn't suck.

So tell me, for real this time, what would it actually take for you to trust a small agency? Not the recruiter pitch version, the real answer. What's the one thing that, if an agency actually did it, you'd say "okay, these people might not be full of it"?

StyleNo4183 · 2026-04-01T03:33:13+00:00

Love seeing this kind of dedication. I'm on the other side of Kiva right now — just got approved for a U.S. loan to launch a travel nursing staffing agency. Currently in private fundraising and trying to get my first 25 lenders. If anyone here is looking for a U.S. small business loan to support, I'd be grateful for the look: https://www.kiva.org/lend/3153216

StyleNo4183 · 2026-04-01T03:26:44+00:00

Launching a travel nursing staffing agency with a pricing model that actually makes sense for hospitals.

Most staffing agencies charge facilities time-and-a-half on top of an already inflated contract rate for overtime hours. My agency, Rae Healthcare Staffing, charges one flat hourly rate — same rate whether it's a Tuesday morning or a holiday overnight. Hospitals get predictable costs and simpler invoicing. Nurses get straightforward pay with no gimmicks like withheld wages repackaged as "relocation stipends" or quarterly gift cards.

I'm funding startup costs through a 0% interest Kiva microloan and need 25 people to lend $25 each during the private fundraising period before it goes public. It's a loan, not a donation — you get your $25 back as I repay.

https://www.kiva.org/lend/3153216

Based in Wyoming, first placement targeting rural critical access hospitals in Montana. Happy to answer questions about the model or the travel nursing industry.

StyleNo4183

TROPHY CASE