Best Locum Tenens Companies for Nurse Practitioners: How to Pick One
Locum tenens was built around physicians, and most of the advice about it still is. Nurse practitioners face a different set of questions: scope of practice by state, collaborating physicians, 1099 math, and companies that treat the advanced practice desk as an afterthought. Here is how to tell the good ones apart.
Demand for locum nurse practitioners has outrun demand for locum physicians for several years now. Community mental health centers need PMHNPs while a search runs, rural health centers need FNPs through a maternity leave, hospitals need acute care NPs for a winter census. Every national locum company has an advanced practice division, and dozens of smaller agencies place NPs alongside physicians. Choosing among them is mostly a matter of knowing which questions are different for an NP than for a physician, and asking them before the first assignment rather than after.
What is different about locums for nurse practitioners
Scope of practice changes by state
A physician's license works the same way in every state. An NP's does not. In a full practice state you evaluate, diagnose, and prescribe under the board of nursing. In a reduced or restricted state you need a collaborative or supervisory agreement with a physician before you can work. A good locum company knows which the assignment state is, confirms the collaborating physician is named and signed before you arrive, and does not send you to a restricted state with a “we will sort it out”. A company that cannot answer the scope question on the first call does not place many NPs.
Population certification has to match the role
An FNP cannot cover an inpatient psychiatric unit in most states, and a PMHNP should not be covering an urgent care. Companies that treat “nurse practitioner” as one job will present you for assignments you are not certified for and waste your time and the facility's. Ask how the company matches certification to the role, and expect a specific answer.
The 1099 math is yours to do
Most locum NPs are independent contractors. The hourly rate looks high next to a W-2 salary until you subtract self-employment tax, health coverage, retirement, and the weeks between assignments. A fair rule of thumb is that a 1099 rate needs to be meaningfully above the equivalent W-2 hourly rate before it is actually better, and that guaranteed hours matter more than the rate itself. A company that offers a high rate with no guaranteed hours is offering you the facility's scheduling risk.
The checklist to get in writing
Every item below should be on the assignment confirmation, not in an email thread. If a company cannot produce a written confirmation that covers them, that is the answer.
| Before you accept | Get this in writing |
|---|---|
| Pay | Hourly or daily rate in writing, with overtime, holiday, and call rates stated, and guaranteed hours per week. |
| Employment | 1099 or W-2, and what that means for taxes, benefits, and retirement contributions. |
| Malpractice | Limits, occurrence or claims-made, and who carries the tail and for how long. |
| Licensing | Who pays for a new state license, who does the paperwork, and whether the company works compact states. |
| Housing and travel | Arranged and paid by the company, or reimbursed, or a stipend; what happens with a cancelled flight. |
| Scope | Full, reduced, or restricted practice in the assignment state, and whether a collaborating physician is in place before you arrive. |
| Cancellation | What you are paid if the facility cancels after you have accepted, and what notice you owe if you need to leave. |
| Timesheets and pay timing | How hours are submitted, how fast they are approved, and when the money arrives. |
How the companies differ
The national firms
CompHealth and Weatherby Healthcare (CHG Healthcare), LocumTenens.com and Jackson & Coker (Jackson Healthcare), AMN Healthcare's locum division, and large independents such as Barton Associates have the most assignments and the most states. If you want to work in a specific city next month, the odds are best there. The trade-off is that you are one of thousands of providers on the bench, your recruiter changes, and the terms are the company's standard terms. For a new locum NP who wants volume and a travel desk that handles everything, that is a reasonable place to start.
Specialty and regional agencies
Smaller companies built around behavioral health, primary care, or one region. Fewer assignments, but the person placing you knows the facility, has placed NPs there before, and can tell you what the collaborating physician is like. Pay is often comparable, terms are more negotiable, and you are not competing with a national bench for the same shift.
Recruiting firms with a locum arm
Firms that recruit NPs for permanent jobs and also place them on assignments. MedStaff Locum Tenens is one. The bench is drawn from clinicians the firm already knows, which means the assignments lean toward the firm's permanent specialties, and the firm has a direct interest in your assignment going well because it may be placing you permanently next year. If you are using locums to try a region or a setting before committing, a firm that does both is the most useful kind to know.
Questions to ask on the first call
- How many nurse practitioners did you place on assignment last quarter, and in which specialties?
- Is the assignment state full, reduced, or restricted practice, and is the collaborating physician already named?
- What are the malpractice limits, is it occurrence or claims-made, and who pays the tail?
- What are the guaranteed hours, and what happens if the facility cancels shifts?
- Who pays for a new state license, and who does the paperwork?
- Is housing arranged and paid, reimbursed, or a stipend, and what is the policy when travel goes wrong?
- When are hours approved and when does pay arrive?
- What are the conversion terms if the facility wants to hire me?
Where MedStaff Locum Tenens fits
We place psychiatric mental health, family, and acute care nurse practitioners on assignments for the same community health centers, behavioral health organizations, and hospitals we recruit for permanently. Assignments go to the bench first, before they are posted anywhere. Every one is confirmed on a written Work Order with the rate, guaranteed hours, premium and call rates, and travel terms; malpractice is $1 million per occurrence and $3 million aggregate with the certificate issued before your first shift; and hours are submitted in your own portal and deemed approved if the facility sits on them. Our bench is smaller than the national firms', and it is strongest in behavioral health and primary care. If that is where you work, the open assignments and the five-minute application are the next step. If you are weighing locums against a permanent move, the PMHNP and FNP job pages show what is open permanently right now.
Frequently asked questions
- Do locum tenens companies place nurse practitioners?
- Yes, and demand for locum NPs has grown faster than for locum physicians. Psychiatric mental health NPs, family NPs, and acute care NPs are the most requested. Most national locum companies have an advanced practice division, and recruiting firms with a locum arm, including MedStaff Locum Tenens, place NPs alongside physicians.
- Are locum nurse practitioners 1099 or W-2?
- Most locum NPs are independent contractors on a 1099, including with MedStaff Locum Tenens. A few companies run W-2 models with benefits and a lower hourly rate. Neither is wrong; the point is to know which one you are signing and to budget for taxes, retirement, and health coverage accordingly on a 1099.
- Who pays malpractice for a locum nurse practitioner?
- The locum company should, at stated limits, for the length of the assignment. Ask whether the policy is occurrence-based or claims-made, and if claims-made, who pays the tail and for how long. MedStaff Locum Tenens covers $1 million per occurrence and $3 million aggregate and carries a three-year tail where a policy is claims-made.
- What are guaranteed hours on a locum NP assignment?
- The minimum weekly hours the facility commits to pay for, written on the assignment confirmation. If the facility cancels shifts, you are still paid the guarantee. Without guaranteed hours, a slow week at the facility becomes a slow week in your paycheck.
- Can an NP take a permanent job after a locum assignment?
- Usually yes, subject to the conversion terms between the company and the facility. A fair agreement credits the hours you have already worked against the conversion fee, which means a facility can hire you after a long assignment at little or no cost. Ask the company how its conversion terms work before you start an assignment you might want to keep.