How Locum/Travel CRNA Work Works
A staffing agency contracts with a hospital or surgery center that needs temporary CRNA coverage — maternity leave, staffing gaps, new facility ramp-up, seasonal volume. The agency finds a CRNA, handles credentialing logistics, and places you at the facility for a defined assignment.
You can work W2 (agency is your employer, pays benefits, withholds taxes) or 1099 (independent contractor, higher gross rate, you handle everything). Most locum CRNAs work 1099 through an LLC or S-Corp for maximum tax efficiency.
Pros
- Higher pay ($120-$175+/hr vs $85-$115/hr staff)
- Geographic freedom — work where you want
- No office politics or committee obligations
- Variety of clinical settings and patient populations
- Tax-free stipends for housing, meals, travel (if you maintain a tax home)
- Flexible scheduling — take breaks between assignments
- Explore new cities and states before committing
Cons
- No employer-provided benefits (health, retirement, disability)
- Credentialing at every new facility (60-120 days)
- Housing logistics — finding short-term rentals, moving frequently
- Tax complexity — multi-state filing, tax home rules, stipend compliance
- Social isolation — new teams, no long-term colleagues
- Assignment cancellations happen (have a financial buffer)
- Malpractice coverage is your responsibility (if 1099)
Tax Home Rules: The Most Misunderstood Part
This is where locum CRNAs get audited.
Tax-free stipends (housing, meals, travel) are only tax-free if you maintain a legitimate "tax home" — a permanent residence that you pay for and return to regularly. If you don't have a tax home, ALL stipends become taxable income, and you may owe back taxes + penalties.
What qualifies as a tax home?
A residence you own or rent, pay for year-round, and return to between assignments. The IRS looks at: do you pay rent/mortgage there? Do you have belongings there? Do you vote there? Is your driver's license there? Do you return between assignments?
What doesn't qualify?
Living with parents rent-free, a storage unit, a PO box, or an address you've never actually lived at. If you give up your apartment and live exclusively in temporary housing at assignment locations, you're 'itinerant' — no tax home, no tax-free stipends.
Duplicate expenses rule
You must be duplicating expenses — maintaining a home you're not living in while paying for housing at your assignment. If you don't have that duplication, the IRS doesn't recognize a travel deduction.
How to protect yourself
Keep your permanent residence. Return between assignments (2+ weeks/year minimum, more is better). File taxes in your home state. Keep records of rent payments, utility bills, and return trips. Work with a CPA who specializes in traveling healthcare workers.
Choosing an Agency
Work with 2-3 agencies simultaneously — never be dependent on one. Compare rates for the same facility (different agencies may offer the same assignment at different rates). Here's what to evaluate:
Bill rate transparency
Ask what the facility pays the agency per hour. The difference between the bill rate and your rate is the agency's cut. 20-25% is standard; over 30% means you're leaving money on the table.
Credentialing support
Good agencies handle credentialing logistics — submitting your documents, following up with facilities, tracking timelines. Bad agencies dump a packet on you and disappear.
Assignment volume
Does the agency have consistent assignments in your preferred states and settings? A great agency with no assignments near you is useless.
Cancellation policy
What happens if the assignment gets cancelled after you've relocated? Good agencies provide cancellation pay (2-4 weeks) or immediately find a replacement assignment.
Housing assistance
Some agencies provide housing; others give a stipend. Agency-provided housing is easier but less control. Stipend gives you flexibility but you find your own.
Malpractice coverage
W2 agencies typically provide malpractice coverage. 1099 agencies don't — you need your own occurrence-based policy.
The Financial Math
Locum rates look higher, but the true comparison requires accounting for everything you lose from a staff position. Here's a realistic breakdown:
Example: 1099 Locum at $150/hr
Compare this to a W2 staff position at $260K with employer-provided benefits. The locum math is better — but only if you manage the business side properly. Use our 1099 vs W2 Calculator for your specific numbers.
Credentialing for Locum CRNAs
Credentialing is the single biggest friction point in locum work. Every new facility means a new credentialing process (60-120 days). The solution: always be credentialing 90 days ahead of your next assignment.
NLC Compact: Your Superpower
If your home state is in the Nurse Licensure Compact, your multistate license covers 40+ states without additional applications. This dramatically reduces credentialing friction and opens up more assignment options. If you're serious about locum work and your home state isn't compact, consider establishing residency in a compact state (TX, FL, AZ, CO, TN are popular choices).
Check NLC status on the 50-State Map