Every fall someone asks me where staffing is heading next year, and every year I give the same caveat first.

I am not an analyst. I am President and COO of Uniti Med, GQR Healthcare and Nebula, and I have spent the last decade in healthcare staffing, including helping build Uniti Med from a startup into one of the largest healthcare staffing companies in the country. Our parent company, GQR, is on Staffing Industry Analysts’ list of the Largest Staffing Firms in the US. I also serve as Vice President of the NATHO board and chair the membership committee for NAHCR, which means I spend a lot of time talking with people on both the hospital side and the agency side of this industry.

So what follows is not a forecast built on a model. It is what I see in our own business, what I hear from clients and peers, and what I think it means for hospital leaders and staffing firms planning for 2027. I have kept it qualitative on purpose. If you want hard numbers on market size and growth, go to the research firms that do that work. This is the operator’s view.

Where are travel nurse rates heading in 2027?

The extreme rates of the pandemic years are behind us, and I do not expect them to come back without another shock of that scale. What I see now is a market that behaves more like a normal market. Rates move with local demand, specialty and urgency. Hard-to-fill specialties and rural facilities still command a premium. General med-surg in a well-staffed metro does not.

For hospitals, that means contract labor is more predictable to budget for than it was. For staffing firms, it means the easy margin is gone. The firms that do well in 2027 will be the ones that win on speed, quality and service, not on being the only option available.

For clinicians, it means travel is still a good option, but it is a career choice again rather than a gold rush. The travelers I see staying in the work are the ones who value the flexibility and the experience, not only the pay.

Are health systems building their own internal staffing pools?

Yes, and I think this is one of the most important shifts in the industry. Many health systems have built or expanded internal float pools, internal travel programs and PRN teams so they can move their own people around rather than calling an agency first.

I think that is healthy. A hospital that can cover its own predictable gaps is a better partner, because when it does call us it is for the specialized, urgent or hard-to-fill needs where an outside partner actually adds value. The relationship becomes less about volume and more about solving the problems the internal pool cannot.

The catch is that an internal pool is only as good as the hospital’s ability to recruit into it and keep people in it. Internal pools face the same retention problem as any other unit, and the systems that treat their pool nurses as second-class staff tend to lose them to the open market.

How are MSP and VMS programs changing the market?

Managed service providers and vendor management systems have become the default way large health systems buy contingent labor. The appeal is clear: one contract, consistent rates, visibility into spend, and less time managing dozens of agencies one by one.

For staffing firms, this changes how you compete. In many programs your submittal sits in a list next to everyone else’s, and the firm that responds fastest with a qualified, credentialed clinician usually wins. Speed to submit and quality of the candidate matter more than relationships with a single manager, although relationships still matter more than people admit.

For hospitals, the risk I would watch is treating the program as the strategy. A VMS can control what you pay. It cannot tell you why you needed the contract labor in the first place. The health systems I respect most use the data from their programs to find the units where turnover is driving demand, and then fix those units.

How will AI change healthcare recruiting in 2027?

I run an AI talent sourcing company, Nebula, so I have an obvious interest here and I will try to be honest about it. AI is already very good at the front end of recruiting: finding people who match a profile, pulling together information across sources, drafting outreach, and getting a recruiter to the right candidates faster. Those are real gains, especially in a business where response time decides who places the clinician.

What AI does not do well is the part that actually matters most in healthcare staffing, which is the relationship. A nurse deciding whether to take a contract three states away wants to talk to a person who understands her situation and will pick up the phone when something goes wrong on week two. I wrote more about where this helps and where it backfires in AI for recruiters: what works, and what backfires.

My expectation for 2027 is that the firms using AI well will have recruiters who spend less time searching and more time talking. The firms using it badly will automate the conversation itself and wonder why candidates stop responding. If you are thinking about this for your own organization, it is a big part of what I cover as an AI keynote speaker.

Are PRN shift marketplaces replacing traditional staffing?

Not replacing, but they are growing and they are changing expectations. On-demand shift platforms let clinicians pick up individual shifts through an app, and let facilities fill short-notice gaps without a long contract. For senior care and some hospital settings, that model has real appeal.

What I see is that the market is splitting by need. A single open shift tomorrow night is a different problem from a thirteen-week ICU contract or a locum tenens physician covering a rural practice for a quarter. Shift marketplaces are well suited to the first. Traditional travel, locum and allied staffing are still better suited to the others, because they come with credentialing, continuity and someone accountable for the placement.

The bigger change is in what clinicians expect. Once a nurse has experienced picking her own shifts from her phone, she starts asking why her staff job cannot offer something similar. Hospitals that build that flexibility into their own scheduling will feel less pressure from every outside option, including ours.

What is happening with locum tenens and allied staffing?

Locum tenens remains steady in my experience, driven by physician and advanced practice gaps that are hard to fill permanently, especially in rural and specialty settings. These are longer, higher-stakes placements, and the relationship and credentialing work matters even more than in nursing.

Allied staffing, meaning therapy, imaging, lab, respiratory and similar roles, often gets less attention than nursing but faces many of the same pressures. Allied professionals are frequently the hardest roles for smaller hospitals to recruit for, and I expect demand there to stay healthy.

Why will retention be the real cost lever in 2027?

Because every other lever is close to its limit. Rates have normalized. Programs have consolidated vendors. Internal pools are built. The remaining question for most health systems is why they still need as much outside help as they do, and the honest answer is almost always turnover.

Every nurse who leaves creates a gap that someone has to fill, often with contract labor or overtime, while a replacement is hired and brought up to speed. Reduce the number of people leaving and you reduce the demand for everything downstream. I wrote a full piece on nurse retention strategies that actually work, built on what our recruiters hear when nurses decide to leave their staff jobs.

That is an odd thing for a staffing executive to argue, I know. But the healthiest version of this industry is one where hospitals use staffing partners deliberately, for the gaps that genuinely need outside help, rather than as a permanent patch for a retention problem nobody has fixed.

What should staffing firms focus on in 2027?

Speed with quality. In a program-driven market, being first with a qualified, fully credentialed candidate wins more than anything else.

Recruiter retention. Staffing firms have their own turnover problem. A recruiter with relationships and judgement is worth far more than a new hire with a better tool. Keeping your own people is as important for us as it is for our clients.

Using AI to give recruiters time back. Not to replace the conversation, but to make room for more of it.

Being a partner on retention, not only a vendor for gaps. The firms that help clients understand why demand exists will be the ones clients keep.

Specialization. In a normal market, generalists compete on price. Firms with deep expertise in a specialty, setting or region compete on value.

I have talked through many of these on podcasts this year, including Is Healthcare Staffing Broken Beyond Repair? with Erik Berglund, TalentTrack: Beyond the Fill, and the Killer Growth podcast, and on stage at the SIA Healthcare Staffing Summit.

What does all of this add up to?

A calmer, more disciplined industry that rewards the basics. Hospitals that keep their people will need less outside help and get more value from the help they buy. Staffing firms that are fast, specialized and genuinely useful will do well. Technology will make good recruiters better and expose the ones who were only ever dialing for volume.

And the clinicians, who are the whole point of this industry, will keep telling us what they want if we listen: flexibility, respect, and a leader who knows their name. Whichever side of the market you are on, that is the trend I would plan around.