How to Reduce Healthcare Agency Spend by Filling Shifts From Your Own Pool
Key Takeaways
Agency staff can cost healthcare facilities two to four times more per hour than permanent employees, and the gap widens when you factor in agency markups, onboarding friction, and inconsistent care quality.
Building an internal staff pool and using scheduling technology to fill open shifts from your own team first is the most direct way to reduce agency dependency.
Shift broadcasting, self-service scheduling, and demand forecasting let you fill gaps in minutes rather than calling an agency.
Retention strategies like flexible scheduling and shift autonomy reduce the vacancies that trigger agency use in the first place.
Table of contents
If you manage a healthcare facility, agency staffing costs are likely one of your biggest budget headaches. Agency hours in US hospitals surged 133% between 2019 and 2022, and the price gap between agency workers and permanent staff keeps widening. The good news: you can cut that spend significantly by filling shifts from your own team first. In this guide, you'll learn how to build an internal staff pool, use scheduling technology to fill gaps faster, and track the metrics that prove your strategy is working.
The real cost of agency staff in healthcare
If you manage staffing at a healthcare facility, you already know agency workers cost more. But the actual numbers might surprise you.
According to research published in PMC (PubMed Central), agency hours in US hospitals surged 133% between 2019 and 2022. Hospital labor costs jumped by more than one-third during the same period, adding roughly $24 billion in expenses according to the American Hospital Association. Travel nurses now earn approximately $102 per hour compared to permanent registered nurses at roughly $41 per hour, based on the NSI 2024 National Health Care Retention & RN Staffing Report. That means you're paying 2.5 to four times more per hour for agency coverage.
And those are just the direct costs. Agency markups, contract minimums, and administrative overhead push the real price even higher.
Every time an unfamiliar agency worker steps onto your floor, you lose care continuity, spend time on orientation, and take on additional compliance risk.
The problem isn't going away. The global healthcare staffing market is projected to grow from $42 billion in 2026 to $68 billion by 2034. Healthcare shift employment in the US has already grown 17% since 2022, the highest growth rate among major shift-based industries, according to Deputy's Big Shift Report.
The bottom line: every shift you fill with an agency worker instead of your own staff is money you could be spending on better patient care, competitive wages, or facility improvements. The right healthcare scheduling software can help you shift that balance.
Why healthcare facilities over-rely on agency staff
Before you can cut agency spend, you need to understand what's driving it. For most facilities, the root cause isn't a shortage of workers. It's a shortage of visibility and speed.
Last-minute call-outs and no-shows create urgent gaps that default to agency calls. When a nurse calls in sick at 5 a.m. and you don't have a fast way to reach available internal staff, the agency hotline becomes your first call, not your last resort.
Lack of visibility into staff availability is another common culprit. Managers often don't know which per-diem or part-time employees are free to pick up shifts. That information lives in text threads, sticky notes, or someone's memory.
Manual scheduling processes make things worse. Spreadsheets and paper schedules can't react fast enough to fill gaps before the shift starts. By the time you've called through a list of names, the shift is already underway with an agency worker in place.
High turnover creates a cycle that's hard to break. According to Deputy's Big Shift Report, healthcare hiring demand has declined to 0.8% of the workforce, which means facilities are prioritizing retention and optimization over new hires. When you lose experienced staff, you lose schedule stability, and agency reliance climbs.
Burnout from understaffing pushes more staff to leave, which creates more gaps, which drives more agency calls. Recognizing this cycle is the first step toward breaking it.
How to build and use an internal staff pool
An internal staff pool is your first line of defense against agency dependency. It's a group of part-time, casual, per-diem, and cross-trained employees who can pick up extra shifts when gaps appear. Here's how to build one that actually works.
Step 1: Audit your current workforce
Start by identifying staff who want more hours, have flexible availability, or hold credentials for multiple roles. You probably have more coverage capacity than you realize. Talk to your team. Many part-time employees and per-diem workers would gladly pick up additional shifts if the process were easier.
Step 2: Make open shifts visible and easy to claim
Your available staff can't fill shifts they don't know about. Use **mobile-first **scheduling tools that let workers see and claim open shifts from their phone. When staff can browse available shifts during their commute or on a break, you get faster fill rates without a single phone call.
Step 3: Broadcast unfilled shifts to qualified staff instantly
Instead of calling through a list, push unfilled shifts to every qualified internal worker at once. The first person to accept gets the shift. This turns a 30-minute phone chain into a process that takes seconds. Deputy's open shift feature, for example, sends mobile notifications to qualified team members the moment a shift becomes available, so your internal pool gets first priority before you ever contact an agency.
Step 4: Only escalate to an agency after internal options are exhausted
Make agency staffing your last step, not your first. Set a clear policy: every open shift goes to your internal pool first. Only after a defined window (say, four hours before the shift) does the request go to an agency. This simple workflow change can dramatically reduce your agency hours.
Organizations that have made this shift see real savings. Marlene Rossi, Staffing Manager at Child Care Staffing, says, 'When we started using Deputy six years ago, we probably had a pool of 18 subs. We've gone to 100 subs now. One person can't schedule all that with paper and a pencil. It takes support from an electronic tool.' The organization saved $100,000 in salary costs by streamlining scheduling with Deputy.
Deputy customers also report up to a 50% reduction in time spent on scheduling management, freeing up hours every week that managers can redirect to patient care and team support.
