A locum CRNA fills a temporary anesthesia role, from a few days to several months, while a facility covers a gap. You can find assignments through a staffing agency or contract directly with a facility or group.
Locums can pay well and give you control over your calendar. They also bring more paperwork: licenses, credentialing, insurance and taxes. This guide covers how it works and what to check.
How locum work is arranged
Through an agency
A staffing agency matches you with a facility, negotiates the rate, and handles much of the paperwork. The facility pays the agency, and the agency pays you.
Ask any agency:
- Whether you will be a W-2 employee of the agency or a 1099 contractor
- What it pays for: travel, housing, licenses, credentialing fees
- Whether malpractice insurance is included, and what type
- Whether its contract with you has a non-compete or a "no direct hire" clause
Directly with a facility or group
You sign a contract with the hospital, surgery center or anesthesia group. You may earn more per hour, since there is no agency in the middle.
You also handle more yourself: finding work, negotiating, chasing payment and arranging insurance. Many direct locum CRNAs work as 1099 contractors.
1099 vs W-2 locums
| W-2 (agency employee) | 1099 (independent contractor) | |
|---|---|---|
| Taxes | Withheld from pay | You pay estimated taxes, including self-employment tax |
| Benefits | Sometimes offered by the agency | You fund your own |
| Malpractice | Often arranged by the agency; confirm | Often your responsibility; check the contract |
| Control | Agency sets more of the terms | You negotiate each contract |
The facts of the job decide your classification, whatever the contract calls you. The IRS looks at who controls how the work is done, the financial side of the job, and the relationship between the parties.
For taxes, entity choice and billing as a contractor, read our 1099 CRNA guide.
Licensing in several states
Licensing is the biggest hurdle for locums. You need an RN license and APRN or CRNA authority in each state where you work.
The Nurse Licensure Compact helps with the RN part only
The NLC lets you hold one multistate RN license and practice in other member states. It has 43 member jurisdictions. It does not cover APRN or CRNA authority, so you still apply to each state board for that.
Nine states and DC are not NLC members, including California, New York and Illinois. Massachusetts has enacted the NLC, with implementation targeted for May 2027. See nursing compact states and the Nurse Licensure Compact.
The APRN Compact is not in effect
The APRN Compact would let APRNs practice across member states. Only four states have enacted it, and it needs seven to take effect. See the APRN Compact.
Getting licensed faster
- Apply for licensure by endorsement in each state where you plan to work.
- Ask whether the state offers a temporary nursing license while your application is processed.
- Start early. Board timelines vary, and you need the license before credentialing can finish.
Use our board of nursing directory to find each state's rules.
Supervision rules change by state
Practice rules follow the state and the facility. A CRNA who works without physician supervision in one state may need supervision in the next.
Medicare requires CRNA supervision by a physician unless a state opts out. As of September 2026, 27 states plus DC and Guam have opted out. Check CRNA opt-out states and the facility's own policies before each assignment.
Credentialing and privileges
Every new facility must credential you and grant privileges before your first case. This can take weeks, so start as soon as you accept an assignment.
Keep a ready file: licenses, NBCRNA certification, NPI, DEA (if required), malpractice certificate, life support cards, references and a gap-free CV. Keep your CAQH profile current. See APRN credentialing.
Malpractice insurance
Ask who provides coverage for each assignment, and get proof in writing.
- Occurrence policies cover incidents during the policy period, whenever the claim is made.
- Claims-made policies cover a claim only if the policy is active when it is made. You may need tail coverage when the policy ends.
Short assignments under claims-made policies can leave gaps. Ask who pays the tail for each one. See CRNA malpractice insurance.
Billing
When you work locums, someone bills payers for your anesthesia services. Usually that is the facility, group or agency client.
For Medicare, a facility or group billing for your work as a contractor typically needs a reassignment of benefits. Reassignments are now reported on the CMS-855I form. CMS discontinued the separate CMS-855R form.
Ask which NPI claims go under, and whether you must sign a reassignment. Claims billed under your NPI can affect you, even if you never see them.
Pros and cons
Pros
- Often higher hourly or daily rates
- Control over when and where you work
- Variety of settings, case mixes and teams
- A way to try a region or employer before committing
Cons
- Uneven income between assignments, and cancellations
- Licensing, credentialing and travel paperwork
- Fewer or no benefits, especially as a 1099 contractor
- Less continuity with a team
- New graduates usually benefit from a stable first job
FAQ
Can a new graduate work locums?
Some do, but many facilities prefer experienced CRNAs for short assignments. Most new graduates start in a W-2 job.
Does a compact license let me work anywhere?
No. The NLC covers your RN license only. You still need APRN or CRNA authority in each state.
Who pays for licenses and travel?
It depends on the contract. Agencies may cover some costs. As a direct contractor, you usually pay and build the cost into your rate.
This page is general information, not legal, tax or financial advice.
Sources
- Nurse Licensure Compact (NCSBN)
- NCSBN: APRN Compact
- AANA: Fact sheet concerning state opt-outs (September 2026)
- IRS: Understanding employee vs. contractor designation
- CMS: Form CMS-855I, Medicare enrollment application for physicians and non-physician practitioners
- eCFR: 42 CFR 424.80, prohibition of reassignment of claims by suppliers (and exceptions)
- AANA Insurance Services: Occurrence or claims-made?