A locum CRNA is a Certified Registered Nurse Anesthetist who works temporary assignments at healthcare facilities rather than holding a permanent staff position. The Latin phrase “locum tenens” translates to “holding the place,” and that’s exactly what these providers do: step in to deliver anesthesia care when a facility’s regular CRNA or anesthesiologist is unavailable due to leave, vacancies, or surges in surgical volume.
What a Locum CRNA Actually Does
Clinically, a locum CRNA performs the same work as any permanent CRNA. They administer anesthesia, monitor patients during surgery, manage pain, and collaborate with surgeons, anesthesiologists, and nursing staff. The difference is entirely structural. A locum CRNA arrives at a facility for a defined period (anywhere from a few days to several months), handles the anesthesia caseload, and moves on when the contract ends.
Because of that temporary focus, locum CRNAs typically aren’t pulled into hospital committees, quality improvement projects, or long-term departmental planning. Their attention stays on direct patient care. The tradeoff is that they need to adapt quickly. Each new assignment may come with unfamiliar electronic health records, different anesthesia protocols, and a surgical team they’ve never met, often with minimal onboarding time.
Where Locum CRNAs Work
Locum CRNAs fill gaps across a wide range of settings. Hospitals, including large trauma centers, hire them to cover staff shortages or seasonal demand. Ambulatory surgery centers (ASCs) are one of the fastest-expanding practice settings for anesthesia providers, and because ASCs run with leaner teams than hospitals, a single vacancy can create an urgent need for temporary coverage. Rural and critical-access hospitals also rely heavily on locum CRNAs, since recruiting permanent anesthesia providers to remote areas is notoriously difficult.
Why Demand Is Growing
Several forces are pushing more facilities toward locum staffing. Employment for CRNAs is projected to grow 10% from 2023 to 2033, creating roughly 5,200 new job openings. At the same time, around 12% of CRNAs plan to retire by 2027. That combination of rising demand and workforce attrition means facilities increasingly turn to temporary providers to keep operating rooms running. As of May 2025, about 4.1% of CRNAs are working locum tenens.
Compensation and Pay Structure
Locum CRNAs consistently earn higher hourly rates than their permanently employed counterparts. In 2025, locum CRNA hourly rates generally fall between $190 and $250 or more per hour, translating to estimated annual gross pay of $385,000 to $520,000 for those who work steadily throughout the year.
That premium reflects a few realities. Locum providers absorb costs that permanent employees don’t, including their own health insurance, retirement contributions, and malpractice coverage in many cases. They also sacrifice job security, paid time off, and the stability of a single workplace. The higher rate is compensation for that risk and flexibility.
1099 vs. W-2: How Employment Works
Locum CRNAs typically work under one of two arrangements, and the distinction has significant financial implications.
As a 1099 independent contractor, you’re self-employed. No taxes are withheld from your pay, so you’re responsible for calculating and submitting your own tax payments, including self-employment taxes covering both the employer and employee portions of Medicare and Social Security. The upside is access to a broad range of tax deductions: business travel, continuing education, liability insurance, equipment purchases, and professional development expenses. You’ll also need to arrange your own health insurance, retirement plan, disability coverage, and malpractice insurance. Many locum CRNAs working 1099 hire a tax accountant or financial planner to manage the complexity.
As a W-2 employee (usually through a staffing agency), your taxes are withheld automatically, and the employer pays half of your Medicare and Social Security taxes. You’ll typically receive benefits like health insurance, retirement plan contributions, malpractice coverage, and paid time off. The base pay is generally lower than a 1099 rate, but the simplified tax filing and employer-covered benefits offset some of that difference.
Travel Perks and Stipends
Most locum assignments involve travel, and compensation packages typically account for that. Agencies may book your housing and travel directly, or offer a stipend to cover those costs yourself. The tax treatment matters here: housing and travel stipends generally aren’t taxable income as long as you’re maintaining a permanent residence (paying rent or a mortgage at home) and your assignment lasts less than a year in any two-year period. If those conditions aren’t met, stipends may be treated as taxable wages.
CRNAs who manage their own travel expenses can also reference federal government per diem rates for both housing and meals to calculate deductions. How you structure these reimbursements can meaningfully affect your take-home pay, which is another reason many locum CRNAs work with a tax professional.
Licensing Across State Lines
Licensing is one of the biggest logistical hurdles for locum CRNAs. The Nurse Licensure Compact (NLC) allows registered nurses to practice across member states with a single multistate RN license, but that compact only covers the base RN license. It does not extend to the CRNA or APRN credential. Very few states offer reciprocal APRN licensing, so in practice, you need to apply individually in each state where you plan to work.
Having a compact RN license can speed up the process, since some states use it to expedite endorsement of the advanced practice credential. But plan ahead: each new state application involves paperwork, fees, and processing time that can add weeks to your timeline before you’re cleared to practice.
Credentialing and How Long It Takes
Beyond state licensing, each facility requires its own credentialing and privileging process. Standard credentialing cycles run 30 to 90 days. In urgent situations where a provider already holds an in-state license and has clean credentials, expedited privileging can sometimes get coverage started within a few weeks. If new state licensure and full credentialing are both needed, the timeline can stretch to several months.
This is why experienced locum CRNAs keep their documents organized and up to date at all times: licenses, certifications, immunization records, DEA registration, references, and continuing education logs. Agencies handle much of the paperwork, but delays almost always trace back to missing or expired documents on the provider’s end.
Malpractice Insurance for Locum CRNAs
Malpractice coverage is a critical detail that varies by arrangement. Some agencies provide it as part of the contract. Others expect you to carry your own policy. Either way, understanding the two main policy types matters.
Occurrence-based policies cover any incident that happens during the policy period, regardless of when a claim is actually filed. Even after the policy ends, you’re covered for events that occurred while it was active. This is the simpler, more protective option.
Claims-made policies only cover incidents if the policy is still active when the claim is filed. Once the policy is canceled (because you moved to a new assignment, retired, or switched carriers), there’s a gap in protection for past events. Closing that gap requires purchasing “tail coverage,” which typically costs about twice the annual premium as a one-time fee. For locum CRNAs who change assignments frequently, claims-made policies can become expensive and administratively burdensome.
Who Locum Work Is a Good Fit For
Locum work appeals to CRNAs at different career stages for different reasons. New graduates sometimes use it to explore practice settings and geographic regions before committing to a permanent position. Mid-career CRNAs may transition to locum work for higher earning potential, schedule flexibility, or a break from institutional politics. CRNAs approaching retirement often take locum assignments to scale back gradually while maintaining income.
The lifestyle requires comfort with uncertainty. You need to build rapport with new teams quickly, troubleshoot unfamiliar equipment without a long orientation, and manage the administrative side of your career (licensing, taxes, insurance, credentialing) that permanent employees largely outsource to their employer. For CRNAs who thrive on variety and independence, those tradeoffs are part of the appeal.