A nursing home staffing agency supplies the nurses and nursing assistants a skilled nursing facility needs when its own schedule comes up short. In Minnesota, that arrangement sits inside a tighter set of rules than most other care settings: federal requirements for nursing services, state registration for the agency, a Nurse Aide Registry check before an aide works a single shift, and a state cap on what an agency can bill a nursing home. This guide covers what a nursing home staffing agency does, the rules that apply when you use one, and what to check before you sign.
Running assisted living instead? See our assisted living staffing agency guide. For aides in any setting, see our CNA staffing agency guide.
What a Nursing Home Staffing Agency Does for a Skilled Nursing Facility
The agency keeps a pool of credentialed clinicians on its own payroll and places them in your building when you need coverage. In a skilled nursing facility, that usually means:
- Certified nursing assistants (CNAs) for direct care on the floor
- Licensed practical nurses (LPNs) for med passes, treatments and charge duties within their scope
- Registered nurses (RNs) for assessments, supervision and charge or RN coverage shifts
Coverage comes in a few shapes. Per diem fills single shifts as they open up. Short-term contracts cover a set stretch, such as a leave of absence or the weeks before a new hire finishes orientation. Block booking reserves the same clinician for a recurring set of shifts, so your residents see the same face on the same unit week after week.
Nursing Home Staffing Rules That Matter When You Use Agency Staff
Agency staff don't change your obligations. These rules apply to every hour worked on site.
Federal nursing services requirements (42 CFR 483.35)
Federal rules require a certified nursing home to have "sufficient nursing staff with the appropriate competencies and skills sets" to meet residents' needs, based on resident assessments, care plans and the facility assessment. Unless a waiver applies, the facility must use the services of an RN for at least 8 consecutive hours a day, 7 days a week, and must have a full-time RN as director of nursing.
The facility must also post nurse staffing data at the start of each shift: name, date, census, and the number and actual hours worked by RNs, LPNs and certified nurse aides giving direct care. Posted data must be kept for at least 18 months, or longer if state law requires. Agency nurses and aides working that shift count in those numbers.
The same section bars a facility from using anyone as a nurse aide on a temporary, per diem or leased basis unless that person meets the nurse aide competency requirements.
What happened to the 2024 federal minimum staffing rule
In 2024, CMS finalized a rule that would have required 3.48 total nurse staffing hours per resident day and an RN on site 24 hours a day, 7 days a week. That rule is gone. On July 4, 2025, Pub. L. 119-21 was signed into law, barring CMS from implementing or enforcing those provisions until after September 30, 2034. CMS then repealed them through an interim final rule published December 3, 2025, effective February 2, 2026. The rule restored the earlier standard described above: 8 consecutive RN hours a day and a full-time RN director of nursing. The facility assessment requirement stayed in place.
Agency hours go into Payroll-Based Journal
Nursing homes must electronically submit direct care staffing data to CMS through the Payroll-Based Journal (PBJ) system. That data includes agency and contract staff. Each person reported must be identified as an employee, a contractor or agency staff. Under CMS's PBJ policy manual, submissions are due by the 45th day after each quarter ends, and contractor hours must be verifiable through payroll, invoices or a contract. Ask how your agency will supply them.
Minnesota: Nurse Aide Registry before the first shift
Minnesota gives directly hired nursing assistant trainees four months to get onto the Nurse Aide Registry. Agency aides don't get that window. The Minnesota Department of Health states that people working for a temporary agency "must be on the Registry before they are eligible to work" in a nursing home or certified boarding care home.
Minnesota: agency registration and the billing cap
Minnesota calls these agencies supplemental nursing services agencies (SNSAs). Under Minn. Stat. 144A.71, every SNSA must register with the Minnesota Department of Health every year, and each business location needs its own registration. Under 144A.72, a registered agency must document that each temporary worker meets the licensing, training and continuing education standards for the role, and that each worker is the agency's employee rather than an independent contractor. The agency also can't charge a buyout fee if your facility hires one of its workers permanently.
Minn. Stat. 144A.74 limits what an SNSA can charge a licensed nursing home. An agency may not bill or receive payment above 150 percent of a benchmark. That benchmark is the weighted average wage rate for the employee classification and geographic group, as calculated by the Department of Human Services, plus a factor for payroll taxes. The cap covers administrative fees, contract fees and other charges added to the hourly rate. Travel and housing costs the nursing home pays are outside the cap. For how agency rates are put together, see our breakdown of what agency staffing costs.
How Agency Staff Fit Into a Nursing Home Staffing Plan
An agency works best as one layer of a staffing plan, not the whole plan. It helps most with:
- Call-ins and open shifts. An agency gives your scheduler somewhere to go besides the people who just worked a double.
- Census and acuity spikes. Admissions, a cluster of high-acuity residents or an outbreak can push your needs past what your base schedule covers.
- Survey readiness. Steady coverage on the floor lets your own nurses focus on care plans, documentation and the follow-through surveyors look at.
- Filling while you recruit. A short-term contract or block booking can hold a line open while you hire and orient a permanent employee.
Agency coverage also takes pressure off your own staff. If mandatory overtime has become routine, our comparison of agency staffing vs. mandatory overtime walks through the tradeoffs.
Block booking matters in skilled nursing. When the same CNA or LPN works the same unit every week, they learn residents' routines and care plans. For more on how agency coverage fits a broader workforce plan, see our guide to senior living staffing in Minnesota.
Onboarding Agency Staff on a SNF Unit
Have a short unit orientation ready before the clinician arrives: charting login, med room and supplies, emergency codes, and who to call. Give a real report on their residents, including fall risks and precautions. Our guide to preparing your facility for agency staff has a fuller checklist.
Choosing a Nursing Home Staffing Agency: A Checklist
Ask these questions before you sign, and get the answers in writing:
- SNSA registration. Is the agency currently registered with MDH as a supplemental nursing services agency, for the location that will serve you?
- Registry verification. Does the agency confirm every aide is on the Minnesota Nurse Aide Registry before placement, and keep that status current?
- Background studies. Are background studies run through DHS NETStudy 2.0? Minnesota law requires an SNSA to start a NETStudy background study before a person begins a position with direct contact with the people it serves.
- W-2 employees. Are clinicians employees of the agency, as Minnesota law requires, rather than 1099 contractors?
- Competency records. Can the agency show license verification, training and skills documentation for each person it sends?
- PBJ support. Will the agency provide hours in a form you can use for Payroll-Based Journal reporting?
- Response time. How does the agency handle a same-day request, and who answers the phone after hours?
- Cancellation policy. What notice does the agency need if your census drops, and what happens if the agency can't fill a confirmed shift?
- Rates within the cap. Does the agency's rate sheet, including all fees, stay within the 144A.74 maximum?
How Interim HealthCare Staffing of Minneapolis Can Help
Interim HealthCare Staffing of Minneapolis places CNAs, LPNs and RNs in nursing homes and other care settings across the Twin Cities and southern Minnesota. We handle credentialing and compliance documentation, and we work on per diem, short-term and contract arrangements depending on what your building needs. You can request staff online or contact us to talk through your schedule.
Frequently Asked Questions
What does a nursing home staffing agency do?
It employs credentialed CNAs, LPNs and RNs and places them in skilled nursing facilities to cover open shifts, leaves, census spikes and vacancies, on a per diem, short-term contract or block-booked basis.
Is the federal 3.48 hours-per-resident-day staffing rule still in effect?
No. CMS repealed the 2024 standards, including 3.48 total nurse staffing hours per resident day and 24/7 on-site RN coverage, effective February 2, 2026. Nursing homes must still have sufficient nursing staff, an RN at least 8 consecutive hours a day, 7 days a week, and a full-time RN director of nursing unless waived.
Can an agency CNA work in a Minnesota nursing home before being on the Nurse Aide Registry?
No. The Minnesota Department of Health states that people working for a temporary agency must be on the Nurse Aide Registry before they are eligible to work in a nursing home or certified boarding care home. The four-month grace period applies only to trainees hired directly by a facility.
Is there a limit on what a staffing agency can charge a Minnesota nursing home?
Yes. Minn. Stat. 144A.74 bars a supplemental nursing services agency from billing a licensed nursing home more than 150 percent of the weighted average wage rate for that job classification and geographic group, plus a payroll tax factor. Fees count toward the cap; travel and housing costs paid by the nursing home don't.
Do nursing homes report agency staff hours to CMS?
Yes. Through the Payroll-Based Journal system, nursing homes report direct care hours to CMS, including agency and contract staff hours, identifying each person's employment type. Submissions are due by the 45th day after each quarter ends.