States with the most job openings for travel nurses include California, Arizona and Massachusetts, according to statistics released by healthcare staffing firm Medical Solutions.

As of the start of October, states with the highest demand for travel nurses ranked in order were:

• California
• Arizona
• Massachusetts
• Texas
• New York
• Ohio
• Missouri
• Pennsylvania
• Virginia
• Illinois

Demand for travel nursing in states can depend on several factors, according to Chase Farmer, chief commercial officer at Medical Solutions.

At the top was California, a large-populations state to begin with.

“Right now, California is the only state that has mandated nursing ratios,” Farmer said. That has put pressure on hospitals in the state to increase the number of bedside nurses. Several California metro areas also have relatively high costs of living, which can make it more difficult to recruit permanent nurses.

Arizona, No. 2 on the list, can be affected by seasonality, he said. States with warmer weather such as Arizona can be affected by snowbirds arriving during the fall. Snowbirds tend to be older as well, and people tend to need more healthcare as they age. Arizona also holds the suspected origin story for travel nursing itself. Farmer said some feel that Arizona’s scrambling for nurses to meet the demands of snowbirds is what first prompted the travel nurse industry to come into existence.

Seasonality can also affect colder states such as Massachusetts, which is also on the list, he said. Staff nurses may be leaving the state to get away from the cold weather, prompting a need for temporary nurses.

Other states, such as Texas, are experiencing more demand as people from other parts of the country migrate into the state. It’s also the second-most populated state, with plenty of demand already in place.

States have higher and lower concentrations of nursing schools and that can affect demand as well.

Overall, demand from states is also variable and can change over time, and the healthcare system is itself adapting to the new normal after the pandemic.

“We are sort of in the midst of reset,” Farmer said. Hospitals margins were typically in the range of 1% to 3% prior to the pandemic, but many hospitals went into the red at the height of Covid-19. Today, hospital margins are back on the rise.