Full-Year Revenue, Cash Flow and Debt Reduction
Reported 2025 revenue of $2.73 billion, operating cash flow for the year of $269 million, and reduced total debt by $285 million during 2025.
Q4 Outperformance vs Guidance
Fourth-quarter revenue of $748 million was 2% higher year‑over‑year and $18 million above the high end of guidance; gross margin and adjusted EBITDA margin came in at or slightly above the high ends of guidance ranges.
Labor Disruption Revenue Surge
Labor disruption revenue in Q4 was $124 million (nearly 2x year‑ago quarter). Management expects approximately $600 million of labor disruption revenue in Q1, which drives operating leverage despite reducing consolidated gross margin (Q4 impact ~130 bps; Q1 expected drag ~300 bps).
Nurse & Allied Momentum
Nurse & Allied Solutions revenue was $491 million in Q4, up 8% year‑over‑year and +36% sequentially. Travelers on assignment grew 6% sequentially. Excluding labor disruption, management expects Nurse & Allied revenue in Q1 to be up 2%–4% year‑over‑year and 4%–6% sequentially. Schools business grew 10% year‑over‑year.
Improving International and Search/Leadership Trends
Sequential growth returned in international nurse staffing; management expects Allied International and Search to return to year‑over‑year growth in Q1. Interim leadership and search outperformed guidance in Q4, and search is expected to be flat to up in Q1.
Technology & AI Investments and VMS Enhancements
Company rolled out ShiftWise Flex and enhanced VMS capabilities (advanced analytics, generative/Agentic AI, internal float support). Investing in AI across recruiting, applicant tracking and credentialing; pilots and Q1 client wins in Language Services pipeline indicate potential for future margin benefits.
Improving Working Capital Metrics
Days sales outstanding improved to 47 days in Q4 (8 days lower year‑over‑year and 10 days sequentially); Q4 operating cash flow was $76 million and capex remained modest ($8 million in Q4; $36 million for full year).
Demonstrated Operational Platform and Strike Playbook
Built and deployed an event management system and dedicated strike operating model that successfully handled two large, concurrent indefinite labor events while largely preserving core-business service levels and enabling rapid supplier onboarding.