This is general information, not legal advice. Whether a particular clause is enforceable turns on your state’s law and on the exact wording of your contract. If real money is at stake, pay an employment lawyer in your state for an hour of their time before you sign — it is the cheapest insurance available.
What the commitment usually is
A service commitment — sometimes called a stay-or-pay clause, or a training repayment agreement — obliges you to remain employed for a set period after the residency, and to repay a stated amount if you leave first. Commitments of one to two years are common and some run to three. Memorial Healthcare System, for example, publishes plainly that a fellow “will be a full-time employee…for at least two continuous years” and signs “a two-year commitment as part of your new employee paperwork.”
These agreements are real, widely used, and enforceable unless and until a court says otherwise. No US court has struck them down as a class. Treat any advice that tells you they are unenforceable as wishful thinking.
The amount is almost never published — and that is the finding
Across the health-system residency and fellowship pages we reviewed, the commitment length is frequently published and the repayment amount essentially never is. Memorial Healthcare System’s FAQ is typical: it answers the length question directly, notes that “certain specialty areas may require additional training agreements,” and routes the detail to a conversation with the nurse leader.
There is no reliable national dataset of nurse residency repayment amounts. Any site quoting you a “typical” figure is guessing. The only concrete numbers in the public record come from litigation and from advocacy reporting — which means you generally cannot find out what breaking the contract costs until the paperwork is in your hands. That is precisely why the questions below matter more than any benchmark.
Proration is not standard
This is the assumption that costs people the most. In a class and collective action filed in 2023 against NCH Healthcare System in Florida, the fellowship agreement quoted in the complaint reads: “I will be responsible to pay back the program fee of $5,000. This fee will not be prorated based on time in the program.” The complaint spells out the consequence — a nurse who leaves after one day and a nurse who leaves one day before the two years are up owe exactly the same $5,000.
Some agreements do prorate. Many do not. Proration is a term to verify in your own document, never to assume.
Read for the trigger, not the headline
The clause that decides whether you owe anything is usually not the number — it is the qualifier. The NCH agreement is triggered by failure to fulfil the obligation “thru no fault of NCH.” That phrase is where the fired-versus-resigned answer lives, and it is contract-specific.
So the useful question is not “what happens if I get fired?” It is: what exactly triggers repayment in this document, and does a termination without cause trigger it? Ask for the answer in writing.
Check whether there is more than one agreement
In the NCH case the named plaintiff had signed three separate documents: a general employment agreement; a fellowship agreement carrying a two-year commitment and a $5,000 penalty; and a separate sign-on bonus agreement requiring two years of full-time emergency-department work in exchange for a $20,000 bonus.
A residency offer can therefore carry more than one commitment, in more than one document, each with its own clock and its own number — and a sign-on bonus almost always carries its own clawback. Ask for every document that contains a repayment or commitment term, and read them together.
Collections are a real consequence
The NCH complaint alleges the employer demands payment within weeks of resignation and refers unpaid balances to third-party collection agencies. Whether an unpaid balance affects your credit, or your eligibility to be rehired later, is not something we could establish from any primary source — so treat both as questions to ask rather than facts to assume.
Four things you may have read that are not true
- “The FTC banned non-competes, so this is unenforceable.” The FTC’s non-compete rule never took effect. It was set aside nationwide by a federal court in August 2024 and was ordered not to be enforced. It also would not have covered repayment clauses cleanly even had it survived — a training-repayment clause is not a non-compete, although it can function like one.
- “The CFPB regulated employer-driven debt.” The CFPB opened a request for information on employer-driven debt in 2022. That was an inquiry, not a rule, and it banned nothing.
- “I’m in California, so my clause is void.” California law voids contracts restraining someone from a lawful profession very broadly, and California nurses have more room to challenge a repayment clause than nurses in most states. But a repayment clause is not automatically a non-compete, and whether that statute reaches a given agreement is a live, fact-specific question. It is an argument, not a guarantee — and one that needs a California employment lawyer.
- “A court struck these down.” The opposite, in the best-documented case. A magistrate judge granted conditional collective certification in March 2024 — a procedural step under a lenient standard, not a ruling on the merits — but the collective was later decertified in January 2026 and summary judgment was entered for the hospital in May 2026. Anyone telling you these agreements have been invalidated is describing a case that was decided the other way.
Challenges are being brought — on wage-law, unenforceable-penalty, consumer-protection and antitrust theories — and so far they are not succeeding. The leading nurse case ended in summary judgment for the employer in May 2026. Outcomes remain highly state-specific, and none of this means a clause is necessarily fair; it means you should plan on the assumption that yours will be enforced.
How common are these?
The best available prevalence estimates come from the Student Borrower Protection Center, an advocacy organisation, writing in AFT Health Care in autumn 2025. It reports that among registered nurses with one to five years of experience, nearly 45% said they had been in a training repayment agreement, against 24% of nurses with 11 to 20 years’ experience. We could not retrieve the underlying survey or its methodology, so treat those as one organisation’s reported figures rather than a neutral statistic. The same reporting documents individual amounts ranging from about $10,000 to $20,000, including a $10,000 repayment attached to a large new-graduate residency programme.
The questions to ask before you sign
- How long is the commitment, and when exactly does the clock start — hire date, or residency completion?
- What is the repayment amount, in dollars, in writing?
- Does it prorate? If so, on what schedule?
- What triggers repayment? Specifically: resignation, termination for cause, termination without cause, redundancy, medical leave, failing to complete the programme?
- Is there more than one agreement in this offer — a fellowship agreement, a sign-on bonus, a relocation payment, a tuition benefit? Ask for all of them.
- What happens if the employer changes my unit, my shift, or my location? Does that release me?
- If I do not complete the residency, am I still employed, and is the repayment still owed?
None of this means you should refuse a commitment. A two-year clause attached to a strong residency at a hospital you want to stay at is often a perfectly good deal. The failure mode is signing without knowing the number, the trigger, or how many documents you just agreed to. Weigh it alongside the rest of the package in comparing two offers.