The Client

The client was Cross Country Healthcare, one of the largest nurse staffing agencies in North America. They have a large network of travel nurses and doctors who they place in hospitals around the country as the need arises. For instance, if a hospital needs a particular kind of resident surgeon or RN for a short period of time, they call Cross Country. Cross Country then finds a qualified professional to send to the hospital.

The Need

Cross Country Healthcare needed a huge, steady flow of nursing leads to sustain their business. They also needed to acquire these leads at an exceptional CPL. Furthermore, they only wanted to spend money on certain types of healthcare professionals: registered nurses (RNs), anaesthesiologists, and locum tenens doctors.

The Work

Initial Audit

I inherited the account from an underperforming agency, so my first task was to audit the existing campaigns. I identified irrelevant keywords, areas of waste, poorly written ads, and low-performing geographic regions. I then sent the client my suggestions for how to address these issues.

Campaign Build

After the client gave me the greenlight to implement changes, I set to work building campaigns and writing ads that would convert:

  • I performed new keyword research using competitor auditing and Google Keyword Planner
  • After seeing how much volume phrases like “travel nurse jobs” received, I implemented a phrase match bidding strategy — I would only be paying for clicks on highly relevant phrases
  • I rewrote all of the ads: I added salary information as well as location into the ad copy. That way, if a nurse wouldn’t be satisfied with the location or pay, they wouldn’t click on the ad and cost us money
  • I audited our landing pages and wrote fresh copy that would turn visitors into leads
  • I launched the campaign at a monthly budget of $350,000-$400,000

Optimization Process

After launching the campaign, I monitored my reports daily to see which keywords and ads were driving leads, and how much each lead cost.

Firstly, I downloaded search term reports daily – if I saw a search query that was exactly relevant, I added it to our negative keyword list. After a couple of days, we no longer paid for clicks from searches that didn’t apply to the business.

Second, I A/B tested all of our ads. When an ad definitely lost the A/B test, I paused it.

Third, I looked at timing reports. I wanted to see which days of the week performed the best, and I even looked at hours of the day. Performance varies wildly in large-scale campaigns, and I implement bid adjustments and schedules to make sure our ads only ran when they would be effective.

Google Ads account optimizations are always more involved than a one-page report can encapsulate, but it all boiled down to one thing: daily reporting and adjustments.


Over the year and a half I managed the account, I gradually decreased the cost per lead and increased lead volume until we actually had to decrease monthly spend – the campaign was generating more leads than the client knew what to do with.

The overall CPL for verified registered nurse leads came to $35 over the life of the campaign, and each nurse placed in a hospital earned the client thousands of dollars.