The ongoing nursing shortage has significantly strained the U.S. health care system. According to the latest industry projections, around 194,500 registered nurses are needed each year over the next decade, along with tens of thousands of nurse practitioners. Retirement and increased demand for health care services due to an aging population are two of the most significant factors behind this surge in demand.

A diminished workforce puts undue strain on nursing staff and can negatively impact patient safety and quality of care. Conversely, numerous studies link appropriate staffing with improved patient safety, mortality, and overall patient outcomes.

One way that health systems are addressing the nursing shortage is through per diem nursing staff. Per diem work helps organizations fill gaps in staffing and affords nurses a level of flexibility in their career. This type of nursing work is an option for nurses at virtually every level of the profession, including nurse practitioners.

Working on a per diem basis has both upsides and downsides. Understanding the potential benefits and drawbacks of this type of nursing is essential for those considering it as a career option.

What Is Per Diem Nursing?

Per diem nurses are a vital resource, enabling health care facilities to consistently provide medical services. What is per diem nursing exactly, and how does it differ from other forms of nursing?

Nurses who work per diem—a Latin phrase meaning “by the day”—work on an as-needed basis, sometimes for multiple health care institutions. Per diem nurses provide their availability, either through a staffing agency or directly to a health care facility, and can then pick shifts that need coverage. In many cases, they are assigned shifts at the last minute.

As opposed to a salary, per diem nurse pay is directly tied to worked hours. Per diem nurses also typically earn more per shift than other nurses, due to the last-minute nature of the role.

What Does Per Diem Mean in a Hospital?

Per diem nurses work in different health care settings, including nursing homes, clinics, and hospitals. The exact nature of per diem work varies based on the type of facility and its needs. Because it is “as needed,” what per diem means in a hospital is that a nurse may work in different specialties and units, like the emergency room (ER) or labor and delivery.

Health care facilities generally employ per diem nurses for two reasons: to fill gaps in staffing or supplement full-time staff during periods of high demand. For example, institutions often hire per diem nurses during the summer and around the holidays when full-time nursing staff take vacations. They’re also used during the winter flu season when demand for medical services tends to increase.

Health systems relied heavily on per diem nurses during the COVID-19 pandemic to supplement existing staff and fill in when full-time workers missed work due to illness or exhaustion. Per diem nurses, along with travel and part-time nurses, were crucial to alleviating some of the strain that the pandemic placed on the health care system.

PRN and Part-Time Nursing

Per diem nursing is different from pro re nata (PRN)—a Latin phrase meaning “as the circumstance arises”—nursing. Similar to per diem nurses, PRN nurses work on an as-needed basis. However, the two have several differences.

  • PRN nurses work for a single health care facility, for a specific medical unit, whereas per diem nurses can work for multiple institutions at the same time.
  • Since they work for a specific unit, PRN nurses have less flexibility to pick and choose shifts than per diem nurses. However, PRN nurses are guaranteed a certain number of shifts; per diem nurses are not.
  • Because they work for a single employer, PRN nurses typically receive benefits, such as health care. Per diem nurses, on the other hand, don’t receive benefits.

Per diem nursing is also different from part-time nursing, which is relatively similar to PRN nursing, with a set schedule and guaranteed hours.

The Benefits of Working Per Diem As a Nurse

Numerous potential benefits of working per diem as a nurse exist, including greater professional flexibility and higher pay. The following are a few of the benefits per diem nurses may enjoy:

  • Flexibility. Per diem nurses can pick and choose shifts, building a schedule that suits their needs and lifestyle. They have the freedom to choose where, when, and how often they work. Depending on their availability, they can work one per diem shift per month or several a week. This may be ideal for those who work a full-time job elsewhere—including another nursing job—or have other responsibilities.
  • Higher earnings. On a shift-by-shift basis, per diem nurses generally earn more than their full-time colleagues. This is partly due to the urgency and last-minute nature of per diem work. One of the trade-offs for this higher compensation is that employers typically don’t offer benefits for per diem work.
  • Learn new skills. Per diem nurses may have the opportunity to expand their skill set by working in different specialties. A full-time nurse who works in the adult ER, for example, could potentially pick up shifts in the pediatric ER, thereby gaining additional skills and knowledge for career growth. They also may work with new technology, allowing them to stay ahead of the curve in a dynamic work environment. By working per diem, nurses can develop all these skills without having to make a permanent commitment.
  • Work for different employers. Per diem nurses have the freedom to work for multiple employers and institutions. This often allows them to work in various clinical settings and different regions, exposing them to new people and learning experiences. Some nurses may find that they enjoy the mental stimulation that comes with an ever-changing work environment.

Benefits for Institutions

Per diem nursing benefits health care facilities as well. First and foremost, it helps fill gaps in staffing, potentially alleviating the burden placed on full-time staff and avoiding the risk of burnout. Other benefits include:

  • Improved patient care. An overburdened and overworked staff may compromise the quality of patient care and increase the risk of patient safety events. Using per diem staff to relieve some of that strain can help keep staff morale high and minimize burnout.
  • Cost savings. Since per diem nurses don’t receive benefits, they can be a cost-effective staffing option. Staffing agencies typically handle paperwork and compliance issues, and health care facilities may even enjoy tax benefits by hiring per diem staff.
  • Versatility. Because of their exposure to different settings and specialties, per diem nurses often have a diverse skill set and can work independently. This means that institutions can use them to plug staffing holes, particularly in crisis situations, with minimal training and be confident in their ability to do the job.

Avoiding Burnout as a Per Diem Nurse

Despite the flexibility and work-life balance that this type of work affords, per diem nurses run the risk of burnout just like any other nurse. The risk of burnout is especially high for those who moonlight as a per diem nurse while maintaining a full-time job.

Fortunately, nurses can employ a number of simple strategies to avoid burnout:

  • Take time to rest and recover by picking up shifts every other week.
  • Practice self-care (e.g., mindfulness and meditation).
  • Exercise regularly.
  • Schedule shifts with less intense workloads, such as office work or vaccine administration.

What Does a Per Diem Nurse Practitioner Do?

The nursing shortage isn’t confined to one discipline. Per diem nurses work in many different capacities such as nursing assistants, RNs, and nurse practitioners. In terms of their fundamental responsibilities, very little difference exists between full-time and per diem nurses.

The role of a per diem nurse practitioner is virtually identical to that of a full-time nurse practitioner. While the scope of practice for nurse practitioners varies by state, it often includes many of the following duties:

  • Perform physical exams.
  • Order and/or perform diagnostic tests.
  • Diagnose and treat acute and chronic conditions.
  • Create patient treatment plans.
  • Prescribe medication.
  • Consult with physicians and other medical professionals.

Just like their full-time counterparts, per diem nurse practitioners need to have at least a master’s degree, hold an active registered nursing license, and pass a certification exam. Nurse practitioners also require at least one to two years of clinical experience before they can practice.

Both per diem and full-time nurse practitioners are highly trained and skilled, operating with more independence than other types of nurses. Because they may cover shifts at the last minute in unfamiliar clinical settings, per diem nursing may be more dynamic than a full-time nurse practitioner role. As such, per diem nurse practitioners should be flexible, nimble, and quick to pick up new skills.

Per Diem Nurse Practitioner Job Outlook and Salary

The median annual salary for nurse practitioners was $111,680 as of May 2020, according to the U.S. Bureau of Labor Statistics (BLS).

The average salary for a per diem nurse practitioner can vary significantly due to the different hours and settings in which they may work. According to an analysis by ZipRecruiter, the hourly rate for per diem nurses ranged between $23 and $33 in 2021.

Rates can go much higher depending on location and level of demand. While exact figures regarding per diem nurse pay were not available at the time of writing, some employers reportedly paid travel nurses thousands of dollars per week during the COVID-19 pandemic.

Per diem nurse practitioner job opportunities will likely be abundant for the foreseeable future as a result of the ongoing nursing shortage and the shortage of primary care physicians, both of which the pandemic exacerbated.

The overall job outlook for nurse practitioners is extremely promising. The BLS projects nurse practitioner employment to grow by 52% from 2020 to 2030. By 2030, there should be more than 335,000 nurse practitioners. Rising demand for health care services from an aging population and increased emphasis on preventive services—along with an exodus of nurse retirees—will be the biggest factors fueling this employment growth, creating plenty of opportunities for per diem nurse practitioners.

The Pros and Cons of Per Diem Work

Per diem nursing can be a highly rewarding career path, offering numerous benefits. That said, per diem work can have drawbacks, which are highly dependent on the individual. Those interested in this type of nursing—whether as a full-time option or to supplement their existing nursing career—should weigh all the pros and cons of per diem work so that they can decide whether it’s right for them.

Pros of Per Diem Nursing

Working as a per diem nurse comes with plenty of potential upsides.

  • Scheduling freedom and flexibility. Similar to ride-hailing drivers or substitute teachers, per diem nurses can pick and choose when they want to work and aren’t locked into a set schedule. This may be a great option for individuals who need a more flexible work-life balance, such as those who have to care for young children or who are going back to school.
  • Opportunity to earn more income. Some nurses use per diem work as a means to earn income on top of their full-time salaries. They can use this extra money to help pay off student loans, plan vacations, purchase a home or car, or simply put it in savings. The higher hourly earning potential of per diem work makes it an even more attractive income stream.
  • Explore different career paths. Nurses can use per diem work as a means to explore different specialties and settings to determine if it’s something they’re interested in long term. They may get to work in a new facility or unit, alongside various medical professionals, or work with new technology. This gives them an opportunity to explore various career options without commitment and figure out the best way to advance their career.

Cons of Per Diem Nursing

For all its perks, per diem work does have some potential downsides as well.

No guaranteed work. While per diem work offers a degree of flexibility and freedom, nurses aren’t guaranteed shifts. Their schedule corresponds directly to the employer’s needs and their own availability, and they may have to compete with other nurses to pick up shifts. Employers may also cancel shifts on short notice, so it’s often advantageous to work with a staffing agency that offers multiple per diem jobs.

No benefits. Partly because they work for multiple employers, per diem nurses typically don’t receive any benefits. Organizations generally offer higher hourly rates to compensate, but the lack of benefits may pose a challenge for some, particularly those with families. Per diem nurses often work full time elsewhere to keep their benefits.

Schedule management. While some may enjoy organizing their own schedules, others may find that an inconsistent schedule does not work for them. The lack of structure may be stressful or difficult to manage for some nurses who prefer to know when they are working ahead of time.

Dynamic work environment. Some nurses enjoy the experience of floating between units and working in different specialties as a way to develop their skills and knowledge. For others, the ever-changing nature of per diem work can be overwhelming and may cause anxiety.

The beauty of per diem nursing is that it gives nurses the opportunity to examine all these options with minimal commitment. Whether it’s a way to broaden their skills or simply earn a little extra money, working per diem may be the ideal choice for nurses looking to advance their career.

A Versatile Nursing Workforce

The U.S. has an urgent need for more nurses. The nation’s nursing shortage, already a concern before COVID-19, is even more evident as a result of the pandemic. The use of per diem nurses has proven to be an effective strategy to address these issues. By filling scheduling gaps and augmenting overburdened staff, per diem nurses can help alleviate some of the strain placed on full-time health care workers and ensure quality patient care.

Working per diem has potentially numerous advantages, both for nurses and the organizations that employ them. By carefully analyzing the pros and cons of this type of work, nurses can decide whether it’s the right choice for them.

Norwich University’s online Master of Science in Nursing and online Master of Science in Nursing: Nurse Practitioner programs can help individuals develop the skills and knowledge necessary to pursue a career as a per diem or full-time nurse. Learn more about how the programs can help prospective nurses achieve their professional goals.

 

Recommended Readings

Why Become a Nurse Practitioner?
Effects of the Continuing U.S. Nursing Shortage
How Family Nurse Practitioners Can Play a Major Role in Addressing the Physician Shortage in the U.S.

 

Sources:

Nursing Shortage, National Center for Biotechnology Information
Registered Nurses, U.S. Bureau of Labor Statistics
Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners, U.S. Bureau of Labor Statistics
AAMC Report Reinforces Mounting Physician Shortage, Association of American Medical Colleges

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