Per Diem Nursing

I’ve talked a little bit about how changing my status at work to per diem has helped alleviate some burnout. In doing so, I’ve heard lots of misconceptions about what it means to be a per diem nurse. So what is per diem nursing? What are the pros and cons? I’m breaking it all down for you here!

Please note that this is not an exhaustive list, but is a great place to start if you’re considering a per diem position.

What is per diem nursing?

The term “per diem” in nursing holds a slightly different meaning than it does in the business world. While business folks think of per diem as a monetary allowance for meals, lodging, and other miscellaneous expenses, in nursing, per diem means “as needed”. These roles fill a staffing need, but are not considered “career” employees like part time or full time employees. Per diems are still employees of a certain hospital system and still have a home unit that they are hired on to.

As a per diem nurse, instead of the 3 12-hour shifts or 4 10-hour shifts (or any combination thereof) that you might work as a full time employee, you give your availability and (usually), those are the days you work. One important thing to note is that the minimum hourly requirements vary from hospital to hospital and unit to unit. For example, one of the ICUs I worked in required 4 shifts a month with 1 weekend and 1 major holiday. My current unit requires 6 shifts in 6 weeks and 1 night call. Before you accept a per diem position, you should do your research and make sure you are clear on the requirements and expectations as a per diem staff member.

Why would you take this kind of job? And what are the pros and cons?

The Pros

• Per diems have MUCH more flexibility than career employees. When I make my schedule, I send my available days, put them in my calendar, and forget about them until I have to work them. Before the schedule even comes out, I know those are the days that I work, so there are no surprises. Which means…
• It’s easier to plan your work schedule around vacations, doctors appointments, and other important events. For me this is a huge perk, and the added flexibility makes a wildly positive impact on my home life.
• Often (but not always depending on the hospital system), you don’t have to ask for time off or work weekends or holidays. You are the boss of your own schedule.
• Not getting benefits means your hourly pay is much higher than career employees (we’re talking 20+ dollars an hour depending on your state / hospital).
• There is usually an opportunity to pick up more hours, but you’re not expected to be there. You can work as much or as little as you want. I have worked part time or full time hours (20-40 hrs / week) at all of the per diem jobs I’ve had.
• Many people think per diems can’t save for retirement. While it is true per diems don’t enjoy the benefits of their company “matching” what they put into their retirement accounts, per diems (like travelers) can and do put quite a bit of money into their retirement savings. Because of the higher pay, I’ve also found it much easier to put money aside when I’m working enough and budgeting appropriately. You just have to remember to set money aside for this purpose!
• Unit drama. You don’t have to deal with any of it. You’ll find yourself working your shifts and moving on with your life.
• Variety. As someone who gets bored easily (which then contributes to burnout), I love that I have two totally different per diem jobs with different schedules, locations, people, and job responsibilities. This means I am always learning something new!

The Cons

• The potential lack of ability to advance in your career. Many (but not all) employers wont let you attend classes or participate in more educational opportunities because you are not a career employee. Employers put more investment into their career employees (which makes perfect sense). This is not always true, and I know many per diems who have taken classes, advanced their degrees, and are on code teams, line insertion teams, etc etc. Again, this is why where you work is so important.
• Like travelers, per diems are often given the “shit shifts“, meaning you might be put on a worse shift (time-wise) or get “worse” patients.
• You’re also the first to float. I work in the PACU at a large hospital system and have floated to all of the PACUs within that system. This can mean dealing with different personalities, not knowing where things are, or driving to different locations at the last minute.
• You’re also the first to get cancelled or flexed, because you’re expensive! This can become a problem if you are relying on a certain income. Not having guaranteed hours can be a very stressful experience for some.
• Your income is variable and hard to predict. If you’re like me and like to make a monthly budget, this is tricky and often needs to be updated as the month goes on. One great way to combat this is to get multiple per diem jobs. This way, even if you are only working your minimums, you are making at least that much in income.
• Most places will not hire newer or inexperienced nurses into per diem roles. As a per diem, the expectation is that you already know what you’re doing (because like I said, your employer isn’t interested in training someone who might only be there once a week). You need to be very confident before you get a per diem job. This can be hard when you want to make a change but don’t have enough experience in the specialty you’re applying to.
• Let’s talk retirement and perks. If your employer has great perks, oftentimes per diems are not allowed to participate in them. For example, at my current facility, while per diems are allowed to precept new employees, they do not get “precepting points” that they can use to purchase cool things like electronic devices and apparel. If you are saving for retirement, this also applies – you can still do it but you’re on your own!
• You are also responsible for your own health insurance, which can be expensive to purchase on your own.

So is it really that different from being part time or full time?

In short, yes. For many reasons.

Per diem nursing vs. part time nursing

You still have some flexibility without having to fulfill full time requirements. You can work 24 hours per week instead of 36. However, you still have to ask for vacation time, don’t have higher pay like per diems do, and still have to adhere to the same scheduling requirements as full timers. Having to ask for time off that can be approved or denied is the worst.

Something to note: Part time positions (at least where I live) are not easy to find because they are not advantageous for hospitals to have. The managers at the inpatient hospital jobs I’ve had always state that “part time makes no sense to have available”. Why? Because when you are a part time employee, hospitals still have to pay for your benefits but your work requirement is less. As a nurse looking for a part time job, this really sucks. In my humble opinion, being part time is the best of both worlds.

Per diem nursing vs. full time nursing

You enjoy the “perks” of being a career employee. You can work towards promotions, have more opportunities for education, and can contribute to retirement. You do also have lower pay then per diems, oftentimes have to deal with unit politics, and can feel like you have no control over your own schedule because everything has to be approved.

Overall, I can honestly say that I am just as passionate about being excellent at my job(s) as I would be if I wasn’t per diem. How many hours you work doesn’t have to mean much, so it’s up to you to make your job what you want it to be! Per diem nursing has totally changed my outlook on nursing, and I would recommend it to anyone who is interested and able to be a per diem nurse.