What is diem in 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.

That is the general idea behind per diem nursing.

Next, let’s talk about what per diem means, and how it's applied to nursing.

The phrase per diem is Latin and means “as needed” or “by the day”. Per diem refers to a job where an employee, of any kind, is paid when their services are needed daily to fill employee gaps.

Per diem pay refers to how much money a business, agency, company, or facility can afford to pay a temporary employee per day. Depending on the negotiated terms within the employment contract, per diem can refer to a few different things.

There are many careers that have per diem employees outside of healthcare. For some, per diem pay may cover all expenses for a temporary employee. For other positions, per diem pay might only cover partial expenses.

Travel nurses, for example, are given options for their living expenses when they travel and how it's paid for. To learn more about travel nursing and per diem nursing, check out how to become a travel nurse vs per diem article here.

With per diem nursing, the amount of pay depends on the staffing agency and the healthcare facilities that use these agencies to hire nurses. We'll go over per diem nursing pay in a minute.

First, let’s talk a bit about what per diem nursing is and how per diem nursing works.

A healthcare facility that needs to hire nurses quickly, goes through a nurse staffing agency to hire a registered nurse as a contract employee. Once a nurse is hired as a temporary employee and their contract is negotiated, they’ll work the shifts they’re scheduled for.

Many times a hospital, clinic, or healthcare facility will have call-offs, unexpected emergencies, or understaffing issues. Per diem nurses will apply for those positions and are hired to fill those vacancies.

Per diem nurses are contractors not fully employed by one facility. This gives them the freedom to work at any healthcare facility they choose.

Since per diem nurses don't have to work for only one hospital, this gives them more freedom on their work choices. It also allows per diem nurses to make a very comfortable salary working as a contractor at different medical facilities.

While per diem nursing is a perfect career for many, some may prefer a definite part-time position. Keep in mind there are pros and cons to both positions. To learn how they’re similar and different, check out our article, are per diem or part-time positions better for nurses?

Per diem nurses do not get traditional employee benefits because they usually work less hours than full-time. Per diem nurses can be hired through a nurse staffing agency or work directly for a hospital.

If they’re employed by contract through a nurse staffing agency, this means they’re not an official employee of the medical facility they work for.

Although per diem nurses don’t have access to health insurance or vacation pay through their employer, there are other benefits to per diem nursing. A few of them include job freedom and increased pay. But if you get sick or want vacation time off, this will have to be paid out-of-pocket.

On the plus side, although benefits would be nice, they’re usually offered more money. The increase of pay is an incentive for the lack of benefits offered for their role at a healthcare facility.

Per diem nurses can make over $80,000 per year. Their annual salary is widely based on their nurse staffing agencies' pay rate negotiated in their contract. It also depends on the amount of hours that a per diem nurse is willing to work.

Zip recruiter’s data shows that the average per diem registered nurse salary differs by state in the United States.

While per diem nurses don’t get paid time off, they have the option to take breaks in between jobs. Though these breaks can be beneficial and necessary, at the end of the day, they are unpaid. These breaks can negatively impact a per diem nurse's annual salary.

There are many pros and cons to per diem nursing aside from the unpaid breaks. Since hours vary depending on if the healthcare facility needs to hire more nurses, this leaves per diem nursing hours uncapped. Which allows for a per diem nurses salary to increase.

Next, let’s talk about per diem nurse schedules.

Per diem nurses aren’t guaranteed hours since they work on an as needed basis. Per diem nursing hours can vary greatly. This depends on the amount of open positions available at the hospital and a nurse's availability.

While per diem nursing schedules can be satisfying, the total amount of hours worked by a per diem nurse depends on a few factors.

A few things that can impact the need to hire more nurses can include:

If a healthcare facility is trying to budget their spending, they may have less or more capital than other hospitals or clinics. Their funding allows them the ability to hire more help when needed.

The amount of help that a hospital, clinic, or healthcare facility hires, will reflect on the amount of hours worked by a nurse. For example, if a healthcare facility doesn't hire enough help, a smaller number of nurses will have more opportunities to fill more shifts.

Hospitals, clinics, and healthcare facilities can have a multitude of reasons they’re demanding more help. Understaffing can be due to nurses calling off sick, taking vacations, not enough on-call nurses, or an overwhelming increase of patients. The pandemic of 2020 and 2021 is a prime example of hospitals having nursing shortages due to increased Covid-19 patients.

Nurses also have the option to ask their staffing recruiter if the current healthcare facility they’re working for is willing to extend their contract. This can help nurses receive more hours before their contract expires.

If you’re a nurse looking to branch out in the world of per diem nursing, you’ll need to go through a nurse staffing agency. This can take time especially if there are no positions available in your field.

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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.

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.

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.

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.

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

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:

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:

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:

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:

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.

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.

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.

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

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.

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 ShortageHow Family Nurse Practitioners Can Play a Major Role in Addressing the Physician Shortage in the U.S.

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"Per diem is a great way to keep your license active and work at a level that allows you time for other things in your life," noted Nurse.com OnCourse Learning. "You could be a new parent and want to stay at home more, or maybe you are close to retirement but still want to be actively employed. Maybe you want to travel and see the world. To each their own!"

But all this independence comes at a cost. Unlike travel nurses, who work on a temporary basis but sign a contract for a set schedule over a defined time, per diem nurses aren't guaranteed work. "As their name suggests, they work on a day-by-day basis, filling in when necessary at a medical facility in their area," noted the All Nursing Schools blog. Sort of like substitute teachers, per diem nurses schedule work as an employer needs them and when they wish to pick up hours.

According to Nurse.org, the usual process involves a nurse letting "the hospital scheduler know their availability for a given time-frame and the scheduler will book them to work, as-needed. Per diem shifts can be scheduled directly with a hospital or through an agency."

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Pro: High hourly wages

Con: Typically, no benefits

Stories of lavish per diem nursing pay have gone viral, like the Northern California nurse who collected $19,954.98 for eight 16-hour shifts in a two-week period. But if you're not able or willing to head to the Pacific Northwest for work, you can still expect enhanced hourly wages working per diem. "The benefits of per diem are more freedom in scheduling your hours and an increase in hourly pay," Nurse.com added. "The down side is if you need some amount of steady income, you may need more than one per diem position to obtain the income you need."

Pro: You can say no

Con: You may have a lot of last-minute call-ins

If, for example, you're choosing per diem work to be able to care for young children or other dependents, it's nice to be able to turn down assignments that interfere with your schedule. On the other hand, per diem jobs typically involve at least some "down to the wire" requests to work. "Per diem staff may be used after full- and part-time staff are scheduled to fill in known holes, but often are called in a few hours before to work to cover sick calls," Nurse.com noted.

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Pro: Good option for new nurses

Con: May not provide enough hours

Nurse.org suggested per diem as an option for nurses looking to secure that first job. "Because on-call or per-diem nurses are needed due to staff shortage, you may find they require less experience and may allow you to work in the specialty or location you really want to be in." Just be aware that early career nurses probably don't want to rely on per diem jobs indefinitely, since most new nurses really do need steady work and predictable income.

Pro: Potential tax breaks

Con: Per diem nurses are responsible for their own tax planning

Pro: Fast-paced environment

Con: Per diem nurses have to switch gears smoothly.

When you only come in to work when a facility needs a hand, you can count on a bustling work environment, which is great if you like to stay busy. "Your position is one that is used for substitute coverage, such as sick calls, vacation or Family Leave and Medical Act," noted Nursing.com. To assist during these times, per diem nurses must be quick on the uptake. "They're expected to adapt extremely quickly to various facilities' policies and procedures," ANS noted.

Pro: Lots of work available

Con: Lots of time spent seeking employment

There are literally dozens of online sites with extensive per diem nurse job postings. Recruiters are also happy to help qualified nurses looking for this type of work. But inevitably, nurses who rely on a per diem schedule have to take more responsibility for their own schedules than they would at a part-time or full-time job.

To relieve the burden, you may want to seek out a nursing staffing agency, according to NursingSchool.org. "One of the better strategies for managing part-time or full-time per diem jobs is to work through a nursing agency," it said. "Most have very flexible online schedule management tools and offer incentives that you won't find elsewhere—"refer-a-friend" bonuses, daily pay, 24-hour scheduling options, and more. Many of the top recruiting companies maintain good relationships with hospital human resource departments."

Pro: Per diem gigs can act like a bonus for full-time nurses.

Con: You still need to achieve work-life balance.

According to NursingSchool.org, "as a part-time gig, per diem situations can’t be beat. Say you’re a working RN employed full-time with a local hospital. You work 3 12-hour shifts. That leaves four more days during the week free. Some nurses opt to pick up an extra per diem shift locally if one is available. Why? The hourly pay is much more than their full-time hourly pay—it’s like making a bonus."