Home > Career Options > Per Diem

Per Diem Nursing

Have you ever wished you could schedule your work around your life instead of the other way around? Have you ever wanted to set your own working hours, yet still earn a decent salary and solid benefits? Then per diem nursing may be for you.

Per diem nurses work on temporary assignments through specialized placement agencies or through hospital staffing pools. They often are on-call, scheduled for a week at a time or responding to last-minute requests to fill in for sick staff members. Some per diem nurses also take on short-term work, covering for staff who are on vacation or maternity leave. These short-term assignments can be part-time or full-time, and can vary—one shift per week for a few months, for example, or 36 hours a week for just a few weeks.

Jean E. Rappoli, MHA, RN, Operations Manager at Cross Country Local, describes per diem nursing as "shopping for shifts." Those who work per diem shifts love the flexibility of determining their own schedules. Take, for instance, registered nurse Sarah Donahue. She doesn't need to work regular shifts, and she likes to travel, so Donahue works per diem. She sets her own hours and picks up shifts as she needs them.

"I can look at the calendar," says Donahue, "see what's coming up in the next few weeks, and make my schedule decisions based on that."

Flexibility is great, but why work per diem when you could have the security of a steady job in a familiar setting?

"Per diem nursing is perfect for someone who likes the adventure of exploring new environments, wants to avoid hospital politics, and enjoys the idea of working when and where they want," says Jean Rappoli.

That includes new moms, those close to retirement, or those who don't want full-time work but need the occasional shift to keep their experience current. Some nurses also use per diem assignments as opportunities to try out hospitals before taking a permanent position.

But, Rappoli cautions, this kind of work is not for everyone. Sometimes nurses can work in four or five different hospitals in one week, so per diems need to be able to adjust quickly to new doctors, new colleagues, and different hospital policies and politics. While it's possible to control how much change you take on, such as how many shifts you'll work per week or at which hospitals you'll accept an assignment, you still need to be comfortable with being a temporary part of the staff.

Per diems, however, are well compensated for their flexibility. Pay varies, based on geographic location, hospital system, and area of specialty, but agency rates will average between $30 and $40 per hour. Working a late-night or weekend shift in intensive care at a hospital in a large metropolitan area may even pay as much as $50 an hour.

In addition, for nurses who qualify with a minimum number of shifts, a good agency will provide a comprehensive benefits package, including health insurance, retirement plans, and shift differentials. The agency also may provide bonus programs, offering such rewards as completion bonuses for fulfilling a certain amount of contract-assignment time, or referral bonuses for recruitment of qualified colleagues.

Nurses also can sign on directly with a hospital system and become part of their pool of per diem staff. Hospital pay rates tend to be lower than those at agencies, however, and shift requirements may be less flexible. Still, working directly with one hospital can provide a little more stability, allowing the opportunity to keep a flexible schedule in a familiar and constant environment.

Rappoli suggests checking out both a number of agencies and hospitals before signing on as a per diem nurse.

"Shop around and see what they have to offer you," she recommends. "When looking at agencies, the most important thing is their reputation. What do local hospitals think of [the agencies] and the staff they provide? Which agencies do good per diem nurses work for?"

Donahue agrees. As a permanent nurse she remembers sometimes dreading working with per diems because agencies often would place per diems without properly screening them to match them with the right job.

"When I became a per diem," Donahue says, "I realized it was important to me to be associated with a professional agency that was well represented in the hospitals. I didn't want to be the person the permanent staff was dreading working with!"

A reputable agency puts candidates through a stringent registration process. Most require an RN license, at least one recent year of critical-care experience, strong references, and good credentials. Prepare to be tested for drug use, as well as having up-to-date immunizations. Some agencies also will administer their own competency tests to ensure the nurses they are placing are knowledgeable enough to jump into a job quickly with minimal supervision.

Keep in mind that if you have dual specialties, especially in several areas of critical care, you'll have a wider choice of shift assignments. And there is higher demand for qualified staff in areas that are experiencing a shortage of nurses, including intensive care, telemetry, cardiac care, and the emergency room.

In the end, much of what you do as a per diem nurse—where you work, when you cover shifts, and how often you do so—is up to you. If you are a qualified nurse who wants freedom and flexibility in your work life, per diem may be for you.