If you have been exploring flexible nursing career options, you have likely come across the term “per diem.” But how does per diem nursing work, exactly, and is it the right fit for your career? This guide breaks down everything healthcare professionals need to know about per diem work, from how shifts are scheduled to how it compares to traditional employment.
What Does “Per Diem” Mean in Healthcare?
The term “per diem” is Latin for “per day” or “by the day.” In the context of healthcare staffing, per diem employees in healthcare are workers who are available to work shifts on an as-needed basis, rather than being employed on a fixed full-time or part-time schedule. Healthcare facilities rely on per diem employees in healthcare to fill gaps caused by staff absences, unexpected surges in patient volume, or temporary vacancies.
Unlike permanent employees, per diem staff typically do not have guaranteed hours each week. Instead, they receive shift offers often on short notice and choose whether to accept them based on their availability and preferences.
How Does Per Diem Nursing Work: A Step-by-Step Overview
Step 1: Onboarding and Credentialing
Before you can begin working per diem, you must complete the onboarding process with either a healthcare facility or a staffing agency. This typically involves submitting your nursing license, certifications (such as BLS, ACLS, or specialty credentials), employment history, and background check documentation. Once cleared, you are added to the facility’s or agency’s available roster.
Step 2: Shift Offers and Scheduling
Once onboarded, you will receive shift offers via phone call, text, app notification, or scheduling software. Facilities post open shifts often days in advance but sometimes with just a few hours’ notice and per diem nurses either accept or decline based on their availability. This is one of the defining aspects of how per diem nursing works: you are in control of your schedule.
Step 3: Working the Shift
When you accept a per diem shift, you arrive at the assigned facility, complete a brief orientation if it is a new site, and integrate into the existing care team for that shift. Per diem nurses are expected to be clinically competent and able to perform independently without the extended orientation period given to permanent hires.
Step 4: Documentation and Pay
After completing your shift, you submit your hours through the facility’s timekeeping system or the staffing agency’s platform. Per diem employees in healthcare are typically paid a higher hourly rate than staff nurses in exchange for the lack of benefits and schedule guarantee. Pay cycles vary by employer or agency.
Who Uses Per Diem Employees in Healthcare?
Per diem employees in healthcare are utilized across virtually every care setting, including:
- Hospitals and acute care facilities
- Long-term care and skilled nursing facilities
- Home health agencies
- Outpatient clinics and surgical centers
- Rehabilitation centers
- School nursing programs
Facilities rely on per diem nursing staff to maintain safe patient-to-nurse ratios during high-census periods, avoid costly agency premiums associated with last-minute external staffing, and reduce burnout among permanent employees by covering unexpected absences.
Advantages of Per Diem Nursing
Flexible Scheduling
Understanding how per diem nursing works starts with recognizing the freedom it provides. You choose when to work and when to take time off a major advantage for nurses who are parents, students, or managing other personal obligations.
Higher Hourly Pay
Per diem nurses typically earn a higher base hourly rate than their full-time counterparts. Because they do not receive employer-sponsored benefits such as health insurance, retirement contributions, or paid time off, the compensation difference is built into the hourly rate to reflect that trade-off.
Diverse Clinical Experience
Working at multiple facilities exposes per diem nurses to a wider range of patient populations, acuity levels, electronic health record systems, and team dynamics. This breadth of experience is a tremendous professional asset and helps build a highly versatile skill set.
Reduced Workplace Politics
Because per diem employees in healthcare are not tied to a single facility’s internal culture or politics, many nurses find per diem work less stressful from an interpersonal standpoint. You show up, care for patients, and leave without being embedded in departmental dynamics.
Challenges of Per Diem Nursing
Lack of Benefits
Most per diem employees in healthcare do not receive employer-sponsored health insurance, dental or vision coverage, paid sick leave, or retirement matching. Nurses in per diem roles must budget for and independently obtain these protections, which can be a significant cost consideration.
Variable Income
Since per diem work offers no guaranteed hours, your weekly income can fluctuate considerably. During low-census periods or holiday weeks, shift offers may decrease. Successful per diem nurses often work with multiple facilities or through a staffing agency to maintain a consistent volume of shifts.
Orientation Requirements
Each new facility you work at may require you to complete a facility-specific orientation, review policies, and pass competency assessments before you can work independently. Managing multiple orientations can be time-consuming, especially when starting with new sites.
Per Diem Nursing vs. Travel Nursing: What’s the Difference?
Both per diem and travel nursing offer flexibility, but they work differently. Travel nursing involves accepting a formal contract (typically 13 weeks) at a single facility, often in a different city or state, with housing stipends and comprehensive benefits packages. Per diem nursing, on the other hand, involves day-by-day shift work with no contract commitment, usually closer to home.
If you are asking how does per diem nursing work compared to travel nursing, think of per diem as maximum flexibility with local roots, while travel nursing provides structured assignments with relocation and higher all-in compensation packages.
How to Find Per Diem Nursing Work
There are two primary pathways for finding per diem nursing opportunities:
Direct Facility Employment
Many hospitals and healthcare facilities hire per diem employees directly and maintain their own internal float pools. You apply through the facility’s HR department, complete their onboarding, and receive shift offers through their internal scheduling system. This model works well if you want to specialize within a single system.
Healthcare Staffing Agencies
Partnering with a healthcare staffing agency is often the most efficient way to maximize your per diem opportunities. Staffing agencies maintain relationships with multiple facilities, handle credentialing and compliance paperwork, and actively match your skills and availability to available shifts. This approach gives you broader access to shifts and simplifies the administrative burden of working across multiple sites.
When evaluating a staffing agency, look for one with a strong local and national network, transparent pay rates, responsive recruiter support, and a track record of placing per diem employees in healthcare successfully across a variety of settings.
Is Per Diem Nursing Right for You?
Per diem nursing is an excellent career option for nurses who value scheduling flexibility, want to supplement their income, are in nursing school and need a non-fixed schedule, or are transitioning between full-time positions. It is also a smart choice for recently retired nurses who want to stay clinically active on their own terms.
However, if financial predictability and comprehensive benefits are a priority, a full-time or contract position may be a better fit until you build up your per diem client base across multiple facilities.
Final Thoughts on How Per Diem Nursing Works
So, how does per diem nursing work in practice? It is a staffing model built on flexibility for both the healthcare facility and the nurse. Per diem employees in healthcare fill critical gaps in patient care while retaining full control over their schedules and, in many cases, earning premium hourly compensation.
Whether you are a nurse exploring flexible career options or a healthcare facility seeking reliable on-call coverage, per diem nursing offers a practical and mutually beneficial solution.
Ready to explore per diem opportunities? EmpowerCare connects qualified nurses with leading healthcare facilities across the country. Contact us today to get started.
Frequently Asked Questions
- What are per diem employees in healthcare?
Per diem employees in healthcare work on an as-needed basis, picking shifts instead of following a fixed schedule. - How do per diem employees in healthcare get shifts?
They receive shift offers from hospitals or agencies and can accept or decline based on availability. - Do per diem healthcare workers earn higher pay?
Yes, they usually earn higher hourly wages since they do not receive full-time benefits. - What are the benefits of per diem roles in healthcare?
They offer flexible schedules, diverse work experience, and control over workload. - Where can I find per diem healthcare jobs?
You can apply directly to healthcare facilities or work with staffing agencies like EmpowerCare.