Per Diem Nursing: Everything You Need to Know

Living your purpose while working as a nurse looks different for everyone. Let's just start with that. I've shared how having a per diem status as nurse has been my golden ticket to fulfillment in my life and as expected the questions start to come rolling in. 

I've collected all of your questions and am spilling the tea on all things per diem (or PRN as some people call it). Remember: this is based on my own experience and varies from facility to facility. 

So let's start with the basics: What is per diem nursing? 

To put it simply, per diem nurses are "as needed" nursing staff. This means they don't get some of the benefits and security that full or part time nurses do but for many the positives of this position outweigh the negative. 

So what are the positives? 

For me, it's three main things: freedom, money and flexibility.

Let's start with freedom. Per diem nurses typically have required hours, weekends, and holidays but they are much less than part-time or full-time employees. 

Where I work, this looks like:

• two weekday shifts a month
• two weekend days a month
• one summer holiday per year (pre-assigned and on rotation year to year)
• one winter holiday per year (pre-assigned and on rotation year to year)

Shifts per month are selected after all of the full time and part time employees have made their schedules and here's the scary part: if there aren't shifts available to pick up, you can't work! 

So I know what you're thinking. How in the heck is this girl telling me this is freedom?! 

I'm here to remind you of these two words: nursing shortage. 

For the first three years I worked in my position, I was able to work full time hours as a per diem nurse until I chose not to. There has consistently been so many holes in the schedule that I had plenty of shifts to select from.

And what feels like real freedom? Being able to select your weekend days.

Have a bridal shower on a random Sunday? Work that Saturday and take the Sunday off.

Hate working Sundays because that's a family day for you? Work two Saturdays per month and never work a Sunday again. 

Oh, and say goodbye to your required Mondays and Fridays. 

You won't get PTO as a per diem, but you'll almost always get mandatory paid sick leave per state policies (ex: In NJ, you will get 40 hours of yearly paid sick time if you call out, get COVID, etc.)

**pro tip: Ask your manager if you can use these hours for a "scheduled mental health day". This is basically a work around that allows you to prepare and use these hours for PTO!

Another huge part of this freedom piece has to do with vacations. You can take them whenever. There's no more requesting PTO or having to wheel and deal with your coworkers to try to get the week of your family vacation off. You have the freedom to take five trips in the summer and grind it out in the winter if you want. 

But if you don't get PTO as a per diem, do you just not get paid while you're on all of these vacations?

This might just be the perfect transition to perk #2 of being per diem: money. 

But first, to actually answer this question, you would be 100% correct. You don't get paid if you don't work. This is intimidating to a lot of people, but this is where money comes in. 

You generally make more per hour if you are per diem. At my hospital, my base pay is $14/hr MORE than my coworkers. If you're working 36 hours a week, that's a whopping $504 more per paycheck. So it is absolutely correct that you won't be getting PTO with this status, but if you plan you'll be just fine. 

Think of it as trading some planning for some freedom! You can open a second checking account online in five minutes and schedule $250 to be automatically transferred into it every other week and use that as your "PTO bank". BOOM. Solution. 

Another insane money hack with being per diem that I used to take advantage of when I was working full time hours was overtime. Not only would be overtime rate be $21/hr MORE than my coworkers, but you can actually work overtime without working overtime. 

I know your head is spinning, so let me explain. 

Rewind to those two words from earlier: nursing shortage. 

Because there are so many holes in the schedule, it's easy to work four shifts in a week and get that OT pay for the fourth shift but remember - you don't have to work three shifts every week. So you can work two shifts one week and four shifts the next. On average, that's three shifts a week. Say hello to an extra $600 per paycheck and goodbye to burnout! 

What about your 401k or 403b?

A valid question and one of the most asked questions I get about being per diem. Not everyone is married and can be on their spouse's insurance. I get that, so here are a few solutions. 

Outsourced Insurance

You can easily purchase insurance through an outside provider. Think about it. Everyone who owns their own business does this. It's absolutely possible. It just feels daunting because you've never done it before.

It might be a little more expensive but remember that you'll be making more money. Again, you'll be trading some planning for some freedom. Needless to say, this falls under the planning category.

Hospital Insurance

You may actually be able to get insurance through your employer. It generally isn't advertised, but do your research. At my facility if you are per diem and work an average of 30+ hours per week over a year's time, you can receive health insurance. I actually managed to stay on my parent's health insurance for the first year I worked per diem and then became eligible for this insurance the next year. 

Okay. That was a lot. Let's move on to more of the fun stuff: flexibility. 

Some people crave structure. They love knowing exactly what unit they'll be on for their twelve hours, three times a week. Other people love to change it up. This perk is for those people. 

As a per diem nurse I'm technically a night shifter but work way more day shifts than I do nights these days simply because I prefer it. The purpose of the per diem role is to fill in holes, so often times management doesn't care what holes these are. 

This is just the beginning.

If you're the kind of nurse who doesn't want to work at the bedside full time or is multi-passionate, you can work in several positions at once. A great example from my personal journey is flu season. Every year during flu season I work with occupational medicine services to help vaccinate our 17,000 employees for the flu. They pay me my per diem hourly rate (I know, can you believe it?!) and I get to work less at the bedside doing something different with my nursing license that I enjoy. 

This could also look like a second per diem or part time job. Think about being able to work a part time role at an MD's office, doing aesthetics, or working as a visiting nurse while still being able to work four shifts a month at the bedside. 

And for my "nurseprenuers" out there this is the perfect option. You'll never have to "go all in" on your business and quit your full time job to leap into your side hustle. You can work full time hours using your per diem status and as your business grows slowly work less and less at the hospital if that's what serves you. 

I could go on, but I think you get it. 

This option within nursing isn't full proof. It's not perfect. You'll be trading security for freedom. You'll need to be diligent with your money but you can easily see a lot more of it if you're smart. You can make your nursing career one that allows you to feel in control. The hospital is at your disposal, not the other way around. 

Comment below letting me know what was most valuable to you! I'm happy to make a follow up post if there are more questions that need to be answered around this topic.