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Nursing retention

Per diem nurses fill an important need

BY: John Roszkowski on September 29, 2017

Per diem nurses are a valuable resource for facilities facing staffing shortages

Hospitals, home healthcare agencies and long-term care facilities often have a hard time finding enough nurses to provide quality care during certain shifts. That’s where per diem nurses can help.

Per diem nurses are paid by contract at an hourly rate for each day they work. They often are older, veteran nurses who don’t want to be tied to a regular work schedule and are looking for flexible work hours where they can earn extra money. Many younger nurses also like the flexibility per diem nursing provides.

Since most per diem nurses are not full-time, employers typically do not provide them with benefits. However, per diem nurses generally receive a higher hourly rate than staff nurses. These nurses offer employers experienced professionals who come with cost certainty and without sacrificing patient care.

Per diem nurses fill gaps in care

Deborah Rowe, MS, RN, PHR, CHCR, senior director at Genesis HealthCare and an RN for nearly 30 years, said employing per-diem nurses is an essential way to fill in gaps with skilled professionals. Genesis employs about 75,000 healthcare workers, including 15,000 nurses, offering full-time, part-time and per diem positions.

“I see the trends, and 27 million Americans will need some kind of long-term care by the year 2050,” Rowe said. “That’s a 100% increase from 2000. And the nurses, as they get older too, are looking for flexibility. Leaving the workforce altogether is something they might have been putting off, but they certainly are wanting to have more flexibility with their hours. They don’t want to fully leave the workforce yet. This is an opportunity to stay engaged and keep experienced, and that’s why it’s appealing to them.”

Using per diem nurses also appeals to hospitals and healthcare facilities because it keeps older, veteran nurses in the workforce for longer.

Maureen Swick, PhD, MSN, RN, NEA-BC and CEO with the American Organization of Nurse Executives, said there’s genuine concern among hospitals across the U.S. that there will not be enough acute-care nurses to go around. Per diems help to maintain those ranks.

“In the acute-care setting, you need to have nurses who have experience in an operating room,” Swick said. “Nurses retire, some move on, so it’s become an issue to make sure there’s a balance of experience in the acute-care setting.”

Swick said per diem nurses help fill gaps in areas where there are regional nursing shortages, particularly in rural areas where quality nursing talent may be hard to find.

Earn extra income

A 2013 survey of registered nurses by AMN Healthcare found about one in six nurses work part-time, Rowe said. Per diem nursing allows full-time nurses to work part-time to supplement their income, she said.

“They may work at one place full-time, doing three 12-hour shifts a week,” Rowe said. “They also want to make that extra income – and this is a great time to make extra money – so they may want to work per diem at another organization.”

Rowe said many younger nurses find per diem nursing to be appealing because of the flexible work schedule and higher hourly pay.

“Young people often promote a work-life balance,” Rowe said. “Per diem is appealing because it is premium pay and they may not want the benefits. Perhaps they get benefits through a spouse or another way. It gives the option for nurses to have flexibility in the workforce and in life.”

Anne Steger, an RN for 40 years, works as a nurse trainer for Genesis and is also a per diem nurse. She enjoys the scheduling flexibility of being a per diem nurse. As a full-time nurse, getting vacation time can be tricky, often requiring weeks or months of notice.

“For a lot of nurses, being a per diem nurse is like being a substitute teacher,” Steger said. “For others, it’s like getting a second job. Many of the nurses use per diem to add on. They’re full-time somewhere else and they pick up a day or two periodically to supplement their income. They tell me, ‘I have a full-time job, I need more money.’”

Additional incentives

Per diem nurses often can boost their pay if they sacrifice some scheduling flexibility to meet a health system’s requirement for high-need shifts.

Rowe said nurses who work a certain number of shifts for Genesis and other agencies may be eligible for benefits such as health insurance and 401(k).

Many younger nurses want to continue their higher education, and working per diem gives them more time and flexibility to pursue their degrees.

“They can flex their [work] time based on school schedule as well,” Rowe said. “It gives them control over their careers.”

Some hospitals and staffing agencies offer sign-on bonuses to attract new employees, including per diem nurses in select cases, but it is a tactic that should be used cautiously, according to Swick.

“You could end up spending a lot of money, and then the nurse moves on two or three years later,” Swick said.

Create welcoming environment

Despite the potential benefits, per diem nurses also are expected to work in unfamiliar work environments where they may feel unwelcome or uncomfortable. Rowe said employers need to remind these nurses they are an important part of the team, even if they are temporary.

“We tell them: ‘You’re not a per diem; you’re an extension of our workforce,’” she said. “We have to instill that in them.”

Even experienced nurses who work per diem have room to grow. Nursing schools and healthcare providers are working on innovative partnerships to make sure existing curricula meet the needs of nurses who may want to work outside a traditional hospital setting, according to Swick.

“Traditionally, nurses who are trained in institutions, colleges and universities go through different clinical rotations in the acute-care setting,” she said. “But the need to do this might be out in the community, with home-health nurses and health centers. We’re trying to come up with some innovative practices that hopefully will meet the needs of the future.”


Freelance writer Dan Brown contributed to the writing and research of this article. 

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John Roszkowski

John Roszkowski is content manager of healthcare recruitment for the Advertising Solutions division at OnCourse Learning. He creates and manages content for the Nursing Recruitment Source blog, newsletters and Digital Resource Guides. He has developed content for healthcare and financial services at OnCourse Learning for the past four years. He has more than 25 years of writing and editing experience and previously worked at weekly and daily newspapers.