Definition · Staffing and agencies
Per Diem Staffing
Definition
Per diem staffing is filling shifts day by day with clinicians who work as needed rather than on a fixed schedule. Common in healthcare, per diem or PRN (from the Latin pro re nata, as needed) nurses, therapists and techs pick up open shifts, usually for a higher hourly rate and few or no benefits.
Also called: PRN staffing, Per diem nursing, As-needed staffing, Float pool staffing
How per diem staffing works
A hospital, clinic or long-term care facility posts open shifts caused by call-outs, census spikes, vacations or vacancies. Per diem staff, already credentialed and oriented to the unit, claim them through a scheduling app or from a staffing coordinator. There are two main models:
- Internal per diem or float pool. The facility employs PRN staff directly. They are on its payroll but have no guaranteed hours, and usually commit to a minimum, such as a few shifts a month and one holiday a year.
- Agency per diem. A staffing agency employs the clinician and bills the facility for each shift. Shifts can be booked with very little notice, but the cost per hour is higher.
Per diem differs from travel and contract staffing, which place a clinician for a fixed assignment of usually 8 to 13 weeks, and from locum tenens, which is the physician and advanced practice equivalent.
Pay and the trade-offs
Per diem nurses are typically paid a premium over staff rates, because they give up benefits, guaranteed hours and often seniority. For the clinician it means flexibility and higher pay per shift. For the facility it means flexible capacity without the fixed cost of extra full-time staff, at the price of less continuity and a workforce that may cancel when its own plans change.
Per diem staff paid hourly are generally non-exempt under the FLSA and owed overtime for hours over 40 in a workweek, or under the 8-and-80 system some hospitals use. Many states add their own overtime and mandatory overtime rules for nurses.
Using per diem well
Build the internal PRN pool first. Former full-time staff who have reduced hours, retirees and clinicians from neighboring facilities already know your systems, and an internal pool usually costs less than agency shifts. Fill the predictable gaps (weekends, holidays, seasonal census) with PRN commitments and keep agency per diem for true short-notice needs.
Track per diem hours as a share of total worked hours by unit. A unit running a large share of per diem and agency hours has a vacancy or retention problem that per diem is masking. Credentials matter as much for a one-shift nurse as for a permanent one: license verification, competencies and unit orientation must be complete before the first shift. See credentialing.
Per diem the allowance versus per diem staffing
The term also means a daily allowance for meals and lodging, such as the travel per diem in a travel nurse package or the federal GSA rates for government travel. Per diem staffing has nothing to do with that allowance; it refers to as-needed scheduling. Confusing the two causes misunderstandings in pay discussions, so spell out which one you mean in offers.
Frequently asked questions
What is per diem staffing?
It is staffing shifts on an as-needed basis with clinicians or workers who have no fixed schedule. It is most common in hospitals and other healthcare settings.
What does PRN mean for a nurse?
PRN comes from pro re nata, Latin for as needed. A PRN nurse works shifts when the facility needs them, usually for a higher hourly rate and with limited or no benefits.
What is the difference between per diem and travel nursing?
Per diem nurses pick up individual shifts, often locally, with no fixed contract length. Travel nurses take fixed assignments, typically 8 to 13 weeks, often away from home.
Do per diem employees get overtime?
Hourly per diem staff are generally non-exempt under the FLSA and receive overtime for hours over 40 in a workweek, or under an approved 8-and-80 arrangement. State rules may add more.