Per diem, or agency nursing as it’s sometimes labelled, can pay you very well, provide incredible flexibility and allow you to experience how other health facilities operate. However, there is also some downside, like working in unfamiliar territory, with people you’ve never met and equipment you’re not familiar with. So, is working this type of ad-hoc schedule worth the momentary stress?
Working per diem allows nurses on varying levels to complete a shift when and where it suits them. While the pay is often higher and the ability to sustain a positive work-life balance more achievable, there are aspects that need consideration. Think varied work opportunities, health insurance and leave benefits.
Wouldn’t it be nice to choose when, where and how much you’d like to work on any given day? Well, per diem nursing allows for this kind of flexibility. Whilst there are obvious advantages, the downside is real and nurses need to be aware of this before getting overly excited and quitting their current job. This post explores what per diem nursing is, the truth behind this schedule and tips for success.
What is Per Dim (Agency) Nursing?
Per Diem is a latin phrase meaning “per day.” It’s a phrase regularly used in the United States to describe a type of nursing schedule where staff are on temporary assignments rather than employed on a permanent basis with set hours and days.
In Australia, my motherland, we often refer to this type of work as agency nursing, but essentially it’s the same thing as in the US.
This type of nursing was created to help meet the staffing requirements of hospitals and health facilities particularly in times of unusually high admissions and vacation or sick calls from staff (ie, flu season and natural disasters).
Nurses may choose to work per diem to either financially support themselves and their family, on top of their current part-time or full time job, whilst others may choose to work per diem full time.
The beauty of this type of work is you get to choose your roster.
But you might be asking, why would you choose to work in random, unknown places, at unusual times and without any friends when you could simply do a job which provides you a higher level of comfort?
Here are some of the positives of per diem Nursing:
|Shift flexibility – you choose when and where you work
|Ability to travel for your job – sometimes this can be overseas
|Work / life balance (no need to work night shift or weekends – in most cases)
|Amazing networking opportunities
|Strengthen and adapt your nursing skills depending on the situation
|Potentially decreased levels of burnout
|You can work multiple per diem jobs for extra money and a greater chance of securing work
|Per diem jobs can lead to a full time / part time position in a desired field
|Great way to try out different nursing specialties before committing to further education.
|Excellent way to stay up-to-date with evolving changes in the medical field
Sounds good right?
While this kind of schedule can be molded to suit your lifestyle, there are other aspects of the job you need to know:
|Your per diem employer is unlikely to pay medical / health insurance
|Potential for low job security
|The higher wages include sick pay and annual leave
|Working in unknown locations with staff you’ve never meet and equipment you haven’t used before can be scary
|Shifts can be cancelled last minute or you can be sent home early
I did want to point out that per diem nursing is not the same at PRN nursing.
Here is a table to summerize the main differences:
|Per Diem Nurse
|Per diem nurses are hired by an external company and can work anywhere within their scope of practice
|PRN nurses are employed by the unit and work solely within that department
|Per diem nurses do not have schedule requirements
|PRN nurses are subject to nursing requirements of that unit. You may need to work a certain number of shifts in a pre-defined time period to maintain employment.
|Per diem nurses can choose when and where they work
|PRN nurses are limited to one specific unit/department
The Truth About Per Diem Nursing and What To Expect
Along with being aware of the pros and cons of per diem nursing, it’s useful to know the truth about this kind of work and what you can expect.
Here is what I have learnt and am still learning about per diem nursing.
You’ll Never Get Bored
Turning up at the same hospital or health care facility with the same people can feel a little repetitive and stagnant – particularly if you’ve worked 6-8 shifts in a row.
Per diem nursing doesn’t give you the chance to ever feel like this.
Even if you are assigned to work at a place you’ve been to before, there will always be something new to learn. From staff, procedures, medications, equipement and documentation there is always something changing to keep you on your toes.
Having to learn new processes limits the chance of you becoming complacent and causing errors. Pushing your brain to learn new information is not only good for you but also for your patient and their family.
Though this can seem intimidating and frightening, try and change your thinking to excitement rather than fear. After working 1-2 shifts in same location, life will soon become easier and the shifts more enjoyable.
Per Diem Nurses Often Get Lost
You will walk the wrong way, drive down the wrong street, catch the wrong train, walk up the wrong stairs and struggle to find a car park, but it’s all part of life for per diem nurses.
If you stop and laugh at your own expense, you’ll see the funny side.
In regards to documentation and where to find information, you may feel a little lost there too. But it’s interesting how quickly you’ll find your way.
Though this can seem intensely overwhelming, I often remind myself that everyone else here has worked it out…so I can too!
Before accepting a shift in a place you’ve never worked, ask you per diem employer which documentation method they use. Are their notes handwritten or do they use a computer system like EMR or EPIC you may have never used. Obtaining necessary training is essential and can be a huge stress reliever.
Per Diem Nurses Are Able to Avoid Workplace Drama
Being able to come in, do your job and leave without any strings attached is one of the incredible advantages to per diem nursing.
Instead of getting caught up in workplace discussions, big decisions and even wearing a specific uniform (for most per diem employers) you can simply swan in and fill a vacancy to the delight of those in charge at the hospital
If you bring the necessary skill set for the job advertised everyone will love you.
It’s simple.. agency nurses can simply enjoy the 8+ hours doing the job they love with no extra commitment.
You’ll often be labelled the “Per Diem” or “Agency Nurse” – Instead of your name
Sometimes regular nursing staff and even in-charge nurses will forget you have a name. You will be referred to by your title, which can feel pretty isolating for those who aren’t prepared.
But instead of getting upset, re-introduce yourself and be proud of the help and support you bring to the shift.
Avoid telling other nurses what you can do at the start of the shift. Otherwise, they will assume “you know what you’re doing” leading to minimal support and potentially a poor orientation. If you do have the skills and knowledge, this will quickly become obvious to those around you.
Per Diem Nursing Shifts Will Get Cancelled
It all comes down to luck. Some shifts will be cancelled the day before whilst others can happen once you arrive on shift.
Frustrating doesn’t even begin to describe it, particularly if you’ve changed and modified plans to suit your family around that shift. However, this shouldn’t stop you from trying out this kind of work.
In the 8 years I have been working per diem nursing, I have been cancelled about 4-5 times and have been sent home early once.
I recommend being aware of the rules and regulations in regards to payment when cancelled early.
For example, my agency will pay for two hours of work if the shift is cancelled within two hours of start time. I know two hours may not seem like a lot, but everything helps.
Per Diem Nurses Learn To Be Resourceful
The manager in charge of the shift expects that you are capable of completing the job successfully and safely, but will generally be there to offer support if you have questions.
So instead of expecting help, you need to take the initiative to ask for it.
This may seem harsh but I found it’s the reality of the job. Everyone is busy. We can’t expect special attention just because we haven’t worked there before.
Though uncomfortable, we have to learn to “check in” with the nurse in charge and other nurses in our area rather than waiting for them to check in with you.
Per Dim Nurses Need to Learn How to Manage Their Money
I am a nurse, not a financial adviser, let’s just make this clear. But managing your often ad-hock income to support you and potentially your family needs a robust system behind it.
Though wages are often higher, this also includes your annual leave and sick leave allowance. What this means is if you’re sick or want to go on a holiday, it won’t be paid for.
You’ll need to save enough money or have money hidden in a “just in case” account if anything was to go wrong.
Seek advice and talk to your spouse/partner about how this looks for you and ask yourselves:
- Do I need a guaranteed level of income every week?
- How many shifts do I need to work to pay the bills? Or does the maximum per diem rate provide the income I need to support my current lifestyle?
- How will you split your wages come payday?
- How much do we want to spend on healthcare benefits?
- As a per diem employee, am I okay with being available more often – essentially on-call?
7 Per Dim Nursing Survival Tips
1. Know Your Availability
Most per diem nursing agencies and employers will have an app or website you can access to request shifts and to receive important information.
While these resources are brilliant, don’t be afraid to pick up the phone and call them if your availability changes last minute. You never know what a little human connection can do.
2. Don’t Over Do It
I know it can be tempting to accept shift after shift when the wages are high and work is available. But we need to ensure we are looking after ourselves better than we do our patients so we don’t get sick.
This is an area we are very passionate about and have written many posts about such as:
- How to Work Night Shift, Stay Healthy and Not Get Sick
- Shift Work Burnout: Causes, Red Flags and How to Beat It
- Is Night Shift Bad for You? 11 Truths Uncovered
3. Don’t Forget About Private Nursing
Private facilities may pay more than public health care centers. When doing your research to become a per diem nurse, investigate the wage variations in different centers close to you, ensuring there are no surprises when you receive your pay.
5. Start Small
If you are feeling anxious about working in different locations with varying people, stick to accepting shifts in only a small handful of places. 2-3 hospitals may give you enough work.
You can always build up to accepting shifts at more places once you feel comfortable.
5. If Jobs are Limited – Consider Moving
Are you having trouble finding work within your local area? If moving interstate is an option, you could really reap the rewards here.
An example of a nurse working in California can make, on average, $102,700, or $49.37 per hour in comparison to the same nurse in Ohio who’s average wage is $65,500, or $31.39 hourly. (source)
6. Request PM/2nd Shifts
To avoid getting angry and frustrated when being cancelled for shift at 5.30am, I tend to request 2nd or 3rd shifts instead. This gives me the ability to still do the jobs I need to do in the morning before late shift. This will of course depend on your family situation.
7. Bring Your Own Food
Like all nursing jobs, it’s tricky to rely on the cafeterias being open to fill our bellies at all hours. This is particularly true when you don’t even know when the opening hours are!
Make sure you have healthy, filling meals and snacks in your fridge and pantry so you’re prepared if called in last minute. See this post for meal prep tips and this post for healthy snack ideas when working nights.
Resources for Per Diem Nurses:
- New Nurse Survival Kit – informative and helpful printable PDF kit to help ease new nurse anxiety and stress. Get your kit here.
- How sore are your feet after a 12-hour+ shift? In this post we talk about the best shoes for comfort and durability.
- Book – “Too Tired to Cook” by Audra Starkey. Brilliant and insightful. Get yours here on Amazon. #ad
- Am I Too Old to Become a Nurse? 7 Tips for Joining After 40
- Being a New Nurse is Hard. How to Stop Feeling Incompetent
- Advice for New Grad Nurses: How to Stop Feeling Like an Idiot
In summary, being an agency nurse takes a special kind of person.
Working in different environments constantly, with people you don’t know, using equipment you’ve never used before can be pretty scary, turning most people away despite the impressive wage.
While I am not painting a pretty picture, agency nursing gives you the incredible opportunity to choose where and when you want to work, limiting burnout.
This type of nursing furthers your skills whilst networking with fellow nurses and medical professionals. And who knows what opportunities this could lead to?
Do you work per diem Nursing? How do you manage the irregular schedule?
If this all sounds a bit stressful, here are a few funny memes about night shift to give you a giggle before you resume your career search.