Should you work day by day? The pros and cons of per diem nursing

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Most nurses don't think of themselves when Dolly Parton's "9 to 5" comes on the radio. The profession is known for flexible hours and offers big chunks of time off, considering that 65% of nurses already work 12- or 13-hour shifts, according to a study drawn from American Hospital Association Annual Survey of Hospitals data.

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But there is an option that offers even more flexibility and even more unusual hours: per diem nursing. Naturally, with those advantages come certain drawbacks. Could per diem nursing be a good fit for you? Here are pros and cons to consider:

Pro: No set schedules.

Con: No guarantee of work.

"Per diem is a great way to keep your license active and work at a level that allows you time for other things in your life," noted OnCourse Learning. "You could be a new parent and want to stay at home more, or maybe you are close to retirement but still want to be actively employed. Maybe you want to travel and see the world. To each their own!"

But all this independence comes at a cost. Unlike travel nurses, who work on a temporary basis but sign a contract for a set schedule over a defined time, per diem nurses aren't guaranteed work. "As their name suggests, they work on a day-by-day basis, filling in when necessary at a medical facility in their area," noted the All Nursing Schools blog. Sort of like substitute teachers, per diem nurses schedule work as an employer needs them and when they wish to pick up hours.

According to, the usual process involves a nurse letting "the hospital scheduler know their availability for a given time-frame and the scheduler will book them to work, as-needed. Per diem shifts can be scheduled directly with a hospital or through an agency."

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Pro: High hourly wages

Con: Typically, no benefits

Stories of lavish per diem nursing pay have gone viral, like the Northern California nurse who collected $19,954.98 for eight 16-hour shifts in a two-week period. But if you're not able or willing to head to the Pacific Northwest for work, you can still expect enhanced hourly wages working per diem. "The benefits of per diem are more freedom in scheduling your hours and an increase in hourly pay," added. "The down side is if you need some amount of steady income, you may need more than one per diem position to obtain the income you need."

Pro: You can say no

Con: You may have a lot of last-minute call-ins

If, for example, you're choosing per diem work to be able to care for young children or other dependents, it's nice to be able to turn down assignments that interfere with your schedule. On the other hand, per diem jobs typically involve at least some "down to the wire" requests to work. "Per diem staff may be used after full- and part-time staff are scheduled to fill in known holes, but often are called in a few hours before to work to cover sick calls," noted.

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Pro: Good option for new nurses

Con: May not provide enough hours suggested per diem as an option for nurses looking to secure that first job. "Because on-call or per-diem nurses are needed due to staff shortage, you may find they require less experience and may allow you to work in the specialty or location you really want to be in." Just be aware that early career nurses probably don't want to rely on per diem jobs indefinitely, since most new nurses really do need steady work and predictable income.

Pro: Potential tax breaks

Con: Per diem nurses are responsible for their own tax planning

Pro: Fast-paced environment

Con: Per diem nurses have to switch gears smoothly.

When you only come in to work when a facility needs a hand, you can count on a bustling work environment, which is great if you like to stay busy. "Your position is one that is used for substitute coverage, such as sick calls, vacation or Family Leave and Medical Act," noted To assist during these times, per diem nurses must be quick on the uptake. "They're expected to adapt extremely quickly to various facilities' policies and procedures," ANS noted.

Pro: Lots of work available

Con: Lots of time spent seeking employment

There are literally dozens of online sites with extensive per diem nurse job postings. Recruiters are also happy to help qualified nurses looking for this type of work. But inevitably, nurses who rely on a per diem schedule have to take more responsibility for their own schedules than they would at a part-time or full-time job.

To relieve the burden, you may want to seek out a nursing staffing agency, according to "One of the better strategies for managing part-time or full-time per diem jobs is to work through a nursing agency," it said. "Most have very flexible online schedule management tools and offer incentives that you won't find elsewhere—"refer-a-friend" bonuses, daily pay, 24-hour scheduling options, and more. Many of the top recruiting companies maintain good relationships with hospital human resource departments."

Pro: Per diem gigs can act like a bonus for full-time nurses.

Con: You still need to achieve work-life balance.

According to, "as a part-time gig, per diem situations can’t be beat. Say you’re a working RN employed full-time with a local hospital. You work 3 12-hour shifts. That leaves four more days during the week free. Some nurses opt to pick up an extra per diem shift locally if one is available. Why? The hourly pay is much more than their full-time hourly pay—it’s like making a bonus."