"Per diem" is Latin for "by the day," and that's exactly how per diem nursing works. You're paid for the shifts you work, with no promise of a set schedule and usually no benefits. In return you often earn a noticeably higher hourly rate and get far more control over when you work. You'll also hear it called PRN, from pro re nata, "as needed."
Per diem work has quietly become one of the most popular arrangements in nursing. Some nurses use it to escape burnout, some to pick up extra income on top of a full-time job, and some to build a schedule around kids, school or caregiving. This guide covers how per diem jobs work for RNs, LPNs and CNAs, what you gain and what you give up, and how to make the arrangement work for you rather than against you.
How per diem nursing works
A per diem nurse is a regular employee of a facility, or of a staffing agency that places them at facilities. Instead of a fixed number of hours each week, they're scheduled when the facility needs extra hands. Typical reasons include covering vacations and sick calls, absorbing a surge in admissions, or filling holes in the schedule before it's published.
There are two common setups:
- Facility per diem. You're on the hospital's or nursing home's own PRN pool. You've done their orientation, you know the unit, and you're offered shifts directly, often through a scheduling app or a manager's group text.
- Agency per diem. You're employed by a staffing company that sends you to different client facilities for individual shifts or short blocks. Rates can be higher, but you'll work in less familiar settings.
Many nurses do both: a home-base PRN job at one facility, plus agency shifts when they want more hours.
Why per diem pays more per hour
Per diem rates are usually higher than the base rate for staff nurses in the same role, often by a meaningful margin. The facility isn't being generous. It's paying for two things. First, you're not receiving benefits like health insurance, paid time off or retirement matching, which can add a large percentage on top of a staff nurse's wage. Second, you're giving the facility flexibility. They only pay you when they need you, which is cheaper for them than keeping extra full-time staff on payroll.
Some facilities offer tiered per diem rates. A "PRN 1" agrees to a higher minimum commitment for a higher rate, and a "PRN 2" commits to less for a little less pay. Ask whether tiers exist where you're applying.
The real pros of per diem work
Control over your schedule
This is the main reason most nurses choose per diem. You pick shifts that fit your life, and you can turn down shifts that don't. You can take a month off for a family trip without asking anyone's permission, as long as you meet your minimum commitment.
Less involvement in unit politics
Per diem nurses typically aren't on unit committees, don't get pulled into scheduling fights and aren't expected at every staff meeting. For nurses recovering from burnout, that distance can be a relief.
Higher hourly pay
If you already have health insurance through a spouse, a partner or another job, the higher hourly rate can mean more money in your pocket for the same hours.
Variety and skill-building
Working PRN at a second facility exposes you to new equipment, new protocols and a different patient population. That's useful if you're considering a change of specialty, or preparing for travel nursing, where adapting quickly to a new unit is the whole job.
The real cons, and how to handle them
No guaranteed hours
When census drops, per diem staff are usually the first to be canceled, sometimes with only a couple of hours' notice. If you depend on per diem income for rent, keep a cash cushion that covers at least a month of expenses, and don't rely on a single facility.
Usually no benefits
You'll need to arrange your own health insurance, through a spouse, another job or the Health Insurance Marketplace. You'll also need your own retirement savings plan, such as an IRA. Price these before you leave a benefited job. For some nurses, the cost of buying insurance eats most of the higher hourly rate.
Minimum commitments
Almost every per diem job has a minimum. It's often a set number of shifts per month or per schedule period, plus a weekend requirement and one or two holidays per year. Fall below it and you can be removed from the pool. Get the requirement in writing during hiring.
Seniority and assignments
Per diem nurses may get the heavier assignment, be the first to float, or be scheduled into whatever shifts are left after staff nurses have picked. Being reliable and easy to work with goes a long way toward getting better treatment.
Who per diem nursing suits best
- Nurses with benefits from elsewhere, such as a spouse's plan, military coverage or another job
- Full-time nurses who want extra income without committing to overtime at their main job
- Students in RN, BSN or graduate programs who need to work around class and clinical schedules
- Parents and caregivers who need to choose their days
- Semi-retired nurses who want to stay clinically active
- Experienced nurses exploring a new setting before committing to a full-time role
It's less ideal for new graduates. Per diem roles usually expect you to work independently from day one, and most require at least one to two years of experience. New grads usually do better with the structured orientation and mentorship of a full-time position. If you're still working out which role to aim for, our RN vs LPN vs CNA comparison can help.
Per diem for LPNs and CNAs
Per diem isn't just for RNs. Nursing homes, assisted living communities and home health agencies rely heavily on PRN LPNs and CNAs to cover call-outs, especially on nights and weekends. Demand in long-term care tends to be steady all year, so experienced LPNs and CNAs with a good attendance record can often build close to full-time hours across one or two PRN jobs if they want them.
How to land good per diem shifts
1. Start where you already have credibility
The easiest per diem job to get is often at a facility where you've worked before or where colleagues can vouch for you. Managers hire PRN staff they trust, because those nurses get little supervision.
2. Make your availability easy to say yes to
Nights, weekends and holidays are where the need is greatest. If you can offer some of those, you'll get more shifts and have more leverage to ask for the shifts you actually want the rest of the time.
3. Keep your credentials current and organized
Per diem staff still need annual competencies, BLS and other certifications, TB screening and flu vaccination. Lapsed items are the fastest way to get pulled off the schedule. Keep a digital folder and calendar reminders.
4. Be the nurse they want back
Arrive on time, take a fair assignment without complaint, chart thoroughly and leave the unit better than you found it. Per diem schedulers have long memories. The nurses who make their lives easier get first pick of shifts.
5. Have a profile where facilities can find you
Many facilities post PRN openings alongside full-time roles. Create a free profile on TheNurs.com with your license type, specialty and availability so hiring managers in your area can reach you directly, and browse current openings filtered by Per Diem.
Taxes and paperwork for per diem nurses
Most per diem nurses are W-2 employees, so taxes are withheld from each paycheck just as they are in a staff job. The catch comes when you work two or more jobs. Each employer withholds as if it were your only job, which can leave you owing money at tax time. Use the IRS Tax Withholding Estimator once or twice a year and adjust your W-4 forms if needed.
If an agency offers to pay you as a 1099 independent contractor instead, understand what that means. You'll owe self-employment tax and have to make quarterly estimated payments, and you won't be covered by the employer's workers' compensation. Ask why they classify nurses that way before you agree.
Keep your own records of every shift you work, including date, hours, unit and rate, and compare them with each pay stub. When you're working for several employers, mistakes are easy to miss.
Questions to ask before you accept a per diem job
- What is the hourly rate, and are there differentials for nights, weekends or holidays?
- What is the minimum commitment per schedule period, including weekends and holidays?
- How are shifts offered, and how far in advance?
- How much notice do you give if a shift is canceled, and is any of it paid?
- Will I float to other units, and which ones?
- How long is orientation, and is it paid?
- Are any benefits available to PRN staff, such as a retirement plan or tuition help?
Per diem nursing won't suit everyone, but for the right nurse it's one of the best ways to keep doing the work you trained for, on terms that fit the rest of your life.
Frequently asked questions
What does PRN mean in nursing jobs?
PRN comes from the Latin pro re nata, meaning “as needed.” A PRN or per diem nurse works shifts as the facility needs them rather than on a fixed schedule.
Do per diem nurses get benefits?
Usually not. Most per diem roles don’t include health insurance or paid time off, which is part of why the hourly rate is higher. Some employers offer limited benefits such as a retirement plan.
How many shifts do per diem nurses have to work?
It varies by employer. A common requirement is a minimum number of shifts per schedule period plus some weekend and holiday coverage. Get the exact commitment in writing before you accept.
Can new graduate nurses work per diem?
It’s uncommon. Most per diem positions require one to two years of experience because PRN nurses are expected to work independently with little orientation.
Can I work per diem and full time at the same time?
Yes, many nurses do. Check your full-time employer’s policy on outside work, and watch your total hours so you stay rested and safe.
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