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per diem nursing

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per diem nursing

Competitive salary and flexible hours attract nurses and help alleviate shortage


With a shortage looming large in the nursing profession, per diem nurses are a boon to hospitals that need extra nurses to cover a few shifts. Per diem work also is favorable to many nurses who enjoy the competitive pay and flexible schedules the positions offer.

"If they are at home and not working because they have a 2-year-old and 4-year-old, per diem nursing offers flexibility and an opportunity to work," said Margaret Simons, MS, RN, vice president of health services at Montgomery General Hospital in Olney, MD.

Nurses who choose to work per diem also help alleviate staffing issues brought on with the nursing shortage, she added. "If they can work whatever the minimum requirement is (ours is four shifts in four weeks) that's a help. Rather than having a nurse not working at all when there is such a great need, I'd take them for the minimum number of hours they can work."

In fact, recruiting for per diem nurses has become intense in light of the shortage, particularly in Simons' area, just outside Washington, DC. The region is densely populated and features several medical facilities that vie for nurses and other health care professionals.

Using Agency Nurses

More recruiting agencies for per diem nurses are becoming active during the shortage. "I see a lot of vendor agencies popping up. Per diem agencies are marketing harder, and the centers seem to be using them," observed Tish Gill, MSN, RN, manager of professional recruiting at Genesis ElderCare, in Kennett Square, PA.

She advises facilities to weigh the benefits of using agencies before starting a relationship with them. "Screen them to get references and ask for spot audits to make sure the agency that brings vendor nurses into your hospital is really checking licenses and backgrounds."

Although working for an agency is not where nurse executives want to see RNs working, said Simons, many are choosing this option. These nurses should look to reputable, stable companies that offer benefits, liability insurance and a market share where there is work available on a regular basis.

Some health care providers have their own in-house staffing division, as Genesis does, Gill told ADVANCE. Genesis works with a pool of per diem nurses within Genesis Staffing Services.

A convenience of this is that the background work is already done by their own staff. This is one reason she predicts that more hospitals and health care facilities will follow the trend of internal staffing of per diem nursing.


FunctOutIn light of the demand for per diem nurses, hospitals and health care facilities are attempting to attract nurses by offering several incentives. "Whoever pays well for the per diem positions and gives nurses the most flexibility in scheduling, that's where the people will go," Simons said.

Salary for per diem nurses has become competitive, and many nurses are employed by several recruiting agencies and look for the highest-paying offer, according to Gill. To keep per diem nurses with Genesis, the company offers a competitive pay rate that is higher than that for full-time nurses.

Simons confirmed the same strategy is used at Montgomery General Hospital. Other incentives are being used as well. "I'm noticing a lot of bonuses being advertised. Everybody is taking a look at salary structure," she said. "[Per diem nurses] are paid at a higher rate than the regular staff nurses because they are expected to go where they are needed."

But they still have a lot of flexibility. "Per diem nurses can choose to work on a specific day or week," Gill said. "The nice thing about working per diem is that you have a lot of flexibility with your lifestyle. You can work when the kids are in school, and not work when they have a day off, or work around your own personal schedule."

Advancement Potential

Another benefit for nurses who work per diem with a facility is having a chance at full-time positions that open up.

According to Gill, "Genesis Staffing Services nurses are Genesis ElderCare employees and are used exclusively at Genesis centers. They have first opportunity to transfer to any position within the company." This includes transferring into permanent positions. Many nurses take advantage of this unique opportunity.

Simons reported, however, that only a small percentage of per diem nurses she sees go onto full-time nursing. "A lot of these nurses work per diem because they have young children and they stay in the position for several years because of the flexibility. When the children get in school, they may apply for a full-time position; otherwise some of them are perfectly happy continuing in the same position."

How They're Used

While per diem work allows nurses flexibility in their lifestyle, they must adapt to the needs of the facility, which may require nurses to have experience in two or more health care areas.

"The more flexible they can be within [a hospital] structure the more opportunity there is to work. If you are an ER nurse and you say, 'I only want to work ER,' I think you may be limited in your opportunities to work," said Simons.

"If you say, 'Let me orient to your critical care unit in addition to the ER,' then you will have more opportunity to work."

At Montgomery General Hospital, per diem nurses are used most often in critical care and med/surg. "We ask that they be willing to work in more than one area--either med/surg and critical care, or critical care and the ER or OB and recovery room," Simons said. "They have to choose at least two places they are willing to work."


To make sure per diem nurses provide the same continuum of care as full-time nurses and are up to speed on hospital policy and procedure, they must receive proper orientation.

"They receive the same orientation that a regular staff nurse would. Depending in what areas they will be working, they may get additional orientation. For instance if they're scheduled to work in critical care they would also be oriented to med/surg," Simons said.

Some Disadvantages

In most cases, per diem nurses do not receive benefits. However, at Montgomery General, earned leave is paid to regular employees who work at least 20 hours per week. Employees who work 20 hours or more are also eligible to obtain health insurance benefits in addition to paid leave. The full benefits package is available to employees working at least 30 hours per week, according to Simons.

Although per diem nurses can basically choose what hours they want to work, they risk cancelled shifts due to fluctuating census.

"While they sign up for a shift, there is no guarantee they will get those hours if we don't have patients," Simons said.

Just as per diem nurses are at the mercy of cancelled shifts, hospitals often must cope with finding nurses to fill shifts at the last minute.

"They give us their availability, but sometimes it is difficult to match their ability with our needs," Simons said. At this time, Montgomery General does not use set schedules for per diem nurses, but may choose this as an option in the future."

However, she feels the nurses deserve some ability to decide when they can work. "We feel that as they're working per diem, they're not getting benefits but they do support the hospital, so we at least should give them the option of deciding what days they want to work and what weekends they can work." *

Abigail Scott is an assistant editor at ADVANCE.


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