End of Per Diem? - page 2

by hdawnRN | 14,120 Views | 39 Comments

I am not a per diem nurse, however, the large hospital organization that work for is ending per diem nursing, presumably at the beginning of the next year. We have been told that all hospitals are straying away from per diem, so... Read More


  1. 16
    Au Contraire - PRN staff are becoming more important as labor budgets are tightened. These nurses are less expensive due to the lack of benefits. There is actually some math behind this. The ideal ratio is to have sufficient 'scheduled' staff (full time & part time) to account for the ADC (average daily census) 'mode' each day. Then PRN staff are added into the mix to care for increases in census or cover for absences. There are additional calculations, of course - but the end result means having much fewer call-offs

    I'm not getting the tie-in to Health Care Reform, unless organizations are anticipating drastic income reductions because they can't achieve the patient sat & quality levels needed to maintain or improve their reimbursement. Sooooo tired of labeling this "Obama-care" Did we call Medicare "Johnson-care"? Do we describe lack of support for Women's services as "Bush-care"? (OK, so that was inadvertently funny )
    Dazglue, bigsick_littlesick, Meriwhen, and 13 others like this.
  2. 1
    I haven't heard anything about eliminating PRN at my hospital, and frankly, I don't see it happening. I worked PRN for my hospital until recently, and am not full time. During my time PRN I received a $6/hr raise. The hospital also became much more aggressive about hiring more nurses to work PRN.

    I think you hospital is just trying to find ways to cut costs. Unfortunately, pts and nurses will suffer
    MBARNBSN likes this.
  3. 5
    Avoiding making a commitment benefits the employer. The employer owes the per diem staff nothing more than hours paid. No benefits, no retirements, health plan, tuition reimbursements, or even full-time hours are owed.
    MBARNBSN, joanna73, One1, and 2 others like this.
  4. 1
    Unless you have seen this in writing from the hospital, I would let this go in one ear and out the other. Gossip and rumor run rampant in institutions. You have read several good reasons why you should ignore it; now, don't repeat it to anyone else and if someone says it to you, now you have a lot of factual reasons to give why it's nonsense.
    MBARNBSN likes this.
  5. 0
    I completely understand the importance of per diem nursing, and during our staff meeting, these points were all made to our director. However, the corporation is adamant that this is reality, and the reason was related to health care reform and every employee being required to have health insurance. Of course, the majority of our per diem nurses are insured through their spouse, but no one is being forced to move positions as of yet, only urged to. Of course most nurses are not going to do anything until they absolutely have to.

    Thanks for the advice not to keep spreading the rumor, I don't believe that's what I was doing... Only asking if any other organizations had been counseled in this area yet.

    Our organization, which consists of many hospitals throughout the state, doesn't necessarily have "float pool" staffing, but when one floor is short, our per diem nurses are the first to get pulled to that floor if there is over staffing. They're also the first to get called off if there is no need for them. Our staffing ratios are excellent and we hardly use agency at all. We love our per diem nurses, and would hate to see them disappear!
  6. 0
    I work per diem in NH and have not heard anything like this. Perhaps it is a state or regional issue. I chose to work per diem because I like the flexibility, and I have health insurance through my husband's job. My hospital still has per diem positions posted, and I don't think any are floats unless you actually apply for the float pool. Then again, I'm in PACU, and no one in my unit floats (though a few have another job in another dept or at a sister facility's PACU).

    I'm not sure I'm getting paid more per hour to work per diem than I would in a coded position, but as this is my first job, I don't have anything to compare it to.

    The only reason I could see this being related at all to AHA would be that employers are supposed to be offering health benefits to their employees, right? That would render the per diem/PRN position "illegal," for lack of a better word. However, if the requirement to be insured is on the individual level rather than the institutional level, the govt would know that I (as a per diem) am insured, period, regardless of the carrier or subscriber.
  7. 0
    Where I work, they don't use per diem, but will use agency staffing. That makes no sense to me. Either way, they don't pay benefits but I know agencies charge them a lot. Am I missing some part of this equation?
  8. 1
    I live in the Southeast and I have not heard of any such nonsense. If the hospital is doing away with per diem to float more nurses from other units, its because the market is flooded with RNs and they have plenty of staff to do so with. The ACA tie in is absurd.
    MBARNBSN likes this.
  9. 1
    If, indeed, the insurance thing is the problem; using agency solves that problem.
    Quote from paradiseboundRN
    Where I work, they don't use per diem, but will use agency staffing. That makes no sense to me. Either way, they don't pay benefits but I know agencies charge them a lot. Am I missing some part of this equation?
    MBARNBSN likes this.
  10. 1
    Quote from xoemmylouox
    I don't believe this is because of "Obama Care", anytime a healthcare organization makes a crappy choice that is their scapegoat. More likely this is just another "cost cutting" measure.. I don't see all hospitals doing this.. Best of luck to yours.
    If you do a search on Obamacare and "per diem," "part-time," etc you see many, many discussions that discuss "per diem," contract, part-time. There are many posts that indicate that per diem employees are being told "no more."

    It does appear that per diem employees can create huge problems (potentially big fines), not necessarily for hospitals but also for colleges or other entities that use per diem ee's. I think it will force entities to define workers carefully because a per diem that works an average of over 30 hours per week averaged over a month appears to become defined as a "full time worker"

    "A full time worker is defined as someone who works an average of at least 30 hours per week for a period of one month."

    I suspect that there will be some creative responses. Entities really cannot make any nurse a 1099 independent contractor so that is not an option. Options are: create 29 hour per week (maximum) employees thus creating part-time jobs, hire contracted employees, or hire agency employees. But the latter is difficult because Fed Regs require that anyone who works for an organization for more than 6 months must be considered an employee for the purpose of earning credit towards retirement which pushes the organization to fill the slot with a regular employee.

    But it's a mess and surely there will be many changes some for the better, and I imagine some for the worse. 25 and 55 employee organizations may downsize beneath minimum categories creating job loss but some places may simply hire more full time employees.
    GrnTea likes this.


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