Per-diem nurses

[Vishwamitr]

I am a registered nurse who works as a per-diem nurse in several hospitals in Florida and want to create awareness among the healthcare industry (mostly hospitals) about the plight and silent injustice that is being perpetrated on per-diem nurses since the inception of its concept.

Per-diem nurses supplement and fill the gaps for hospitals during their acute shortages of nurses such as during holidays or when the hospitals' census is high.

Typically, 4-week schedules are drawn up a month or two in advance and per-diem nurses are scheduled according to hospitals' projected needs. However, for per-diem nurses, that schedule is not worth the paper it is written on because they can be canceled by the hospital any time before the commencement of the shift. Per-diem nurses are often canceled as late as 30 minutes before the shift starts or sometimes even after reporting to the unit "because there was a mistake in the schedule" or "our census went down." In reality, a scheduling slot is created for regular nurses who might have missed a shift during that pay-period.

Per-diem nurses are held accountable for their end of the commitment but the hospitals are not.

A schedule is an unwritten contract between a per-diem nurse and a hospital; as such, each party should be responsible to live up to its committment. There has to be some reasonable compensation for per-diem nurses (like payment for half of the shift) when a hospital's needs have changed at the last minute.

Per-diem nurses have families and bills to pay just like everyone else. They have adjusted their social calendar assuming that they would be working. Sometimes, per-diem nurses have turned down offers from other hospitals for the same shift, only to be canceled by the first hospital. Upon cancellation, it is then too late for per-diem nurses to be accommodated by the other hospital that had offered that shift because it has already made its own arrangement.

It is not unreasonable to think that there are nurses who may consider working per-diem but just do not want to deal with the uncertainty of working on a per-diem basis.

I believe that there ought to be a law where a schedule is honored like a contract and the offending party is required to reasonably compensate the other party for breach of contract.

[TheCommuter, BSN, RN]

Perhaps it's bc I work in long term care (or it's bc I was a brand new nurse-RN when they hired me, so they had to train me), but I don't get a "per diem" rate as u all talk about here. I get paid starting rate for a new nurse in the state of CT. Is that normal or did I short change myself?

Most of the LTC facilities in my area do not offer a significantly higher rate to PRN/per diem staff. Sometimes PRN/per diem nurses get the same wage as the full time staff, whereas other facilities may only offer a dollar or two more per hour. This might be part of the reason why LTC facilities have difficulty attracting and retaining quality PRN/per diem staff.

Many hospital systems, on the other hand, will offer PRN/per diem nurses a significantly higher hourly pay rate to compensate for the many inconveniences surrounding this classification. My proposed full-time pay rate would be $11 less than the current PRN/per diem rate being offered by the hospital where I work.

[Mulan]

Been there done that, for years.

The only alternative is to get a full-time position.

Even full-time is no guarantee you won't be canceled due to low census.

[Fedide]

Perhaps it's bc I work in long term care (or it's bc I was a brand new nurse-RN when they hired me, so they had to train me), but I don't get a "per diem" rate as u all talk about here. I get paid starting rate for a new nurse in the state of CT. Is that normal or did I short change myself?

Yes, LTC is different, because it is not census driven like a hospital. We need "x" number of nurses per shift, and that number doesn't change. I worked PRN for a lot of years, we do not get cancelled. My commitment was one weekend a month (that was the minimum required from me, and what they were in turn required to schedule me for).

[RNitis]

To fedide: thanks for clarifying for me, I appreciate it!! Didn't mean to cut into the original post, but thanks for answering!

[wannabecnl]

I work per diem in a PACU with about 16 RNs. I don't think I'm getting paid any more for being per diem, but I'm a new grad, which may be why. I get paid when I work, I don't when I don't, and I have the freedom to say when I'm available. I'm not automatically the first person called off for low census; we rotate that among full-time, part-time, and per diem. I have never gotten to work only to be sent home again, and I think my hospital has a minimum pay of 2 hours if you come in, even on call. BTW, our per diems do take call, though I know in some hospitals they don't have to.

So while I don't get paid extra (or rather I hope not, because otherwise the coded positions are REALLY underpaid) and I don't get benefits, I love working per diem for the flexibility. I think if you want a more predictable schedule, you should go for a part-time position if there is one available.

[Meriwhen, ASN, BSN, MSN, RN]

Perhaps it's bc I work in long term care (or it's bc I was a brand new nurse-RN when they hired me, so they had to train me), but I don't get a "per diem" rate as u all talk about here. I get paid starting rate for a new nurse in the state of CT. Is that normal or did I short change myself?

Not every facility offers their per-diems an increased rate. Some offer the same rate as they'd offer a permanent nurse with similar experience.

In my first job, per-diems got whatever permanent staff got.

[Meriwhen, ASN, BSN, MSN, RN]

Sorry, OP, but while what you are experiencing may seem lousy, the facilities are doing nothing wrong.

When you sign on as a per-diem, you do so knowing that you are not guaranteed any hours at all. YOU have to make yourself available for X number of hours per pay period, but they are not obligated to schedule you for any of them. It's one of the risks of working per-diem, and no nurse should go into a per-diem job thinking those hours are certain and rely solely on that to pay the bills.

You signed on voluntarily as a per-diem, and nothing is forcing you to continue working in a per-diem position. You are free to seek a permanent FT/PT position, whether in that facility or another organization.

Best of luck.

[omsteelo]

Then don't work per diem -- get a job as regular staff, full- or part-time, as meets your needs. There is no injustice here that I see.

Nice attitude towards a fellow nurse. Small wonder nursing will always be considred an unprofessional carreer, mainly taken up by women that can't do anything better. Not to mention there may not be a full time job available for her, or that by having access to a per diem nurse may be the only reason you are allowed off to attend a funeral, get your teeth fixed, ot whatever? Shameful and arrogant. I'm embrassed, really.

[BrandonLPN, LPN]

Nice attitude towards a fellow nurse. Small wonder nursing will always be considred an unprofessional carreer, mainly taken up by women that can't do anything better. Not to mention there may not be a full time job available for her, or that by having access to a per diem nurse may be the only reason you are allowed off to attend a funeral, get your teeth fixed, ot whatever? Shameful and arrogant. I'm embrassed, really.

But per diem employment is what it is.... by definition you're the first one called off and you're expected to be able to hit the floor running.

What would you have us say? "Don't work per diem if you don't like it" seems like the only sensible advice in this case.

[IEDave, ASN, CNA, LVN]

You can always find another per-diem job...

When I worked per-diem, I always had another in order to make sure if I got cancelled at another facility, I had another way to make money.

It would be nice for facilities to give 2-4 hours of pay for last minute cancellations; I just don't see it happening.

Funny you should mention this, LadyFree28 - my LTC does! Got scheduled to do a pt. escort run, and at the last minute they did a pt. shuffle so that they didn't need a CNA for the run. They paid me for 3 hours in spite of the fact that I did exactly nothing but show up. And, yes, I'm per diem as well.

Far as the scheduling goes - I've turned them down FAR more then they've turned me down. Side effect of being a 50 y.o. student - I can handle the class load, but not sleep deprivation.

+1 to the OP as far as looking at another scheduling option - multiple sites, P/T, F/T; there's got to be something that works for you.

----- Dave

[DedHedRN]

I wish I could get a per diem job to supplement my regular job.

[jazzymom]

I rarely EVER comment, but I had to say something here!

Having spent my career (nearly 20 years), I want to point out that everyone has a good point. First, the original poster made a VERY valid comment/opinion. Per diem nurses are often disrespected. I have been made to feel BEYOND guilty for calling off with 24 hrs notice, but I might be only given 30 mins notice. The AGREEMENT is 2 hrs notice and then the hospital is SUPPOSED to pay a 2 hr penalty for the inconvenience. This is rarely IF EVER enforced by the agencies since "he who has the gold makes the rules". True, I have "control" over my hours, so I use that control to only schedule myself a day or two at a time. I have learned that it ONLY benefits the hospital to schedule further in advance. Usually by the "day of" the shift, any employees who are likely to take the shift have stepped forward. Hospitals that cancel very last minute are less likely to get "my" availability. Same with ones that bring me in for a few hours and then send me home.

I've learned how to "survive and thrive" as an agency nurse, but I learned a lot of hard lessons, "given" to me by people who acted like I "deserved" it because I was "agency" and that's how it goes. One hospital "block booked" me (scheduled me for the whole month). It was in December and I was a single mother and a student. I would be "confirmed" and work about 3 hours and then be sent home "due to low census". I knew this was a "risk" and didn't question it until it kept on for multiple shifts. After working 4 nights and having less than 20 hrs, I started to ask if they really needed me. I was assured that I was needed. And then I was sent home. However, I had "committed" for the whole month. The last shift to get paid before Christmas I begged the manager to be sure of her needs because this would make or break my ability to give ANY Christmas at all. There was another hospital who was willing to "guarantee" hours (in writing) if I would come. However, I had committed to the first hospital, so I call the manager. The manager "Promised" I would have a whole shift. When I got there, there was a note for me to be sent home after 3 hrs. The manager was still there. I asked her why she would do this to me and she told me it was "my fault" that I was agency and if I didn't want to be cancelled I should hire on to her floor. I cancelled the remaining bookings and was banned from working there again.

That happened 6 years ago and I have learned to be more conservative about "giving" out my hours. I also "sell" my skills and try to make myself helpful and memorable.

I try to always introduce myself to the manager and/or house sup and be extremely helpful and flexible in floating or helping others. This makes me memorable and valuable.

I have had "regular" shifts. However, when census was low, I wasn't "allowed" to pick up an agency assignment to make up lost wages. I was "required" to wait and see if I was needed. So I have learned to treat the hospitals like I am treated.

It's hard because I like to be helpful. Last week, I "broke" my rule of not scheduling more than a day or two. A manager was "desparately" short and scheduled me for 4 days. I was cancelled on 3 of them, twice with only an hour's notice, after I had turned down other assignments.

People (nurses!) have this perception that agency is paid "so much more". That used to be true. It used to be that the pay was worth the inconvenience. I like going different places. It keeps my skills sharp and I have learned there are a LOT of ways to do nursing. But the VERY prevelent attitude is one that definitely keeps per diem nursing an area that will always have a shortage. I can't honestly say I would recommend another nurse become an agency nurse. It's a career choice I've learned to love, but it's not an easy path. I love it; but it's like dealing a spider or a snake. Our eco-system needs spiders and snakes. And nursing needs nurses who are willing to put everything aside at the last minute and go to an unknown area, with unknown charting and unknown people and do the same level of work as everyone else. But just like a spider or snake will kill you if you don't know what you are doing, the attitudes towards agency nurses kill the budding nurse just as fast and with the same amount of remorse. So for the same reason most people avoid snakes and spiders, most nurses avoid working agency and per diem. This is also why "good" agency nurses are hard to find. Most people "give it a try" and succumb to the "poisonous" attitude that agency nurses "deserve" the treatment they get and should leave if they don't. Therefore, most do!