Please explain "per diem"?

maggijo · Jul 29, 2005

... and what's "Per Diem I" and "Per Diem II"? Thanks for your help!

FocusRN · Jul 29, 2005

Per diem positions are positions that the employer isn't able to guarantee hours. Like when people go on vacations or take sick. For per diem when you get a call you will be working a whole shift, if you decide to accept it.

PRN is as needed basically the same as per diem but for the fact that you may not be working a whole shift. You may just be working until someone else gets there. And you may work split shifts.

But usually employers use these terms interchangebly, so tyou can basically make these as one in the same.

Now being on call is different b/c you must go in when called.

rn/writer, RN · Jul 29, 2005

... and what's "Per Diem I" and "Per Diem II"? Thanks for your help!

Per diem is Latin for "by the day." It usually refers to what are called pool positions.

Agency pool nurses work for private nursing agencies, which contract with various facilities to provide nurses to cover staffing shortages. An agency can provide nurses on an actual per diem basis with just a couple of hours' notice, sort of like substitute teachers. Or they can work out scheduling for a longer term if the shortage is known ahead of time. For instance, a unit that is going to be down several nurses for a week or longer might use an agency to fill at least one of the spots to make sure that additional call-ins don't wreak havoc on the existing staff. Such a per diem spot might be filled by more than one nurse during the contracted period but all the nurses would be considered per diem employees because it is still a short-term committment. Agency nurses can have a single area of expertise and limit the jobs they will accept to that specialty, or they can work a variety of units, as long as their credentials are acceptable to the agency.

As great as agency nurses can be, there are several drawbacks to using them. In a city of any size, they can be sent (with their agreement) all over town and may not be the least bit familiar with a particular hospital or unit. Depending on the integrity of the agency, they may send nurses with questionable or outdated qualifications. But, the biggest drawback is the high cost of using agency nurses. Their hourly rate can be double that of regular staff. The agency takes a large cut of that amount and the nurses rarely receive any benefits (from the agency or the hospitals) so the perception that agency nurses make big bucks can be misleading. Still, if you don't need bennies and you like constant variety, it can be a good career choice.

Because hiring outside agency nurses is so expensive, many facilities now have gone to using what is called in-house pool. This amounts to a hospital having its own agency and offers some important advantages. First, the nurses are often full- or part-time staffers who, for whatever reason (flexible hours, fewer hours, variety) decide to give up a regular position and switch to pool. They are already familiar with the hospital and may have worked a number of units within it. Even people hired fresh can be oriented to just the one facility (or several within a corporate body). This promotes consistency and continuity. Another advantage is that in-house pool personnel can help cover vacations, leaves, and other staffing gaps as soon as they are known on the unit. Both the nurse and the various units might be able to plan six weeks out (or longer) if the need is known that far in advance. The nurse then works like a temp does in the business world.

In-house pool nurses don't make as much as the agency nurses do, but the trade-off is greater familiarity with their assignments, and usually, longer-range planning. Some in-house pools offer benefits. Which brings me to the difference between per diem I and per diem II.

While it varies from place to place, the two levels have to do with the amount of committment and corresponding perks.

For example, Level I might require 12 shifts per month (minimum) and offer a few basic perks (probably at a cost to the employee), while Level II could set the minimum at 6 shifts a month with no bennies available. The higher committment level usually pays more.

Ideally, per diem workers (agency or in-house pool) are flexible and adaptable. They think on their feet and have fabulous assessment skills. They take notes on various places/units they have worked and are rarely bored. The downside is that they are sometimes dumped on by staff nurses who are jealous of the "big money" (see above) or who figure they won't have to see this new person again, so, why not give them the worst patients.

Per diem is not for anyone who needs stability and a predicatable routine (me among them). But for those who like variety and adventure, I've heard it can be great.

Hope this helps.

Miranda