Per Diem Nursing: Pros, Cons and Whether Flexible Shifts Are Right for You

What if you could choose exactly when you work? Per diem nursing (called bank or casual nursing in some countries) offers that freedom, often with a higher hourly rate. But the flexibility comes with trade-offs that every nurse should understand before switching.

Imagine missing your child’s school play again because the rota came out late. Your friend works per diem: she picks shifts around her family, earns more per hour, and seems happier. But last month the hospital had low patient numbers and she was cancelled three times. Freedom and uncertainty arrive together.

What is per diem nursing?

“Per diem” means “by the day.” Per diem nurses work as needed, filling gaps in a hospital or health system’s staffing. In the UK and some other countries, the equivalent is bank nursing through the employer’s own staff bank, while agency nursing is through outside companies.

The pros

• Choose your own shifts and say no when you need to
• Often a higher hourly rate than staff roles
• Easier to fit around study, family or a second job
• A way to try different units or ease into or out of a career
• Less involvement in workplace politics

The cons

• No guaranteed hours, and shifts can be cancelled at short notice
• Often fewer or no benefits, such as health insurance, paid leave or retirement contributions, depending on the country and employer
• Minimum commitments, such as a set number of shifts, weekends or holidays
• Being sent to unfamiliar units, sometimes the busiest ones
• Less access to training, promotion and a stable team

But who is per diem right for?

It often suits experienced nurses with benefits from elsewhere (for example, through a partner), nurses studying for advanced degrees, semi-retired nurses, and staff nurses who want extra income. It’s usually less suitable for new graduates, who benefit from the support and structure of a permanent team. Many nurses combine a part-time staff job with per diem shifts for the best of both.

Sources: US Bureau of Labor Statistics (Registered nurses), NHS Employers (Bank staff), International Council of Nurses (workforce reports). This article is for general information and is not financial advice.