A per diem roster is the cheapest flexible coverage an employer can hold, and the one that takes the most sustained effort to keep usable. The failure mode is not building it. It is building it and then only calling when desperate.
What it is for
Per diem cover exists for variation the permanent rota cannot absorb: sick calls, vacations, seasonal surges, a run of high acuity, a vacancy waiting on a permanent hire. It is turned on for one shift and off again, without a benefits cost or a permanent post.
It is not a substitute for permanent staffing. A nurse new to a unit each shift carries the same patient load with less knowledge of local practice, the patients and where things are kept, which is one reason staffing research measures continuity and skill mix rather than headcount. See nurse staffing and patient outcomes.
Where it sits against the alternatives
Covering variable demand costs different amounts depending on the instrument. Overtime is immediate and paid at a premium to people who are already tired; see nurse overtime. An internal float pool is scheduled, benefited and reliable. A per diem roster is cheaper than agency cover because it removes the agency margin, but the employer does the recruiting and credentialing itself. Agency and travel staffing is the fastest and the most expensive: on the 2026 figures a travel nurse costs $91.23 an hour or $189,758 a year, against $59.46 an hour or $123,676 for an employed registered nurse including a benefits load of 25.8 percent.
The same gap is visible in long-term care, where it is reported to Medicare. By 2021 an hour of contract registered nurse time cost a nursing home $68.41 against $42.95 for its own employee, and across all nursing categories contract hours cost about 75 percent more than employed hours.
Most facilities need several of these. The question is the mix, and the mix is a budget decision that ought to be made deliberately rather than at four o'clock on a Friday.
The vacancy this is really filling
The gap a per diem roster covers is expensive when it is left open. It takes 78 days to hire one experienced registered nurse, the typical hospital carries 43 unfilled nursing posts, and each nurse who leaves costs an average of $60,090 to replace. Flexible cover does not fix any of that, but it decides whether the months in between are staffed by your own oriented nurses or bought at agency rates.
How much your neighbours rely on agency staff
Agency use is not evenly spread, and in long-term care it is public. Nationally, contract staff were 7.5 percent of nursing home nurse hours in early 2024, down from 10.1 percent a year before and still above the 3 to 4 percent of 2019. The share of nursing homes using any contract nurses went from 19 percent in 2017 to 43 percent in 2021.
By state the spread is extreme. In mid-2025 contract staff were 25.1 percent of nurse hours in Vermont and 13.4 percent in Pennsylvania and New Hampshire, against 1.0 percent in Alabama, 2.5 percent in Nevada and 2.8 percent in Oklahoma.
That number is worth knowing for your own state before deciding what a roster is worth. In a high-reliance market, building one is competing with agencies for the same nurses and is the main way to stop paying them. In a low-reliance market, heavy agency use is usually a local recruiting problem rather than a market condition. The travel side of the same map is in where the assignments are.
Who actually takes per diem work
The recruiting mistake is to advertise a per diem post to the same audience as a full-time one. The people who want shift-by-shift work are usually people for whom a full-time post is not available or not wanted.
The pool is also larger than the travel pool. Of the 375,448 registered nurse profiles on NurseRecruiter, 45.7 percent say they will take per diem work against 38.9 percent for travel, and per diem willingness is higher than travel willingness in nearly every state. It follows a different map, too: willingness to travel is highest in Montana, Mississippi and Alabama and lowest in New Jersey and Connecticut, while per diem willingness is highest in Rhode Island, Hawaii and New Jersey. A flexible roster reaches nurses who will not leave home.
Nurses stepping back from full-time work. Retirement is the single largest force pulling nurses out of the profession, named by 61.4 percent of those who said they intended to leave, and it now ranks third among the reasons nurses give when they actually resign. It is rarely all-or-nothing: nurses leaving a full-time roster frequently want to keep working reduced hours, which is exactly what a per diem roster offers. With a median nurse age of 50 and the under-30 share of the workforce down to 7.9 percent, that population is growing. See nurse turnover and retention.
Nurses leaving the hospital rather than the profession. The share of registered nurses whose main job is in a hospital fell from 57.5 percent to 53.3 percent in two years, and 20 percent of nurses reported changing setting in 2024 against 16 percent in 2022. Those nurses are still licensed, still working, and frequently willing to pick up shifts in the building they left full-time.
Nurses with caring responsibilities, particularly parents of young children, who cannot commit to a fixed rota but can work regularly.
Nurses holding a staff post elsewhere and adding shifts, who are covered for benefits already and are therefore the group for whom your rate is worth the most.
Recent graduates and students building experience, and nurses returning after a break.
The practical implication is to recruit before there is a vacancy, keep previous applicants warm, run a referral programme among the per diem nurses you already have, and look at your own full-time staff approaching retirement before a competitor does.
What keeps a roster answering the phone
Fast credentialing. A cumbersome onboarding process is off-putting to anyone and disqualifying to someone weighing up four shifts a month. Fast-track the paperwork or lose the candidate.
Predictability where you can offer it. Publishing shifts in a self-scheduling window, rather than calling on the day, is the single change that most improves fill rates, because it lets a per diem nurse plan.
Honest commitment terms. Minimum shifts, weekend and holiday requirements should be stated up front. Nurses discover them anyway, and discovering them late costs the roster.
Fair treatment on cancellation. Per diem staff are the first people sent home when the census drops. Notice, and any minimum payment or on-call option, is what decides whether they pick up your shift next month. Note also that on-call time can be working time under federal wage law when the restrictions on the nurse are tight enough. See how per diem scheduling works.
Orientation that is real. A nurse who has been properly oriented is worth several who have not, and the difference shows up on the unit rather than in the staffing report.
Being treated as staff. Per diem nurses know which units regard them as colleagues and which regard them as spare capacity, and they allocate their availability accordingly.
Watch the hours, and the classification
Under the federal health law, a large employer's full-time employee is one averaging at least 30 hours of service a week, or 130 hours a month, measured monthly or across a look-back period. A per diem nurse who consistently works that much can cross into the group that must be offered coverage. Know where your roster sits rather than discovering it at the end of a measurement period.
If you fill shifts through an intermediary rather than your own roster, the classification and registration questions become yours to check as well: several states now require staffing businesses, including online platforms and nursing registries, to register and report their rates. See per diem employment status and nurse staffing agencies.
Reaching them
Per diem candidates are reached where nurses actually are rather than on general job boards, and hiring is faster when candidates can be searched for directly rather than waited for. That matters more than usual right now: 71.8 percent of hospitals expect to grow their nursing workforce this year and 6.8 percent expect to add anyone to the recruiting team that has to do it.
NurseRecruiter's job posting and nurse database exist for exactly this, and the fuller recruiting playbook is in how to find per diem nurses to hire.
Related
- Per diem nursing
- How per diem scheduling works
- Float pools and internal resource pools
- Using travel nurses
- Nurse turnover and retention
Sources
- How to find per diem nurses to hire. NurseRecruiter, 26 January 2025, on candidate sources, referral programmes, in-house pools and streamlining credentialing. Accessed September 9, 2026.
- National Health Care Retention and RN Staffing Report. NSI Nursing Solutions, 2026 edition, for costs, vacancy, time to fill, turnover cost and recruitment staffing. Accessed September 9, 2026.
- The use of contract staff in nursing homes. Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, January 2025, for contract hours, the share of facilities using contract staff and the cost of contract hours. Accessed September 9, 2026.
- Nursing home staffing data. Long Term Care Community Coalition, for contract staffing by state. Accessed September 9, 2026.
- 78 days to hire one nurse: the 2026 staffing numbers every nurse employer should know. NurseRecruiter, 3 September 2026. Accessed September 9, 2026.
- Burnout finally fell. So why do four in ten nurses say they are leaving? NurseRecruiter, 17 June 2025, for median age, the under-30 share and the fall in hospital employment. Accessed September 9, 2026.
- Identifying full-time employees. Internal Revenue Service, on the 30-hour and 130-hour thresholds. Accessed September 9, 2026.
- NurseRecruiter registered nurse profiles, all years, for stated willingness to take per diem and travel work. Method and limits are set out in where the assignments are.