A per diem nurse is paid more per hour than a staff nurse doing the same work on the same unit, and receives almost nothing else. The premium is not a bonus. It is the purchase price of everything that has been removed.
Why there is no reliable national figure
No national wage survey reports per diem rates separately. Federal occupational wage statistics cover registered nurses as a single occupation and do not distinguish shift-by-shift work from salaried employment. Every per diem figure in circulation comes from job postings, agency marketing or platform averages rather than from a survey.
What can be said with confidence is the shape. The rate is set above the local staff rate for the same role, and it varies by region as much as staff pay does, because the premium is applied on top of a local market rate. Judging a per diem offer therefore starts with knowing the local staff rate; see registered nurse pay. The national midpoint is a starting reference: median pre-tax earnings for registered nurses were $88,000 in 2024, up from $80,000 two years earlier.
The one place the premium has been measured
Federal wage data does separate nurses by the industry that employs them, and that gives a usable comparison: nurses employed by staffing agencies against nurses employed by the facilities they work in.
In 2023 the median hourly wage of a registered nurse employed by a staffing agency was $48.30, against $38.37 for one employed by a nursing home. The gap had widened sharply: in 2019 the nursing home nurse earned 94 percent of the agency nurse's wage, and by 2023 only 79 percent. For licensed practical nurses the ratio went from 99 percent to 86 percent.
Two cautions. The agency figure covers travel contracts as well as shift work, and the facility figure is nursing homes rather than hospitals, which pay more. It is still the only measured version of the premium that exists, and a quarter above the facility rate is the right order of magnitude to expect.
What the premium is buying out
Put the two arrangements side by side and the difference is not really an hourly rate at all.
A staff post carries employer-subsidised health cover, a retirement plan and often a match, paid time off and holidays, sick pay, paid orientation and education time, disability and life cover, seniority, and a schedule that pays the same whether the unit is busy or empty.
A per diem post carries none of those in most cases, and the hours themselves are not guaranteed. A quiet month is a smaller income; a cancelled shift is usually simply unpaid.
The value of the missing benefits is not guesswork in aggregate. Hospitals budget the benefits load on an employed nurse at 25.8 percent of wages on the current staffing survey figures, which is how an employed nurse costing $59.46 an hour is paid rather less than that. A per diem rate a quarter above the staff rate is therefore closer to parity than to a premium, and it still carries none of the schedule protection.
The parts of a per diem rate
Beyond the base rate, per diem pay is usually assembled from the same differentials as staff pay: evening and night shift, weekend, holiday, and sometimes charge or preceptor pay where the nurse is eligible.
Two things are worth checking because they vary. Whether call pay exists and at what rate, if the role involves being available rather than scheduled. And whether there is any cancellation provision at all, or whether a call-off two hours before a shift is simply a day without income. See how per diem scheduling works.
On-call arrangements have a wage and hour dimension as well. Time spent on call is working time under federal law when the nurse is so restricted that they cannot use it effectively for their own purposes, and is not when they are merely required to be reachable. Which side an arrangement falls on depends on the facts, and it is a fair thing to ask about before agreeing to carry the phone.
The annual figure is a projection, not a salary
An hourly rate multiplied by three shifts a week and 52 weeks produces a number that describes a year in which every shift existed and every shift was worked. Neither is guaranteed.
For anyone relying on per diem work as their main income, the honest calculation uses the shifts realistically available in a slow month, not a good one, and subtracts the cost of the health cover and retirement saving the nurse now buys personally.
Overtime, and holding two jobs
Federal law requires one and a half times the regular rate for hours over 40 in a week, calculated per employer. Hours worked for two separate employers are generally not added together, so a nurse with a full-time staff post who picks up per diem shifts elsewhere is usually not owed overtime by either. Picking up extra shifts at your own employer is a different case, and there the hours do combine.
If the arrangement is as an independent contractor rather than an employee, overtime protection does not apply at all, and payroll taxes change too. That distinction is worth settling before the first shift; see per diem employment status.
When the premium is worth taking
The arithmetic favours per diem work for nurses whose benefits come from elsewhere: covered by a spouse's plan, retired with cover already in place, or holding a staff post and adding shifts on top of it. For them the premium is close to pure gain, because the expensive part of a staff job is already paid for.
It works least well for a nurse with no other coverage and no cushion, where the higher hourly rate is quietly funding the things a staff job would have provided, and doing it in a month when the shifts happen to exist.
Related
- Per diem nursing
- Per diem employment status
- How per diem scheduling works
- Registered nurse pay
- Per diem shift apps and marketplaces
Sources
- Occupational Employment and Wage Statistics, registered nurses. U.S. Bureau of Labor Statistics, which reports registered nurses as one occupation without separating contract work. 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 agency and facility hourly wages in 2019 and 2023. Accessed September 9, 2026.
- National Health Care Retention and RN Staffing Report. NSI Nursing Solutions, 2026 edition, for the benefits load and hourly cost of an employed nurse. Accessed September 9, 2026.
- Burnout finally fell. So why do four in ten nurses say they are leaving? NurseRecruiter, 17 June 2025, for median registered nurse earnings. Accessed September 9, 2026.
- Overtime pay. U.S. Department of Labor, on the regular rate and the per-employer basis of overtime. Accessed September 9, 2026.
- Fact Sheet #22: Hours worked under the Fair Labor Standards Act. U.S. Department of Labor, on waiting and on-call time. Accessed September 9, 2026.
- What is Per Diem Nursing? NurseRecruiter, 13 February 2024, on the trade between rate and benefits. Accessed September 9, 2026.