How to Use Per Diem Nurses Instead of Agency Staff

To fill shifts with per diem nurses instead of agency, build an internal pool of hospital-employed nurses who work as needed, and offer every open shift to them, along with your core staff and float pool, before any shift goes to an agency. A pool like this works when pay is competitive, minimum commitments are clear, onboarding covers each unit they work, and nurses can see and claim shifts quickly. Agency then becomes a backup for gaps your own people can't cover, not your first call.

How do you use per diem nurses to fill shifts instead of agency?

The short answer: build an internal per diem pool and offer it shifts first

A per diem nurse is a hospital employee who works shifts as needed rather than holding a fixed FTE (full-time equivalent) position. The savings come from the order in which you release shifts. Open shifts should go first to core staff, then to the float pool and per diem nurses, and only then to agency. If agency sees a shift before your pool does, the pool can't do its job.

Which shifts per diem nurses fill best

• Predictable gaps: vacation, leave of absence and orientation coverage you know about weeks ahead
• Recurring holes: weekend nights, holidays and seasonal census peaks
• Short-notice call-outs: if your pool is active and can claim shifts from a phone
• Units with stable skill needs: where a cross-trained nurse can be productive after unit orientation

When agency still makes sense

Agency still has a place. It can cover specialty skills your pool doesn't have, long-term vacancies that need a 13-week commitment, and surges larger than your pool can absorb. The goal is to make agency a deliberate choice for those cases, not the default answer to every open shift.

How to set up an internal per diem nurse pool

Recruit from former staff, retirees, and local nurses who want flexibility

Your best candidates already know your hospital:

• Nurses who left in good standing and may want occasional shifts
• Recently retired nurses who want to keep their skills current
• Staff nurses considering going part-time instead of leaving
• Local nurses who work elsewhere and want extra shifts on their own terms

Former staff need less orientation and already know your EHR (electronic health record) and policies.

Set minimum commitment rules (shifts per month, weekends, holidays)

A pool without commitments looks good on paper and fills few shifts. Define minimums before you hire, for example a set number of shifts per scheduling period, a weekend requirement and a holiday rotation. Put these in writing. HR should confirm how they fit your employment policies and any applicable contracts, since these vary by state, contract and employer.

Onboard and cross-train per diem nurses for multiple units

A per diem nurse who can work three similar units is far more useful than one limited to a single unit. Follow these steps:

1. Complete hospital orientation and EHR training.
2. Assign a home unit and complete its unit orientation.
3. Identify one or two units with similar patient populations.
4. Complete competency validation for each additional unit.
5. Record which units each nurse is cleared for, so schedulers only offer shifts they can safely work.

Post open shifts to per diem staff before releasing to agency

Set a release rule and enforce it. For example, a shift goes to core staff and the per diem/float pool for a defined window, then to agency only if it is still unfilled. Write the window down and apply it every time. The guide to open shift management covers how to structure this. NurseTide Enterprise offers open shifts to staff, the float pool and per diem nurses first, before anyone turns to agency.

Use a scheduling app so nurses can claim shifts in minutes

Phone trees and mass texts are slow, and responses are hard to track. A scheduling app lets per diem nurses see open shifts they're qualified for, claim them and get confirmation, while managers keep approval control. When you evaluate options, check three things:

• Can the app filter shifts by unit competency?
• Does it flag overtime and rest-time conflicts?
• Does it record who was offered what, and when?

What do per diem nurses cost compared with agency?

Typical per diem pay premium vs. agency bill rates

Per diem nurses usually earn a higher hourly rate than staff nurses, often in exchange for limited benefits and no guaranteed hours. Agency bill rates include the nurse's pay plus the agency's margin and costs. Rates vary widely by market, specialty and contract, so the only reliable comparison is your own numbers: your per diem hourly cost against your agency invoices.

Hidden agency costs: markups, minimums, and orientation time

When you compare the two, look beyond the hourly bill rate:

• Markups built into the bill rate
• Minimum hour or cancellation terms in agency contracts
• Orientation hours your staff spend training each new agency nurse
• Travel or housing stipends on longer contracts
• Staff time spent managing agency requests and invoices

Some of these never appear on the agency invoice, so they are easy to miss.

Sample cost comparison for 100 open shifts

This is a template, not real data. Fill it in with your own rates.

Savings = (A − P) × H, plus the difference in orientation time and fees. The agency spend calculator runs this math with your figures.

How to set per diem rates that attract nurses without overspending

Set rates high enough to compete with agency pay in your market and low enough to stay below your agency bill rate. Finance and HR should agree on the range together. Check fill rates after launch. If shifts sit unclaimed until the agency window opens, your rate or your commitment rules likely need adjustment.

Per diem vs. agency nurses: side-by-side comparison

Cost per hour

Compare your fully loaded per diem cost (pay plus employer costs) with the agency bill rate, not with the agency nurse's take-home pay.

Speed to fill a shift

Agency can fill a shift quickly when supply is good. An engaged per diem pool with mobile shift claiming can often be faster for short-notice holes.

Familiarity with your units, policies, and EHR

Familiarity is a major advantage for per diem nurses. A nurse who already knows the unit's workflows and documentation needs less hand-holding from charge nurses.

Quality, retention, and patient safety

Per diem nurses go through your hiring, credentialing and competency processes. Continuity also builds trust with core staff.

Administrative burden and contracts

Per diem staff add HR and scheduling work. Agency adds contract management and invoice reconciliation. Decide which workload your team handles better.

What to measure to know it's working

Track these metrics monthly, by unit and hospital-wide. NurseTide Enterprise includes agency spend savings reports that show how agency spend changes as internal fill improves.

Agency hours and spend per month

This is your headline metric. Watch both hours and dollars, since rate changes can hide volume changes.

Open shift fill rate and time to fill

Fill rate is the share of open shifts filled. Time to fill is how long a shift stays open before someone claims it. Long times to fill suggest shifts aren't reaching nurses fast enough.

Percentage of shifts filled by per diem staff

This measures how much work the pool is actually doing. If this percentage stays low while agency use stays high, look at your release rules and rates.

Per diem pool size, activity rate, and turnover

Track three numbers:

• Headcount: how many nurses are in the pool
• Activity rate: how many worked a shift in the period
• Turnover: how many left

A large pool with low activity isn't really a pool.

Overtime and incentive pay trends

Make sure you aren't simply shifting cost from agency into overtime or bonus pay for core staff. Watch these trends alongside agency spend.

Common mistakes when replacing agency with per diem nurses

Setting rates too low to compete with agency

If agency pays nurses noticeably more, your best per diem candidates will choose agency. Review market pay regularly.

No minimum availability requirements

Without minimums, nurses join the pool but rarely pick up shifts. Enforce the commitments you set.

Releasing shifts to agency before per diem staff see them

This often happens under time pressure. A written release rule, applied every time, prevents it.

Skipping unit orientation and competency checks

Floating an unoriented nurse puts patients and the nurse at risk, and it drives nurses out of the pool. Validate competency for every unit before offering shifts there.

Letting the pool go inactive without regular engagement

Keep per diem nurses connected. Include them in unit announcements and policy updates, check in on their availability, and follow up with nurses who haven't worked in a while.

Frequently asked questions

How much more do per diem nurses get paid than staff nurses?

It varies by employer, market and specialty. Per diem nurses often earn a higher hourly rate than staff nurses in exchange for fewer benefits and no guaranteed hours. Your HR and compensation teams set the actual differential.

Can per diem nurses work in multiple units or facilities?

Yes, if they complete orientation and competency validation for each unit. Working across facilities depends on your health system's employment structure and credentialing, which HR decides.

How many per diem nurses do you need to cut agency use?

Start from your data. Divide your monthly agency hours by the hours a typical per diem nurse works each month, then adjust for unit competencies and the fact that not every nurse will be active every month.

Do per diem nurses get benefits?

It depends on your employer policies, any applicable contracts, and the rules in your state. Many per diem roles offer limited benefits, but HR or counsel determines eligibility.

How fast can a hospital reduce agency spend with a per diem pool?

Timing depends on how quickly you can recruit, onboard and cross-train nurses, and how consistently you enforce shift release rules. Track agency hours monthly from launch so you can see the trend.

To see how per diem-first scheduling works on your units, book a demo.