Some Nurses Are Reporting Per Diem (PRN) Nursing is Being Phased Out, So We Investigated

As a former bedside nurse who took time off to care for my kids and is now trying to figure out my next career step, I've been exploring returning to the bedside as a Per Diem (PRN) nurse. I worked as a PRN nurse near the end of my past bedside career, and I really enjoyed the flexibility it offered as I grew my family: it felt like the best of both worlds, because there was always an opportunity to work, but I still had the chance to work around my kids' schedules. 

I'm privileged in that my husband carries health insurance for our family through his job, so I don't need the benefits of a full-time role. Now that it's time for me to go back to work, however, I was surprised to discover that some hospitals are moving away from hiring PRN nurses. Some nurses even claim that PRN nursing will be a thing of the past. 

Is PRN nursing really dead? I did some digging to find out if hospitals really are phasing out PRN nurses and the reasons driving the change. 

PRN Requirements May Be Changing

There are significant variations across the country and among different hospitals and healthcare facilities, but Nurse.org uncovered a few instances where nurses reported changes in PRN requirements at their hospitals. 

Specifically, hospitals started requiring more weekend, holiday, or frequency of shifts per pay period out of PRN nurses than ever before. They may also take away any incentive pay or even lower pay, which has led many nurses to wonder if hospitals are intentionally trying to phase out PRN nursing. 

"I think our hospital is trying to get rid of PRN," said one nurse recently on Reddit. "I think they’re finding that they have an overwhelming amount of PRN RNs that they can’t control, and with some for-profit hospitals now owning their own insurance company, I think it’s more costly for them to have PRN RNs at the top of the pay scale. Going PRN was one way for us nurses to hack the system—get paid more and make our own schedules."

"My hospital did something similar before I left," chimed in another nurse. "Increase in weekend requirements, and it was hard to get the hours, so you basically had to work weekends to make money. Many people started leaving. Go figure, they ended up closing many PRN positions entirely after many left. Makes me wonder if it was all to get rid of PRN staff."

"I feel like a lot of hospitals are trying to phase out PRN positions," added yet another RN on the Reddit thread. "My old job changed the requirements, where you essentially had to work once a week, and their rate was not much higher than my full-time rate, despite not having benefits. Gone are the days when you could have a PRN job and pick up when you’d like."

PRN nurse Toni Diller Loutzenhiser, RN, who works at a Med/Surg Oncology unit in Port Huron, Michigan, does not make any shift differential with her per diem job, but did notice a change after the pandemic in her role's requirements. 

"At my hospital, it used to be a six-shift/year requirement to maintaina  PRN position," she explains. "After COVID, it changed to 2 shifts per 6-week schedule, 1 holiday a year, and 1 weekend quarterly."

PRN Nurses Might Be Bad for the Budget

A nurse manager on Reddit explained that one possible reason that PRN nursing might be less favorable from a hospital leadership perspective is the budget side of it.

"Every unit is budgeted for staff. This is measured in FTEs. One FTE is 40 hours/week. Since most nurses on the floor work 12s, most nurses are 0.9/36 hours or 0.6/24 hours FTEs," she explained. PRNs, on the other hand, can be listed as a 0.1 FTE, so depending on how the budget lines up, PRN positions may be closed off. 

"From a purely business side, I don’t need another PRN, I need that full-time slot," she added. 

Although it wasn't the case when I worked as a PRN nurse, some hospitals have historically paid PRN nurses a higher base wage than staff nurses. In theory, the higher way was to make up for the lack of other benefits, like retirement or insurance. So one possible theory is that with any budget constraints, PRN nurses might be the first to go.

Less PRN Could = More Stability

Another possible theory floated is that an overreliance on PRN nurses could leave the hospital in a tough situation if the nurses leave or don't pick up enough shifts. 

For instance, some hospitals lost PRN staff to higher-paying travel agency jobs during the pandemic (the PRN nurses had fewer ties to staying, so they were the first to leave, the theory goes), so hospitals have taken new policies to better stabilize their core staffing. 

Focusing on building a core staff that doesn't rely on PRN or overtime to fill a unit could also come with other benefits, like ensuring continuity of care, up-to-date, trained staff, and no gaps in scheduling. 

The Downsides of PRN Nursing

Having worked PRN, I will be the first to admit that there are some downsides and challenges to the role. For instance, I often felt 'behind' and never fully felt part of the team as a PRN nurse. Coming to work infrequently or with large gaps made it feel like I never truly learned enough to feel comfortable, so each shift would feel like I had to relearn everything again.

I also strangely felt guilty, as if I was getting some kind of special privilege only working PRN (when in actuality, the job was never guaranteed, meant guaranteed holiday and weekend coverage for staffers, and came with zero PTO or benefits). I would also feel guilty for either working too much and taking a "real" nurse's time or for not working enough when the unit was busy. 

Matt Jones, a PRN ICU nurse, also struggles with feeling like he lets his team down when he's unable to pick up shifts as often as he would like, due to childcare constraints.

"Today is an example," he told Nurse.org. "My unit is so short with such high acuity patients, and while I'd love to go to work, I don't have anyone to pick the kids up from school. I feel guilty when I get the texts, 'Hey, can you come in, we are drowning,' and because I say no so much, I feel kind of like a black sheep."

The Bottom Line

Right now, while some hospitals may be phasing out PRN nurses, it's not an industry-wide standard. It is still possible to find per diem nursing roles, but before you take on a PRN job, be sure you fully understand the requirements, pay, any applicable incentive pay (and the minimum required hours to work before that pay kicks in), and if your contract is subject to change at the manager's discretion. 

(And for the record, I did successfully find several PRN postings when I was job hunting, and even some without any weekend or holiday requirements, so they do still exist.)

PRN nursing can provide flexibility for both the hospital and the nurse, but like so many things with nursing, whether or not it's a positive experience could highly depend on the facility, unit, and manager.

"I think I have it pretty good as per diem where I'm at," Jones sums up. "But it can be tough, and it can be up to your manager and how they treat per diem staff."

🤔Nurses, have you noticed any changes in PRN roles at your hospital? Share your experience in the discussion forum below!