Healthcare facilities do not have the same staffing needs
every day. Patient numbers change, staff take leave, seasonal illness adds
pressure, and sudden absences can strain the whole team. Knowing when to use
per diem nurses is part of smart healthcare facility staffing. These nurses are
one of the flexible staffing solutions for healthcare facilities when
short-term demand rises.
For facilities exploring per diem healthcare staffing in Canada, this model
can offer a practical way to respond to changing workforce needs while
maintaining reliable patient care.
Per diem nurses work on an as-needed basis, not a fixed
full-time schedule. They may take single shifts, cover busy periods, or step in
for absent staff. This helps facilities add support without hiring permanent
staff too soon.
Yet per diem staffing should be used with care. Used well,
it can support safety, protect the core team, and keep care steady.
What Is a Per Diem Nurse?
"Per diem" means "per day." A per diem
nurse works shifts based on a facility's needs and the nurse's availability.
Unlike a permanent employee with set weekly hours, a per diem nurse works only
when extra help is needed.
Per diem nurses can work in a range of settings, including:
Hospitals
Outpatient clinics
Skilled nursing facilities
Rehabilitation centers
Long-term care facilities
Home health services
Urgent care centers
Community health organizations
These nurses may be hired directly or through a staffing
agency. Many are used to different settings, so they can join a team quickly if
onboarding is clear.
1. When Patient Numbers Rise Suddenly
Patient demand can change quickly. A hospital may see a
sudden rise in admissions, an emergency department may become extra busy, or a
care facility may receive several new residents in a short time.
If the team cannot safely handle the extra work, per diem
nurses can help close the gap. They give facilities access to extra clinical
support without forcing a long-term hiring choice before leaders know whether
demand will last.
This can be especially useful when patient volume is hard to
predict. By bringing in qualified nurses for specific shifts, managers can
react to real-time demand and reduce pressure on permanent staff.
This makes per diem staffing for nursing shortages especially valuable when a
facility needs qualified support quickly but does not yet require another
permanent hire.
2. During Seasonal Surges
Certain times of year put more pressure on healthcare
services. Flu season, winter lung illnesses, extreme weather, and local
outbreaks can all increase patient numbers. Holidays may also create staffing
problems because more permanent employees requested leave.
Per diem nurses can help prepare facilities for these known
periods. Instead of waiting until staffing reaches a critical point, managers
can build a pool of approved per diem professionals and schedule extra support
ahead of time.
Planning early can help facilities:
Maintain safe nurse-to-patient ratios
Cover planned annual leave
Reduce last-minute scheduling problems
Keep care going
Respond well if demand rises above expectations
A planned per diem strategy is often better than trying to
find available professionals after a surge has already started.
3. To Cover Short-Term Employee Absences
Even well-staffed facilities have short gaps. Nurses may be
absent because of illness, family duties, annual leave, training, parental
leave, or other personal reasons.
When an absence is likely to last only a shift, a few days,
or a few weeks, hiring another permanent employee may not be practical. Per
diem nurses can provide temporary cover while the absent employees keep their
regular role.
This approach can also stop other team members from taking
on extra shifts again. Although occasional overtime may be manageable, relying
on it too often can lead to fatigue, unhappiness, and burnout.
4. When Permanent Employees Are Reaching Overtime Limits
Overtime is sometimes needed, but it should not be the main
answer to ongoing staffing gaps. Nurses who work long hours often may feel
physical and mental fatigue. In a clinical setting, fatigue can affect focus,
communication, and overall wellbeing.
Per diem nurses can help spread the work more evenly.
Facilities can use them to fill open shifts before asking permanent staff to
work too many hours.
Reducing overtime may also help control labor costs. The
exact cost will depend on local pay rates, contracts, agency fees, and overtime
rules. Even so, per diem staffing gives managers another option when comparing
staffing solutions.
One of the benefits of per diem staffing is that facilities can strengthen
coverage only when it is needed, rather than adding fixed hours to the schedule
throughout the year.
5. While Recruiting for Permanent Positions
Healthcare hiring can take time. A facility must post the
opening, review applications, interview candidates, complete checks, and
support the selected person through onboarding. Meanwhile, patient care must
continue.
Per diem nurses can provide cover while the organization
searches for the right permanent employee. This can reduce pressure to make a
rushed hiring choice just because a shift must be filled.
Temporary support can be especially useful when:
A permanent employee resigns without warning
A new unit is being launched
A role needs special clinical experience
Background checks or credential checks are taking longer than expected
The chosen candidate must finish a notice period before starting
Per diem staffing does not replace strong permanent hiring,
but it can give a facility time to recruit with care.
6. When a Facility Needs Specialized Skills
Some patients need clinical skills that are not available on
every shift. A facility may briefly need a nurse with experience in critical
care, emergency nursing, pediatrics, behavioral health, rehabilitation,
dialysis, or another specialty area.
A properly qualified per diem nurse can strengthen the team
for a given case, procedure, or busy period. This allows the facility to access
special expertise without creating a permanent role that may not be needed all
year.
Facilities should still verify every nurse's license,
credentials, experience, and skills before assigning clinical duties. A nurse
should never be placed in a specialty setting based only on general nursing
experience.
7. During New Service Launches or Periods of Growth
Opening a new unit, extending hours, or starting a new
service can make staffing needs hard to predict. Leaders may not yet know how
many patients will use the service or which shifts will be busiest.
Per diem nurses can give flexibility during this early
stage. The facility can adjust staffing as demand grows and use real data to
decide how many permanent employees may eventually be needed.
This approach can also support healthcare organizations
expanding into new locations. Per diem staff can help keep coverage in place
while permanent teams are hired and trained.
8. To Support Staff Training and Development
Permanent employees need time away from their usual duties
to complete required training, attend professional development programs, or
learn new systems and procedures. However, facilities may struggle to release
nurses from the floor when staffing is tight.
Per diem nurses can provide shift cover while permanent team
members attend training. This helps the organization invest in employee
development without leaving clinical areas short of staff.
The same idea applies when new technology, documentation
steps, or compliance rules are introduced. Extra temporary cover can give
employees the time and attention they need to learn without putting patient
care under extra pressure.
9. When Reducing Burnout and Improving Retention
Persistent understaffing affects more than the schedule. It
can increase stress, lower morale, and leave employees feeling that they cannot
take time off without burdening their coworkers.
Using per diem nurses during demanding periods can give the
core team important relief. Permanent staff may have more manageable workloads,
better access to leave, and fewer requests to work extra shifts.
Per diem staffing alone will not solve burnout. Facilities
must also think about leadership, workload, scheduling, workplace culture, and
employee support. Still, flexible staffing can be part of a wider retention
plan by reducing avoidable pressure on the core team.
10. To Maintain Safe and Consistent Patient Care
The most important reason to use per diem nurses is to
protect the quality and smooth flow of care. When too few nurses are available,
response times may rise, workloads may become too many, and key tasks may be
delayed.
Per diem nurses can help maintain coverage when
the alternative would be operating with serious staffing gaps. They may also
help keep beds, units, or services open when qualified staff are not
free.
However, the decision should be based on patient needs and
staff skills, not just the number of people on the schedule. Managers must
think about patient acuity, team experience, care complexity, and the level of
supervision available.
How to Use Per Diem Nurses Effectively
Per diem staffing works best when it is part of a planned
workforce strategy. Healthcare facilities should consider these steps.
Forecast Demand
Review past patient volumes, planned leave, seasonal trends,
and overtime use. This can show the shifts and periods most likely to need
extra support.
Build a Reliable Staffing Pool
Work with trusted per diem nurses or a reputable staffing
partner. A familiar group of professionals is more likely to know the
facility's expectations, systems, and work setting.
Confirm Credentials and Skills
Verify licenses, certifications, background checks, health
requirements, and relevant clinical experience before a nurse begins work.
Requirements should be reviewed often and recorded clearly.
Provide a Clear Orientation
Even experienced nurses need to understand the facility's
policies, escalation steps, documentation systems, emergency rules, and
unit-specific expectations. A short but complete orientation can improve safety
and confidence.
Communication Assignments Clearly
Per diem nurses should know the shift time, location,
patient group, required skills, dress code, and contact person before arrival.
Clear communication cuts confusion and supports a smoother start to the shift.
Monitor Quality and Performance
Facilities should collect feedback from supervisors,
permanent staff, and per diem nurses. Attendance, clinical work,
professionalism, and patient safety should be reviewed as if they would be for
other workers.
When Per Diem Staffing May Not Be the Best Fit
Per diem nurses are useful, but they are not the answer to
every staffing problem. If a facility has the same gaps on the same shifts
every week, the organization may need more permanent or part-time staff. Heavy
use of temporary staff for core needs can affect care flow, team ties, and
long-term cost.
Per diem staffing may also be less suitable when a role
needs deep facility-specific training, long-term patient relationships, or
detailed knowledge of highly specialized internal steps.
When leaders compare healthcare staffing models, they should consider demand,
continuity of care, workforce costs, required skills, and how long each staffing
gap is expected to last.
The best workforce model often combines a stable permanent
team with flexible help with real changes in demand. These hospital staffing
strategies work best when they are planned, not rushed.
Conclusion
Healthcare facilities should consider using per diem nurses
when they need qualified help for short-term absences, seasonal surges,
unexpected patient demand, hiring gaps, specialized care, or periods of growth.
Used well, per diem staffing can help maintain coverage, reduce extra overtime,
and protect permanent staff from needless pressure.
The key is to treat per diem nurses as part of a structured
staffing plan. Careful forecasting, credential checks, clear communication, and
good orientation helps these professionals fit into the clinical team more
smoothly.
With the right approach, per diem nurses can give healthcare
facilities the flexibility to respond to changing needs while still providing
safe, steady, and patient-centered care.