Updated July 2026 · 7 min read
Per diem nursing — picking up shifts as needed at a flat hourly rate without a guaranteed schedule — is the most flexible way for nurses to earn extra income using their existing license and skills. Done strategically, it can add $15,000 to $30,000 per year on top of your primary income. Here's how to find per diem positions and maximize what they pay.
Your own hospital first: The easiest per diem position to land is at your own employer. Most health systems maintain a float pool or per diem pool that allows staff nurses to pick up extra shifts. Ask HR or your manager about the internal per diem pool — at many facilities, staff nurses can add per diem status at a higher hourly rate for shifts picked up beyond their scheduled hours.
Other hospitals in your area: Many hospitals near your primary employer will hire per diem nurses — you just need a separate application and orientation (usually 1 to 3 days). Having per diem credentials at 2 to 3 facilities in your metro area dramatically expands your shift availability, especially useful if one hospital has low census while another is slammed.
Staffing agency per diem: Agencies like Aya Healthcare, AMN, Cross Country, and regional agencies also place per diem (local) nurses in addition to travel nurses. You pick your shifts, decline what you don't want, and can often earn more per hour than a direct hospital per diem rate — though you'll typically be self-responsible for benefits.
Gig-style nursing apps: Platforms like Clipboard Health, ShiftMed, and CareRev connect nurses directly with facilities for per diem shifts. These platforms often pay same-day or next-day and require minimal onboarding. ICU nurses are in particularly high demand on these platforms — critical care shifts are harder to fill than med-surg.
| Position Type | Typical Hourly Premium Over Staff Base |
|---|---|
| Internal per diem (own hospital) | +$3–$8/hour |
| External per diem (other hospital) | +$5–$15/hour |
| Agency local per diem | +$10–$20/hour (no benefits) |
| Incentive/crisis shift bonus | +$15–$40/hour above base |
An ICU nurse earning $40/hour base who picks up agency per diem at $55/hour is earning 37.5% more for the same clinical work. Over 6 extra shifts per month, that's roughly $1,620/month in additional income — $19,440 per year. The math compounds quickly when you add in holiday and high-demand shift bonuses.
Not all per diem shifts pay the same. Facilities pay premiums for the hardest-to-fill times. The highest-paying windows are typically:
Set up alerts on any per diem apps you use so you see last-minute postings immediately. The nurses who earn the most from per diem are the ones who are responsive and available for urgent fill requests — not the ones who browse casually a week in advance.
Many nurses assume their primary employer has no say over outside per diem work. That's not always true. Some health systems include non-compete-adjacent clauses in employment contracts or have conflict-of-interest policies. Review your employment agreement and understand whether you need to disclose outside employment. At most systems there's no issue, but being surprised mid-tax-season is avoidable.
If you work per diem through an agency that pays W2, taxes are withheld normally. If you work through a gig platform that pays you as a 1099 contractor (increasingly common), you're responsible for self-employment tax (15.3% on top of income tax) plus making quarterly estimated tax payments. Budget approximately 25 to 30% of 1099 per diem income for taxes. The advantage of 1099 income is that it opens SEP-IRA contribution space — see our travel nurse retirement guide for how to leverage this.
Related: Travel nurse tax home · Legal nurse consulting · Nurse educator side income
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