Part of the Nurse Side Hustle Hub — browse every related guide in one place.
Per diem nursing — also called PRN (pro re nata, or "as needed") work — is the highest-paying hourly nursing role in most markets. No benefits, no guarantee, but complete schedule control and rates that beat most staff positions by 20-40%. Here's everything you need to know to make it work.
Per diem nurses work on a shift-by-shift basis — no set schedule, no commitment to a minimum number of hours. Facilities post open shifts, you pick the ones that work for you, show up, complete the shift, leave. No politics, no unit meetings, no mandatory in-services.
The trade-off: no benefits (health insurance, retirement, PTO), no job security, and during periods of census decline, no shifts to pick up. It works best as either a primary income strategy (high earners who self-insure) or a supplement to a staff or travel position.
Rates spike during staffing crises, on holidays, and for difficult-to-fill shifts (3 AM Sunday, holiday weekends). Some platforms now run bidding systems where rates increase as shift start time approaches without a fill.
Internal per diem at your current employer: The easiest start. Most hospitals allow staff nurses to add a PRN designation. You pick up extra shifts when posted, at a higher rate than your staff rate. No new credentialing, no new orientation.
Agency per diem: Apply to staffing agencies (AMN Healthcare, Cross Country Nurses, Aya Healthcare, local regional agencies). You'll go through credentialing (background check, drug screen, skills assessment), then gain access to a pool of shifts across multiple facilities in your area.
Float pool positions: Hospital-employed float pools offer per diem or part-time positions where you float across units. Pays a premium, requires a broad skill set, but gets you access to high-volume shift availability.
Gig platforms: Apps like Clipboard Health, Intelycare, ShiftMed, and NurseGrid connect nurses directly to facilities with open shifts. In some markets, these platforms have the best rates because they cut out the agency middleman. In others, facility quality varies — read reviews before accepting a new facility.
Clipboard Health: Strong in urban markets (CA, TX, FL, NY). Instant payment options. Rates competitive. Best for ICU and specialty nurses who can screen facilities before accepting.
Intelycare: Strong in long-term care and SNF markets. Rates very high in LTC where staffing crises are severe. Not ideal for acute care nurses who want hospital settings.
ShiftMed: Growing presence in acute care. App-based scheduling with decent rating systems for facilities.
NurseGrid: More of a schedule management tool that also connects to open shifts. Good supplementary platform.
Nurses targeting financial independence use per diem strategically: staff a 3-day-per-week position for stability and benefits, then fill 1-2 per diem shifts per week at premium rates. A nurse at $65/hour base earning $75–80/hour for per diem on their days off adds $1,500–2,000/month in gross income with minimal additional lifestyle change.
The key is picking per diem shifts at different facilities than your employer to avoid conflicts of interest and to maintain access to multiple shift pools.
Per diem nursing income is always taxable W-2 income (from agencies or facilities) or 1099 income (rare, from some gig platforms). Unlike travel nursing, there are no stipend structures — what you earn per hour is what's taxable.
If you're doing per diem as an S-Corp contractor (uncommon but it exists in some markets), consult a nursing-specialized CPA. The tax savings can be significant but the setup overhead is real.
Calculating your next move?
Use the Travel Nurse Contract Calculator to compare assignments by take-home pay — stipends included.
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