By JJ Ewing

On a busy Friday morning, an ICU nurse manager receives the dreaded call: two of her nurses have called out sick, and another has been reassigned to an understaffed floor. She scans the roster, but there’s no one left to fill the gap without stretching her already overworked team even thinner.

It’s a scenario that’s all too familiar to nurse leaders, HR leaders, and central staffing teams across the country as healthcare providers continue to struggle to meet patient demand. Historically, the choices were to increase the utilization of your current team with overtime or request a travel nurse on a 13-week contract. Both affect your culture and increase nurse turnover.
However, there is a new approach gaining momentum with healthcare innovators. These leaders are revisiting a time-tested solution: per diem nursing. Historically, this was the backbone of workforce management, allowing facilities to fill shifts with local workers. With the rise of contract and travel nursing, per diem models took a backseat.

Now, as the industry navigates high costs and workforce burnout, per diem nursing is experiencing a resurgence—powered by modern technology and on-demand platforms.

The evolution of healthcare staffing models
In the early 2000s, local nurses accounted for a significant share of healthcare staffing, offering localized flexibility to meet immediate patient needs. However, the introduction of MSPs (Managed Service Providers) in the 2010s catalyzed a shift toward travel nursing. Unknowingly, this created an assembly line for the travel nursing industry and substantially changed the economics of healthcare labor in health systems. Travel nursing grew from $4B in 2009 to $60B in 2022. This has been a huge drag on health system finances and has driven up the cost of healthcare nationally.

Balancing costs with per diem staffing
The cost of employing local per diem nurses has consistently been lower than that of travel nurses. According to SIA, facilities can save $20–$25 per hour by leveraging per diem staff instead of travel nurses. However, managing large volumes of part-time workers has historically been a logistical challenge.

Two key factors have shifted this dynamic:

Increased interest in flexible work: The demand for part-time work among nurses has skyrocketed. In a survey, 78% of nurses identified schedule flexibility as their top priority, making it the #1 driver of satisfaction and retention.

Advances in technology: Mobile and cloud-based platforms now provide health systems with 24/7 access to an on-demand float pool. These tools streamline processes like credentialing and compliance management while offering features such as instant pay and transportation, enhancing the overall on-demand experience for both staff and administrators.

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