Per diem nursing has become a central feature of healthcare workforce planning in the United States. As staffing shortages persist across hospitals, long-term care, and post-acute settings, per diem staffing is now embedded in operational strategy rather than used as occasional backup coverage.
According to the U.S. Bureau of Labor Statistics, registered nurse employment is projected to grow 5 percent from 2024 through 2034, resulting in an estimated 189,100 job openings annually (Bureau of Labor Statistics, 2024). Despite this growth, national labor analyses conducted in 2025 estimate a full-time equivalent RN shortfall of approximately 78,610 positions, indicating a sustained gap between supply and demand (AAG Healthcare, 2025).
Workforce exits remain a significant driver of staffing instability. The National Council of State Boards of Nursing reported that more than 138,000 nurses left the workforce between 2022 and 2024. In the same survey, nearly 40 percent of RNs and more than 40 percent of LPNs and vocational nurses stated they plan to leave or retire by the end of the decade (NCSBN, 2025). These trends continue to compress the available labor pool across care settings.
The combination of high demand for nurses and elevated voluntary exit rates produces a persistent structural imbalance in healthcare staffing. Hospitals and care facilities must maintain regulatory staffing ratios while responding to fluctuating patient volumes, making flexible labor models a permanent component of workforce design.
By 2026, per diem nursing is fully integrated into healthcare staffing systems. Per diem clinicians are routinely used to fill coverage gaps caused by turnover, unexpected absences, census surges, and post-acute demand variability. A 2025 national workforce trends analysis found that flexible staffing models, including local per diem pools, remain among the most widely implemented strategies for maintaining staffing resilience and continuity of care (symplr, 2025).
Per diem staffing allows healthcare organizations to stabilize shift coverage without exclusive reliance on external agency labor. Local per diem pools also improve speed of deployment and continuity relative to temporary travel staffing.
For registered nurses, licensed practical nurses, and certified nursing assistants, per diem work offers meaningful scheduling control, shift selection autonomy, and the ability to regulate exposure to high-acuity workloads. In an environment where many full-time roles remain operationally intense and unpredictable, per diem nursing provides a mechanism for sustaining long-term clinical participation while supporting personal recovery cycles.
Per diem employment does not eliminate the physical and emotional demands of bedside care. Nursing workforce surveys continue to identify stress, emotional fatigue, and burnout as primary contributors to workforce exit across employment types (NCSBN, 2025). These risks remain present regardless of employment classification.
Per diem nursing is expected to remain a foundational element of healthcare staffing strategy through 2026 and beyond. Its effectiveness depends on how well it is integrated into a balanced workforce structure that includes stable core staff, internal per diem pools, and long-term retention infrastructure.
Healthcare organizations that embed per diem staffing within a coordinated labor ecosystem are better positioned to sustain coverage, regulatory compliance, and continuity of patient care under ongoing demand volatility. Isolated or reactive use of per diem labor offers limited long-term protection against workforce instability.
