How PRN and per diem healthcare work works

What PRN and per diem mean

In healthcare, PRN and per diem are used almost interchangeably for work you pick up as needed. A hospital, nursing home, clinic or dental office posts a shift it needs covered, and you choose whether to take it. Some people work PRN as their only job; many add a few shifts on top of a full-time role.

Employers use these words differently, so read the details. Some PRN roles expect you to work a minimum number of shifts a month, a weekend rotation or some holidays. Others have no minimum at all.

Who it suits

• People who want control of their schedule, such as parents, students and caregivers.
• Nurses and aides building experience in different settings (long-term care, acute care, home health, clinics).
• People between jobs or new to an area who want to try workplaces before committing.

The trade-off is predictability. Shifts can be canceled when a unit is fully staffed, and hours can swing week to week.

What gets checked before your first shift

Expect the employer (or the platform you use) to confirm, at minimum:

1. Your license or certification is active in the state where you'll work. Employers check the board's official lookup. For nurses, many use Nursys QuickConfirm, NCSBN's free lookup for participating boards.
2. Nurse aides are on the state registry. Federal rules require a nursing facility to get registry verification before someone works there as a nurse aide (42 CFR 483.35).
3. You aren't excluded from federal health programs. Employers commonly search the HHS Office of Inspector General's exclusion list.
4. Health and safety documents, which vary by employer and state. See the PRN credentials checklist.

Questions to ask about pay

• What's the hourly rate, and does it change for nights, weekends or holidays?
• When and how do I get paid?
• Will I be paid as an employee (Form W-2) or as an independent contractor (Form 1099)? This affects taxes, overtime and benefits. Federal agencies and each state apply their own tests (California uses the "ABC test"). See W-2 vs. 1099 healthcare work, and if you're unsure which applies to you, ask the employer and a tax professional.
• What happens if a shift is canceled? Ask whether there's a cancellation window or any pay for late cancellations.

To see what your role typically earns, compare an offer with the BLS wage data for your profession and state.

California notes

• License lookups: most California health licenses (RN, LVN, respiratory care, dental, PT, OT, SLP) are on the Department of Consumer Affairs License Search. CNA and home health aide certificates are checked through the California Department of Public Health.
• CNAs must keep their certificate current. CDPH requires 48 hours of in-service training or continuing education in each 2-year period, at least 12 hours each year.

Working PRN through SHIFTit

SHIFTit is a workforce platform that lets healthcare facilities work with SHIFTerz directly. You keep your credentials in one place, and they travel with you to every facility on the platform. See how it works for professionals.