Pros and Cons of per Diem Nurses Journal

Health Care

The overall health care industry has undergone fundamental change over the last decade. Most of the changes have occurred within the underlying business operation of the healthcare industry. These changes will ultimately effect nursing administration as it continues to evolve and innovate. Legislation in particular has had a profound impact on the health care industry. First, due to the Affordable Care Act of 2010, the nursing profession is undergoing a fundamental shift in regards to the patient experience. The U.S. health care system is now shifting the focus from acute and specialty care to that of primary care which requires a shift in business operations. Also, due primarily to that aging of the baby boomer generation, the need for primary car overall is shifting and will be needed heavily in the future. The last 10 years in particular has seen an increasing influx of retiring baby boomers that subsequently need care. Nursing administration will therefore need to reflect these changes. A positive impact on the ACA legislation is that more individuals are now insured. As such, the need for primary care will also increase over subsequent years, particular within the minority population. This patient centric approach will require more care predicated on specific communities in a seamless manner. Furthermore, primary care physicians will be in high demand over the coming years. Nursing administration must therefore be able to attract and retain competent talent in the appropriate fields. Per Diem nurses will have a significant impact on the industry overall.

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Con- High demand combined with low availability

An alarming issue that has occurred over the past 10 years is the lack of potential primary care candidates. This lack of candidates will have a negative impact on per diem nurses. The practice overall has experience a modest decline of late as the number of medical students and primary care residents have declined. The overall profession of primary care has undergone a fundamental change due to regulation. For example, the VA uses primary care providers in all settings including inpatient and outpatient. Prior to the last decade, primary care practitioners were more concentrated on one specific aspect. Over the last 10 years, due to regulation, primary care practitioners are multi-disciplined in their approach to health. Many now serve as researchers and educators. This expansion of roles has occurred due primarily to more patient centric approach to primary care as it relates to the overall nursing practice. Due to this approach for the VA, both quality and outcomes have improved. Errors have diminished, patients are more satisfied, patient hospital stints are less, and the overall work environment is improved. Per Diem nurses will have to work harder as there is less workers within the industry overall. In addition, per diem nurses must work rigorously to learn new and often convoluted systems. This will cost the organization heftily as it must compensate for these costs. Inefficiencies of per diem nurses will have extensive costs on the organization. For one per diem nurses have a limited amount of time in regards to their shift and their work for the firm. It is very common for per diem nurses to work at multiple hospitals over a given time frame. As such per diem workers must first become acclimated quickly to their working environment, while also performing hefty tasks immediately.

Con- The rapid evolution of technology may make jobs obsolete or too difficult

Over the next decade, I believe technology will have a profound impact on the overall health care field. Technology is currently mitigating many of the problems that are pervasive within the nursing administration field. For example, online record keeping helps prevent fraud, and identity theft that has occurred with an over reliance on paper records. Furthermore, online records increases the operational efficiencies of the medical firm as less time is allocated to subsequent research and searching for records. Records can seamlessly and effortlessly be transferred irrespective of geographical distance. This allows for better treatment of patients, lowering the amount of time spent within the hospital, and subsequently enhancing the customer experience. Per Diem nurses must learn these systems in rapid fashion. As per diem nurses, their time is limited by the extent of their work. As such, the inefficiencies of learning new and innovative systems may adversely affect firms that use per diem nurses.

Pro- Required skill sets will change

In addition, I believe the biggest change within per diem nurses will occur within the personnel themselves. This will be to the benefit of the firm and the management of the firm. Education and a revised curriculum now call for a seamless transition from the classroom to the work environment (Fang, 2006). As a recent IOM report indicates, health care practitioners in the near future will have job requirements that are more business oriented. Health care practitioners will need to have a better understanding of quality management methods in addition to overall concepts of management to better aid the medical facility. As the health care system continues its rapid reform health care practitioners must also be cognizant of the effects these changes will have on their overall roles and responsibilities within the firm. This will subsequently involve a fundamental transformation of the roles and responsibilities of health care practitioners as they enter the profession. As the health care landscape continues to change, so too must the health care practitioners of the future. A dedication to continual learning is therefore needed to help diminish the influence of antiquated and obsolete knowledge regarding the profession. This will ultimately will allow per diem associates to have a more meaningful impact on the organization and management overall.

Pro- Per Diem Nurses will become more productive through use of technology

These elements collectively improve the quality of health care by providing a more customer centric approach to the underlying business operations of the health care facility. The improve efficiencies provides clients with more quality time with medical personnel. The efficiencies reduce errors in diagnosis and treatment within the facility. The cost savings can be allocating to hiring, training and retaining better talent within the medical profession. Through IM and IT management, processes will also be quicker and more seamless. This reduction in time allows medical practitioners to spend more time on their clients needs as well. Through IM and IT management, all the above mentioned components are improved, which translates into a better overall customer experience within the medical facility. Per Diem associates must therefore become very knowledgeable regarding technological advances occurring in the industry.

As I mentioned in detail above, technology will help improve efficiencies within the health care profession within the coming decade. Patients will benefit from less errors, more timely results, lower bills, and less time spent within the hospital. This is all garnered through increased technologies that will only get better as time passes. Technology will also be better able to alleviate many of the health concerns that plague the world. Technology for instance, can help improve the success rate of surgeries across the world. The increased cost savings garnered through technology can help alleviate the cost burden placed on society. Medications that were once expensive can now be cheaply produced through economies of scale. This allows vaccines and antidotes to be distributed to the masses without incurring substantial costs on a per unit basis. Technology can also provide lower cost solutions in regards to the overall budget of a facility. Malpractice and errors are both costly for the institution, the patient, and the practitioner. By minimizing the prevalence of these errors on a daily basis, money set aside in the event of a terrible outcome will be reduced. These reduced loss provisions can then be used for more productive means such as investing in new, more accurate equipment, or hiring competent personnel (Lucia, 2009). The methods by which technology can help the health care profession are nearly limitless. It is through this technology that lives will be saved both physically and financially.

Strengths and Weaknesses

To continue, per diem nurses have many strengths and weaknesses that correlate directly with how the firm implements their use. For instance, as mentioned above, technology can positively effect nurse performance, from a management perspective, if it is easy to implement and intuitive. Per diem nurses often have limited time, and work with numerous hospitals. These hospitals may have very disparate systems and methods. Therefore, when using per diem nurses, management must be cognizant of their ability to easily and seamlessly adapt. To facilitate this transition, methods, technology, and overall operations must be intuitive. A strength of the use of per diem nurses is the ability to shift labor when demand dictates. Per diem nurses are often temporary by nature. They often work defined shifts within a limited time frame. As such, management can place per diem nurses in areas that are best suited for the overall business. This often reduces cost from the management perspective as nurses are not used when they are not needed. By shifting demand and having temporary workers, management can reduce costs and place labor in the most productive areas of the firm.


To remedy many of the negatives occurrences described above regarding per diem associates, reform must occur within the industry overall. My recommendation would be to help streamline processes within organizations to make a seamless transition for per diem nurses. This transition will mitigate many of the negative aspects mentioned above. Technology should be used that is simple and intuitive for per diem nurses to use without the risk of error. For example, the document discusses the rapid evolution of technology. Firms should not adopt innovative technology unless the general population of workers can easily implement the proposed technological solution. In addition, training will become vital to the increase the efficiencies of the overall nursing profession. My recommendation will encourage proper training of associates to better prepare them for the coming technological evolution in minimal time. In addition, I would create a seamless integration of technology that is seamless to help minimize the risk of error from per diem nurses. I would also institute training to help nurses better acclimate to the culture of my department within the health care firm.


In conclusion, as discussed in detail above, per diem nurses have numerous pros and cons in regards to management. For one, there is declining number of qualified nurses. Second, technological advances require massive amounts to training. Third, particularly due to legislation, the skill set needed to perform the job has changes. All of which has created a negative atmosphere regarding per diem nurses. However, many nurses have skill sets that transcend tradition roles. These skills include leadership, business, motivation, and team building. All of which is needed to compete in a more dynamic environment. In addition management can place nurses in high demand areas within the firm which reduces client wait times, while also enhancing customer service. When the nurse is no longer needed, management can simply allocate the labor to more productive areas within the firm. As such, as with many industries, there are many pros and cons to per diem nurses. However, when viewed in a holistic manner, the benefits seem to outweigh the costs associate with them.


1) Draper, Elaine, Joseph LaDou, and Dan J. Tennenhouse. 2011. “Occupational Health Nursing and the Quest for Professional Authority,” New Solutions 21, 47 — 81

2) Fang, D., Wilsey-Wisniewski, S.J., & Bednash, G.D. (2006). 2005-2006 enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: American Association of Colleges of Nursing

3) Levsey, K.R., Campbell, D., & Green, A. (2007). Yesterday, Today, and Tomorrow; Challenges in Securing Federal Support for Graduate Nurses. Journal of Nursing Education, 46(4), 176-183

4) Lucia, Patricia R.; Otto, Tammy E.; Palmier, Patrick A. (2009). “Chapter 1

Performance in Nursing.” Reviews of Human Factors and Ergonomics 5: 5 — 39

5) Charles Maynard and Michael K. Chapko. Data Resources in the Department of Veterans Affairs Diabetes Care. May 2004. 27:b22-b26; doi:10.2337/diacare.27.suppl_2.B22

6) Journal of Clinical Epidemiology Volume 54, Issue 12, December 2001, Pages 1195-1203

7) Accuracy of the VA databases for diagnoses of knee replacement. Osteoarthritis and Cartilage, Volume 18, Issue 12, December 2010, Pages 1639-1642

8) Creating a sampling frame for population-based veteran research: Representativeness and overlap of VA and department of defense databases. Journal of Rehabilitation Research and Development Volume 47, Issue 8, June 2002 pp. 763-772

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