External Nurses
Part 3 · Chapter 4

External Travel & Per Diem Nurses

Managing external travel nurse assignments and per diem programs to maximize flexibility and minimize costs.

5 min read

External Travel & Per Diem Nurses

The same discipline applied to internal programs should extend to external travel nurse labor. The first question: can the organization eliminate external travel nurses entirely? If so, focus on internal programs. If some external labor is needed, build effective management practices around it.

A healthy workforce should only have about 2% to 5% labor spend reserved for external labor to manage census swings, seasonal challenges, and unpredictable staffing needs.

Travel Nurse Assignments

If you hire travel nurses for standard 13-week assignments, the best approach is to hire them into the float pool either for the hospital or at the system level. Build the 6-week schedule so they know the days they work but not where. The staffing office should assign the traveler to the unit 1.5 hours before the start of the shift.

Best Practice
Assess the type of specialty travel nurses you need (critical care, step-down, labor and delivery) and assign them to the float pool for their 13-week contract instead of an individual unit. This gives you the most flexibility.

External Per Diem Nurses

Consider using per diem external labor in addition to traditional travel assignments. The external per diem program offers organizations the opportunity to secure labor the day it's needed, at a lower bill rate than traditional traveler cost.

To be successful:

  • Work with travel companies (vendors) who can supply local external talent
  • Onboard at least two to three suppliers for ample supply
  • Onboard a pool of per diem nurses (skills, competencies, background checks)
  • Orient them to preferred areas
  • Place per diem nurses into the active group of cleared workers

Use mobile technology that integrates with your scheduling technology to automate the process end to end and allow organizations to scale pools from fewer than 50 to over 1,000 nurses.

Analyzing Effectiveness

Analyze the effectiveness of each flexible program by reviewing:

  • Retention and recruitment metrics
  • Staffing outcomes
  • Vacancy and productivity metrics
  • Qualitative results from surveys and meetings

Review on a quarterly or biannual basis for the first year. After the first year, move to annual evaluation.