Per Diem, Travel & Local Nurses in One System: Managing Mixed Shift Types

Nurse staffing companies don't operate only one type of shift. Instead, they have to deal with all three at the same time and even more than one for the same client, and even sometimes fill the same shift vacancy with each: per diem, travel, and local nurses. The scheduling software that they buy to manage this is usually designed with one employment type in mind and expanded for the other two.

The problems begin where the expansion takes place. Payment systems diverge. Consequences of call-outs diverge. Credentialing processes diverge. A scheduling system that views all three employment types as merely a variation of one record works just fine until it doesn't, which typically happens when the week that per diem no-show and travel nurse contract expiration coincide in the scheduler and nobody realizes which set of rules applied where.

This is not a discussion on whether travel nursing rates are on the way down or where the market is moving. This is an operations discussion about what you need your scheduling system to do when three employment types of nurses fill your shifts side by side.

The reason why it is important to pinpoint the problem here is that the challenge is neither the number nor variety of shifts per se. After all, many agencies have three kinds of shift systems in place without any problems at all. The problem lies in how the seams come into play where a certain decision about one kind of employment affects another, and the software is either able to reveal the overlap or not until it’s too late for the client, nurse, or payroll to spot it first.

Here’s what it means to have mixed shift systems, why one kind of scheduling system does not apply to all three, and what to consider first before committing to the platform’s handling of your entire roster.

What “mixed shift types” actually means

However, it may seem that per diem, travel, and local are merely three names of the same entity: a nurse that works shifts. In reality, these three terms refer to three types of relationship with different conditions applied to each.

• Per diem nurses are hired for each shift with no fixed schedule and minimum commitment in advance. These nurses can be readily assigned to different wards, and they earn money according to a flat or differential rate calculated for each shift, and not according to a contracted salary.

• A travel nurse works according to a contract, usually of 13 weeks' length, that provides him/her with certain guaranteed hours, blended compensation (base rate + housing & meals allowance), bill rate for the client, and is deliberately separated from the pay rate of the nurse. Also, credentialing should be renewed after each new assignment.

• Local nurses are W-2 staff with benefits, paid time off, seniority for scheduling preference, and an overtime policy based on labor law, not based on any contract.

And all of those differences- pay logic, notice period, call-out penalty, credentialing frequency, and scheduling preference must be represented accurately at once, in one system, without the rules of one getting mixed up with those of the other. A platform that only distinguishes shifts according to the shift type listed in the nurse's profile has not solved that problem; it has just put the problem in a dropdown menu.

Why one scheduling system for all three gets harder than it looks

A platform designed to accommodate only one type of shift is good at one aspect but hides the rest. Let us see how it manifests itself in practical terms.

Payment structures

Local staff payment is relatively simple: an hourly payment with an overtime structure. Per diem payment is typically a rate per shift with either a flat or differential structure without accrual of any benefits. Travel payment is the complex one, a combination of the base rate and housing/meals stipends, which can be 1099 or W-2, along with the bill rate to the facility, which should be distinctly separated from the actual nurse payment. Any system that holds "rate" as a single variable for each nurse will incorrectly calculate travel pay on both sides of the payroll and the client invoice, compounding each other.

Call-outs

There is an easy penalty attached to no-shows of Per Diem nurses; there won't be any booking of the nurse, and the agency will have to try filling the vacancy. In case of a travel nurse who is trying to end his contract prematurely, the whole new process of terminating the contract will kick in, and it may require the travel nurse to claw back any funds provided for lodging or travel which may have been paid in advance in many cases. The nurse calling out of the local nurse commences the process of attending through a progressive disciplinary process and a paid time off/sick time bank. Calling out of nurses with the use of a generic term in both processes means that either the agency is reacting too much against the Per Diem who was never obligated to show up in the first place or reacting too little to the travel nurse terminating his contract.

Credentialing timeline

Local staff credential only once at hiring and renew at fixed intervals thereafter. Travelers must have their credentials re-verified each time they are placed into a new facility, often against a fixed start date that the facility will not budge on. Per Diems rotating through departments must go through a separate competency verification process per department, and not just per facility. Any system that checks credentials only once, at the point of hiring, will get all this wrong, and the issue will generally arise when a traveler is sent to a unit they never got credentialed for.

Shift filling priority

Agencies generally have an order in which open shifts need to be filled: protect travelers' guaranteed hours first, offer per diems, and offer local core staff only as a last resort. Or something similar depending on the specific agreement the agency made with the facility. A simple open-shift board, with shifts being claimed on a first-come-first-served basis, will violate that order every single time it is used.

Onboarding and orientation cadence

Local staff undergo one-time orientation and become comfortable with the workflow in a unit through a process lasting months. The orientation process for per diem nurses requires a lightweight list of orientation steps that can be done before almost any shift at a new unit because the nurse may never have worked in this unit before. Travel nurses get an orientation procedure once at the beginning of each contract period and then nothing else until their next contract. An approach focusing on one kind of onboarding process may lead to over-processing per diem nurses with too much paperwork or under-processing travel nurses.

The question most agencies forget to ask

Solving one shift type efficiently is an easy problem. This risk is revealed the minute two shift types are placed into a schedule, since the pay, call-out, and credentialing policies for each do not converge, but rather coexist in parallel and require some way of resolution.

The question that really serves as protection in a discussion with a vendor would therefore not be "does your platform support per diem, travel and local employees?"

Sure, it does, as far as it supports three different tags to be stored. However, the actual question here would be:

"What is going to happen in my system when a per diem nurse cancels four hours before the shift begins, on the unit where a travel nurse's contract also expires in the same week?"

How to evaluate a platform for real mixed-shift-type coverage

When you’re talking with vendors, this is how you determine whether they’ve developed a system for a hybrid staffing roster versus a system tailored to only one roster and rebranded as hybrid. None of these questions are difficult. They are the questions a vendor who has developed a hybrid staffing system can readily answer, and the ones a vendor who has bolted per diem or travel onto their local-staff system will struggle with.

• Can the software model payment based on shift type and not by nurse record? Are base, stipend, and bill rates tracked separately by shift type, as well as differential rates for per diem nurses and local staff hourly + overtime and PTO, and produce accurate billing without a manual correction at month’s end?

• Does the software handle the call-out policies based on employment type? Shouldn’t the lack of confirmation for a per diem shift be a different process than contract termination for travel nurses, and isn’t it also completely different than an attendance write-up for local staff?

• How does the platform track credentialing expiration by individual assignment rather than per nurse? Does the system check licensure and competency upon each new assignment for travel nurses, and identify a per diem nurse who has not been credentialed for a particular unit?

• How is the shift-fill priority implemented? Can the user assign a preferred order of shift fills with travel time guaranteed first, followed by per diem, then local nurses, or any other order of his choice?

• How are the reports separated? Does the accounting department have the ability to generate reports with a clear separation between the three types of shifts, or do they need to reconcile the three manually each time?

If the platform cannot answer those five questions clearly, then it is not a multi-shift platform but a single-shift platform with workarounds attached to the other two.

Compliance and pay logic built in, not bolted on

There are two possibilities for why a platform winds up having to support a blended roster. One is that they knew they were going to have to account for per diem, travel, and local logic right from the start. And the other is that each new shift type is an afterthought – something bolted onto a platform that was designed with just one employment model in mind.

It’s easy to spot one of these in a demo. The bolted-on platform will tend to refer to the travel or per diem function as a module, a tab, or something to sell you in addition to your existing product, rather than as something built into the scheduling logic for your local employees. If your salesperson talks about your blended roster as three different products cobbled together, you’ll wind up having to do that yourself.

Within the company Staffinc, nurse staffing solutions are tailor-made based on the established model of the program, rather than offered as the pre-packaged solution, which means that pay logic, call-out escalation, credentialing cadence and shift filling prioritization for per diems, travel and locals could be included into the program as the starting point for the company that uses mixed shift roster, rather than three separate solutions that have to be tied together later. In case the company is expanding and working on multiple shifts, this small detail will determine whether managing the mixed roster will become an everyday thing or an ordeal each month.

The bottom line is not in the vendor’s “we cover all shift types” guarantee, but in the specifics of handling the differences within the solution itself.