For years, per diem was the call you made when everything else fell through. When the travel contract expired, the float pool was tapped, or the charge nurse had already texted three people; per diem filled the gap.

However, that pattern has shifted with hospitals turning per diem into a deliberate staffing strategy. It’s being seen as the foundation of a flexible healthcare workforce, and the latest forecast from Staffing Industry Analysts shows where that shift is heading.

The forecast, and the part that gets missed

SIA’s September 2026 US Staffing Industry Forecast projects the healthcare staffing market will grow 1% in 2026 to $39.0 billion, then 3% in 2027 to $40.1 billion. After three straight years of contraction, the market is expanding again. Travel nursing leads the headline numbers at 2% growth in 2026 and 3% in 2027.

Per diem nursing is the easiest line in that table to misread. Revenue is down 7% for 2026, the sharpest drop in the forecast, with stabilization expected next year.

But that revenue decline can mask rising utilization as facilities shift hours from higher-cost travel contracts to local per diem. SIA points to hospitals turning to local per diem as a lower-cost alternative to travel assignments. Per diem revenue can fall while per diem usage rises, because a local clinician costs a fraction of a 13-week travel contract with housing and premium pay attached. A facility can move hours out of travel and into per diem, cover the same schedule, and spend less. The revenue line shrinks, even as the staffing model gets stronger.

The math that pushed leaders here

The 2026 NSI National Health Care Retention & RN Staffing Report puts RN turnover at 17.6% and the national RN vacancy rate at 8.6%. The average hospital carries 43 unfilled RN positions. Over the past five years, the average hospital has replaced more than its entire RN workforce.

Nurse satisfaction sits at 47% in the 2026 Nurses.org survey, down from 55% a year earlier. Twenty-three percent of nurses say they are at least somewhat likely to leave the profession within the year, while fifty-three percent report burnout.

CFOs spent 2021 through 2024 buying their way out of those gaps with agency contracts. It worked as triage, but failed as strategy. Taking action reactively with premium coverage stabilized a unit for a quarter but left the underlying schedule just as fragile, with a bigger line item attached.

What a per diem bench does

A bench is a pool of credentialed local professionals who have already worked your floors. They know where supplies live. They know your charting system. Your charge nurses know their names.

The operational difference shows up in three places:

1. Fill speed. A shift posted to clinicians who have worked the unit fills faster than a requisition sent to an agency desk.
2. Consistency. Repeat workers need less orientation, and your permanent staff stop absorbing the ramp-up cost of a stranger every week.
3. Cost per filled shift. Local rates, no housing stipend, no minimum contract length.

Medely built its Favorites feature for this. Instead of posting a shift to everyone and hoping someone takes it, the hospital offers it first to a “preferred” group of clinicians they already know and trust. In other words, the hospital keeps a list of nurses who’ve worked there before and performed well.

When a shift opens up, they offer it to that list first, and because these clinicians already know the unit, it’s faster and less stressful to fill shifts. Ultimately, it helps full-time staff because they don’t have to keep covering every last-minute gap.

Per diem vs. travel nursing cost: what the bench actually saves

The comparison usually stays theoretical until a facility runs its own numbers. Lincoln Glen, a skilled nursing facility in the San Jose area, built a Favorites-first bench with Medely starting in 2022. Over four years and 1,926 completed shifts, the facility held a 96.6% fill rate and averaged 22% savings against traditional agency staffing. Seventeen favorited professionals covered 55% of those shifts, and its top clinician worked 154 shifts over 592 consecutive days.

That is the per diem vs. travel nursing cost math in practice: no housing stipend, no 13-week minimum, and a fill rate that rivals what most facilities expect from a far more expensive contract.

Where per diem becomes the default

Hospitals are not abandoning travel nursing altogether. It still makes sense for strike coverage and seasonal surges, and for hard-to-fill specialties that justify a contract. The default has flipped: facilities are building the local bench first and using travel only for exceptions.

Per diem has moved from the backup plan to the foundation of the schedule. Building that bench is becoming the default per diem staffing strategy for any facility serious about a flexible healthcare workforce, and the facilities making that shift now will spend the next two years with steadier coverage and a smaller agency bill than the ones that wait.