In America’s healthcare system, one question looms large for administrators, HR managers, and care coordinators alike: how do you build a workforce that’s not just qualified, but sustainable, scalable, and smartly aligned with patient needs? The answer, as always, isn’t one-size-fits-all. From bustling urban hospitals to suburban Adult Foster Care (AFC) agencies, healthcare facilities are wrestling with how best to staff their operations—per diem, travel nurses, or full-time?
Each model comes with its own promises and pitfalls. Think of them like the cast of a long-running drama: the full-timers are your series regulars, offering stability and depth. Per diem staff are your recurring guest stars—versatile and cost-effective, but fleeting. Travel nurses? They’re your high-billing headliners, swooping in with skills and swagger, but often moving on before the credits roll.
So, how do you decide which casting strategy is right for your facility? Let’s break it down.
Full-Time Staff: The Backbone of Continuity
The Case For: Full-time healthcare professionals—RNs, LPNs, social workers, and case managers—form the heartbeat of any care facility. They’re embedded in the culture, familiar with your protocols, and often bring a sense of loyalty that’s hard to replicate.
This model is particularly critical in Adult Foster Care settings, where relationships and continuity of care are paramount. Patients often feel more secure seeing the same faces month after month. Full-time staff can also handle administrative tasks, coordinate multidisciplinary care, and flag subtle changes in a patient’s behavior or health—things a temporary staffer might miss.
The Caveat: With benefits, insurance, PTO, and the growing demand for competitive salaries, full-time employees come at a premium. Burnout is also a real concern. In a post-pandemic landscape, where turnover in healthcare has skyrocketed, relying solely on full-timers can put your facility in a bind if even a few staffers call out or resign.
“You can’t run a modern hospital on nostalgia,” says Sara Mitchell, HR Director at a mid-sized Boston hospital. “We love our long-timers, but the economics don’t always line up when we’re trying to fill three shifts a day, seven days a week.”
Best For:
Facilities with stable patient volume
Adult Foster Care agencies focused on long-term relationships
Organizations looking to build in-house leadership
Per Diem: The Swiss Army Knife of Staffing
The Case For: Per diem (Latin for “per day”) staff are the ultimate utility players. Hospitals and clinics lean on them to fill in last-minute gaps, staff holidays, or manage seasonal surges (hello, flu season). They’re often paid at a slightly higher hourly rate in exchange for the lack of benefits, making them a cost-effective solution when used strategically.
For clinics with fluctuating patient loads, or AFC agencies looking to onboard RN contractors for compliance visits, per diem staff can be a godsend. You get the skills without the long-term commitment or overhead.
“They’re flexible, they’re fast, and they’re used to hitting the ground running,” says Dr. Raj Desai, who runs a chain of urgent care centers in the Midwest. “But you have to be careful not to over-rely, or you start losing team cohesion.”
The Caveat: Per diem workers may not be as invested in your organization. They may work at multiple facilities, which can lead to schedule conflicts, orientation fatigue, or inconsistent patient experiences. Training them on your unique systems (EHRs, protocols, workflows) also takes time—time that’s in short supply when staffing is thin.
Best For:
Facilities that need last-minute coverage
AFC agencies hiring contract nurses for MassHealth compliance visits
Clinics with variable or seasonal patient traffic
Travel Nurses: High Skill, High Cost
The Case For: Travel nurses are licensed professionals who take on short-term contracts, often through staffing agencies, to work in areas facing acute shortages. They can arrive within days, already credentialed, experienced, and ready to tackle high-pressure environments. They’re often open to night shifts, weekend rotations, and hard-to-fill departments like ICU or oncology.
During COVID, they were the heroes flown in from out of state, plugging the gaping holes in ER staffing from New York to Los Angeles. Even now, in a post-pandemic world, travel nurses are vital in rural hospitals, behavioral health facilities, and AFC agencies expanding into underserved communities.
“Our entire expansion into western Massachusetts would’ve stalled without travel nurses,” says Anjalli Sidhu, CEO of OMNISTARR, a staffing firm specializing in healthcare workforce solutions. “They gave us room to breathe while we built a more permanent team.”
The Caveat: They’re expensive. Agencies may charge double or triple the hourly rate of a full-time nurse, and the contracts often include housing stipends, relocation bonuses, and other perks. Plus, travel nurses are temporary by nature. The revolving door can lead to fragmented patient care, lower morale among permanent staff, and administrative headaches.
Best For:
Hospitals with urgent staffing shortages
AFC or home care agencies piloting new geographies
Facilities needing niche skills for short periods
Mix and Match: The Modern Model
The savviest healthcare facilities are rejecting binary choices in favor of a blended staffing strategy. They maintain a solid core of full-time professionals, supplement with per diem staff for flexibility, and call in travel nurses to manage spikes or open new units.
This “portfolio approach” to staffing allows for resilience. It lets organizations scale up or down based on census, budget, and community need—crucial in a healthcare economy that’s still recovering from the pandemic’s aftershocks.
Technology is helping, too. Platforms like ShiftKey, Aya Healthcare, and OMNISTARR’s scheduling team let administrators post open shifts in real time, tapping into a regional network of credentialed professionals. Data analytics also help predict when staffing shortages might hit, allowing for proactive hiring.
“It’s not about finding the cheapest or even the most experienced option,” says Sidhu. “It’s about building a workforce that’s agile, compliant, and compassionate—no matter the badge color or shift status.”
So, What’s Right for You?
Here’s a quick cheat sheet to help you decide:
Facility Type
Best Primary Model
Suggested Supplement
Hospital (Urban)
Full-time Core + Travel
Per Diem pool for peak times
Community Clinic
Full-time + Per Diem
Occasional Travel for specialty care
Adult Foster Care
Full-time + Contract RNs
Travel RNs for new markets or emergencies
Rural Hospital
Travel + Full-time Hybrid
Per Diem from neighboring towns
Behavioral Health
Full-time therapists
Per Diem or Travel for RNs and aides
The Bottom Line
Staffing your healthcare facility isn’t just a logistical challenge—it’s a strategic decision that affects everything from patient satisfaction to regulatory compliance and your bottom line. In 2025, flexibility is no longer a perk—it’s a requirement.
Whether you’re caring for ten patients or a thousand, in a sleek urban tower or a quiet home setting, your staffing model should be as dynamic as the field itself. Because in healthcare, as in Hollywood, success hinges not just on talent—but on timing, teamwork, and the right cast for the role.
Want help building your ideal workforce mix? Companies like OMNISTARR specialize in tailored staffing solutions for Adult Foster Care, home health, and clinical settings. Learn more about how their model could work for you here.
