The Pros and Cons of Being a PRN Occupational Therapist
PRN occupational therapy: There is a lot to say about it, and because I’ve been a PRN (or per diem) occupational therapist for over five years now, I really wanted to share my PRN experiences (the good AND the bad).
In this article, I cover both the pros and cons of working as a PRN occupational therapist. This will help you decide if it’s the right career move for you. This pros/cons list is applicable whether you’re a new grad or a full-time OT or COTA with experience.
But first, what does being PRN even mean?
Derived from the Latin phrase “pro re nata,” PRN stands for “when necessary,” as circumstances require, or as needed (MedicineNet). This definition sums it up perfectly for OT, as a PRN OT is hired to work as much as the facility needs. I want to add that this can equate to just part-time hours or regular full-time hours depending on your facility.
The Pros of Being a PRN Occupational Therapist
PRN hourly rates are considerably higher than the same full-time OT position due to the lack of benefits and PTO that the facility does not have to cover for PRN therapists.
For example, where I live (Atlanta, GA) an average hospital hourly rate for full-time new graduates is around $29-31. The PRN rate ranges by hospital from around $45-50 an hour, whether or not you’re a new grad.
Before starting my PRN position, I did the math of what I would be covering myself with benefits, lack of PTO, etc. and the numbers still worked out quite a bit better for me with the higher PRN hourly rate.
Another thing to take note of is that hospitals oftentimes pay their full-time OTs a salary (averaging the $30/hour for a 40-hour workweek). However, as many OTs can attest, salaried therapists are often working more than their scheduled 40 hours a week and may not be getting paid for the extra time.
PRN therapists, however, almost always clock in hourly, so any extra time they put in is actually paid for by the facility.
For more in-depth data on the pay differences of full-time and PRN OT, be sure to check out our article covering OT/COTA Salary Data from 2,322 Therapists here.
The flexibility of working when you want and taking off when you want is my favorite aspect of working PRN.
PRN positions typically have some weekend and holiday requirements, but you are not required to work a set schedule or set number of hours. If working five days a week becomes too physically and mentally exhausting, you are under no contractual obligation to work the traditional M-F schedule.
If you want to take a month or more to travel the world, you can! Want to work 3 days a week based on childcare schedules? You can do that too!
Alternatively, if you do want to work five days a week like a full-time OT, you can do that as well (as long as your employer has PRN positions that have those available hours). I’ve now worked at two different hospitals in different states in acute care that almost always have full-time hours available for their PRNs.
Working PRN also means no vacation/PTO requests, no two-week vacation limits, no trying to scramble to find other therapists to cover your caseload if you need off. Each week you are able to choose whichever days you want to work or don’t want to work.
PRN Offers a Good Change of Pace
If you have several PRN positions (which I recommend for consistency of hours), you can work in one setting one day and switch it up to another setting another day. It’s a great way to break up the week versus doing the same routine over and over.
I also enjoy having two sets of work friends (my acute care friends and my inpatient rehab friends) and two different settings mean I’m also learning more than if I worked in just one setting.
Less Workplace Drama and Politics
When you’re PRN, you can just come in, do your job, and leave, without having to get sucked into any conflicts or drama that may be occurring. OT can be stressful enough without the workplace politics, so being able to avoid this is great to reduce work stress levels.
You Can Work More than 40 Hours
If you just have one full-time job, you’re generally stuck with the standard 40-hour workweek. If you pick up a second (PRN) job, or you have multiple PRN jobs, you can choose to work an extra 6th day or even 7th day (not recommended!) if you’re saving up for something big.
This is because you will not be hitting the 40 hour overtime requirements if you’re working at two different facilities.
The Cons of Being a PRN Occupational Therapist
The Lack of Benefits
As I mentioned in the Pros section, the significantly higher hourly rate that PRNs get is due to the lack of health insurance, PTO, and retirement benefits. For many therapists, having these benefits is extremely important and worth it to have a full-time position.
Paying for your own private health insurance is getting increasingly more expensive, and taking vacations without getting PTO takes a lot of pre-planning and saving up.
It can also be really easy to forget to stash savings for retirement if you don’t have a 401k, so you’ll need to do some extra planning on this end, as well.
The most important point is to make sure you do the math for your own financial situation. Questions to consider: What is the difference in pay for full-time vs. PRN? How many hours do you anticipate working? What is the approximate monthly value in dollars for the benefits you would receive if you were full-time? If you were PRN, how much would you pay for health insurance? Which option truly has the higher payout on a monthly basis?
When you’re a full-time occupational therapist or COTA, you don’t ever need to worry if you’re going to have work each week.
If you’re PRN, this is a different story. PRN therapists are only used when needed, and they’re more expensive. If census is low or if the full-time therapists are able to cover the caseload, you won’t be used. If you only have one PRN job and you aren’t needed, you won’t be able to work.
PRN therapists are also the first to get sent home early if caseloads fall apart.
This is why I recommend if you’re going to work strictly PRN and want full time hours, you should consider having two PRN jobs so that you will have options every week. With two PRN positions, I personally don’t have an issue with getting enough hours.
Note: If you want to stay at just one facility, offering to float to their other settings/locations will also help you with hours (i.e., floating to inpatient or outpatient if you’re in acute, etc.)
Challenges Building Relationships with Patients
When you’re a full-time OT, you will likely have a consistent caseload of patients that you are able to see from the beginning of their rehab journey all the way to the end.
Working full time, you’re able to get to know each person and build a relationship while helping them achieve their goals. There is nothing more special than helping people with their rehab journey and celebrating each milestone as things progress.
When you’re PRN and working all over the place, you don’t usually get this benefit and may only work with a patient once. If you’re missing this aspect, pick up multiple days in a row in one setting like inpatient rehab or subacute rehab. You’re more likely to work with patients more than once and can see some of that progress.
Less Mentoring for New Grads
PRN occupational therapists, like travel therapists, are hired to hit the ground running. They’re hired to fill urgent staffing needs, and since they’re also more expensive, facilities usually don’t like to take up a lot of time and resources to train them.
If you’re a new grad and get hired as a PRN occupational therapist, you may find that you’re not given the proper mentorship that a you would get if you were hired full-time.
This certainly varies depending on the facility and whether you’ll be around other therapists. From personal experience, I would not recommend getting a PRN job in a setting where you are the only OT or where you will be alone frequently. Remember to ask during the interview/hiring process how much actual training and mentoring you’ll get.
PRNs Sometimes Get the “Short End of the Stick”
Since PRN therapists usually don’t get to make their own schedules, they can be given “less desirable” caseloads and patients that the full-time therapists don’t want to work with.
I won’t go too much into this because I’m sure many facilities are wonderful and wouldn’t selectively choose difficult patients to load onto the PRN therapists, but I will say that it can happen from time to time.
And there you have the biggest pros and cons of being a PRN occupational therapist! I hope this gives you a beginning idea of whether or not PRN occupational therapy is right for you.
If you’re already a PRN occupational therapist, what pros or cons would you add to this list? Please share them in the comments!
This post was originally published on February 24, 2018 and updated on September 15, 2020.