The Pros and Cons of Being a PRN Occupational Therapist

PRN occupational therapy: There is a lot to say about it, and because I’m a PRN (or per diem) occupational therapist myself, I really wanted to share my PRN experiences (the good AND the bad).

In this article, I lay out the pros and cons of becoming 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 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 needed.


The Pros of Being PRN

Increased Pay

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.

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 PRN, 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 rate.

Another thing to take note 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 are not 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.


Amazing Flexibility

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 off to travel Southeast Asia, 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).

Working PRN 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 so much more than if I had stayed 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 work politics issues, so being able to avoid this is great to try 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 PRN

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 (trust me on this one!), and taking vacations without getting paid 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 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?

Inconsistent Hours

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 always recommend if you’re going to work strictly PRN, you should have at least two jobs so that you will provide options every week. With two PRN positions, I personally don’t have an issue with getting enough hours (your results may vary).


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.

With 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 people 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 PRNs 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.


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!

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  • Anthony February 26, 2018   Reply →

    This is a great overview on what A PRN OT/COTA will face much of the time! Having worked PRN for years, I’d say you can better avoid politics but not always! Sometimes you can get a PRN assignment that lasts 1-3 weeks, giving them plenty of time to drag you in. Been there, done that!

    Don’t be shy about it! The regular staff will OFTEN dump the worst patients on you, saying they get paid a lot, let em ‘earn’ it!

    Just thoughts from a Cali COTA.

    • Sarah Stromsdorfer, OTR/L February 27, 2018   Reply →

      Thanks so much for sharing your insight and personal experiences!

  • Alexandra Myers February 27, 2018   Reply →

    I will graduate in May and have been trying to weigh the pros and cons of PRN myself, so thank you for this post! It was very timely and helpful! What are your thoughts on working part time and PRN as a new grad?

    • Sarah Stromsdorfer, OTR/L February 27, 2018   Reply →

      I’m glad you found it helpful! I started PRN as a new grad and my biggest recommendation is to make sure you have other OTs around. It can be a big challenge to be PRN as a new grad so I would say make sure you have a good support system at the workplace. If you have that then I would say go for it!

  • Melissa March 2, 2018   Reply →

    Great overview! I work multiple positions PRN and contract work for years now! All the pros are point on! One hard thing is to juggle sometimes to stay busy- my family thinks I’m nuts lol but I love the flexibility and learning!

    • Sarah Stromsdorfer, OTR/L March 3, 2018   Reply →

      I couldn’t agree more! The flexibility is what’s going to keep me a PRN “lifer”, personally 🙂

  • Marie March 14, 2018   Reply →

    Thank you for laying it all out. I have been a fulltime OT in SNF and Home Health. I am starting a PRN job that has potential for fulltime or part time. They are paying me by the visit with benefits kicking in when I reach part time or full time status. Mileage compensation now. How does that sound to you?

    • Sarah Stromsdorfer, OTR/L March 14, 2018   Reply →

      Congrats on going PRN! I think you’ll enjoy the flexibility compared to the typical full-time schedule. If you find that you aren’t getting enough visits, you can always get a second PRN position in another setting to make sure you have enough work each week. Best of luck to you!

  • Mary Della Mora MS, OTRL March 21, 2018   Reply →

    I definitely agree that if your’e a new grad, or new to the setting (ie never worked in a snf before) that you should work with more seasoned OT’s nearby to answer questions and support you. The biggest issue that I had when I worked prn in a snf after my full time school based position, was not being trained in documentation software that wasn’t user friendly, and getting progress notes dumped on me when I only saw a patient one time. I personally find it unethical and unfair to the patient to expect a therapist who has worked with the patient once to write a comprehensive progress report that could have an affect on medical care coverage.

    • Sarah Stromsdorfer, OTR/L March 21, 2018   Reply →

      Wow, that’s really awful to hear. I’ve found that hospital positions (full time and PRN) are generally quite a bit more ethical and rarely will pull that type of nonsense. You might get some heavier patients from time to time but they (the hospitals) aren’t looking to set their PRNs up for failure like that.

  • Morgan June 21, 2018   Reply →

    I have been a PRN OT for 5 years and you hit all the pros and cons right on and I think I also will be a PRN for life. I will say that both my PRN employers have 401k plans with matching for PRN which is nice!

    • Sarah Stromsdorfer, OTR/L June 23, 2018   Reply →

      That’s great to know that some PRN positions do offer 401k plans! I’ll definitely have to look into that when I switch to another PRN position out of state in the future.

  • Katie June 27, 2018   Reply →

    WOW this was so helpful. I am in the process of taking boards and trying to find motivation to keep going by looking up jobs. I initially was thinking of travel OT because of being unsure about settings and commitments to a full time but I didn’t even consider doing multiple per diems. Since I will be new to the work force, how long did you stay at your per diems (in the case you didn’t like one) without it looking hurting your credibility or working against you? Thank you!

    • Sarah Stromsdorfer, OTR/L June 27, 2018   Reply →

      I’m so glad this was helpful for you! I definitely recommend keeping one that you don’t like for at least a year to not look bad on your resume. Since you’ll be working PRN, you won’t have to work much at one that you don’t like as long as you can get a second one in the meantime to make up for lack of hours, if you happen to not like one of them. Best of luck to you with your boards and job hunting!

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