Staffing has long been a fundamental challenge to businesses, whether because it is cyclical or scaling.  The pandemic turbocharged this challenge when the resulting closures and slowdowns impacted staffing needs as a result of the ebbs and flows of consumer demands.  On top of that, the often discussed “Great Resignation” amplifies the challenges of keeping the right staffing levels for a business.

The health care industry is no different.  Yet, it has had staffing alternatives that may become more viable in the post-pandemic world–PRNs.

What does PRN mean?

PRN stands for pro re nata, meaning “as needed.”  In other industries, the term would be per diem – by the day.  The reference is to someone who provides part-time coverage, usually on a shift basis for a business.  While hospitals and larger practices have commonly used PRN staff, it is now becoming more prevalent in private medical practices and medical businesses where PRNs are committed to the practice and typically expected to work a certain number of hours or shifts per month.

Who are PRN’s?

Any licensed provider, including physicians, nurse practitioners, physician assistants, and registered nurses, can be a PRN.

Are PRNs employees or independent contractors?

PRNs are employees.  The employer retains behavioral control and direction of the PRN’s services, so the PRN will have to follow the employer’s processes and procedures when providing patient care.

What benefits does an employed PRN receive?

Employed PRNs should receive the statutory minimum for all applicable local, state, and federal benefits.  Beyond that, the employer may elect to provide other benefits that they offer to full-time employees. For example, if a PRN is employed in a state that requires employers to provide paid sick leave, the PRN is entitled to this benefit, but it would be up to the employer whether to also offer them participation in a tuition reimbursement program for continuing professional education that is available to full-time employees.

Who covers the PRN’s malpractice insurance?

In most cases, the employer provides malpractice coverage of PRNs.  Supplemental personal coverage is often available for a PRN.  This type of policy can be protective where employer polices have gaps and can allow the PRN to have their own counsel in a malpractice lawsuit.

What are the potential liabilities when using a PRN?

As with any standard employment setting, the employer is legally responsible for the conduct of a PRN based on the employment relationship.  This is referred to as vicarious liability because the employer itself may not have committed a wrongful act but is assumed to have direction and control over the PRN’s conduct and so will be responsible for what the PRN does.

An employer can also have direct liability – liability for its own acts or omissions – if it hires negligently by failing to vet the PRN, or supervises negligently by failing to make sure that the PRN is carrying out their work within the applicable standard of care.

How can I make sure that the PRN will be available when I need them?

The first key to making sure PRNs are available when needed is to design PRN policies customized to the practice. Setting the right expectations becomes the most important tool to a good PRN program.  Once the policy is set, the parties will work together on setting the schedules.  For example, some practices allow PRNs to provide their availability and then choose to accept or decline an open shift offered by the employer. Some practices have stronger requirements to accept a shift or require a minimum number of shifts per month. Finally, a practice may also incentivize PRNs to pick up more shifts by offering bonuses or benefits that accrue with more shifts taken.

How can hiring PRNs help my medical business?

Adding PRN staffing transforms an inflexible situation into a flexible one. PRNs can cover night, weekend, and holiday shifts, provide coverage when there is an unexpected staff shortage, or can cover extended appointment hours.

A potential downside is that PRNs are often paid at a higher compensation rate than permanent, salaried employees. A practice should evaluate the competing issues of a more costly hourly shift worker versus overtime and benefits for salaried employees, as well as the possibility of lost business if a shift is uncovered or requested appointments cannot be met.

In summary

PRNs can be advantageous to a practice or medical business, reducing scheduling stress and even allowing expansion.  However, as an employer the practice will need to comply with the associated tax and benefits issues, set up its own contractual relationships with the PRN, and avoid liability pitfalls that can arise from the PRN’s work.  Having a firm on your side that can help you manage these aspects is essential.  If you are considering hiring PRNs, contact us at to set up a consultation.

ByrdAdatto attorney Grace Lee

Grace Lee

With a financial background from working at a Fortune 500 investment, Grace Lee started her legal career in complex commercial and business litigation.