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At least once per week, Carolann “Nan” Parisi, a registered nurse (RN), finishes an 8-hour shift at her school nurse job and heads straight to the hospital in Ocean Township, New Jersey, for a second shift. Parisi picks up even more hours as a per diem nurse for the hospital during summers and holidays. It’s a schedule she’s maintained for more than two decades.
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Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape advanced practice registered nurse (APRN) Job Market Report 2025 found that:
- APRNs surveyed reported that the supply of qualified nurses was high.
- Nurses reported that rigid hiring processes add to perception of the real shortage of nurses.
- 12% of APRNs surveyed said they had no position to negotiate better pay or benefits in a job offer.
“When I left the hospital and went to school nursing [to have a more flexible schedule for my children], I took more than a 50% cut in pay,” Parisi said. “I needed to make it up.”
There is disparate data about the number of nurses working two jobs. A 2023 report found that 50% of nurses had a second job while more recent research estimates the number is closer to 14%, which is still more than double the national average.
Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, president of the American Nurses Association believes some RNs work second jobs to maintain professional competency. Nursing faculty, she explained, might pick up shifts at a hospital to keep their expertise relevant or to maintain certifications that require a minimum number of clinical practice hours, but it’s often the need for an extra paycheck that drives RNs to take second jobs.
Feeling the Financial Pressure
While more than half of the nurses reported increased compensation over the past year, inflation has outpaced wage growth in many regions, particularly in expensive urban markets where housing and childcare costs have surged, according to Amy Witkoski Stimpfel PhD, RN, assistant professor at the NYU Rory Meyers College of Nursing in New York City.
“We know that wages have increased since the beginning of the pandemic,” Stimpfel said. “But like other industries, it’s not the same pace as inflation and housing, and particularly in the high-cost urban settings.”
In fact, 25% of nurses lack sufficient income to cover their essential expenses and 37% reported that financial pressure pushed them to work extra shifts or overtime.
“Nursing is one of those areas where you can pick up extra shifts and [work overtime] to be able to pay down your debt faster,” Kennedy added. “Oftentimes those [per diem] shifts pay a lot more than their primary shifts.”
Widespread nursing shortages mean that hospitals frequently rely on per diem nurses to fill staffing gaps, often offering premium pay for those shifts. Nurses who work per diem shifts through gig work apps earn an average rate of $59/h compared to a median wage of $41.38/h for staff nurses.
Nursing specialty may also play a role in the decision to take a second job. RNs working in higher-paying specialties, including nurse anesthetists, certified nurse midwives, and operating room nurses, might have less economic need to work a second shift than school nurses, public health nurses, or other RNs in lower-paying specialties.
The Downside of a Second Shift
The structure of some nursing roles also makes it easier for RNs to take on second jobs. School nurses with open summers or nursing faculty with regular daytime hours might work contract or per diem shifts during their downtime to earn extra income.
Parisi often picks up extra shifts at the hospital during the summer months when she isn’t working as a school nurse. In addition to the extra income, she believes that working a second job provides additional benefits.
“I always wanted to keep my foot in the door at the hospital because…I wanted to keep up to date…I didn’t want to panic if I was called to the football field or a classroom,” she said. “In the school system, [the school nurse] is the only medical person, and I wanted to be comfortable with emergencies.”
But working a second shift can come at a cost.
Research links long work hours and insufficient recovery time to fatigue, impaired concentration, and an increased risk for medical errors. Nurses working shifts longer than 12 hours are also significantly more likely to experience burnout and lower job satisfaction.
“We know [that] scheduling practices and overtime hours and working multiple consecutive shifts…impacts nurses’ ability to care for their own health,” said Stimpfel. “There’s only a certain number of hours in a day, and when you start to increase [the number of hours you work], similar deleterious outcomes are likely to happen, like errors or…decreased concentration and impaired judgment and slower reaction times and all the things that are very critical to nursing practice.”
Healthcare organizations have attempted to address the issue through internal scheduling safeguards. Some systems prohibit nurses from working more than four consecutive shifts or require minimum rest periods between shifts, according to Kennedy. But those protections rarely extend across employers, making it difficult to monitor total hours worked by nurses juggling multiple jobs.
“Quite possibly the hospital might have put that rule in place and [the RN] working the second shift is coming from a different hospital because they have limited the number of shifts that [their staff can work],” she added. “Most of the time when this happens…it’s about economics. They are paying off debt, trying to buy a home [or] pay down their student loans as quickly as possible.”
The emotional toll can be harder to quantify. Parisi says working two jobs meant sacrificing social events and personal downtime. As she looks toward retirement, she doesn’t regret the decision to shift to a lower paying nursing specialty and pick up extra shifts to make up the difference in wages.
“A lot of the nurses I know at the hospital work two jobs…I don’t think it’s hurt me in any way,” Parisi said. “I think there’s a certain sense of fulfillment and accomplishment.”
For healthcare leaders grappling with staffing shortages and retention challenges, the growing prevalence of RNs working two jobs underscores a deeper need to rethink workplace support, which could mean offering more flexible scheduling models, improving staffing ratios, addressing workplace violence concerns, or increasing wages in regions where the cost of living continues to climb. In addition to reducing the need for RNs to work additional shifts, structural shifts might help increase retention and reduce burnout.
“Nurses want to work in environments that are supportive of them,” Stimpfel said. “It’s not always just the monetary value, but the quality of their working environment.”
Sources reported having no financial disclosures.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.
