More work, no pay increase..

Jules A, MSN · Dec 20, 2014

It sounds like you handled it well by asking for time to consider. I always save my evaluations, accolades as well as emails from my colleagues and supervisors indicating the quality of my work just in case. If they are trying to intimidate you that would be lousy but not enough to stop me from requiring a fair wage or walking. Like others have said although I have no clue about your particular area your pay rate sounds fairly low and if your rationale was for the experience, perhaps you have met that goal and it is time to take your experience and look for another position with more appropriate compensation.

Riburn3, BSN, MSN, APRN, NP · Dec 20, 2014

Don't let them guilt you into it or make you feel threatened if you don't. Obviously they value your ability if they're comfortable adding to your work load, just don't let them get away with it for free. Politely tell them if they're going to be expanding your responsibility and work load then you should be compensated appropriately.

globalRN · Dec 20, 2014

It sounds like a bum deal for you.

No, you don't need the extra stress of working with more docs if there isn't commensurate increase in salary.

Your pay is definitely on the low end too.

allnurses Guide · Dec 20, 2014

Reflected in your evaluation? As in, you'll get a bigger pat on the back instead of appropriate compensation? Whoopee. Employers only get away with this crap as long as we permit them to.

Advanced Practice Columnist / Guide · Dec 21, 2014

I think everybody agrees that this is an attempt at taking advantage of you. But what should be your next step?

If I were in your shoes, I would start by gathering data that support you current value to the two intensivists you work with and the hospital as a whole. Do you write billable notes, perform procedures? How much revenue does this translate to? Do you spend "x" amount of time with each patient you see and do you ensure adherence to national quality and safety guidelines (i.e., DVT prophylaxis, VAP prevention, reasonable ventilator days, responsible antibiotic usage, etc)?

Present measurable data that supports the fact that what they should be asking for is to hire an additional provider that you could train and work alongside with. While at it, present that you have value enough to the system that you deserve a raise. CNO's are not providers so they don't relate to the burden of work they are imposing on you but I think CNO's understand revenue and work flow better if you phrase it that way.

SubSippi · Dec 21, 2014

Also, do you think you will be able to provide the same quality of care to all of your patients if your workload is doubled? If not, I think that would be a pretty legitimate reason to turn down the offer.

Once you agree to that, if you start to struggle, nobody is going to give you a break because you've done them a favor. Each doctor you work with will expect you to function at the exact same level you always have. And if there are any complaints, I doubt management will take that into consideration either.

ronchelednik · Dec 24, 2014

Ok you're smart because you attained you Masters and your a NP. But at the same time your question leaves questions for asking such a question. Your response should of been an immediate NO. If you are the type of person that find it hard to say no, then maybe you could of said. Put your request and offer in writing for I can review it, I don't answer verbal request. Please try to remember these encouraging words: I'm a Nurse Practitioner, I don't need practice to perform my duties, no one is going to walk on me. Also your under paid by 15%.

automotiveRN67 · Dec 27, 2014

Why is this even a question? They would never ask a physician to take on twice as much work for the same pay on the grounds that it will "advance their knowledge". Presumably if you're going to be billing, they are going to be making money off your work - I assume that increasing revenue is why they want an NP to begin with. So they need to give you a cut of the potential increased income.

Of course they would. I have seen so many hospitalists screwed over with the offer of "12-15 patients", and then see 30. Cardiology groups are even worse. It's the way the system works. Overpromise, overwork.

As for the OP. You have to do what works. There is no reason why you can't pick up the extra for a short time, see if there are ways to improve your efficiency, and then negotiate. If not, take your new found skills somewhere else. Pressure is a great educator.

allnurses Guide · Dec 28, 2014

Of course they would. I have seen so many hospitalists screwed over with the offer of "12-15 patients", and then see 30. Cardiology groups are even worse. It's the way the system works. Overpromise, overwork.

Ok well that's your opinion, I disagree. Workload that isn't as advertised is one thing. I can't see them saying to a physician "Hey, how about you just cover this new service as well as yours? We're not going to pay you anything or give you any more resources to do it, but gosh we will be grateful!" - all while trying to snow them that it's actually an opportunity for their career growth.

MikeFNPC, MSN · Dec 29, 2014

The only way I would consider this is if it was some kind of opportunity. Considering the salary now I can't imagine how it could be. Commonly taking on more responsibility without compensation with the verbal promise of some kind of management position that inevitably leads to increased salary increases are offered. I've seen similar propositions that no one wanted due to the work/compensation dilemma. Then one person took bit the bullet and ended up pretty high up the food chain. Sounds like you need more information. I just wouldn't get my expectation too high.

lindarn · Dec 29, 2014

This is sort of off the mark, but here it goes.

Aren't staff nurses increasingly taking on more work and responsibility, with no increase in pay and/or compensation??

That seems to be the crux of most of the complaints, here on All Nurses.

More work piled on, no increase in pay, etc.

What can nurses do about it?

Nurse Practitioners are now a dime a dozen, and have lost their bargaining chip.

UNIONIZE!! There is a glut of nurses now, and without a union to cover our backs. we have NO bargaining power to improve our situation.

Nurses missed the golden opportunity to wrest power from the PTB, when there really was a nursing shortage.

Instead, we fell for all of the, "attaboys", and crumbs thrown our way to make us feel that we had some sort of power and control, when in reality, we still had none.

We are now paying the price for the indecision. In essence, they called our bluff, and they won. The bluff was, "we will allow you to think that we have become benevolent, and and on your side", but what they were really doing was just biding their time, continuing to yell, "nursing shortage", until the shortage became a glut. There is now a glut of nurses in this country, and we have lost any bargaining power we had when there was a shortage. THEY are now calling the shots, and the ONLY thing that will even out the playing field, is for nursing to unionize, en masse. Period.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

allnurses Guide · Dec 29, 2014

Nurse Practitioners are now a dime a dozen, and have lost their bargaining chip.

Maybe true for your area, but this is absolutely not true for most of the US. I can't hire enough ACNPs and I get recruitment emails daily via Linked In.