I've been going over the older posts and I am alarmed at how many times issues such as poor pay/benefits and long hours arise for many of the NPs out there.
There is no way I am spending the next 2-3 years in school to make just a little more then I do now as an experienced critical care RN, never mind the same old two weeks vacation and lousy or non-existent retirement.
Please tell me this is not the 'norm' for NPs!!! If it is then I am definitely going the CRNA route. At least they are well paid, have good benefits and fair vacation.
"Personal preference" is determined by so many factors--you MUST get a certain amount of satisfaction out of your job. In the ideal world, your job is your passion. However, you have to make the $ to survive and to support a family.
When I start my FNP job (still waiting to get authorization to test), I will be getting into primary care. After 15 years in the ICU setting I knew I wanted to prevent people from having to go for critical care if possible. Can I alone change the world? Probably not but if I could help even one person to avoid intubation for an asthma exacerbation it will be worth it.
Also, I worked hard to negotiate the contract I will be entering into. I negotiated for base pay, plus incentive bonus, plus 4 weeks vacation, plus a week with pay for CE. As far as I see in my area this is the best deal around. It will be difficult to make the switch from the critical care mentality, also to start with a new employer, but it will be worth it.
That being said--this is for ME. What makes you or anyone else tick will be different. There is a real rush to critical care, and as a staff nurse it is nice to go home at the end of the shift and be done. While I knew--sorta--that I wanted more than staff nursing it wasn't until my last year of FNP school, sitting with a patient, that I knew I had found my passion.
:yeahthat: That's generally the impression I've gotten, being an NP is less about money and more about things like satisfaction and autonomy. You might or might not make more money, the question is will you like this new role?
Obviously, as an RN you can do quite a number of different things, so perhaps the first thing you need to ask yourself is could you reach your goals by moving to another area of nursing? Or is there something inherent in the NP role that you wouldn't find anywhere else?
I've asked the "NP or not" question many times here. Most recently I've said "or not", as I'd rather do specialized rather than primary care and don't care as much about autonomy or prescriptive authority. But that may change, yet again.
Being a NP is about the role not about the $$$. Better money with CRNA, RN and for that matter as a dental hygentist. Even worse, a NP faculty member as they have a lower salary than their new FNP grads. Money is important, so are a lot of other variables, just need to find the ones that work in your life.
Yes, most NPs make more than RNs -- but often times it's not even about that. It's about being the one calling the shots rather than having them told you to. Autonomy is a great thing, and I'd assume being able to direct patient care yourself is very liberating. Like many have said, it's not about working harder, it's about working smarter. That's why I think getting a MSN and becoming a NP can be so valuable -- the overall improvement in the quality of your life.
In my case I find myself drawn to the NP role after graduation and a few years of experience.
My primary motivation is a desire to do missions work. While there is a demand for RNs, there's a greater need for providers -- physicians and dentists especially, but NPs, too.
My stamina, family, and hobbies are telling me to (first become and then) remain a bedside nurse. My intellect, pride, and bank account tell me to become a CRNA. My heart and soul tell me to become an NP.
It remains to be seen how it's all going to work out.
For those of you who are making equal or even less money then you were as an RN - don't you think that's a major issue????
You are held liable and function at a higher level, but yet some of you are willing to take less money??? Hello what's wrong with this picture???
The physicians must laugh their butts off at us - no wonder so many of us feel we aren't respected. We're letting them walk all over us.
Is this a gender issue? Are men better at standing up for their rights and demanding to be paid better??
I'd like to see the gender break down for each APN roles to see if their is any merit to the above statement. Anyone know where I might find this data?
Change only happens when we demand it. If we continue to make excuses and accept lousy pay for more responsibility and work....
.... well then we deserve what we get.
The pay issue in one sense is one of supply and demand. The RN job market is almost purely supply and demand. There is a regional shortage of nurses and this has pushed the wage of RNs up. The wages have risen fasted in areas where regulatory rules have increased the demand (California). You have to have RNs to keep the hospital open so the pay is whatever the market demands. In the long run this is not sustainable since the hospital is not getting additional income to support this salaries. Short term the hospital can compensate by cutting ancillary staff but this is only short term.
NP pay on the other hand is production based. The NP brings in income in the form of billing for services and has a cost based on salary plus benefits as well as support costs. Support costs are highest in primary care and income is lowest in primary care. So the salary for primary care NPs is based largely on how much they can produce vs. how much they cost. Depending on the payor mix and local insurance market there may not be a way to pay a NP more than the local RN wage. Remembering that the average FP salary is now around $150k there are probably nurses in northern California that are making more than family practice physicians. This also tends to produce a bimodal salary distribution with private practice NPs making less than experienced RN wages and NPs working for institutions (where their salaries are set above RN wages because of the nursing hierarchy) making more than RN wages. You can see this effect in a number of areas of the country.
Specialty medicine is a whole different story and there are a number of different models. In the PA world most models for orthopedics show that the office billing plus first assist fees essentially cover the cost of the PA. However the downstream revenue (being able to do more cases and see more consults because of the PA) increases income more than $100k on average.
The other point is that private practice is a business. The owners (partners) are there to make money. It does not make sense to hire NPs if they will in the end diminish the partners income. In this sense it makes sense to hire the lowest paid NP that will do the job. The profusion of MEPN programs may worsen this since their comparison is to new graduate RNs (I say may because in the two locations I've practice in MEPN grads don't get NP jobs).
This is borne out in the nursing market. For RNs non hospital based positions have traditionally paid less than hospital positions. In terms of numbers hospitals dominate the nursing workforce. On the other hand for NPs non-hospital positions have dominated the workforce (although this is changing somewhat).
You raise an interesting question about the issue of sex and pay. Male nurses on the average make $6000 more than female nurses. However, there are three major distinctions between male and female nurses. Male nurses are more likely to work in the ICU, more likely to be managers and more likely to have graduate degrees. All characteristics associated with higher pay.
In the PA world this is also discussed. There was a recent article from one program that showed that on the average female PA students salary expectations were $10k lower than male PA students. You can also explore this in terms of PA vs NP salary. Traditionally PAs on the average have made between $6-10k more than NPs. Also traditionally this has been explained by the larger number of PAs that work in surgery and specialty medicine. In the last five years the gap has narrowed leading to the question: is it due to increasing number of NPs in specialty medicine or an increasingly female PA workforce?
Overall the nursing workforce is becoming more male and the PA workforce is becoming more female.
***obligatory disclaimer: the salary data on the NP workforce is extremely poor and the above effects may not actually exist).
Specializes in Med surg, cardiac, case management.
My stamina, family, and hobbies are telling me to (first become and then) remain a bedside nurse. My intellect, pride, and bank account tell me to become a CRNA. My heart and soul tell me to become an NP.
I have to agree with a lot of what David said. IMO it is not that NP salary is low, it is that RN salary is so inflated right now. I am making 80K working three 12 hour shifts. The average NP salary here is in the 70s. I don't know if hospitals can keep up the pace or not. If they don't (meaning they cut wages) I think you will see a mass exodus of nurses from the bedside. Myself included. Because if I have to work for 40-50K a year I can find something better (easier) to do with my time.
Hi, I have been a RN for 20 years. I was recently accepted to start BSU for my masters/FNP this august. Any words of wisdom or ideas that would help me with my future as a nurse prac.
I am currently an assistant director of nurses at a long term care facility. I absolutely love my job! Love it! I feel it is a role I was born to be in. I would work this job for the rest of my working days if it were not for the money.
I must make more money. So, I'm in the FNP program. Every day when I do clinicals, I think to myself, I don't want to do this, I don't like it. But my financial situation tells me, I must. NP's are in much demand in the area where I live.
It would be nice to be able to follow your heart but for some of us that isn't possible.
I am currently an assistant director of nurses at a long term care facility. I absolutely love my job! Love it! I feel it is a role I was born to be in. I would work this job for the rest of my working days if it were not for the money.
I must make more money. So, I'm in the FNP program. Every day when I do clinicals, I think to myself, I don't want to do this, I don't like it. But my financial situation tells me, I must. NP's are in much demand in the area where I live.
It would be nice to be able to follow your heart but for some of us that isn't possible.
Dixiecup, where do you live (approximate locale)? Just curious where NPs are in much demand. Thanks!
Joan Z
121 Posts
"Personal preference" is determined by so many factors--you MUST get a certain amount of satisfaction out of your job. In the ideal world, your job is your passion. However, you have to make the $ to survive and to support a family.
When I start my FNP job (still waiting to get authorization to test), I will be getting into primary care. After 15 years in the ICU setting I knew I wanted to prevent people from having to go for critical care if possible. Can I alone change the world? Probably not but if I could help even one person to avoid intubation for an asthma exacerbation it will be worth it.
Also, I worked hard to negotiate the contract I will be entering into. I negotiated for base pay, plus incentive bonus, plus 4 weeks vacation, plus a week with pay for CE. As far as I see in my area this is the best deal around. It will be difficult to make the switch from the critical care mentality, also to start with a new employer, but it will be worth it.
That being said--this is for ME. What makes you or anyone else tick will be different. There is a real rush to critical care, and as a staff nurse it is nice to go home at the end of the shift and be done. While I knew--sorta--that I wanted more than staff nursing it wasn't until my last year of FNP school, sitting with a patient, that I knew I had found my passion.
Joan