How do we prevent Nurse Practitioners from undervaluing themselves?

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by MentalKlarity MentalKlarity, BSN, NP Member Nurse

Specializes in Psychiatry. Has 9 years experience.

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I've been an NP for a while, and I am happy and proud to be one. I am well aware of both our shortcomings and our successes. I think we fill a need in the world of healthcare, and "going to see my NP" has become a normal phrase in American households.

For all of our successes, we seem to have a problem with consistently selling ourselves short when it comes to compensation. I have been reaching out to colleagues and previous students, and I have also been serving as a mentor for some new NP graduates looking for advice. As they navigate positions, one common theme is they do not know how much they are worth, and do not understand that as a provider they are revenue producers! We should be paid as such!

Case in point: last week I had a new graduate FNP telling me about a job in a specialty office she intended to accept. She told me she was satisfied with the salary and benefits and shared them with me. It turned out to be a salaried position at $96K annually working 8 AM to 5 PM five days a week. Vacation was 2 weeks paid going up to 3 weeks after FIVE years. It included all the usual benefits but there was no 401K match and no CME.

Sometimes I feel like nurse practitioners are not being taught about healthcare economics at all. Maybe instead of 4-5 classes on research and "NP roles" we should be teaching a dedicated course on billing and reimbursement? I see NP after NP working for peanuts while the practice that employs them is making hundreds of dollars per hour off of their work. The long-term effect, of course, is that all NP salaries will start to flatten out. Those that do the research and demand a salary that reflects what they bring to the practice will be laughed out the door while those who do not know their worth will end up taking their place.

Does anyone else notice this in the NP world? What can we do to bring awareness to it? Let's Discuss! ?

LibraSunCNM, MSN

Specializes in OB. Has 10 years experience. 1,603 Posts

I'm a CNM, not an NP, but can relate to this.  From my experience, I think a lot of nurses want to become NPs because it's a way to advance and (in many cases, although not all) earn a better salary than a staff/floor RN, and still keep a moderate work/life balance, compared to MDs.  This has led to a glut of new NPs, many of whom become generic FNPs, which isn't exactly a lucrative specialty, much less when there are hundreds of resumes in the stack with your own competing for a job.  

I also agree we're not taught enough about healthcare economics in our masters programs, it's still totally fuzzy to me and I've been in practice almost 8 years.  

Just my anecdotal experience.

ThePrincessBride, MSN, RN, NP

Specializes in Med-Surg, NICU. Has 7 years experience. 1 Article; 2,549 Posts

Because there are too many FNPs and not enough demand. For my first job, I am contemplating taking a pay cut (even though I have been an RN for only six years) to get into an internship making 70k per year. It sucks, but I think I will have to take what I can get.

96k is pretty good for a new grad NP.

MentalKlarity, BSN, NP

Specializes in Psychiatry. Has 9 years experience. 220 Posts

1 hour ago, ThePrincessBride said:

 

96k is pretty good for a new grad NP.

But it's actually not. It's about $40 per hour. The problem is so many people are willing to accept it that it is becoming the norm. Obviously oversupply is an issue but it wouldn't be if more nurse practitioners knew what they brought to the table and how much revenue they bring in and hold out for acceptable wages. When even one person is willing to work for less than they're worth they hurt the profession as a whole.

Neuro Guy NP

Neuro Guy NP, DNP, PhD, APRN

Specializes in Vascular Neurology and Neurocritical Care. Has 10 years experience. 373 Posts

23 hours ago, ThePrincessBride said:

Because there are too many FNPs and not enough demand. For my first job, I am contemplating taking a pay cut (even though I have been an RN for only six years) to get into an internship making 70k per year. It sucks, but I think I will have to take what I can get.

96k is pretty good for a new grad NP.

But this is for an internship right, not a regular staff NP job?

Numenor

Has 10 years experience. 385 Posts

Low barrier to entry, glut, not enough demand

Fix those things first

MentalKlarity, BSN, NP

Specializes in Psychiatry. Has 9 years experience. 220 Posts

8 hours ago, Numenor said:

Low barrier to entry, glut, not enough demand

Fix those things first

I'm curious, how do we fix those things? I have actually written letters in the past to the credentialing boards asking why they continue to certify low performing programs that graduate thousands of NPs annually with almost no oversight. I explain how it hurts the profession both by causing a massive oversupply and by graduating subpar NPs that perform poorly and hurts the reputation of nurse practitioners for colleagues and patients. I have never even received a reply.

I do agree with you though. Part of the problem is that nurse practitioners who find themselves unable to find a job become desperate and accept jobs that are insulting. 1-2 weeks of vacation, pay that works out to 5-10% of what they bring in to the practice, etc.

Numenor

Has 10 years experience. 385 Posts

16 hours ago, MentalKlarity said:

I'm curious, how do we fix those things? I have actually written letters in the past to the credentialing boards asking why they continue to certify low performing programs that graduate thousands of NPs annually with almost no oversight. I explain how it hurts the profession both by causing a massive oversupply and by graduating subpar NPs that perform poorly and hurts the reputation of nurse practitioners for colleagues and patients. I have never even received a reply.

I do agree with you though. Part of the problem is that nurse practitioners who find themselves unable to find a job become desperate and accept jobs that are insulting. 1-2 weeks of vacation, pay that works out to 5-10% of what they bring in to the practice, etc.

Tough because schools can cash easy checks with their crazy online school presence. Look at online doctorates, most are nursing or education related. It's a racket. The credentialing groups don't care what its like in the "field".They just want to pump out grads under the guise of "profession advocacy"

aok7

aok7, NP

Has 13 years experience. 111 Posts

Thank you for the thread.  I think a big part of the issue lies in one of the responses, referring sadly to the new NP thinking a low-pay first job "internship" will lead to higher-paying opportunities.  Unless NP organizational leaders (?) return to more rigorous requirements and standards toward being a NP, there will be more new grads willing to work for even less.  Related, and underlying, we need to protect our reputation.  We do that with high standards, just as PA and MD schools insist.  

Not too long ago only the best and brightest RNs (seen by not only excellent grades, but clinical and social skills earned with work experience) were accepted into NP programs.  It is no accident the timing of quick 'work full-time and go become a NP at your leisure' schools popped up everywhere that we have NPs grateful for even a second interview.  In my setting, speaking of NP hiring is risky, as even basic 101 skills can not assumed of new grads.  Emergency for our profession here!

While respectable pay and NPs with high expectations out in the community is the hoped outcome, I think targeting the inner workings of day-in-day-out development toward becoming a professional who has earned a solid stand to argue for high pay and respect is step one.  You can not jump ahead with quick schemes to be skilled to the level of a provider.  We are shooting ourselves in the foot, and I do not blame the new grad NPs, rather I blame the schools and our nursing organizations for lowering standards.  What a chance we had.  

aok7

aok7, NP

Has 13 years experience. 111 Posts

BTW, my first NP job I made $135K between base, on-call, and stipends.  Between education time off, vacation, and sick time about 4 weeks.  I took a pay cut since to enter a specialty practice of my wish, but cost of living balances out the above Seattle pay.  Let's not forget we can always work as a RN before we accept RN pay to be a NP!  Base the pay you expect of your first job of NP pay based about three years ago in your specific geographic area, not based on the pay of the current glut of NPs willing to work for $40 an hour!  This would sincerely stop the problem until we get our inner workings as a profession more aligned with quality outcomes.

MentalKlarity, BSN, NP

Specializes in Psychiatry. Has 9 years experience. 220 Posts

I agree with the above, and also think concrete guidelines would be helpful for those looking for jobs. Some ideas:

 

  • Ask what the average provider brings in to the practice in terms of revenue. You should be getting a decent percentage of that. Time and time again I see NPs in lucrative specialties who being in 350-500K and are paid 95K or less annually. You deserve a piece of the pie!!
  • Make sure you get at least 4 weeks vacation. You'll need it!
  • Don't accept 40+ hour work weeks. I've seen positions that advertise 8AM to 6PM five days a week. That's burnout! If you work those hours, ask for 4 days a week for full-time. 
  • Always ask for paid admin time! It can be a half day per week or an hour at the end of every day but you need time to make calls and finish charts, and otherwise you'll be doing it for free at home.
  • For a full-time, 40 hour work week the average NP should make no less than $120K annually. Shoot for that as a minimum. 
vintagegal

vintagegal, BSN, RN

Specializes in Geriatrics. Has 3 years experience. 231 Posts

On 4/6/2021 at 1:15 PM, ThePrincessBride said:

Because there are too many FNPs and not enough demand. For my first job, I am contemplating taking a pay cut (even though I have been an RN for only six years) to get into an internship making 70k per year. It sucks, but I think I will have to take what I can get.

96k is pretty good for a new grad NP.

I am in the DNP program currently working on my AGNP. I politely disagree with you. I think it depends on where you reside. The rural area in which I live makes it hard to get to my state university 4 hours away for classes, however, in my town there is such a demand for primary and specialty care that people are waiting up to 8 months to see a specialty and up to 6 months to see primary care, if they are lucky enough to get an appointment and if that particular practitioner is accepting patients.