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! ?
The point of many of these tests is that they narrow down your differential and point you to the most appropriate imaging to be performing. They're really part of a more comprehensive assessment of the patient's chief complaint. That's why I find them important, but you're right, most of the primary care NP preceptors I had were unfamiliar with them. I have a particular interest in orthopedics, so I took the time to learn them and the nuances of orthopedic assessment, diagnostics, and management. I might even go for the post-master's certification in orthopedics. Part of our role is also knowing when not to image, such as utilizing the Ottowa ankle rules, assessing for ankle sprains vs ankle fracture or distal fibular fracture.
I, personally, what like to be more proficient at ortho maneuvers, since musculoskeletal pain comprises a large portion of what is seen in the clinic but I’m in my next to last semester and from what I’ve seen in clinic, insurance basically forces you to start with an xray regardless of what you believe the issue to be.
Any group worth their salt recognizes a new grad will need a ramp up and their initial salary may not reflect the actual revenue. Not to mention the complete lack of billing knowledge often lowers the amounts new grads tend to bill for (taken from my own personal experience of accidentally billing 75% 212s for my whole first quarter as a NP). Thanks EPIC magic wand tool. <,< But practices that are playing the long game for their employees will recognize that by year two and three, the profits should be rebounding.
The hard part is not-so-hot practices can get burned in this practice. They have such a revolving door due to their business operations, they ultimately lose money if they pay a nominal salary for someone who is out in a year or less. They often don't or refuse to recognize their own shortcomings and this also can be where lower salaries tend to factor in (aside from NP degree glut).
Realistically, new grads are in limited position to negotiate only because they don't know their own potential. They often fail to research or understand what exactly NPs bring in. Not to mention, RN positions generally aren't a negotiating job. They often fall under pay structures for time and degree level that is regulated on a hospital scale. So many come in from no history of negotiating a salary and accept the first thing they're offered. I negotiated up for my first job and for more PTO. I shudder to think of what my colleagues did, but knowing that one of them had at least 7 days less PTO than I did, I'm fairly certain many take whatever they were given.
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.
So, a new graduate nurse should demand the same pay as a 'top of scale' RN? After all they are bringing an 'RN' tp the floor!
So, a new graduate nurse should demand the same pay as a 'top of scale' RN? After all they are bringing an 'RN' tp the floor!
I think she’s suggesting that you can’t come in guns blazing and demand the rate a fully qualified and functional NP could potentially command as there is a presumption they won’t be seeing the acuity or total patients for some time. Nobody would hire them. Not to mention people who don’t know their worth are likely to get the job just because they will accept whatever rate they’re offered.
There is a balancing act to knowing your worth and recognizing what the local or going rate is. And the downside to the glut of NP is that entry value goes way down. clinics have more flexibility in what someone is willing to accept.
I, personally, what like to be more proficient at ortho maneuvers, since musculoskeletal pain comprises a large portion of what is seen in the clinic but I’m in my next to last semester and from what I’ve seen in clinic, insurance basically forces you to start with an xray regardless of what you believe the issue to be.
Indeed. Drives me nuts, but it is what it is. I was able to do part of my clinical rotation time in a specialty podiatry practice and learned a great deal there. What I learned there also stepped up my game for assessing my diabetic patient's feet and providing better teaching during my primary care time, as well. I'm still leaning towards ortho/pod as a specialty.
Specializes in MSN, FNP-C, PMHNP, CEN, CCRN, TCRN, EMT-P.
Start your own business or show your value to an established business. There is a ton of money in NP. I know several who are breaking 300k and I hit around 250k last year.
kridanpiper, BSN
10 Posts
I, personally, what like to be more proficient at ortho maneuvers, since musculoskeletal pain comprises a large portion of what is seen in the clinic but I’m in my next to last semester and from what I’ve seen in clinic, insurance basically forces you to start with an xray regardless of what you believe the issue to be.