How would RN's "make out" if we switched to a Canadian style single payer...

fergus51 · Feb 5, 2004

The system was implemented here almost 30 years ago, so I don't have any experience with that. If you are interested in looking at wages and benefits, I would suggest you go to the provincial union's websites. For BC it is http://www.bcnu.org and I believe it has links to other provincial unions as well. The wages for nurses in Ontario are from 22-34 an hour (so figure about 18-28$ US). Agency nurses can make 50 an hour. In BC, it goes from somewhere around 25 to 34 ish as well. Cost of living makes a big difference. My own personal experience is that you can make more money in certain areas of the US (like NY and California), but in other areas, the pay is ridiculously low. Benefits in Canada have been better for me than when I was in the US.

Roland · Feb 5, 2004

CRNA's, adult NP, nurse mid-wives, and advanced pediatric nurses make out in Canada? Since the system has been in place for thirty years it's difficult to know how much of the pay/benefit situation can be attributed to "the transition". Perhaps, Australia would provide more useful data since I think their transition to "Medicare" was more recent, wasn't it? Also, don't they practice a dual public/private system where citizens can choose to "opt out" to the private system? This would be especially interesting since the pay and benefits of nurses who worked in "public" facilities could be compared with those that worked in the "private" system.

fergus51 · Feb 5, 2004

NPs are used differently. We do have NPs in certain specialties, like neonatal nurse practitionner, and they tend to function like residents and work in larger centers. We also have general NPs who tend to work in rural communities. I don't know the salaries, but they are nice from what I have heard. Midwives here are not nurses, they have their own program at a Bachelor's level. CRNAs do not exist either.

I think the salaries and benefits here have more to do with the unions than anything else. Our nursing workforce is almost all unionized. I don't think the "transition" to a universal single payor system has anything to do with it. Nurses still get paid under a government funded system, we just negotiate with the government rather than Tenet or Kaiser's execs.

gwenith, BSN, RN · Feb 5, 2004

Australia certainly does have a dual system but would you believe you get paid MORE in the public system than in the private system. We are more heavily unionised than the USA and so our wages are tied to a universal wage. Check out the sticky thread in the Australasian forum - there are links there to the unions - the ANF and the QNU.

Our wages are adequate and there is a bedside career structure designed to keep more experienced nurses at the care delivery end. Direct money amount do not translate as the cost of living is different but let me list the additional "benefits" on top of the wage.

1) Superannuation - paid by the employer - a retirement fund

2) 38 hour week

3) 6 weeks holiday a year

4) shift allowance for evenings and weekends

5) long service leave - you accumulate 1 week leave for every year with the employer - only to be taken after 10 years

6) Holiday loading - extra pay for holidays

7) TOIL - time off in lieu means that you can either get paid up front for your overtime or take as time back - ie leave 1/2 hour early if not required

8) Workers compensation that not just pays but will help get you back into the workforce.

mattsmom81 · Feb 5, 2004

Gwenith I sure like that list of benes!! :)

Roland · Feb 5, 2004

to twenty hours per week? I know of several nurses who increase their incomes from around 40K (at their regular jobs) to over $70,000 by working an extra twenty four hours a week at agencies. They only earn around $25.00 at their regular jobs, but are able to get $33-38/hr at the agency jobs. Does this sort of "overtime" opportunity exist in the Aussie, or Canadian systems? Also, why don't you think CRNA's exist? Is it a matter of the Dr's being more "successful" in holding on to their turf or something else? I would think that these publicly based systems would seek to maximize value by expanding the use of nurses as far as possible.

fergus51 · Feb 5, 2004

I do a lot of OT. Agency work is available where I live now, but I make just as much doing regular OT because we get time and a half. So a nurse who makes 25 at their regular job would be nuts to do agency for 33, when she'd get 38 for OT.

I don't really know how CRNAs developped in the US, so I can't really say why they never developped here (doesn't it have to do with their use in the military or something?). They simply don't exist. There are no universities or nursing groups trying to start up CRNA programs anyways. The move to expand the role of nurses has started taking off recently, but for NPs that already exist (in family practice, emergency rooms, NICUs, etc). It is not looking at starting a whole new profession.

Roland · Feb 6, 2004

without sending income taxes even higher. Right now a husband and wife nursing team in the US with two kids earning a combined $80,000 gross, will pay about thirty three percent or so in federal income taxes. When you add in state income, local income, property taxes, sales taxes, and gasoline tax that family will pay on average around fifty to fifty five percent of their income in taxes. How does this compare to a similiar "RN family" in Canada?

Also, just to provide some perspective on "costs" this average "RN Family" will pay between 100K to 200K for a house (depending on what part of the country in which they live). Their grocery bill will probably run from $80.00 to $150.00 per week (depending on where they live, and how economically they shop). How do these "averages" stack up against similiar scenarios where you are?

fergus51 · Feb 6, 2004

I can say for myself, about 1/3 of my paycheque is deductions (I am single and make about 50K a year + OT). But, that includes my union retirement plan, unemployment insurance, Canada Pension Plan (like social security), dental & vision, union dues and regular taxes (both provincial and federal), and I am expecting a refund cause I get one pretty much every year. Last paycheque was about 2100 and I took home 1450 or so. When you take into account the cost of health insurance in the US, my take home pay is almost the same as it was when I was there. I take home a little more here and like I said, I pretty much always get a refund (between 800 and 2200 for the last 4 years).

I am in the most expensive city in the country, so small homes start around 300K (210K USD or so), and you can get appartments for 120K or so. Rent for a one bedroom is around 800 a month. Groceries sound similar.

That said, the US will never implement such a system. Americans are WAAAAAYYYYYYYYY too afraid of anything government funded or regulated and associate single payer with socialism. America needs an American solution, and incorporating what works in Canada or Australia is great, but it will not be the model that Americans will follow.

Roland · Feb 6, 2004

America IS a quasi/Socialist country. Consider that we spend over half of our budget on entitlements such as Medicaid, Medicare (just massively expanded under Bush's prescription drug proposal), Social Security, Farm subsidies, Federal Funding of education (All of my education is paid for by Pell grants and state grants for instance) Federally funded housing, the list goes on. By definition these reflect elements of Socialism, abeit not to the degree of perhaps Sweden, but far more than America fifty years ago.

When these facts are considered in the context of expoenentially rising health care costs I think there is a real chance of this occuring. Republican Presidents and Congresses tend to "move to the left" in the hope to attract voters from that part of the political spectrum (Clinton did the same except that he moved to to the RIGHT with NAFTA, and welfare reform). I especially think that an Aussie style DUAL system might be POLITICALLY feasible for passage sometime in the next ten to twenty years.

fergus51 · Feb 6, 2004

I agree that it already is a socialist influenced country. But that doesn't change perception. And in politics, perception is reality. I can not imagine Americans agreeing to institute a universal system. It just isn't in their nature as a group. Even if there were a perfect universal system out there that outperformed the American one in every respect, Americans still wouldn't institute it in their own country. Just look at any thread on universal healthcare. Americans think that the government makes treatment decisions, we can't pick our doctors, it's more expensive, it is completely ineffective, etc. Even when some or all of those perceptions are proven to be untrue, they still stick to the philosophy of free market improving the system through competition. One member is convinced that our system is more expensive to taxpayers, despite the fact that 1/3 of her income goes to health care alone when my total deductions are 1/3! Those perceptions don't change.