NP working as RN?

futureeastcoastNP · Jun 20, 2014

Many nurses, especially those with experience, make more as RNs than as NPs.

Unfortunately, what a lot of people don't understand as they go rushing into an online NP program, is how there are just so many programs available now. Some accept a low percentage of applicants, but some (like for profits that have multiple start dates per year) are accepting almost anyone who applies. This is drastically saturating the market and will eventually lead to NP salaries and demand being lower than RN salaries.

Its supply and demand. Physicians keep their salary and demand high by making medical school almost impossible to get into. Nurses don't realize this and now the number of graduating nurse practitioners has more than doubled in just the last few years. I honestly don't know any RNs that aren't at least taking a few classes part time to become an NP...do you really think the market can handle that many nurses becoming midlevels?

APei · Jun 20, 2014

Very true insight!

PMFB-RN, RN · Jun 20, 2014

I know lots of nurses who have gone to NP school. Usually they don't expect to make more and most of the time they don't. Greater automomy and better schedules are usually the draw, not more pay.

One friend who graduated this year and took a job in our health system as an NP is making about $20K/year less that I do and than she did as a staff RN. However we had to work every other weekend, holidays and nights to make that. She works Mon-Fri, no nights and no weekends.

She is very happy with her new job and schedule but was fully expecting a significant pay cut to be an NP.

P.S. NPs are not "midlevels" and many dislike being refered to as such.

APei · Jun 20, 2014

The typical salary for a RN around the area that I am at is around $64,000. The NPs who specialize, which I plan to do, are typically starting at around $85,000. I work in an ER and the place is over-ran by PAs who work with MDs. I informed the director of the ER that I would be attending NP school and would be interested in working in the ER dept. and he said that he could hire me and I would be performing the same duties as the PAs who are doing it now. I know for a fact that the PAs make more than the RNs in the ED. Granted, my friend, who is a FNP, said she went back to the floor because she wasn't making enough in a primary care clinic.

I also know of an ACNP who started out in the ICU at a local hospital and is earning $110,000 as a new grad. However, it's just a few NPs that I know who went back to the floor. Guess it just depends on where you end up working at.

Also, I didn't know NPs are not considered mid-level providers. I just read several articles on the term "mid-level providers." Thanks for pointing that out.

TammyG · Jun 20, 2014

My preceptors in NP school chided me several times for calling NPs physician extenders and instructed me that "mid-level" was the correct term to use. I have seen that term numerous times and did not know it was not politically correct.

Trauma Columnist · Jun 20, 2014

It depends on who you talk to: personally I prefer mid-level provider over physician extender which, to me sounds just pain nasty.

i am credentialed at multiple healthcare systems and one uses MLP for mid level provider, one uses AAPN which is affiliated advanced practice nurse, one uses ancillary provider and my own practice just uses extender.

So, out of all those choices MLP seems the best to me.

zmansc, ASN, RN · Jun 20, 2014

Look at salary surveys from government or reliable organizations and although there is some overlap, NP median vs RN median salaries, NP is higher. For some reason that I can only attribute to the fact that the majority of PAs are male and the majority of NPs are female and the gender inequality of pay, PAs tend to make roughly 10% more than NPs. That fluctuates annually when the data for a new year is evaluated. NP salaries have been trending upward (slowly), and maintaining the same basic (10% ish) position relative to PA salaries as well as being substantially above RN salaries for several years. There is no indication from statistical evaluations of salaries that the current increase in NP graduates is negatively effecting NP salaries, although it is something I'm concerned might occur in the future.

Anyone can find an anomaly or two where someone is outside of the normal pay scales for the profession/region/etc. And this seems to be a bit more of a regular occurrence in RN/NP transition as people think that being a new NP, they should somehow retain their status of having 20+ yr as a RN. Your not going to get a 20+ yr experience salary, or be offered a job just because you graduated. The posts that amaze me are the "I just graduated and no one came knocking on my door begging me to work for them". New grads are going to have to earn those first few years of experience, it doesn't come for free. It may be in relocating, or working in a job that is not ideal to your desires, or with less than optimal pay for the first year or two until you are a more valuable member of the team. Then you can demand more.

What I'm describing is not a crisis, or something that is new/only a NP issue. It is something that all professions generally go through. The new members of that profession have to learn and be trained somewhere, and the place that takes that on generally pays less in $$ to get lower skilled workers. Then once they have become trained and higher skilled, they make more and as more valuable members of the team, are able to demand better conditions. This is the case with every field of engineers I have ever worked with, and in many other fields as well. Of course, in every field again, there will be exceptions to that rule, and that is great for those who got the exception.

As for future concerns, as I mentioned the increase in output of NP graduates per year is a concern both for future salaries and future positions for new grads. I don't anticipate it being a big concern for experienced NPs as if they have proven themselves, they will continue to be valuable members of the team. I also think that as long as NPs prove themselves to be generating sufficient revenue to be profitable and being a lower cost option than other providers, NPs in general will be in high demand. If anything I think NPs and PAs (to a lesser extent) will continue to hasten the decrease in physicians going into family practice. Of course much of this depends on the state practice acts. But of course, all of this is speculative and out of my control. I do know that my original goal in getting into healthcare was to be in the provider role, so no matter how many others try to become NPs, I will continue my education, and do my best to make myself indispensable once I'm in that role. If I have to start my own practice, or work two part time jobs to make that work for me, then that is what I will do. No profession is going to be safe to fluctuations in the supply/demand for that job.

allnurses Guide · Jun 20, 2014

My preceptors in NP school chided me several times for calling NPs physician extenders and instructed me that "mid-level" was the correct term to use. I have seen that term numerous times and did not know it was not politically correct.

Mid-level was a term that came from the DEA and unfortunately stuck.

It's my personal and professional belief that all advanced practice nurses should push for a "single term" for all providers.

Personally I dislike the midlevel term because of what it implies about nurses.

PMFB-RN, RN · Jun 20, 2014

The NPs who specialize, which I plan to do, are typically starting at around $85,000. I work in an ER and the place is over-ran by PAs who work with MDs.

For an acute care RN in my area, with 5-10 years experience, working nights, or day nigh rotation full time $85K would be a large pay cut. Around 30%. As attracted as I often am to the NP roll and the autonomy that come with it, it's very difficult for me to justify grad school for such a large pay cut.

I know there are NPs who make far, far more. I would like to learn more about that.

allnurses Guide · Jun 20, 2014

For an acute care RN in my area, with 5-10 years experience, working nights, or day nigh rotation full time $85K would be a large pay cut. Around 30%. As attracted as I often am to the NP roll and the autonomy that come with it, it's very difficult for me to justify grad school for such a large pay cut.
I know there are NPs who make far, far more. I would like to learn more about that.

I would venture to say that most RNs with 10 years experience working rotating/nights making 111k per year are fairly close their career cap: and if they want to switch to days or more typical business hours than they would be forced to take a pay cut for the same job. I would also venture that many of those nurses would also like more independence.

For most NPs that 85-95k per year is a starting pay for more independence and (often) a weekday job without weekends or holidays. While salaries vary by practice area and location, most of my NP colleagues make 10-50% more than their base salary.

I do always tell my students and perspective students that shadow is that it's. It about the money. It's about the role.

PMFB-RN, RN · Jun 20, 2014

I would venture to say that most RNs with 10 years experience working rotating/nights making 111k per year are fairly close their career cap:

Yes I think you are absolutely right for "most" RNs. Not in my area. There is a fair amount of room for income growth once a nurse gets to the 15-25 year stage of their career. Top paid RNs with 20+ years in my hospital are making around $107K base and another $ 20-$30K or so in differentials, holiday pay, bonuses, etc.

and if they want to switch to days or more typical business hours than they would be forced to take a pay cut for the same job.

Yes, very true. About 30-35% of my pay is based on differentials for working nights (15%), critical care (5%), 36 weekend hours each pay period at 25% weekend differential. Plus we get performance bonuses and 10 days of holiday pay each year.

would also venture that many of those nurses would also like more independence.

Yes, absolutely.

For most NPs that 85-95k per year is a starting pay for more independence and (often) a weekday job without weekends or holidays. While salaries vary by practice area and location, most of my NP colleagues make 10-50% more than their base salary.
I do always tell my students and perspective students that shadow is that it's. It about the money. It's about the role

I agree completely it's not all about the money. For me personally I am vastly more interested in autonomy and independence that can come with being an NP than a large pay check. I currently enjoy a lot of independence and autonomy, about as much as I can imagine a regular RN having. However I would love to get out of my current situation of constantly having to talk scared, green residents into doing the right thing for my patients.

I actually have zero interest in working Mon-Fri on day shift. Are there good NP jobs out there where I could continue to work nights and weekends? If so what NP specialty would most likely have those kind of positions? I was thinking acute care NP since some of the smaller hospitals in the health system I work for use them as hospitalists. Or maybe something in ER? Some of the very small rural hospitals in my area have NPs as solo providers in the ER, especially at night. The idea of being a solo provider in a remote / rural area is highly appealing to me.

I am very happy to hear that the NPs you know can make quite a bit more than their base pay.