Is your salary keeping up with your staff's?

[ACNORN]

I'm wondering if all of the salary wars, bonuses, incentives, etc. that are offered to the bedside nurses these days is removing one of the long standing advantages (higher pay) of nurses moving into leadership positions. I am finding it much more difficult to hire nursing leaders. Is it because it is too stressful to be in management these days, are nurses scared of the shortage and don't want to be responsible, or are they making enough money at the bedside so they figure - why have the headaches of management?

When your facility gives RNs across the board raises or offers incentives- are the managers included or eligible?

Don't get me wrong, bedside nurses deserve to be very well paid for what they do, but there is a certain advantage to being able to go home at the end of the shift and have no further responsibility for the operation.

I'd love to hear the thoughts of other nursing managers. Thanks.

[ACNORN]

I have paid more than that in income taxes in one year! My son graduated from Texas A&M 1.5 years ago and yanks down over $90K, and he is still a grunt in his occupation. I will rattle everyone's cage here. It is no secret, you do not ask, and you do not receive. Now, stop following nursing school doctrine and engage in business doctrine, and get in there an get paid for what you are worth, and be able to show it on paper, spreadsheets and all.

I agree that we have to be assertive and make sure that we are paid what we are worth. The only problem with the comparison is that in other businesses you don't have the majority of revenues coming from the government with caps on the payments. Short term hospitals have DRGs, and all the post acute providers have PPS reimbursements. If consumers directly paid for their healthcare (which I'm not suggesting is the answer) and we didn't have built-in controls on the revenue side then we could operate more like the free market systems of many other industries where the harder and smarter you work the more money you can make. Since a major segment of the labor costs in a hospital comes from nursing care, if we all made major bucks, without the reimbursements of hospitals going up also, the hospital would go broke. I have seen the financial statements and know this to be true.

Pharmacists in our area are demanding 75K to 100K as a starting salary because they changed their regulations of requiring a doctorate degree to be a pharmacist. I thought about whether nursing could do something like this, but there is a significant difference in the numbers of pharmacists employed versus nurses. I guess hospitals can afford to pay them the big bucks that the market demands because there are usually only a handful of pharmacists needed in the first place. The other factor that the pharmacists have that we don't is the influence of the retail drug store sector. Their salaries went up because the Walmarts and CVSs of the world are paying pharmacists 6 figure salaries.

On the other hand, there are usually only a handful of nurse educators and nursing administrators.....If highly degreed and highly talented nurses could choose a job in the free-market sector, I bet our salaries would go up too. The bottom line is we need to create a situation where the hospitals feel they need to compete for the nursing leadership talent in their market as much as they already feel they need to compete for staff RNs and pharmacists. Hummm.......something to think about.

I appreciate all the perspectives and comments of everyone. This is one of the more thought provoking discussions I've seen. Glad2behere, don't let this discussion dissuade you. You no doubt are just the type with spunk that we need to help make things better.

[Glad2behere]

ACNORN,

Thank you for input, I have decided to initiate action and commence preparation for the GRE, I have to score about 1100 on the two parts that are accepted by the graduate school, surely I can get that done. I am not dissuaded one iota, but I did want to know some of the substance of what I am getting into from an internal perspective. All of you posting here have been very generous with your knowledge, and it is sincerely appreciated. I think you are correct about other avenues to pursue nursing leadership. This is a growth process and a learning curve, and to date, there has really been no need to accelerate or direct it. The roll call of individuals responding to this thread can be taken as evidence that that need is maturing and will be addressed. I feel I am in good company, will seek more education, and hope that I will be able to make contributions of significant caliber, adding to what has been done and what you are doing now.

[llg, PhD, RN]

Hi, folks. I'm back at my computer after having been off for the weekend. Great post, ACNORN! Yes, the financial situation is complicated and I agree with everything you said.

The Pharmacists are in a different position. They are a relatively small item in the hospital budget because of their low numbers. Legally, they can not be replaced by people with less education. And the commercial market provides great competition to keep their salaries up.

Unfortunately, nurses with advanced education can be legally replaced with anyone with an RN. Also, the hospital can downsize it's leadership positions by simply asking the few of us remaining to cover more and more territory. Finally, the chief competitor for nurses with graduate degrees are colleges -- and they pay even less than hospitals!

Personally, I try to use my relatively low pay to my advantage whenever I can. For example, I rarely work more than 45 hours per week, don't work weekends, holidays, etc. Whenever that fact comes up in conversation, I am quick to point out that the hospital only pays me for 40 hours and doesn't compensate me for holidays, etc. Also, I take maximum benefit of the scheduling flexibility, etc. that I do have available in my job. In other words, I make sure I take full advantage of the benefits that do exist and I don't let myself be abused.

Because I put limits on the amount I "give" to work (to equalize what I receive in pay), the overall quality of my life is pretty good. I sometimes worry that if they paid me more, they would expect me to work more -- and I really don't want to be a slave to my job. It's the trade-off I make. Some of my friends make more than I do, but they are slaves to their job and not very happy.

llg

[Glad2behere]

llg and ACNORN,

Therein lies the itch. Admittedly, pharmacists make more for the reasons you all stated. On the nursing side of the equation, nursing and nursing leadership are considered the same thing. My observation is that they are not. Not any ole nurse can be a good NM and some NM's are worthless as nurses. There is a lot of role confusion here. Pharmacists are low census, as is nursing management. How many nurses for every NM, every DON or NA? I am not sure, but I would wager there are fewer nursing management positions than there are pharmacists for the same hospital census. Sure, it would be great if all nurses had a bump in salary, but that is not the objective sought. If every nursing management position had a $20k raise in the hospital, it would have virtually no impact on financial statements that could not be recovered very easily somewhere else in expenditures. There is simply too much money involved to not scrimp somewhere else. Too many early discharges, too many agency nurses, too much overtime, too many syringes walking home in people's pockets. The more I work in the hospital setting the more I am astounded by the incredible amount of waste that goes on as a laisse-faire fact of business. The paperwork alone is so self defeating and time consuming, and I understand most of it comes from liability issues, but still steamlining even that would lessen the printing bill. Maybe I am too much of an idealist, or having substantial business experience makes me cynical of much of what goes on in the healthcare environment, but I see daily things I could change and never touch the income stream...deal with that later.

I think the mentality of questioning every expenditure, and asking a simple question would do wonders. That question is this "Am I trading a dollar for a dollar, or is that dollar going to bring back an equitable return?". If it doesn't, don't spend it!

[llg, PhD, RN]

Glad2behere: I agree that there is money spent all the time that could probably be saved. But like most people, I am overwhelmed at the enormity of the task of trying to sort it all out. That's why we need people like you (with both a business background and also a nursing one) to take the plunge and go into nursing management. However, as you know, you won't be making that big salary you would prefer -- at least not for a long time.

llg

[Glad2behere]

llg,

Thank you for the response. And the compliment. I suppose I will have to enter graduate school and sign up with you all. I will be glad to and feel alive again combing over financials and employing methods to maximize efficiency, but it's gonna cost 'em:D I'll split the increased bottom line and let them keep a larger percentage when the forecast is met. That is how you sell it upstairs, on a trial basis. Then take a percentage that is above the projections. That is how I did car dealerships, and hospitals are not that much different really, from a business perspective. Actually car dealerships are probably much more susceptible to business cycles than hospitals are, in a way making them easier in some aspects.

[llg, PhD, RN]

Glad2behere: Good luck with whatever you decide ... and keep us posted!

llg

[ACNORN]

Unfortunately, nurses with advanced education can be legally replaced with anyone with an RN. Also, the hospital can downsize it's leadership positions by simply asking the few of us remaining to cover more and more territory. Finally, the chief competitor for nurses with graduate degrees are colleges -- and they pay even less than hospitals!

nursing and nursing leadership are considered the same thing. My observation is that they are not. Not any ole nurse can be a good NM and some NM's are worthless as nurses. There is a lot of role confusion here.

Two very astute points llg & Glad2behere. We know that nursing leaders and advanced practice nurses have an entirely different skill set (in addition to their clinical one). I have seen many companies put good clinical nurses in managerial positions that they weren't ready for and when they failed, it was remembered that they needed to recruit a "higher caliber" candidate. Yet they don't really see any initial differences because we are all RNs. Seems like we need an additional designation that is legally required.

llg, are all college professors paid low salaries or are the nursing profs. on the lower end of the scale in academia? Just wonderin'.

[RNPATL, DNP, RN]

This is a great thread with a lot of great information. I would love revive the discussion and see if things have changed in the last year since the thread was started.

From my perspective, I think that there are many nursing management roles that go unfilled because of the amount of responsibility. Compensation for the nurse manager has not kept pace with the staff nurse increases and incentives. Someone shared that there was not a nurse manager shortage in their area and that only staff nurse positions have incentives. I would probably agree with that statement, but think that if there is not a shortage of nurse managers, their is a shortage of qualified nurse managers.

Someone else also added that there is a direct lack of people getting into education and CNS. I think the next generation of young people are practical and looking at their career options with objectivity. When a young person compares advanced degrees in nursing with other professions (i.e. law, engineering, IT, etc) .... there is little prestige, money or reason to pursue nursing as a life long career. I think this is improving, but we have a long way to go.

In relationship to my salary compared to staff nurses .... we are very close! For me, the amount of responsibility, amount of hours worked and the 24/7 call should be reason enough for nurse managers to receive a nice compensation package. I am fortunate to work for a great health care system and have confidence that this will be reviewed.

This is a great thread and I hope the dicussion can be revived. Thanks!

[SarasotaRN2b]

Hi Patrick,

I'm glad that you revived this thread. I'm still on the waiting list to actually get into nursing, but the area I'm interested is management. I've already received an associates degree in health care administration. Since I've finished all of my prereqs and I'm just waiting until next Fall, I've decided to take some more business classes in management and accounting. To be able to blend the two interests (nursing and business) would be great. Of course, when I finish my ADN program, I plan on working a couple of years in Med/Surg while working on my Bachelors/Masters. I look forward to reading whatever other input comes in.

[RNPATL, DNP, RN]

Hi Patrick,

I'm glad that you revived this thread. I'm still on the waiting list to actually get into nursing, but the area I'm interested is management. I've already received an associates degree in health care administration. Since I've finished all of my prereqs and I'm just waiting until next Fall, I've decided to take some more business classes in management and accounting. To be able to blend the two interests (nursing and business) would be great. Of course, when I finish my ADN program, I plan on working a couple of years in Med/Surg while working on my Bachelors/Masters. I look forward to reading whatever other input comes in.

Good luck with your nursing education. I am certain that when you graduate, there will be many, many nurse management opportunities out there for you. I am glad that you desire to get some epxerience first before moving into a role of nurse manager or higher. All too often nurses take on the responsibility of management before they have the practical work experience to truly understand the challenges that nurses on the front line face each and everyday.

Working as a staff nurse can give you a real appreciation for what the issues are and how to effectively and positively impact change for the nurses. I have been a nurse for over 20 years and have worked in management positions on and off throughout my career. I really believe that nursing has changed so dramatically these days that is can be very hard balancing the responsibilities of running a unit and providing the best clinical care and outcomes possible. It can be done, but it is difficult.

One of the reasons that nurse managers get such a bad rap from staff nurses is that they enter the role without a true appreciation for the challenges faced by staff nurses. In addition, the pressure from upper management to balance the budget can be great. A nurse manager needs to be able to effectively manage the budget challenges while providing the nurses with the tools and resources necessary for them to get their job done. I am very lucky in that I have a great group of nurses working for me and together we are making a difference for the patient.

Good luck as you continue and complete your education and thanks for your response.

[joannep]

When I finally made DON I was so excited, it was the fulfilment of many dreams. I did a Master of Nursing Leadership prior to applying for any management position.

However, there is always a shadow, and for me it was when I found out that the two previous DON's had less qualifications and experience than me, but had been paid more.

I have been in this position 5 months. I like lots about it. I don't miss being a staff nurse. In my last staff nurse position I had been rostered 7 weekends in a row! But will I be here after 2 years? I don't know, I'll wait and see.

Joanne :)