Nurse Salaries Versus Executive Administrative Salaries: A Chasm Worth Crossing

[Melissa Mills]

According to the World Health Organization, there is a 1 in 300 chance of a patient being hurt while receiving healthcare. Compare this to a 1 in a million chance of being harmed while traveling by plane and you start to understand the inherent problems of being a patient. These statistics might lead you to believe that healthcare clinicians are highly compensated for the care they provide.

However, a recent article in Healthcare Finance illustrates just the opposite for those who dedicate themselves to patient care, such as doctors and nurses. But, the same isn't true for non-clinical administrative staff, like CEOs and CFOs. In fact, the article reports that between 2005 and 2015, average CEO compensation increased from $1.6 million to $3.1 million, an increase of 93%. While most people won't argue that administrative professionals are essential to the function of our healthcare system, we might need to explore the value they bring to patient care and safety.

The Cost of Healthcare

We would be remiss not to discuss the overall cost of healthcare when reviewing salaries for those who work in the industry. It's estimated that we spend 2.9 trillion dollars each year on healthcare services. This is around 18% of the Gross Domestic Product or the total value of everything produced by all people and companies in the United States. If we break this number down per person in the U.S. - it comes out to just a bit over $9000 per year.

The sad reality of these numbers is that they don't equate to a safer environment for patients. These numbers beg us to start questioning where the money is actually going.

Healthcare Salaries

As a nurse, you understand the critical role you play in the delivery of care. And, you know what you make. But, have you ever considered your salary increases compared to those in executive level administrative positions?

One study looked at the salary changes for clinical staff during the same time as reported above for healthcare executive salaries. The researchers found the gap between executives and orthopedic surgeons went from 3:1 to 5:1. For pediatricians, the deficit increased from 7:1 to 12:1. The gap became a chasm for registered nurses, when it jumped from 23:1 to 44:1.

This means that from 2005 to 2015, administrative executives and other non-clinical workers contributed 27% to the increase in healthcare costs. Management specifically added 7% or an increase of 15 billion dollars.

Healthcare Dollars

You might be wondering if our healthcare system will have the ability to pay for the number of nurses needed to keep patients safe. While administrative executives have a critical role within the system, they aren't at the bedside when hearts stop, kidneys fail, or brain waves cease. So, how do nurses positively impact healthcare policy?

Nurses Act for Change

Change doesn't come easily or quickly. But, if these numbers are concerning, becoming involved in policy changes might be the best way to help. Here are a few things nurses can do to change the culture positively:

Get Involved with Politics

This might not be something you like or ever considered before, but all healthcare policies and politics are controlled by federal and state laws. You could get involved on a local level by volunteering for committees that examine pay, safety, and other critical issues in your hospital. You could also join professional nursing organizations that take nursing issues to Capitol Hill. If you don't want to go to meetings, then write to your state representative about the policies and situations that are concerning to you.

Be part of a movement

If getting involved individually isn't comfortable, you can join movements, such as Nurses Take DC. This group is a grassroots movement of bedside nurses who advocate for safer patient ratios and stronger voices for nurses as shareholders in healthcare decisions.

Looking Towards the Future

We need to have open, honest conversations about the importance of nurse salaries, patient safety, and healthcare advocacy. Where do you see the future of nursing salaries? How do you propose this ever increasing wage gap between those who provide care and those who hold executive level positions be solved?

Let us know your thoughts and solutions in the comments below.

[Neats, BSN]

I agree nurses should make way more monies. Unionize...well maybe. I am a nurse who follow the rules. If HR and managers are smart they will follow the rules too. Most places follow rules so you are wasting your monies on unions. What we need to join together and fight for is this;

Outpatient/Inpatient Nursing codes for what we do as part of reimbursement. For each injection I give that is IM a code should be attached and the hospital should get reimbursed. Same with IV, with anything we do. Helping with ADL's, education....just like Physical Therapy/Occupational Therapy/Speech Therapy.

A Home Health Nurse RN with the code G0299 is usually billed in 15 min increments and the total cost for an hour visit is usually reimbursed at 120.00. As we know well, we usually spend a considerable time there teaching, changing wounds, sorting meds with ongoing education, calling MD for new orders...I can go on and on but clearly everyone gets their moneys worth for nurses.

We do this for Home Health why not hospitals?? When it comes to uniting for a cause remember we are in a business and if we get our codes based on services we become more valuable to our employee. This is where we succeed, this is where we should unit and get the reimbursement we deserve.

[HomeBound]

I agree nurses should make way more monies. Unionize...well maybe. I am a nurse who follow the rules. If HR and managers are smart they will follow the rules too. Most places follow rules so you are wasting your monies on unions. What we need to join together and fight for is this;

Outpatient/Inpatient Nursing codes for what we do as part of reimbursement. For each injection I give that is IM a code should be attached and the hospital should get reimbursed. Same with IV, with anything we do. Helping with ADL's, education....just like Physical Therapy/Occupational Therapy/Speech Therapy.

A Home Health Nurse RN with the code G0299 is usually billed in 15 min increments and the total cost for an hour visit is usually reimbursed at 120.00. As we know well, we usually spend a considerable time there teaching, changing wounds, sorting meds with ongoing education, calling MD for new orders...I can go on and on but clearly everyone gets their moneys worth for nurses.

We do this for Home Health why not hospitals?? When it comes to uniting for a cause remember we are in a business and if we get our codes based on services we become more valuable to our employee. This is where we succeed, this is where we should unit and get the reimbursement we deserve.

"...what we need to join together and fight for is..." like, as in, a union? Joining together....fighting for things....like in a union?

Coding for separate procedures IS done. What the article is about is the fact that the administrators take that extra money and line their own pockets...and do NOT invest it back into the hospital.

It's not a problem of "making more money". It's a problem of DISPARITY between those at the top, and those of us at the bottom.

I'll repeat myself. Unionize. The only voice you have is when you collectively bargain as equals with the hospital, and there are repercussions when this disparity becomes blatant, as it does in....the South and many parts of the Midwest. Especially the South. They do not care about turnover, safety issues, resource scarcity---as long as the higher ups get their bonuses at years' end.

The other thing that chaps my butt is the connection of a hospital to a college--that has a sports team and all of the rigamarole that goes with that. Gotta cater to the alumni bucks--if they are to give, then it's certainly never to the hospital needs, it's to the sports team needs, bringing in those dollars---which we as employees never saw. But we sure as **** took care of all of the drunks post game with no insurance.

Collective bargaining is really the only way to alleviate any of the gap. If you have zero power to change anything, because there are no real consequences for administration...they can do with you what they will.

Which is why if you say the word "union" in the Southern states and some of the midwestern states? You will not only be immediately targeted--you most likely will not find another job in the area once they make you miserable enough to quit (they're smart enough to not fire you, because they will have to pay UI).

My dad was a Teamster in the days of old. I have been in 4 union shops. The ONLY way CA RNs got the nursing ratio passed was because the CNA is an aggressive, in-your-face-willing-to-strike union. Strong and loud for patient safety and living wages for RNs. The facilities fight tooth and nail to hamstring the union--but the employees...

"....join together and fight for things..."

[SN2014]

I wish there was a way to change this. At the place I'm employed the CEO just received a raise. He also gets >$300,000 just to his retirement fund alone. If he is fired before a certain age, we will have to pay him his salary and his retirement fund still. Nurses get paid very low $20s, no room for growth. Nurses in ED have 4 pts, med/surg 7, and icu 3. CNAs sometimes have more than 30 patients. We are looked at as disposable and anyone who won't tolerate being treated that way - over worked and underpaid - leaves and is replaced with a new nurse. The new nurses get paid the lowest in the county. They're often trained by other new grads and their orientation is cut short to meet staffing needs. They sign a 2 year contract agreeing to work for the company (with no sign on bonus) for training them and if they leave early they must pay the hospital 6k. It's a vicious cycle that's top-heavy. There was talks of a union but everyone is too scared, they tried a few years ago and those who spoke out had a target on their backs and were fired.

Mandating ratios is a great start and I don't know why there's so much push back from nurses themselves. However, that doesn't really solve the top heavy corruption seen in many acute care facilities.

[CeciBean, ASN, RN]

I swear there is NOTHING more useless than an "assistant" administrator. NOTHING!!