Pay vs. specialty

[Ted D]

Seems like ED and especially ICU start off with lower wages than fields like school/rehab/mental health. Why is this? Not to belittle rehab or mental health nursing, but isn't there a lot more critical thinking and stress involved for a nurse in the critical care setting?

[llg, PhD, RN]

In my hospital, the starting wages are the same regardless of unit. However, the ICU and ED nurses make a little MORE after they have a year of experience.

... And the level of knowledge and skill usually has nothing to do with pay differences. It's usually all about supply and demand. If some specialties pay more than others, it is usually because they are harder to fill.

[MunoRN, RN]

In my state area a Masters is required for School Nursing, although many hospital Nurses still make more than school Nurses. In terms of hospitals, I don't know of any that pay more based on the area you work.

[BrandonLPN, LPN]

I'm surprised so many people keep saying school nurses need a batchelors/masters degree. Where I live at least 50% of school nurses are LPNs, with one or two RNs to supervise entire school districts. I also know school nurses here (both RN and LPN) make much, much lower wages than nurses in hospitals or LTC.

[Altra, BSN, RN]

As other posters have indicated, this varies widely from employer to employer, and by region. It really is impossible to generalize. You might get better info on your state forum.

In my area there is generally no difference in hospital pay for different specialties. LTC RNs generally make slightly more than hospital RNs. Your mileage may differ.

[KelRN215, BSN, RN]

I don't think it has anything to do with specialty and more to do with employers. A school nurse is employed by a different institution than an ER or ICU nurse. In my city/state school nurses are paid per the teachers' wages and usually represented by the teachers' union. A step 1 school nurse with a Bachelor's degree (and, yes, a BSN is required for a school nurse in MA) in my city makes an annual salary of just under 47,000. A full time new grad nurse in the hospital I worked at as a new grad makes about $58-$59,000 annually, regardless of specialty. A new grad RN working inpatient psych earns the same salary as a new grad RN working ER, ICU or on the floor. Now, for someone with my experience (nearly 6 years), I'd actually be making more working as a school nurse in my city than I was making when I left the hospital. If you break down the hourly wage, it's undoubtedly more for the school nurse here because they work 6-7 hrs/day 180 days/year. That, and since they're represented by the union they have guaranteed raises. It appears (as I'm looking at the salary steps published on the school system's website), that school nurses/teachers in my state get about a 6% raise every year. My raises while working in the hospital were 0-2% and were at the discretion of department supervisors.

[Meriwhen, ASN, BSN, MSN, RN]

Not to belittle rehab or mental health nursing, but isn't there a lot more critical thinking and stress involved for a nurse in the critical care setting?

Come work the psych emergency room with me for a while, then tell me what you think

Seriously, it's all apples and oranges--different specialities, different environments, different skill sets. Same important outcome though: (hopefully) a safe and recovering patient. For the most part, you really can't say that specialty X involves more or less skills and CT than specialty Y. I personally think the toughest specialty to work is LTC, but that's a story for another thread.

I'm more inclined to agree with llg and KelRN. It's probably more about supply and demand than it is about the specialty itself. It seems like everyone wants to work ICU/ER/L&D/other high-profile areas, but not as many want to work in other specialities...so there has to be something extra in the carrot dangled to lure them over there.

It's also probably very facility specific too: a big hospital with lots of applicants probably doesn't feel the need to pay as high wages as a smaller facility/setting might have to in order to attract staff.

[proud nurse, BSN, RN]

I'm surprised so many people keep saying school nurses need a batchelors/masters degree. Where I live at least 50% of school nurses are LPNs, with one or two RNs to supervise entire school districts. I also know school nurses here (both RN and LPN) make much, much lower wages than nurses in hospitals or LTC.

It's kind of like that in my area, too. When I was an LPN I worked for the public school district for 3 years. The LPNs were school nurse associates, and the RNs were school nurses. At that time, there were 40 nurses employed by the the district and 32 of them were LPNs.

I made the same wage with full benefits that I made in LTC on nights with a shift diff.

[Roseyposey]

My hospital starts new grads at $25/hour. The only areas that are lower are the hospital-owned doctor's offices, which ironically, don't take new graduates - I guess that's the trade off. There are other certain areas that do not take new graduate nurses, so I guess indirectly, the pay is higher for the specialty (I work in PACU, and new graduates are not hired into any of the peri-anesthesia areas).

In my area, school nurses are paid the same as the teachers, and they are required to have a BSN. Teachers are paid more for more education, and a nurse with an MSN is also paid better. Even though teachers are actually paid pretty well in this state, I still think that the nurses are being underpaid.

[FlyingScot, RN]

I took a $10/hr pay CUT to work as a flight nurse. I was being paid $27/hr and I had 20 years of experience. $6/hr more than a freaking new grad!!! Supply and demand rears its ugly head.

[adzem08]

Where I work, ICU, CCU and ER nurses get a higher starting salary than everyone else, also a nurse with a BSN gets a higher starting salary than a nurse with a diploma, and a nurse with an MSN gets a higher starting salary than the previous 2, regardless of experience. A lot of people dont like this and the argument is always that, nurses working on the same floor do the same thing so why the pay difference if not based on experience? We also have a direct entry masters program here, for people interested in going into nursing with a bachelors degree in another field. When they graduate, they have a higher starting salary even though they have no experience

[marg571]

I'm not sure why the individual states in the U.S don't have unions to regulate wages. I work in Saskatchewan, Canada. I have been a diploma RN for 22 years and am at the top of my wage scale. The facility I work at is not unionized but we follow the pay grades of the union which include increases when new contracts are negotiated with the government. I am not sure what new grads start out with but I am sure it must be around $ 30.00 an hour. It always amazes me that we are going to the Philipines and other countries to recruit for nurses when I read that jobs in the U.S are scarce. Why are USA nurses not applying for jobs over here?? I work in LTC and make $45.35 an hour. Our dollar for the past few years has been at par or better. It is like we don't exist for US nurses. I realize why the unions haven't been able to organize like ours is because your healthcare is privatized and ours is government run. There are good and bad things to be said about both, but that is another topic.