Questions for Current NPs

[TheOldGuy]

I'm sure you've seen others indicate that compensation and opportunities really vary based on location. I make approx $125k as an RN. As an NP, compensation is around $95-120k. Lots of NPs work as RNs in this area....Northern Calif.

Why is NP compensation so much lower?

1. CANP does nothing to promote independent practice.

2. Docs pay as little as they can.

3. Oversupply of underutilized FNPs

4. Hospitals don't see value - why hire an NP to do what a doc can do when the doc doesn't cost the hospital anything?

It is extremely difficult to get a job in this region as a new grad RN (or NP). Solid specialty experience eg ED/ICU/OR makes you a candidate.

[myelin]

Sounds like it depends on the region... I'm hoping to practice as a psych NP in the Pacific Northwest (OR or WA). I've heard the opportunities are wide open for psych in this region, and since both states are independent practice states, I've heard compensation is excellent (around 6 figures for psych NP). I'm wondering if anyone has heard anything similar about psych NPs ... or the region... or both?

[allennp]

Sounds like it depends on the region... I'm hoping to practice as a psych NP in the Pacific Northwest (OR or WA). I've heard the opportunities are wide open for psych in this region, and since both states are independent practice states, I've heard compensation is excellent (around 6 figures for psych NP). I'm wondering if anyone has heard anything similar about psych NPs ... or the region... or both?

As with everything it depends..... There are a number of psych np positions open here in the PNW, and I have a couple of friends who are psych np in their own practice. I would question though deep triple digits though. Billing is tough and it depends on your overhead and patient population. Private practice in WA state can be a tough road, both for MD and NP practices. I am aware of multiple realignments of practices due to overhead, decreasing pt loads, decreased reimbursement. Private practice from my view can be very tough. Just my view...ymmv

A

[myelin]

Thanks for the post, Allen! I've read that the national average pay for Psych NP is ~ 95k and that in the pacific northwest the average is a bit higher than that. By "deep six figures" do you mean 130, 140k+ or something? Because yeah, that seems too high. What I was hearing is more like 100-110k is pretty doable as a psych NP in independent practice states. I guess I'll find out... (hopefully!)

[juan de la cruz, MSN, RN, NP]

I'm sure you've seen others indicate that compensation and opportunities really vary based on location. I make approx $125k as an RN. As an NP, compensation is around $95-120k. Lots of NPs work as RNs in this area....Northern Calif.

Why is NP compensation so much lower?

1. CANP does nothing to promote independent practice.

2. Docs pay as little as they can.

3. Oversupply of underutilized FNPs

4. Hospitals don't see value - why hire an NP to do what a doc can do when the doc doesn't cost the hospital anything?

It is extremely difficult to get a job in this region as a new grad RN (or NP). Solid specialty experience eg ED/ICU/OR makes you a candidate.

Agree with some of your opinions. True, CANP does little for the profession. Physicians who hire NP's for private practices in the area seem to offer lower salaries if you compare it to the hyperinflated, union-strong, hospital RN pay scale in Northern California (especially in regard to Kaiser, Sutter payscales). I also see an oversupply of FNP's not just in California but everywhere else. However, there is a market for FNP's here though the jobs are in areas where the pay is traditionally lower than average (i.e., low-income settings/uninsured free clinics/HIV clinics). The pay may not be attractive in general but another person might not see the low salary as a deal-breaker, rather, the opportunity to serve a population in need of care to be a more important goal. I disagree about hospitals not seeing the value of NP's and PA's. Maybe in some institutions yes but definitely not in all. I work for a hospital right in San Francisco that employs over 275 NP's many of which are also part of the CNA collective bargaining group and are entitled to a higher salary than their RN counterparts in the system. What I personally see as the root cause of why there are so many NP's working as RN's in Northern California (and in the entire state for that matter) is the abundance of direct-entry NP/MSN programs that crank out numerous grads each year many of whom can't find a job as an NP.

[TheOldGuy]

Juan, buddy, why do you think that nurses salaries are hyperinflated??

Nor Cal RNs don't get a hyperinflated salary - RNs everywhere else are simply getting screwed. RNs are responsible for everything from cleaning bottoms to catching med errors from pharmacists, and MDs - catching dietary errors, ensuring that PT isn't doing something that will endanger pts and the list goes on and on! Thank heaven for CNA in Calif - we have better earnings and ratio protection - in January there are mandated lift teams.

I'm happy that you're working for a hospital that pays NPs more. But that is not typical. Most private hospitals have a hard time justifying NPs. The reason is as I stated: MDs are not on the payroll and cost the facility nothing. Why should they hire an NP and pay them $10k per month when they don't need to?

The reality is that California has a potential workforce of over 15,000 NPs and we don't even have a defined scope of practice. NPs in California are dependent upon someone paying them - it is very difficult to be in private practice. I'm not talking about new grads - I know a number of experienced RN/NPs who make more as an RN than as an NP - so they don't work as NPs - and why should they? The nearly 400 bed hospital I work at as an RN pays its 2 experienced NPs about $10k less than I make.....

If you work for Kaiser its a different story - Kaiser has to pay its docs - nobody else does.....

Econ 101 ......

[juan de la cruz, MSN, RN, NP]

Juan, buddy, why do you think that nurses salaries are hyperinflated??

Nor Cal RNs don't get a hyperinflated salary - RNs everywhere else are simply getting screwed. RNs are responsible for everything from cleaning bottoms to catching med errors from pharmacists, and MDs - catching dietary errors, ensuring that PT isn't doing something that will endanger pts and the list goes on and on! Thank heaven for CNA in Calif - we have better earnings and ratio protection - in January there are mandated lift teams.

You ain't got to tell me that. I worked as a bedside RN from 1991 to 2004 in LTC, Med/Surg, ER, and ICU. I've done bedside work in most settings involved in caring for the adult population. When I said hyperinflated, I didn't mean that in a negative way. You see I moved to California from Michigan where the salaries are higher by midwest standards yet miniscule by California standards. Michigan is the birthplace of the union movement - the sitdowns at the GM plant in Flint started collective bargaining for auto workers. I hope I could say the same about Michigan RN's but the fact that the Michigan Nurses Association broke off from ANA is a huge step in the direction of getting more respect for RN's there. I am all for unionization and I love California for the strong nursing unions here. What the CNA has accomplished here is a model for the rest of the country.

[SE_BSN_RN, BSN]

So, even though you have a MSN you can still work at the bedside as a "regular" RN? Or does is depend on the state you live in? Or just whatever track of MSN you decide to take? I suppose that is a question for me that really doesn't apply since I know what I want to do with that MSN but it is always good to have other options just in case something else doesn't work out.

Mandated lift teams, wow! That is certainly something that should be adopted by other places. That would be great.

[Lovanurse]

So, even though you have a MSN you can still work at the bedside as a "regular" RN? Or does is depend on the state you live in? Or just whatever track of MSN you decide to take?

Yes. You will always maintain your Registered Nurse License as an advanced practice nurse (MSN or DNP). So you can always work as an RN. An Advanced Practice nurse is a nurse who has completed a graduate level education. So, you can get an MSN with a focus in education, NP, CNM, CNS, CRNA or whatever your interest is. But you will always have your RN license.

[SE_BSN_RN, BSN]

So, even though you have a MSN you can still work at the bedside as a "regular" RN? Or does is depend on the state you live in? Or just whatever track of MSN you decide to take?

Yes. You will always maintain your Registered Nurse License as an advanced practice nurse (MSN or DNP). So you can always work as an RN. An Advanced Practice nurse is a nurse who has completed a graduate level education. So, you can get an MSN with a focus in education, NP, CNM, CNS, CRNA or whatever your interest is. But you will always have your RN license.

Thanks! Finally someone who can answer a direct question! I was curious about that, I wasn't sure how that all worked.

[traumaRUs, MSN, APRN]

But, when you are an APN and you work as an RN, you are held to the standard of the APN licensure.

This provides little to no protection for you as a licensed APN working as an RN.

Risk managers nightmare.

[SE_BSN_RN, BSN]

But, when you are an APN and you work as an RN, you are held to the standard of the APN licensure.

This provides little to no protection for you as a licensed APN working as an RN.

Risk managers nightmare.

I know that, too! :) But working at the bedside, are you working as the APN or the RN? My problem is there is so much to do as a BSN I can't decide, cuz I want to do it all! But, really, my ultimate goal is getting my DNP with the emphasis in midwifery. That is my passion, and my dream. But I want to keep my options open if indeed the job market is that tight for nurses in that specialty.