Raise after (a little) experience?

[studentnurserachel]

I have only been in practice for about 6 months, but I am beginning to get worried about my prospects for a raise eventually. My husband and I both work for the same hospital system in a rural area. He is a PA who has about 6 years of experience and works in the ER and I am a new grad FNP working in an adolescent health clinic. I like my job quite a bit and it is pretty easy work, very light schedule, no billing/RVU pressure because we get state funds to help support the program, and I basically get along with my coworkers. When I accepted the position, the hourly rate they offered was pretty much my absolute bottom line I was willing to accept as it is a little below the 10th percentile according to salary.com, and way below state median/mean. I was okay with that because I was a new grad and job opportunities in this area are not exactly abundant. I also assumed that with experience I would get raises in addition to the regular cost of living that every employee gets. Recent off the record discussions with more long-term employees have left me a little worried that I can expect to stay at the 10th percentile forever (and eventually fall off the curve!) if I stay at this job. My husband has heard from other PAs that the only raises they have gotten have been the cost of living raises at the end of each year, which are not quite keeping pace with inflation. I have heard the same and that the only raises that any nurse in the facility gets are cost of living or if they move into a different position with more responsibility. There is really no upward mobility potential at this place and I don't care about that, I am good being the clinic provider, don't really want to get involved with management. It is not the type of place where I could get a bonus because we don't make money, we are lucky to break even on our billing and only continue because of state funds for these types of clinics. So how do I approach this at my 6 month or 1 year review? I don't have the ammunition that some can bring to the table with how much money I generate for the practice, because I don't, although the practice cannot continue to exist without me because the clinic must staff a provider at least 30 hours a week to maintain state funding. Asking for things besides money is probably not an option because I am an hourly, not salaried employee, I accrue PTO based on their rigid formula (which is not great, but not terrible). I get 1 week of CME and a somewhat paltry 1500 CME allowance (does not actually cover a week of CME unless I don't stay in a hotel, have a car, have any other expenses!). I don't want to job hop just to eventually get up to a reasonable wage, I do not necessarily expect to get up to the 50th percentile any time in the near future, I know I am not working as hard as a lot of other people, but I still paid a lot of money to get my degree and it's hard to work for not much more than I was making as a staff nurse (actually less, because I moved from a slightly higher cost area) with a great deal more responsibility. Sorry for the novel, I just really would appreciate some insight from anyone who has been through salary/raise/benefit negotiations after they started work. Thanks in advance!

[patrick1rn, MSN, RN, NP]

Work, get experience, get some primary care experience, focus on your weak points and make them stronger and look for the next best thing.

[traumaRUs, MSN, APRN]

Well, its all about the reimbursement. Since your position is contigent on state funding, I think you might have to move to another position in order to get the salary you want. I've been in my position 6 yrs. I get cost of living, the "paltry" (your words, not mine) $1500 CME - (going rate in the rural midwest), and from salary.com, I'm at the 60th percentile for my area/credentials. However, when we look at requesting a raise, we have to come to the bargaining table with what we propose to do in exchange for more money. Some suggestions based on what you have posted:

1. Since you generate/bill no fees, you are going to have to come up with some other carrot to dangle in front of the boss.

2. Perhaps you could offer to teach a class to unlicensed personnel re: HIPAA, charting documentation, patient care protocols.

3. Revamp the flow of the clinic to improve the number of pts you can see in a day.

4. Institute protocols for unlicensed personnel in order to improve pt care.

5. Start a customer service plan - I immediately think of Pres-Gainey but it doesn't have to be something big and flashy.

6. If there isn't a call back system for labs, appts, no shows, draft a plan.

[sailornurse]

The CME of $1500 is pretty standard & actually doable depending on the location of the conferences you attend. You could attend 2 three day conferences. Conferences range in costs but I would suggest breaking the 7 days you are allowed into 2 or 3 conferences. You do not have to stay at the fancy hotel the conference is held (all you need is clean room/clean bed) & I try to go with a friend and share the rooms. Most big cities have subways/bus systems or shuttles so no need to rent a car. Meals are included in many conferences. I've attended one day conferences 45 miles from my hometown for 8 CEUs for $150 for one day conference. I also will drive to the next largest city about 275 miles away to attend conference and stay with friends. I attended Keystone conference one time and only spent $1000 including the conference (3 days & tons of CEUs) airfar/hotel/rental car but I rented the cheapes littlest car). Same with the UTAH NP annual pharmacology conference. My friend works for a non-profit grant supported clinic system and the 1 week CME/$1500 is what she also gets.