Show Bedside Nurses the Money

[NRSKarenRN, BSN, RN]

american journal of nursing - april, 2003 - volume 103, issue 4

show bedside nurses the money

new uan poll offers solutions to the staffing crisis.

by suzanne martin

http://www.nursingworld.org/ajn/2003/april/issues.htm

the media has cited possible solutions to the nursing shortage in studies conducted by health care groups ranging from the joint commission on accreditation of healthcare organizations (jcaho) to the american hospital association (aha), but nurses' own solutions have received far less attention. results of a new survey, nurses' solution to the nurse shortage, released in january by the united american nurses (uan), afl-cio, the labor arm of the american nurses association, sheds light on what staff nurses, who deliver direct care at the bedside, see as the most effective ways of putting a dent in the shortage.

of the 600 hospital staff nurses polled nationwide in november 2002 for the uan survey, 82% indicated that increased wages would be an effective solution to the nurse staffing shortage. a reduced nurse-to-patient ratio was also a highly rated solution (85%), as were greater autonomy and control for staff nurses (66%) and safer working conditions (65%).

few dispute that the shortage is a problem. the aha reports that there are 126,000 rn positions currently unfilled, and government experts estimate there will be a deficit of between 800,000 to 1 million bedside nurses by 2020. of respondents to the uan survey, eight out of 10 said that there is already a serious shortage at their hospitals, and three out of 10 answered that it is unlikely that they will continue to be hospital staff nurses in five years. the survey cited the top three reasons nurses leave the profession: work-related stress, patient load, and inadequate pay.

perhaps the most surprising result in the survey was the emphasis respondents placed on increased wages. in a profession that historically has emphasized dedication to patients above the nurse's personal well-being, salary has often been of low priority.

that is changing, however, as some unionized nurses have negotiated double-digit pay increases at the bargaining table and base pay rates in the low $60,000 range in high cost-of-living areas such as new york city. in most cases, these wage boosts came after years of little or no pay increases and in some were won only after lengthy strikes that enabled nurses to demonstrate dangerous staffing practices, poor working conditions, and inadequate compensation.

overall, nurses responding to the uan survey suggested that salary is clearly a consideration when they evaluate whether to stay in the profession. six out of 10 said they earn less than $46,000 a year, and 55% with more than 10 years of experience earn less than that amount. some two-thirds of those polled felt that they make less money than the demands their jobs warrant, and of those, a third believed their appropriate yearly salary is in the range of $70,000 or more.

"no one is suggesting that nurses throw aside concern for patients as a motivating factor in what we do," said uan chairperson cheryl johnson, rn, a nurse at the university of michigan medical center in ann arbor. "but the cold reality is that we must make bedside nursing an attractive career choice--including offering pay that stacks up against other jobs--or more young people will opt not to become staff nurses and those already in bedside nursing will leave. and 10 years from now we'll still be here wringing our hands over how to recruit and retain nurses."

according to the national sample survey of registered nurses, staff nurses in march 2000 earned an average annual salary of $42,133.40. nurses rank 115th among the 292 major occupational groups in the bureau of labor statistics national compensation survey, behind such jobs as sheet-metal duct installers, tile setters, editors and reporters, and funeral directors. elementary and secondary school teachers earn more, too.

"while all these and many other jobs with higher pay are important and far reaching, nothing equates with the critical impact staff nurses have on patient outcomes," said uan director susan bianchi-sand.

since 1996 pay for hospital staff nurses has increased only 2.2% per year, according to a february 2002 u.s. department of health and human services bureau of health professions report. by most accounts, this increase fails to even keep pace with the cost of living. staff nurse pay increases also lagged behind that of other rns, with higher increases going to rn administrators (3.7%), instructors (3.7%), and supervisors-head nurses (3.3%).

last year a jcaho report, health care at the crossroads: strategies for addressing the evolving nursing crisis, identified "a fair and competitive compensation and benefits packages for nursing staff" as a key solution to staffing shortage and called on hospitals to implement this tactic. but the jcaho report also stated, "hospitals have few incentives to invest in nursing staff, and to improve patient safety and health quality . . . they [nurses] are paid the same whether . . . their medical-surgical nurse-to-patient ratios are 1:4 or 1:10." opponents to increasing rn salaries have been quick to latch on to this reasoning and say that hospitals are paying nurses as much as they can, and that higher nursing costs will likely be passed on to patients.

for bianchi-sand, the balance sheet belies those arguments: "when i pick up a paper and read that the ceo [harvey holzberg] of robert wood johnson university hospital [in new brunswick, new jersey,] made $2.15 million in his 2001 compensation package, it's hard to fathom how anyone could suggest that paying a staff nurse--who will be at your bedside and providing critical care for you when you're a patient--isn't worth at least $70,000 a year." holzberg's $2.15 million package included $1.2 million in salary and bonuses and $925,199 in deferred compensation and other benefits, reported the january 12, 2003, issue of the home news tribune.

johnson agrees. "we know that when staffing isn't at safe levels, our patients are at risk and they're not getting full value for their money. in this [uan] poll, nurses have given us their professional assessment that the nursing shortage is the biggest problem in hospitals today. more to the point, they've told us what it will take to cure it. now, as nurses we've got to work collectively with hospitals to implement these solutions and ensure that there are enough bedside nurses to give patients the care they need in the future."

to read the full results of the uan staff rn poll, go to www.uannurse.org. suzanne martin is associate director of communications, united american nurses, afl-cio, the labor arm of the ana.

[newgrad2004]

I hope they soon pay us what we are worth I cant believe some grads are starting at 17 or less an hour, one guy on another post said something even more hideous and It is really degrading to think of being paid or offered so little for all the work nurses do and all the schooling...

[sjoe]

new writes: "I cant believe some grads are starting at 17 or less an hour"

Believe it. The AVERAGE pay for RNs in Florida is still less than $18/hour. Check out other states at http://www.salary.com for more info.

[missmercy]

I know that salary is a definate issue here -- especially now that we are offering sign on bonus perks. We are finding (understandably so) that some of our loyal, long term nurses are less than tickled to orient and precept the new kid who is making more than they are (with the bonus figured in etc.)

Not only is salary an issue, but insurance coverage and co-pay is a huge issue here. I have worked in other hosps where an employee could go to the ED, the lab, x-ray, pharmacy etc and get greatly reduced costs for tx ( or even have just the insurance coverage be accepted as payment for services) -- here, the premiums just keep going up and seems that the service doesn't correlate.

I believe that there is a huge issue r/t appreciation and valuing loyalty and committment too!! I am looking for ways to let our long-term staffers know how much I appreciate them!! They certainly are a huge help for my job (staff development) They are invaluable resources, calming factors, EXCELLENT care givers and truly fabulous folks!! Any creative ideas r/t how we can honor them?! I have a miniscule budget, so I have to be really creative -- any suggestions?!

[oramar]

I personally am in premium pool so I make almost as much as agency. However, the other nurses where I work are under paid, I predict we are going to start bleeding staff where I work. The people with 25 years or so won't leave because they are getting close to retirement. In the past month three different nurses with 15 to 20 years and in their early 40s said to me that they are serious about striking out for greener pastures. They seem to feel that they need to change jobs to better their pay and bennies, it just ain't going to happen otherwise.

[missmercy]

I can't influence salaries here, but would like to find some way to let them know how valued they really are. I know money talks -- LOUDLY, but I just don't have it to hand out!! Sure wish I could!

[MellowOne]

The bottom line is...money. Hospitals have tried to cut benefits and limit pay, and now they're paying for it with a nursing shortage.

In Cincinnati (I don't live there, but go there for Reserves) the number of nurses who work agency has increased greatly, forcing understaffed hospitals to pay the extra bucks. If the Cincy hospitals had raised pay rates, not cut benefits, and taken care of their folks, they wouldn't have to pay for so many nurses that finally got tired of the crap and went agency.

Unfortunately, most hospital HR people and administrators are absolutely clueless about what their staff think, and what's happening in the trenches. They're watching the bottom line so that they can meet higher HQ targets and get their bonuses.

I still dislike Unions, and will never work at a Union hospital. Nevertheless, I once read a person's statement to the effect that, "Hospitals who are unionized usually deserve it."

Be well....

The Mellow One

[barefootlady, ADN, RN]

I do not believe that administrators and HR people are clueless about how lower benefits and no real gains in salary have depleted their pool of staff. I don't think they care. They did believe like the rest of the world that nurses have no interest in MONEY, they do this job because they have a need to make others feel better and take care of others. I for one am sick to death of hearing about how nurses are being used and abused. WE ask for it if we don't demand better.

[fergus51]

I can't influence salaries here, but would like to find some way to let them know how valued they really are. I know money talks -- LOUDLY, but I just don't have it to hand out!! Sure wish I could!

My aunt worked on a unit where the unit manager would write down good things she noticed about the staff. Then on nursing week, they got a small bag of goodies (candy and the like) and a note that said something like "I noticed how great you were at helping that new nurse when she was on orientation, thank you" or "Your attitude and professionalism in this situation was remarkable. thank you". It always had a very specific description of the event and the date. Very much appreciated by the staff.

[tiliimnrn]

Fergus51, I can see where that would make an impression on the staff, but don't you think a raise or a bonus would make more of an impression then "candy"? I work at a place where they always try to come up with "non-monetary" ways of making us "happy". The other day in a staff meeting I asked, "Why does it always have to be non-monetary?" All of the staff in the meeting started yelling and grumbling (I thought I was in trouble), but they were ALL agreeing with me. Nursing is a very intensive job, I don't care what floor, or what area you work in, we deserve more then we're getting. I know that my NM got a bonus when she screwed us with the staffing matrix. Yeah, they get bonuses when they ---- us over. She also won a trip when our floor stuck to the rule that you are to use no outside pool. We suffered, she won a trip

[fergus51]

Of course money would be better than candy (and I think you missed the point because it tended to be the notes that were appreciated), but the manager has no say on payscales here. Wages are negotiated at contract time by the union and voted on by the nurses. You can't complain about not getting money to someone who doesn't have the ability to give it. I understand money is better, but when it is impossible, something nice and thoughtful is better than nothing for most people.

[NotReady4PrimeTime, RN]

Hear, hear, Fergus51. When the money's spent, it's gone, with no guarantee I'll remember any part of its departure. On my desk, right in front of me where I can see and remember every day, are two thank you cards I received from families of patients I have cared for. I don't recall doing anything particularly special for these patients, but their families felt that I had. Their praise means a lot. (Not that I don't like my paycheque...)