Why is our salary so low?

Jules A, MSN · Sep 30, 2016

Having 20 years of nursing experience hurts you rather than helps you in the salary department. You are likely at the top of your pay scale as a RN but as a new grad NP, at the bottom. Most employers that I've seen will give credit for up to 5 years of nursing experience (usually half to one). I had 6 years and got a $30k increase although my colleague with 25 years experience made just about the same amount she did as a RN.

This makes no sense and exactly how high is the base salary of a super RN even with 25 years of experience? $90,000? Although I do not think we should be compensated equally to physicians due to our underwhelming education there is no way I'd take on the added responsibility of diagnosing and prescribing medications without making at least $150,000 a year. That our profession has been willing to take this on for less is incredulous to me although I would bet it goes back to the large portion still acting as glorified RNs or nursing's version of physician's assistants rather than independent practitioners.

taivin · Sep 30, 2016

As a lot of us have been saying for a long time, our reputations (and earning ability) are being damaged by the proliferation of low-quality schools turning out hordes of minimally prepared graduates. Physicians are so aware of the ubiquity of on-line "diploma-mill" graduate programs in nursing that many assume that is the prevailing model of graduate education in nursing. I talk to physicians who are sincerely surprised to learn that I attended a "real" graduate program at a well-known and well-respected B&M school, and have a "real" degree; they didn't know there was such a thing. IMO, we should be v. alarmed about the fact that the physician community is starting to assume that all graduate degrees in nursing are a joke and don't need to be taken seriously.
But, again, like so many problems in nursing, this is something we (collectively) are doing to ourselves.

This, plus the fact that you're the one who negotiates salary. We bring the salary down by accepting to work for smaller amounts than we should (not me). Also, the language is what I think does it as well.

When one hears nurse, they don't think graduate school. I always ask for an NP if available, but most people are under the impression NP's are regular nurses. I'm an RN, and most people are shocked at my scope of practice ("can you really do that?"). They have no idea what we are capable of, so NP's get it even worse.

Aromatic · Sep 30, 2016

I hope you are responsible enough to review all of those nerves. Some future patient might be having trouble with some of them. And remember to look for zebras, not just horses.
The reason rare diseases seem rare is that providers rarely think of them.

we remember the clinically relevant lesion patterns. The rest not so much.

hunting for zebras is usually a waste of resources until common things are ruled out anyway.

PG2018 · Sep 30, 2016

so you make more than most most physicians at over $200k? How do you do it?

I think most docs are clearing more than 200k. If not, they need a new career.

PG2018 · Sep 30, 2016

So some NP applies for a position with less than 2 years nursing experience and a degree from Walden and she should make almost as much as a physician. That is a hard pill to swallow!

Why? They do the same job. And it's the one I force down.

PG2018 · Sep 30, 2016

I swear, I had the best answers to your question all typed out but decided against posting it because it isn't PC, and people would get angry, and I would be banned from this website. But, essentially what JulesA said.
When I'm negotiating or considering an employment situation I don't just look at a dollar amount as the end all. Cash is always king, but how much cash you should ask for (and reasonably expect to get) depends a whole lot on where you live and what else they're offering in the bag. It also depends on your tax situation. If you want to earn decent pay and benefits and keep more of what you earn you need to pay much closer attention to these things than the average NP does. Just one example is the tax thing. Many do not understand what the differences/advantages/disadvantages are of doing different types of employment contracts vs working staff, or how if we incorporated and took advantage of certain deductions how we might come out further ahead despite the seemingly daunting tax codes. I've tried to talk to people about this stuff and they really didn't care enough to bother to change anything even though they were always complaining about not making enough money or paying too much tax, or whatever.
I've decided to go locum for another year and then open my own practice. I'm still in the research and planning phase of this. What I have discovered thus far is that you can make a lot or a little--depending on what type of practice you're running, where you're located, your business acumen, and your determination to be successful. And, by 'successful' I don't just mean having a lot of patients and working yourself to death, but managing your business and your time the way that you want them to be, earning a lot more money for your work and making YOURSELF wealthier rather than someone else, and not feeling bad about making more money and being successful just because you are in healthcare. Most NPs never even look down this road, which is too bad.
Btw, you don't have to be in an independent state to open your own practice, its just that the rules are different.

So recently I was offered 55/hr for a position that will bill 480/hr. Do you think I told them to kiss my tail? Yes, their negotiation tactics were unreasonable, I.e. take ot or leave although we really need the help.

Nope, I'm not a physician, yet I'm sure as heck not working for the good of mankind so I need more money than 55/hr.

This was also at a clinic dominated by doctors who I suppose are either altruists, which I'm not, or not NP favorable. I don't wish to work with altruists or docs who aren't pro NP.

The other NPs there do like Jules said and work for stupid reasons.

PG2018 · Sep 30, 2016

What is all this hate with online degree programs? I came in having a very positive view of online programs, but the hatred in this forum against them is insane and i feel like i'm starting to drink the koolaid for it as well. There are ZERO studies showing quality differences between a brick and moartar prepared NP and a online degree NP from Walden. You don't need to go to a brick and mortar school to learn stuff.

Don't base anything on quality measures. It's stupid. Humans do not live by the numbers. We all have feelings and preconceptions and these dominate logic. Heck testimony can and usually does beat physical evidence. If quality is in favor of online education then most will still value or less because it's online and "seems" more base.

PG2018 · Sep 30, 2016

This makes no sense and exactly how high is the base salary of a super RN even with 25 years of experience? $90,000? Although I do not think we should be compensated equally to physicians due to our underwhelming education there is no way I'd take on the added responsibility of diagnosing and prescribing medications without making at least $150,000 a year. That our profession has been willing to take this on for less is incredulous to me although I would bet it goes back to the large portion still acting as glorified RNs or nursing's version of physician's assistants rather than independent practitioners.

This. Why do a doctor's job without commensurate pay? I'm not going to listen to people 30 times a day, open my house up to liability, and give them meds that we often prescribe based often on inferences for crappy pay. Heck if I wanted only 80k I'd been a civil engineer.

PG2018 · Sep 30, 2016

This, plus the fact that you're the one who negotiates salary. We bring the salary down by accepting to work for smaller amounts than we should (not me). Also, the language is what I think does it as well.
When one hears nurse, they don't think graduate school. I always ask for an NP if available, but most people are under the impression NP's are regular nurses. I'm an RN, and most people are shocked at my scope of practice ("can you really do that?"). They have no idea what we are capable of, so NP's get it even worse.

What can a RN do really? Some kind of verbiage similar to an order is required for any initiative. An assessment is merely structured observation amd nursing interventions like rolling warming and feeding we do at home. So what's the scope?

Julius Seizure · Sep 30, 2016

When one hears nurse, they don't think graduate school. I always ask for an NP if available, but most people are under the impression NP's are regular nurses. I'm an RN, and most people are shocked at my scope of practice ("can you really do that?"). They have no idea what we are capable of, so NP's get it even worse.

I recently started grad school, and the majority of time when it happens to come up in conversations, it goes like this:

Me: "I recently started grad school"

Them: "Oh, that's great! What are you studying?"

Me: "To be a nurse practitioner."

Them: "Oh wow. My [random relative] is a nurse at [whatever hospital]. Nurses are great, that's a great job. You will really love it."

(awkward pause)

Me: "No, I'm already a nurse. I'm going back to school to be a nurse practitioner."

Them: (look of confusion)

Graduategalen · Oct 1, 2016

I too am doing online for NP starting in January. It allows me to work and go to school, I have a wonderful clinical group (small) in the facility where I work. I actually am going more hands on than I would be if I went through the local U. You get out of a program what you put into it. A good clinician will be good online or off. I have personally seen some very bad NPs where I currently work and they were all from the local U.

PG2018 · Oct 1, 2016

I recently started grad school, and the majority of time when it happens to come up in conversations, it goes like this:
Me: "I recently started grad school"
Them: "Oh, that's great! What are you studying?"
Me: "To be a nurse practitioner."
Them: "Oh wow. My [random relative] is a nurse at [whatever hospital]. Nurses are great, that's a great job. You will really love it."
(awkward pause)
Me: "No, I'm already a nurse. I'm going back to school to be a nurse practitioner."
Them: (look of confusion)

Just tell them what you make. Them the POA president will kiss your ass.