Friday, June 2, 2023
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Medscape invited practicing advanced practice registered nurses (APRNs) from the United States to participate in a 10- to 15-minute online survey about annual earnings as part of a larger survey that included registered nurses (RNs) and licensed practical nurses (LPNs). After a recruitment period lasting from June 27 through August 31, 2016, a total of 10,026 nurses met the screening criteria and completed the survey, 3016 (30%) of whom were APRNs. This group includes 290 certified registered nurse anesthetists (CRNAs), 2004 nurse practitioners (NPs), 458 clinical nurse specialists (CNSs), and 264 nurse midwives (NMs).
Like the general US population of APRNs from which our sample was drawn, survey respondents tended to be older and more experienced. More than one fourth were 45-54 years of age, and over two fifths were 55 years or older. Sixty-four percent of the sample had been in practice for 21 years or longer. (See slide 19 for detailed demographic data.)
The following slides report survey findings from these APRNs, primarily those who work full-time. Where applicable, we compare findings from the current year with results of last year's compensation survey.[1] A separate slideshow describes the survey findings of RNs and LPNs.
Interested in commenting on what you see in this slideshow? Go to slide 20 for more information.
Image from Science Source
APRNs reported working in many diverse settings, depending on specialty area and certification. Most CRNAs (75%) work in acute care hospitals. More than one half of NPs (56%) work in hospital or non-hospital-based ambulatory clinical settings, while only 17% work in hospitals. NMs are split between inpatient settings (20%), hospital-based clinics (22%), and non-hospital settings (19%). The highest proportion of CNS respondents (42%) work in hospitals.
Every APRN group was represented in academic settings as nursing faculty members. The "other" work setting category included skilled nursing facilities or long-term care, home health, school or college health services, public or occupational health, and military or government healthcare settings. The largest proportion of APRNs in the "other" category work in military/government settings and in public health (3% each). These specialties represent a range of healthcare settings, from acute care to ambulatory clinics.
The annual income reported by all APRNs this year ($109,000) was significantly higher than what was reported in last year's survey ($106,000).
It's common wisdom that among full-time APRNs, earnings are highest for CRNAs, and indeed, CRNAs reported the highest annual incomes of all respondents. "Average income for full-time CRNAs was $176,000. This aligns well with the compensation data for CRNAs gathered annually by the American Association of Nurse Anesthetists (AANA) on CRNA compensation and benefits," said Luis Rivera, MBA, CAE, senior director of State Management Affairs for the AANA. "The total median compensation for CRNAs for calendar year 2015 was $175,000, as reported in the 2016 CRNA Compensation and Benefits Survey."
The second highest incomes were reported by NMs, followed by NPs. CNS respondents reported the lowest annual salaries. All of these annual incomes among full-time APRNs, however, were significantly higher than those reported by registered nurses, who earned an average of $79,000 annually (See Medscape's RN/LPN Salary Report 2016).
When annual full-time earnings are viewed by years of experience, an expected pattern emerges. Earnings tend to increase as the APRN moves up the experience ladder and then flatten after a period of years. The failure of APRN income to rise significantly with years of experience could be an effect of reaching a wage ceiling; we simply don't know for sure.
Full-time APRNs can be either salaried (also known as "exempt") or hourly ("non-exempt") employees. More than one third of CRNAs (35%) in this survey report being hourly employees while 65% are salaried, proportions that are statistically different from other APRNs. "AANA survey data analyzed for the past 5 years reflects that the percentage of nurse anesthetists working full-time versus part-time has increased slightly. CRNA employment arrangements are really across the board and don't seem to be trending in any one direction," said AANA's Rivera.
Being salaried rather than hourly was more common among NPs (80%), CNSs (82%), and NMs (90%).
Average hourly earnings for part-time and per-diem APRNs ranged from $51/hour for NPs to $99/hour for NAs. As expected, full-time, salaried positions were more highly paid overall.
For NPs, who comprise the largest group of APRNs, annual pay was highest for those working in acute care hospital settings, and was lowest for those serving as faculty in academic settings or working in school or college health services.
We hoped to be able to report earnings according to practice setting for all APRN types, but we didn't have sufficient numbers of CRNAs, NMs, or CNSs in many settings to provide that breakdown.
In many professions, earning power is tied to educational attainment. The expected trend that nurses earn more with increasing levels of education was confirmed in our survey, at least for NPs. APRNs are required to have at least a master's degree, and many clinical APRNs are now pursuing the doctor of nursing practice degree. NPs with a doctorate earned significantly more ($110,000) than those with a master's degree ($102,000).
The data also seem to show that the average earnings of CNSs with doctoral degrees are actually lower rather than higher, but statistically, CNS earnings were not different between those with a master's and those with a doctorate.
We did not have enough CRNA and NM respondents with doctoral degrees to provide a meaningful earnings average.
Men who are APRNs, like men who are RNs and LPNs, report higher annual salaries, on average, than women. Men outearned women in every APRN category: by $21,000 for CRNAs and $11,000 for NPs, CNSs, and NMs combined.
This is not a new trend; it has been documented in previous studies.[2] Often, it is speculated that the reason for this pay disparity is because men are more likely to work full-time, but the data presented here pertain only to full-time APRNs of both sexes.
Some of the pay difference between men and women can be explained, however, by the amount of overtime worked. We took a close look at the data, and among all APRNs, men work more overtime than women (58% vs 49%), and when men work overtime, they work more hours: 67% work 6 or more hours weekly compared with 57% of women.
Not surprisingly, these findings are similar to those in the RN/LPN report. The mean salary range for all full-time APRNs is $104,000 – $124,000. Earnings for APRNs were higher in the West and Northwest. The lowest earnings for APRNs were reported in the North Central, Great Lakes, and Southwest regions of the country.
In this year's survey, APRNs reported working a great deal of overtime, led by the 65% of CRNAs who regularly work overtime. Even among NPs, who are least likely to work overtime, 46% regularly do so. We also asked APRNs who work overtime how many extra hours they typically worked per week. CRNAs were most likely (52%) to work 1-5 overtime hours, and NMs were most likely (40%) to work more than 10 overtime hours.
In most professions, hours worked by salaried employees in excess of 40 hours/week are not considered "overtime," nor are salaried employees paid for these hours. The salary is intended to compensate for variable working hours.
An unusual finding in our survey was that salaried APRNs were almost as likely (and in some cases, more likely) as hourly APRNs to report routinely working overtime hours. For example, 47% of salaried NPs reported routinely working overtime compared with 41% of hourly NPs (data not shown). We do not have data to explain the circumstances in which salaried and hourly APRNs work overtime, or whether these overtime hours are paid.
We asked APRNs whether their total income for 2015 had increased or decreased compared with 2014, and by how much. Income rose for approximately 64%, fell for 7%, and remained the same for 28% of all APRNs. Patterns were similar for other APRN groups, with CRNAs least likely to report that their income had increased (51%).
Among APRNs who saw their earnings rise last year compared with 2014, the primary reason was a merit or cost-of-living raise (62% of all APRNs), followed by working more hours (14%), including overtime hours (although CRNAs reported this reason significantly more often than NPs, NMs, or CNSs; data not shown).
Receiving a promotion (8% of all APRNs) and advancing on a clinical ladder (7% of all APRNs) were other, less frequent reasons for rising income. While wages reported included earnings from all sources, we did not specifically ask APRNs to report income from bonuses or incentive pay (including pay for performance and other models), sources of income that are becoming more prevalent in these professions.
Far fewer APRNs overall reported earning less in 2015 than 2014, but we found some differences in the reasons for lower incomes among different APRN types, although they weren't statistically significant. Changing jobs was the reason for a decline in earnings for 39% of these APRNs, followed by working fewer hours (28%). Overall, very few full-time APRNs attributed income reductions to being laid off, and almost none attributed a decline in earnings to quitting or being fired from their jobs in 2015.
We asked full-time APRNs what benefits were offered by their employers, regardless of whether they took advantage of these benefits. Paid time off and health insurance were offered to 91% of all APRNs, with little variation among different APRN types. Education allowance or tuition reimbursement was offered to 77% of APRNs, and professional liability coverage to 73% (although only 32% of CNSs reported being offered this benefit). Another difference was seen in professional society membership dues, which were offered to 53% of CRNAs and 58% of NMs but to only 39% of NPs and 21% of CNSs. Of interest, 9% of CRNAs (and 3% of all APRNs) reported being offered none of these traditional benefits.
Paying off student loans can be a tremendous and long-lasting burden on the income of APRNs. Most APRNs have at least 6 years of formal education, and those with doctoral degrees have 8 years or more. It is not surprising, then, that 37% of full-time APRNs overall have not finished paying off their student loans. Slight differences were found among APRN types: CNSs were least likely (23%) and NPs were most likely (41%) to still have unpaid loans, although these findings were not statistically different. In last year's survey, 28% of all nurses (APRNs as well as RNs and LPNs) reported having outstanding student loans.
The length of time that APRNs continued to be encumbered by student debt was surprising (data not shown). Among all APRNs who were still paying off their student loans, 67% had been in practice for 6-10 years, 57% had been in practice 11-20 years, and 23% had been in practice for 21 years or longer.
Overall, nearly two thirds (63%) of full-time APRNs say that they are fairly compensated for their work. Like last year, APRNs who earned the most (CRNAs) were most likely to say that they were fairly compensated, and those who earned the least (CNSs) were least satisfied with their compensation. Other than the income disparity, the survey did not reveal a reason for differences in satisfaction with compensation.
Tell us what you think! Do the incomes reported by this year's survey respondents match your own experience as an APRN? Has your annual income gone up or down significantly, and if so, why? Are your benefits in line with what is reported here? Finally, is there anything else you would like us to ask APRNs in next year's survey?
Please add your comments at Voice Your Opinion: Medscape APRN Salary Report 2016.
Image from iStock
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