Our Survey

Nurses from the United States were invited to participate in a 10- to 15-minute online survey about their annual earnings. Respondents were required to be practicing nurses identified as registered nurses (RNs), licensed practical nurses (LPNs), or advanced practice registered nurses (APRNs). 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.

This slideshow reports survey findings from two subgroups of respondents: RNs (n = 4056) and LPNs (n = 1688). In a few instances, we compare findings from the current year with those from last year's compensation survey. A future slideshow will focus on the compensation of APRNs.

At the end of this slideshow, you will have the opportunity to share your comments.

(Note: LPNs are referred to as "licensed vocational nurses" [LVNs] in some states, but the positions are similar. We combine LPNs/LVNs in this survey.)

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Compared with other work settings, RNs overwhelmingly work in hospitals or hospital systems (56%), mostly in inpatient settings (41%). The primary work settings of LPNs were divided among hospital-based clinics (15%), non-hospital ambulatory settings (18%), and skilled nursing facility/long-term care, which is the work setting of the largest proportion (22%) of LPNs.

RNs were significantly more likely than LPNs to work in hospital inpatient units, whereas the opposite was true for non-hospital-based medical clinics and long-term care. Other settings where RNs were significantly more likely to work, although they represented relatively small proportions of RNs, include academic (nursing faculty) and public health nursing.

Average full-time RN and LPN earnings for the year 2015 were $78,000 and $43,000, respectively. These figures are not significantly different from 2014 earnings, which were $79,000 for RNs and $46,000 for LPNs. Of interest, according to data gathered by the US Bureau of Labor Statistics, the median annual full-time salaries were $67,490 for RNs and $43,170 for LPNs in 2015.^[1]

Why hasn't the average salary of RNs increased? We can't say for certain, but one reason, pointed out by a respondent, could be that as nurses advance in age and years of employment, they often reach a wage or salary "cap" after which they receive no further wage increases. With the average age of RNs now in the late 40s (and almost half of our RN respondents—47%—were in the 55- to 64-years age group), salary caps could increasingly have a flattening effect on RN wages from year to year.

Although not shown on this slide, nurses who are considering advancing their education and embarking on new careers may be interested to know the average earnings of APRNs. In 2015, this survey showed that full-time APRN earnings averaged $176,000 for nurse anesthetists, $104,000 for nurse midwives, $103,000 for nurse practitioners, and $95,000 for clinical nurse specialists.

Among all survey respondents, 83% reported that they work full time, 13% work part time, and 4% work per diem.

As might be expected, most (53% of RNs and 83% of LPNs) are paid by the hour. Still, this means that very nearly half (47%) of RNs are now salaried employees, which is a substantial proportion. This probably reflects the trend of RNs working in increasingly diverse healthcare settings, where many hold positions that offer a more traditional 9-to-5, Monday-through-Friday work week.

This year, we asked respondents not only to report their total annual income from nursing but also their hourly rate of pay. This allows the many nurses who work part time or per diem to compare their earnings with the findings of this survey. We found that average hourly wages were similar for full-time and part-time/per-diem RNs ($37/hour for both full-time and part-time/per-diem RNs) and LPNs ($21/hour for full-time and $23/hour for part-time/per-diem LPNs).

It might be worth noting that according to US Bureau of Labor Statistics data,^[1] the median hourly rate of pay across the United States in 2015 was $32.45 for RNs and $20.76 for LPNs.

Traditionally, nurses in acute care hospitals are paid the highest wages, whereas nurses in academic positions and non-hospital-based clinics are paid considerably less. This year, reported full-time earnings for RNs and LPNs varied somewhat predictably by practice setting, consistent with what we have conventionally experienced in the nursing profession.

RNs employed by the military/government reported the highest annual full-time earnings, at $84,000. The lowest RN earnings were reported by those working in school or college health services ($61,000), a significant difference. Home health and visiting RNs reported the only significant change from 2014 in average full-time annual income, which decreased from $77,000 to $72,000.

Although this survey had very low numbers of LPN respondents indicating that they worked in military/government and academic settings, overall these LPNs' annual full-time earnings followed the same relative pattern, from most to least, as for RNs.

(Note: Too few LPNs responded to our survey last year to make any year-to-year comparisons.)

For RNs and LPNs, earnings increase with level of education. Nurses with an associate's degree in nursing (ADN) typically earn less than nurses with a bachelor's degree (BSN), who earn less than nurses with a master's degree (MSN). The average income of RNs with diplomas falls between that of ADN and BSN nurses, but this may reflect a longer tenure in nursing, with correspondingly more clinical or administrative responsibilities, rather than an effect of education.

Today, the most frequent jump in educational attainment among RNs is from the ADN to the BSN. A goal of the Future of Nursing initiative was that 80% of the nursing workforce would have at least a BSN by 2020.^[2] According to this survey, the economic advantage is an 11% increase in annual full-time salary. Going from a BSN to a MSN, the average salary increases by 9%, and a move from MSN to doctorate is associated with a 5% increase.

Among LPNs, 1386 reported having undergone practical nurse training, and 168 reported earning an associate's degree. No significant difference in annual average salary was found between these groups.

For many nurses, career advancement, and corresponding increasing income, happen with moving up the educational ladder. For example, when a nurse obtains the necessary education to become an APRN (currently at least an MSN), average pay increases accordingly. Our survey indicated that full-time APRN earnings averaged $176,000 for nurse anesthetists, $104,000 for CNMs, $103,000 for NPs, and $95,000 for CNSs—data which will be reported in a future slideshow.

But what about RNs who obtain advanced degrees but do not become APRNs? In what settings are they practicing? Although the largest number of RNs with ADN, diploma, BSN, and even MSN degrees work in hospital inpatient settings (range, 34%-43%), after obtaining a doctoral degree, only 19% of RNs continue to work in hospital inpatient settings, many of whom probably hold administrative positions. Most RNs with doctoral degrees work in academic settings (54%), as do 11% of those with master's degrees.

We don't have the data on specific roles within the various clinical settings to explain why RNs with advanced degrees earn more across the board. Advanced education may open other doors to these RNs, both in the clinical and administrative arenas, and their pay may increase in proportion to their education.

Among all respondents to this year's survey, only 8% of RNs and 8% of LPNs were men. As nurses are aware, a gender pay disparity is often reported throughout the entire nursing profession. This survey again indicated a significant difference between the pay of men and women this year. Male RNs reported full-time earnings of $83,000 on average compared with $78,000 for women, a 6% difference. Male LPNs earned $47,000 compared with $43,000 for female LPNs, a 9% difference.

We looked to see what factors may be affecting this. In our survey, men worked significantly more overtime and also took on more supplemental activities (worked on-call shifts, night shifts, weekends, extra holidays, and charge nurse responsibilities) than women.

Like last year, average annual full-time earnings for RNs in 2015 were reported to be highest ($98,000) in the West, which includes California, Alaska, and Hawaii. The next highest incomes were reported in the Northeast region ($85,000). The lowest average full-time annual incomes were reported in the North Central region of the United States ($70,000), reflecting a difference of $28,000 from the highest- to the lowest-paid region. Last year's survey reported that the difference between the highest-paid West ($105,000) and the lowest-paid North Central region ($69,000) was $36,000.

These findings are similar to what the Bureau of Labor Statistics reports.^[3] Health economist Peter McMenamin, of the American Nurses Association, suggests that this may be due to the cost-of-living differences in these areas, as well as the effect of high-status institutions increasing wages to recruit and retain nurses. In addition, nursing unions have been successful and powerful on the West Coast and in the Northeast.

The average annual full-time earnings reported by LPNs showed the same regional differences as RN earnings. LPN earnings were highest in the West ($50,000), Southwest ($49,000) and Northeast ($49,000), and were lowest in the North Central states ($39,000), an $11,000 difference between the highest- and lowest-paid regions of the United States.

Overtime is extremely common among full-time nurses, with 47% of RNs and 52% of LPNs reporting that they regularly put in overtime hours. Among RNs and LPNs who routinely do so, 86% work up to 10 additional hours weekly, and the remainder work 11 or more hours.

The survey did not ask whether these overtime hours were mandatory or voluntary, or whether these nurses were paid for their overtime hours. This is important, because how we view overtime could depend on whether the nurses themselves consider working overtime beneficial—as a way of increasing their income—or difficult and stressful.

Overtime can become necessary for many reasons: unanticipated increases in census or acuity, staff illnesses or vacations, and even public health emergencies or natural disasters, which can prevent employees from reaching the workplace. Therefore, RNs in almost any setting can be faced with working overtime. To find out where most overtime was worked in the past year, we compared respondents' work settings with the number of weekly overtime hours they reported. We found that it is not unusual for RNs in skilled nursing facilities and inpatient hospital units to work significant amounts of overtime.

However, it is not as easy to explain why nurses work significant overtime hours in settings that aren't typically associated with overtime, such as home health, public health, and college health services, or settings where most nurses are salaried, rather than hourly employees. For example, more than half (56%) of RNs in academic settings report routinely working overtime, a proportion not significantly different from the 49% of RNs in hospital inpatient units who do so.

LPNs working in hospital inpatient settings (58%), skilled nursing facility/long-term care (64%), and home health (56%) most often reported working overtime, findings that parallel those of RN respondents to the survey. Because almost no LPN respondents worked in academic settings, they did not report the same significant number of overtime hours as RNs in a setting that traditionally has been considered a salaried wage position.

We asked nurses whether their income increased, decreased, or remained the same from the previous year. Among nurses who reported earning more between 2014 and 2015, receiving a merit or cost-of-living raise was by far the primary reason for the increase, reported by 76% of RNs and 60% of LPNs. Much smaller proportions of nurses earned more money by working more hours at their primary jobs (15% of RNs and 22% of LPNs), receiving a promotion (8% of RNs and 10% of LPNs), advancing on a clinical ladder (based on clinical expertise; 6% of RNs and 5% of LPNs), or taking on a second job (3% of RNs and 6% of LPNs).

Among RNs who reported earning less between 2014 and 2015, the most prominent reason was a job change, followed by a reduction in hours worked at their current position. Only 6% of RNs reported quitting their jobs, being laid off, or being fired. Among LPNs who experienced a reduction in year-to-year income, almost half (47%) attributed it to a change in jobs and 26% to working fewer hours. Another 8% of LPNs were laid off, quit their jobs, or were fired.

In some settings, nurses have opportunities to supplement their regular full-time income by taking on additional responsibilities or activities, such as acting as charge nurse or preceptor, which can earn them a pay differential. The most common sources of supplemental income reported by respondents, however, were working nights or weekends to earn shift differentials, and taking call to receive on-call pay. Respondents were asked how much these activities increased their income, and 54% of RNs and 56% of LPNs reported that these activities increased their annual income by 5% or less (data not shown).

The benefits provided by employers to full-time nurses are paid time off (offered to 96% of RNs and 92% of LPNs) and health insurance (offered to 96% of RNs and 90% of LPNs). For all nurses, tuition/education reimbursement was less frequently offered, with 67% of full-time RNs and 41% of LPNs reporting that this benefit was available to them. Professional liability coverage, paid parental leave, and professional membership dues were all offered much less frequently to both RNs and LPNs. Across the board, however, these benefits were significantly more likely to be offered to RNs than to LPNs.

By practice setting, few differences in the availability of health insurance were seen between RNs and LPNs. The exception was those working in home health or visiting nurse agencies, where health insurance was offered to only 87% of RNs and 77% of LPNs.

When physicians, especially early-career physicians, talk about their income, the burden of medical school loans comes up often. We rarely hear about nursing school loans. Sure, most nurses have fewer years of schooling to pay for, but their earning power is also substantially lower than physicians' and it increases much more slowly.

In this survey, 26% of RNs and 38% of LPNs report that they are currently paying off college or nursing school loans. A significant proportion of these nurses were still paying off their nursing school loans many years after graduation. For example, 43% of RNs reported still paying off nursing school loans after they had been in practice for 11-20 years. LPNs with loans are younger and have been practicing for less time.

Only slightly more than half (55%; 58% of men) of full-time RNs overall acknowledge that they feel fairly compensated for their work as nurses. Significantly fewer full-time LPNs (41% overall, but 47% of men) believe that they are fairly compensated for the work that they do.

Satisfaction with nursing income in 2015 was comparable to the findings of the 2014 survey, when 53% of full-time RNs and 43% of full-time LPNs agreed that they were paid fairly for their work.

Tell us what you think! Do the incomes reported by this year's survey respondents match your own experience? 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 nurses in next year's survey?

Please add your comments at Voice Your Opinion: Medscape Nurses RN/LPN Salary Report 2016.

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