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Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

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 13 through August 2, 2017, a total of 10,523 nurses met the screening criteria and completed the survey, 3417 (32%) of whom were APRNs. This group includes 501 certified registered nurse anesthetists (CRNAs), 2036 nurse practitioners (NPs), 567 clinical nurse specialists (CNSs), and 313 nurse midwives (NMs).

This slideshow reports survey findings from those APRNs. Where applicable, we compare findings from the current year with those of last year's compensation survey. A separate slideshow describes the survey findings from RNs and LPNs.

(Note: Although the survey was conducted in 2017, respondents were asked to report earnings from 2016. Except where noted, annual gross income figures are based on full-time APRNs.)

Interested in commenting on what you see in this report? Go to slide 26 for more information.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

The acute care hospital is the primary work setting of 76% of CRNAs and 46% of CNSs. Only 17% of NPs work in hospitals, and 54% work in outpatient settings. NMs are divided between hospitals and non-hospital clinic settings. Like in the previous year, every APRN group was represented in academic settings as nursing faculty members. The "other" work setting category includes diverse healthcare settings such as public health, long-term care, hospice/palliative care, school/college health, and industry-related positions. The proportions of APRNs who work in these settings were small, ranging from < 1% to 3%.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

The general trends in full-time APRN earnings of the past 2 years have continued. Earnings were highest for CRNAs ($182,000), which is significantly higher than the $176,000 reported last year. The second highest incomes were reported by NPs, followed by NMs. CNS respondents reported the lowest annual earnings. All of these annual incomes among full-time APRNs, however, were significantly higher than those reported by RNs, who reported average earnings of $80,000.

For purposes of comparison, we looked at the Bureau of Labor Statistics (BLS) occupational wage data for 2016. BLS estimated the mean annual wages to be $104,610 for NPs, $164,030 for CRNAs, and $102,390 for CNMs. (BLS doesn't report wage estimates for the CNS role.) [1-3] A 2017 survey by the American Association of Nurse Anesthetists (AANA) found that the mean full-time annual income was $186,000 for CRNAs, a figure that is higher than the mean annual income reported by our respondents.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

For NPs, who comprise the largest group of APRNs among our respondents, annual pay was highest for those working in acute care hospital settings and was lowest for those serving as faculty in academic settings. The average annual income of NPs in acute care hospitals increased significantly from the previous year.

The numbers of CRNA, NM, or CNS respondents in many healthcare settings were not sufficient to provide comparisons of the earnings of APRNs in the individual work settings.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Most APRNs (80%-87%) work full-time. Another 10%-17% of APRNs work part-time, and 2%-3% work in per-diem ("as needed") positions. Compared with last year's survey, two groups of APRNs—NPs and CNSs—were less likely to report working full-time. However, this year, we defined full-time as being 36 or more hours weekly, so this could account for differences between this year and last year.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

In general, this year we saw no difference in the proportions of APRNs who reported being paid by salary ("exempt") or hourly ("non-exempt"). More CRNAs were paid by the hour (34%) compared with NPs (19%), CNSs (15%), and NMs (13%).

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Hourly-paid NPs and CNSs, but not CRNAs, earned significantly more than their salaried counterparts in this year's report. We didn't have enough respondents who were paid hourly to compare the earnings of hourly NMs with those of salaried NMs.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Among APRNs who are paid by the hour, the hourly pay rates reported by NPs were $58 (full-time) and $54 (part-time). CNSs reported hourly pay rates of $59 (full-time) and $58 (part-time). CRNAs had the highest hourly wages, at $85. Compared with last year, the full-time hourly wages of two groups of APRNs—NPs and CNSs—were statistically higher in this survey.

These hourly pay rates are somewhat higher than those reported by the BLS, which estimates the mean hourly wages for 2016 at $78.86 per hour for CRNAs, $50.30 per hour for NPs, and $49.23 per hour for CNMs. (BLS doesn't report estimated mean hourly wages for the CNS role.) [1-3]

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

This year, we asked two new questions central to the compensation of APRNs. The first, shown here, was whether the APRN's regular compensation was based on an incentive system (productivity or pay-for-performance). NPs and CNSs were the most likely to report being compensated under incentive programs. Healthcare attorney and frequent Medscape Nurses contributor Carolyn Buppert also finds, in reviewing employment contracts, that "many nurse NPs may earn a bonus for collections over a specified amount. They are guaranteed a base salary and may improve that number through high productivity, similar to physician contracts. Many APRNs work for government entities and large organizations where APRNs are part of large teams and productivity may not be attributable to individuals," perhaps explaining why the proportion of NPs with incentive pay programs is relatively low.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

We also wondered how many APRNs owned their own practices, and whether being self-employed or working as an independent contractor was economically advantageous. It turns out that owning a practice is still relatively uncommon among APRNs, with 11% of CRNAs, 7% of CNSs, 4% of NPs, and 4% of NMs reporting that they do so. But do APRNs who own their own practices earn more money annually than those who don't? Only NPs, as a group, provided enough responses for this analysis. We found that NP practice owners earned $110,000 compared with $105,000 for NPs who worked for someone else, but this difference was not statistically significant. Carolyn Buppert suggests that these data "reflect the current trend away from clinician-owned practices. Less than half of physicians now own their own practices. Given the learning curve when starting one's own practice, high guaranteed salaries being offered by employers, and the remaining barriers for APRNs (required physician collaboration in some states and some third-party payers' reluctance to directly reimburse APRNs), the data aren't surprising."

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

The entry-level educational requirement for APRNs in the United States is the master's degree. Indeed, the majority of APRNs hold master's degrees, and 12%-16% hold doctorates. NPs, CRNAs, and CNSs who attained doctoral degrees earned 4%-5% more than those with master's degrees.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Men represent almost half (47%) of CRNAs and substantially smaller proportions of CNSs (7%) and NPs (11%). Only two male NMs responded to our survey. A question of considerable interest is whether men who are APRNs earn more than women. The answer continues to be yes, according to our data. Male CRNAs reported earnings that were almost 13% higher than female CRNAs. Among NPs, men earned almost 7% more. Last year's differences were similar, and we see no evidence in our survey of the gender pay gap narrowing. However, the pay differences alone are only part of the story (see next slide).

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

This graph shows some of the work-related differences between men and women at the advanced practice nursing level. It's possible that one or more of these variables is driving the persistent gender pay gap between male and female APRNs.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

How much does the APRN's income change with increasing years of experience? We wanted to report the association between income and years of experience, but the number of respondents was large enough only for NPs. On this slide we show how income for NPs rises steadily with increasing years in practice.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

This heat map shows the relative average annual incomes of all APRNs combined in nine regions of the United States. Like last year, the highest overall APRN incomes were reported in the Western states. The lowest average annual incomes from all APRNs combined were reported in the Great Lakes and Southeast regions.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Because NPs comprise the majority of APRNs in our survey, this slide shows the regional earnings of NP respondents only, which were highest in the Western states (California, Alaska, and Hawaii). The lowest annual earnings were reported by NPs working in the Southeast, Great Lakes, and North Central regions.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

APRNs working in the same region, or even in the same state, can earn vastly different incomes depending on the type of community. To find out whether community type was a factor in how much APRNs earned, we asked respondents about the type of community where their workplace was located. Urban areas were the location of 39%-52% of the workplaces, with CNSs most likely to work in those settings. For all APRNs, the second highest concentration of workplaces was found in suburban areas.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Next, we analyzed APRN annual income by workplace community type. Typically, urban areas are believed to pay the most and rural areas the least, and this trend was indeed evident in our survey. However, CRNAs differed from the other groups of APRNs in that the earnings of those working in rural areas were significantly higher than those in urban or suburban settings. This finding is consistent with data collected by AANA and "most likely reflects the higher demand, and lower supply, of CRNAs in rural areas, and the relative difficulty in recruiting CRNAs to less populated regions of the country," according to Luis Rivera, AANA senior director of state management affairs.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Many hourly paid APRNs increase their annual gross income with paid overtime hours. Significantly more CRNAs (63%) than NPs (39%) or CNSs (39%) worked overtime. Among APRNs who put in overtime, 43% of CRNAs and 53% of NPs reported working 1 to 5 extra hours weekly, and 16% of both groups worked more than 11 extra hours weekly (data not shown). Most overtime reported here was voluntary, although about one fourth was mandatory. We can't directly compare this year's and last year's overtime data because this year, we asked only hourly paid APRNs to report their overtime habits. The greater tendency of CRNAs to regularly work overtime may partly explain the higher annual incomes reported by these APRNs.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Most APRNs reported an increase in annual gross income compared with the previous year, with NPs and CNSs reporting an increase more often than the other two groups. A substantial proportion of APRN incomes remained unchanged, and a small proportion (6% to 9%) of incomes declined. The most common reasons reported for an increased income were receiving a merit or cost-of-living raise, followed by working more hours or switching jobs. Among APRNs who saw a decline in income, the reasons noted most often were changing jobs, working fewer hours, or going part-time. Unchanged income from year to year was typically the result of not receiving a raise, and a small proportion (8%-15%) blamed this on reaching a salary cap (data not shown).

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

We asked full-time APRNs what benefits were offered by their employers, whether or not they took advantage of these benefits. Benefits were similar across APRN groups, with the exception of CNSs, who less often received liability coverage and professional membership dues, and CRNAs, who less often received parental leave.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Depending on the educational route taken from RN to APRN and the final degree earned (master's or doctorate), it can take from 5 to 8 or more years to complete the APRN's college education. As a result, many APRNs are still paying off their student loans, and as expected, younger APRNs more often report being encumbered by this. However, like last year, we found that 15% to 24% of late-career APRNs are still paying off their student loans, at age 55 and older.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

More CRNAs than other groups of APRNs feel that their compensation is fair for the work they do. Among all APRNs, we found no significant differences in opinions about the fairness of compensation related to any other variable (gender, age, years of experience, work setting)—with one exception. NPs who work in public health settings more often feel that their compensation is unfair (52%) compared with hospital-based NPs (32%), NPs working in hospital-based outpatient clinics (34%), and those working in other medical offices or urgent care (31%). CRNAs, who earn the most, also are most likely to view their compensation as fair.

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Medscape APRN Compensation Report 2017

Laura A. Stokowski, RN, MS; Susan B. Yox, RN, EdD; Mary McBride; Emily Berry | November 1, 2017 | Contributor Information

Tell Us What You Think

Do the incomes reported by this year's survey respondents match your own experience? Do you have a novel payment structure as an APRN, or do you own your own practice? What other factors affect your earning power? Finally, what else would you like us to ask APRNs in next year's compensation survey?

Please add your comments at Voice Your Opinion: Medscape APRN Compensation Report 2017.

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