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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Medscape US nurses were invited to participate in a 10- to 15-minute online survey about their annual earnings. Respondents were required to be practicing nurses identifying as registered nurses (RNs), licensed practical nurses (LPNs), or advanced practice registered nurses (APRNs). After a recruitment period lasting from July 12 through August 31, 2018, a total of 10,282 nurses met the screening criteria and completed the survey.

The following slides report survey findings from two subgroups of respondents: RNs (n = 5011) and LPNs (n = 2002). In a few instances, we compare findings from the current year with those of last year's compensation survey. A future report will focus on findings about the compensation of APRNs.

Notes:

  1. Although the survey was conducted in 2018, respondents were asked to report earnings from 2017.
  2. LPNs are referred to as "licensed vocational nurses" (LVNs) in some states, but the positions are similar. We combine LPNs and LVNs in this survey.
  3. It's important to remember that the annual salaries and hourly rates reported here are averages. Some nurses make less and some make more than what is reported here.
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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The hospital continues to be the primary employment setting for most RNs (52%), with 39% in inpatient settings and 13% in hospital-based outpatient settings. Tied for a very distant second place were school/college health services, academic settings, public health, and non-hospital-based clinics (5% each), followed by home health/visiting nursing and skilled nursing/long-term care (4% each). Small numbers (≤ 3%) of RNs report working in industry, skilled nursing facilities, hospice/palliative care, and occupational health. Fewer than 1% of RNs are agency/travel nurses. Most LPNs report working in skilled nursing/long-term care, private medical offices/clinics, or hospital-based outpatient settings.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The average earnings of full-time RNs and LPNs for 2017 were $81,000 and $46,000, respectively. Although this appears to be a small increase from 2016 when RNs averaged $80,000, the difference is not statistically significant. LPNs saw no change from last year. These findings suggest a flattening of RN and LPN wages overall from the previous year and very little change from 2 years ago. This trend could be partly related to increasing retirements of older (and higher-paid) nurses. Their replacement by younger, early-career nurses could have the effect of lowering average nurse wages. And if we had adjusted for inflation, it's likely that wages for both would have fallen. Wages might not be stagnant across the board, however. We know from data on income by work setting that wages for the largest group of RNs (acute care hospital) did not increase from 2016 to 2017, but RN wages in almost every other work setting did show an increase (slide 8).

The failure of average RN wages to rise is also reflected in the US Bureau of Labor Statistics (BLS) data, which show an average pay of $73,550 for RNs in 2017 (up only 2% from 2016)[1] and $45,710 for LPNs.[2] Government figures are usually lower than those reported in our survey because BLS reports average base pay, calculated by multiplying the average hourly pay rate by 2080 hours. Our respondents reported their entire nursing-related gross income (including overtime and differential pay, among other factors). However, both our figures and the BLS estimates suggest that RN wages have failed to increase appreciably.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Most RNs and LPNs are still employed full-time, although compared with the previous year, fewer RNs (75% vs 80% in 2017) and LPNs (81% vs 82% in 2017) reported working full-time. The 5% reduction in the number of full-time RNs was accompanied by corresponding increases in part-time and per-diem RNs. As the largest segment of nurses (baby boomers) ages, it's likely that even larger proportions will shift to part-time or per diem work in the future.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Like last year, most RNs (57%) reported that they are paid by the hour, while 43% are salaried. Among LPNs, only 15% have salaried positions; the remainder (85%) are paid on an hourly basis (data not shown).

For RNs paid by the hour, average hourly wages were $37 for full-time and $38 for part-time/per diem work. LPNs reported hourly wages of $22 (full-time) and $23 (part-time). These $1-per-hour increases are not statistically significant, so we don't know whether part-time hourly rates are actually higher than full-time rates, but it is a trend worth watching. The evidence suggests, once again, a flattening of wages for both RNs and LPNs.

The BLS reports lower average hourly wages for RNs in 2017 ($33.65),[1] but it's noteworthy that this was down from 2016's average of $34.70. Like last year, the BLS reports an hourly wage for LPNs in 2017 ($21.65) that is slightly less than what our survey found and virtually unchanged from BLS data in 2016 ($21.56).

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Salaried nurses reported significantly higher annual gross incomes (8% higher for RNs and 13% higher for LPNs) than nurses paid by the hour. An interesting finding is that the average gross income of salaried RNs increased (from $82,000 to $84,000) but hourly-paid RNs' did not. This is surprising because salaried RNs can't typically supplement their income with overtime or differentials. It would appear that any wage growth in professional nursing is occurring in salaried rather than hourly positions, thus benefiting a much smaller number of nurses. Most nurses are paid by the hour, and hourly wages reported here are flat.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Conventional wisdom holds that the highest-paying jobs for nurses are in the hospital. This is still true, but two other work settings are challenging that. Although significantly fewer nurses work in these settings, according to our survey, occupational health and the insurance industry pay as much as the hospital (an average of $84,000) for full-time RNs. Medical offices, public health, and school nursing pay the least. Of interest, average RN wages increased (although not significantly) in every major work setting except hospice/palliative care, which declined significantly. Annual wages for the bulk of the nursing workforce—hospital-based RNs—have not changed.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The average annual wages reported by LPNs this year were highest in skilled nursing/long-term care, although these wages declined slightly from 2016, as did average wages in school/college health. Every other major work setting showed a small (1%-2%) increase in annual wages over the previous year.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

For the fourth year in a row, our survey reveals that men take home more pay than women for the same work in nursing. Men earned $4000 more than women across the board, which represented 5% more among RNs and 9% more among LPNs.

Ours is not the only salary survey to find that men are paid higher wages than women in nursing. But in spite of this persistent and apparently universal gender wage gap, we still lack firm data to inform us of why this occurs. We are hampered by the fact that only 8%-10% of nurses are men, resulting in a large imbalance in the size of the dataset. In our survey, only 8% of RN respondents were men.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The annual gross income of men was higher in 2017 regardless of method of pay (salary or hourly). Among salaried RNs, men earned an average of $6000 (7%) more annually than women. In contrast, in 2016, salaried men earned 10% more than women. Here, the somewhat narrower gender pay gap was a consequence of salaried women earning $2000 more in 2017 than in 2016. Annual salaries among hourly-paid RNs were 5% higher for men than women ($82,000 vs $78,000), identical to what we saw the previous year. The news is more grim for LPNs. Among hourly-paid LPNs, the annual income of men was $6000 (13%) higher than that of women, a significantly wider gender gap than what we saw last year. Too few salaried male LPNs provided data to calculate the difference among this subgroup.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

A curious finding in our survey is that RNs report identical hourly rates of pay for men and women ($37 for both), and nearly identical hourly rates among LPNs ($23 vs $22), with no change from 2016. Like last year, these finding suggest that the higher annual gross incomes of hourly-paid men are not related to a difference in base pay. But this "equality" is deceptive. Pay rates are typically tied to years of experience. The fact that women in nursing, on average, have practiced longer than men (51% of RN/LPN women have worked more than 20 years compared with 32% of men) should translate to a higher average hourly rate of pay for women. Obviously, this isn't the case. So why do men earn more annually than women? We can find a few clues to this disparity by looking more closely at the work habits of men and women in nursing.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The work characteristics of men and women in nursing differ in several respects, and it's reasonable that these differences at least partially explain the gender wage gap. Men are more likely to hold positions that pay hourly (rather than a fixed salary), which provides more opportunities for income supplementation. Men are more likely to choose healthcare settings that pay higher wages, such as hospital inpatient units and intensive care. Men are also more likely to work in urban, rather than rural, areas. We found that men were more likely than women to routinely work overtime, and when they did, they worked more hours of overtime per week. Men were more likely to supplement their regular income by taking call, working shifts that paid a higher differential, or functioning as charge nurses. Any of these factors could contribute to a higher annual gross income for men in nursing, despite their hourly rates of pay being equivalent to those of women.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Among RNs, 49% reported having a bachelor's degree (BSN), a proportion that is unchanged from the previous year. Unfortunately it becomes even less likely that the nursing profession will achieve its stated goal of 80% of the workforce having at least a BSN by the year 2020, now just 2 years away.[3] The proportions of RNs with a hospital diploma, associate's degree (ADN), master's degree (MSN), or doctoral degree have remained relatively stable. Among LPNs, 83% in this year's survey reported having had practical nurse training compared with 89% in the previous year (data not shown).

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

No educational subgroup reported significantly higher earnings in 2017 than 2016, another factor supporting a lack of wage growth among nurses. For the most part, annual earnings of RNs increase with their level of education, primarily because positions of greater responsibility, which pay more, often require more advanced education. The economic boost from each educational step from ADN to BSN, BSN to MSN, and MSN to doctorate is 9%-10%. An exception to this pattern is the diploma in nursing. This year, the annual income of RNs with a diploma in nursing was identical to that of nurses with a BSN. We know that diploma RNs are generally older and have more years of nursing experience; as a result, they might have more clinical or administrative responsibilities than BSN nurses.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

A similar proportion of RNs reported holding specialty certifications in this survey compared with the previous year's (53% vs 56%). It's not clear why this number is not rising. Certified RNs earned an average of $84,000 and noncertified RNs earned $73,000 (15% more for certified nurses). This year, we also asked RNs whether they received a monetary reward (and what type) tied to specialty certification. About one fourth reported that they receive a higher annual rate of pay, 6% received a one-time bonus, 8% received an annual bonus, and 60% reported that they received no monetary reward for being certified. It remains possible, however, that having specialty certification enabled nurses to advance on a clinical ladder, resulting in higher pay by that route. Specialty certification remains optional in most healthcare organizations, and it's not inexpensive. Nurses often purchase certification exam guides or take special classes to prepare for the certification exam. There are fees for the exam and for certification renewal, not to mention the cost of continuing education credits required to maintain specialty certification.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

This year's survey had a new question. Nurses were asked whether they belonged to a professional nursing society or association, be it a general group for nurses (such as the American Nurses Association [ANA]) or a specialty group (such as the Emergency Nurses Association). More than half of RN respondents (53%) belonged to a professional nursing society. RN membership in professional organizations increases with years of experience and reaches the highest level (80%) among RNs in academic settings. We know from other data that 12% of RNs and 5% of LPNs receive professional society memberships as a job benefit.

Although only 16% of LPNs are members of such groups, this is probably related more to opportunity than to motivation. LPNs are not permitted to join the ANA. Rules for other associations may vary; some allow LPNs to become affiliate members. LPNs do have their own society, the National Association of Licensed Practical Nurses. Without career ladders and promotion opportunities, however, they have less incentive than RNs to join these societies.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Like in previous years, we found that the earnings of both RNs and LPNs rise reliably with years of experience. This is true whether we look at annual gross income or hourly rate of pay. Nurses who have been working 5 years or less also reported the hourly rate they received for their first job in nursing. The average "first-job pay" was $25 per hour for RNs and $19 per hour for LPNs, compared with $24 and $18, respectively, in last year's survey.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Union membership was still fairly uncommon (16% of RNs and 10% of LPNs) but slightly higher than last year. And like last year, nurses who work in hospitals were much more likely to be members of unions (RNs, 59%; LPNs, 51%). These figures are in line with other national surveys. A significant benefit of belonging to a union or collective bargaining unit is a higher level of income. RNs who belonged to a union earned about 13% more than those who did not, and LPNs earned about 10% more. However, we did not take into account union dues. Union membership was associated with a few differences in benefits offered by employers. RNs belonging to unions were more likely to receive education allowance or reimbursement. Among LPNs, union membership was linked to even more benefits: professional liability coverage, education allowance, professional society dues, paid parental leave, and contributions to retirement savings.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The regional pattern for RN wages across the United States was again apparent in this year's survey. We categorized the regions differently this year based on some feedback we received after last year's survey. This didn't change the findings appreciably for the highest-paid region, which continued to be the most western (Pacific) region of the United States (California, Oregon, Washington, Alaska, and Hawaii). Income for the RNs in this region averaged $102,000. The reconfiguration may have been a factor in the finding that the East South Central region (Tennessee, Kentucky, Mississippi, and Alabama) had the lowest average RN pay, at $69,000 annually, a difference of $33,000 from the Pacific region. (Note: These incomes are not adjusted for cost of living.)

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The highest- and lowest-paying regions differed somewhat for LPNs this year. Average annual full-time earnings reported by LPNs were highest in the New England region ($56,000) followed by the Pacific region ($53,000), a difference of only $3000 (6%). Except for these two highest-paying regions, the average annual earnings of LPNs varied only slightly throughout the rest of the country, ranging from $42,000 to $48,000.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

In last year's survey, we found that union membership varied a great deal throughout the United States, which could explain some of the regional pay differences for RNs. This graph shows that union membership is indeed highest in the Pacific region (43%), followed by the Mid-Atlantic (26%) and New England (25%) regions. We didn't have sufficient numbers of respondents to analyze the salary differences between unionized and non-unionized RNs for the entire United States, but in the regions that we were able to analyze, the RNs who belonged to unions reported higher annual incomes than non-unionized nurses in the Pacific and Mid-Atlantic, but not in the New England region.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

We found a consistent and predictable pattern of average annual income for both RNs and LPNs according to community type. Less than one half (44%) of RNs work in urban settings, and about one third (35%) work in suburban settings. Average annual wages declined as community type shifted from urban (most populated areas/highest wages) to rural (least populated areas/lowest wages), explaining why two nurses working in the same state can have vastly different annual incomes. The average difference in wages reported between urban and rural RNs was 16%, and for LPNs it was 14%.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

The number of nurses who routinely work overtime is rising. This year, 42% of RNs reported working overtime, compared with 37% last year. Among LPNs, 50% report working overtime in this year's survey, compared with 45% last year. Most RNs (60%) worked 1-5 hours of overtime weekly; only 15% worked more than 10 hours per week. Most overtime for both groups was voluntary.

The overtime question was asked only of full-time RNs and LPNs who were paid hourly. This year, we also asked nurses how they were compensated for working overtime. As expected, a large majority of RNs (94%) and LPNs (92%) were paid for overtime, boosting their paychecks. Another 3% of each group reported that although they saw no increase in their pay for overtime, they were able to take an equal number of hours off to compensate for overtime hours worked. Because hospitals typically pay for overtime, the nurses who work unpaid overtime are probably working in non-hospital healthcare settings.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Returning to the issue of men earning more than women for the same nursing work, one possible variable is the amount of overtime worked. Among RNs, more men reported routinely working overtime (51% of men vs 41% of women). Men also tended to work more hours of overtime. A similar pattern was found among LPNs (not shown). Whether overtime fully explains the gender pay gap in nursing could be answered more definitively if we had reliable data on how much of each nurse's income was attributable to overtime, but such information would be difficult to obtain.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

A new question on this year's survey was whether the nurse routinely took call and whether she or he was paid for being on call. We found that taking call is relatively uncommon: Only 29% of RNs and 22% of LPNs took call. And was on-call time paid? Among RNs who took call, 66% were paid, and among LPNs, 55% received pay. So a significant proportion of nurses are taking unpaid call (34% of the RNs and 45% of the LPNs who take call). Like working overtime, men were more likely (36% vs 28%) to take call. The pattern was similar among LPNs. Men were also more likely to be paid for call time, but this could be a reflection of choosing to take call in settings where call time is paid. Paid call for RNs was most common in hospice and home health settings, and least common in skilled nursing facilities.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Our findings on annual gross income and hourly rate of pay suggest that, as a group, nurses have seen little, if any, wage growth during the past year, particularly if inflation is considered in the equation. So we asked nurses whether their individual 2017 income had increased, decreased, or remained the same compared with the previous year. For 61% of RNs and 58% of LPNs, nursing income had increased. Roughly one third of each group reported no change in income from year to year, and 10% reported a reduced income. However, we don't have data on the magnitude of these increases or reductions in income. And these findings don't necessarily mean that nurses are being paid more. Cost-of-living increases (which are not considered wage growth) could be a factor in rising income among some nurses. It's also possible that nurses who saw an increase were supplementing their income to a greater degree, either in their primary nursing position (next slide) or with other nursing or non-nursing work.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Most nurses have opportunities to supplement their regular full-time pay by assuming additional responsibilities in their primary nursing positions. This year, apart from working extra hours or shifts (30% of RNs and 34% of LPNs), RNs most often reported taking call and performing charge nurse or preceptor functions to increase their nursing income. Having a second job or another income-producing activity boosted earnings for 11% of RNs and 16% of LPNs.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Paid time off and health insurance are the most common and nearly universal benefits for nurses, offered to 96% of RNs and 90% of LPNs. RNs are more likely than LPNs to receive such benefits as contributions to retirement savings, education allowance/reimbursement, paid parental leave, or professional liability coverage. Only 1% of RNs and 3% of LPNs work for employers who offer no benefits.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

As shown in the previous slide, 16% of RNs and 12% of LPNs reported having professional liability coverage from their employers. Nurses aren't typically required to carry their own malpractice insurance; they are covered by the employer when functioning within the scope of their job description. However, there are other benefits to having one's own professional liability coverage,[4] and 29% of RNs and 16% of LPNs agree. The annual cost of these policies varies according to how much is covered for claims against the nurse, but a large majority of nurses report that their policies cost less than $500 annually.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

This year, more nurses reported that they are still paying off nursing educational loans (29% of RNs and 39% of LPNs) compared with in our 2017 report (26% of RNs and 33% of LPNs). Younger nurses, as expected, were more likely to still be paying off these loans. Among RNs, 65% of those 25-34 years of age, 60% of those 35-44 years, 39% of those 45-54 years, 14% of those 55-64 years, and 8% of those 65 years or older were still paying off loans. It's always bewildering to find that even a small percentage of nurses are still paying off their student loans as they approach retirement age. We also found, like last year, that men (40%) were more likely than women (28%) to still be paying off nursing school loans.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Our final survey question asked whether nurses feel that they are compensated fairly for their work. Just over half of all RNs (56%) and only 46% of LPNs said "yes," a slight decline from our 2017 report. This could be considered more evidence of the overall failure of nurses' wages to rise over the past year. Salaried RNs (60%) more often felt fairly compensated compared with hourly-paid RNs (54%). No differences were found for gender, age, years of experience, work setting, community type, or union membership.

An expected finding was that a belief that compensation was fair correlated with the comparative size of the nurse's income. Among those who earned more than the average annual income for RNs, 69% feel that they are fairly compensated, whereas among those who earned less than average, only 47% admit to feeling fairly compensated. Similarly, among LPNs with above-average earnings, 56% feel fairly compensated, whereas only 36% of those with below-average earnings would agree.

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

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Medscape RN/LPN Compensation Report, 2018

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | October 10, 2018 | Contributor Information

Tell us what you think: Do the incomes reported by this year's survey respondents match your own experience? Have you received a wage increase? And 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 RN/LPN Compensation Report, 2018.

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Medscape RN/LPN Salary Report, 2017

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