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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019
| Contributor Information
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Medscape invited 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 10 through August 26, 2019, a total of 7145 nurses met the screening criteria and completed the survey, 3545 (50%) of whom were APRNs. This group includes 460 certified registered nurse anesthetists (CRNAs), 2001 nurse practitioners (NPs), 626 clinical nurse specialists (CNSs), and 458 nurse midwives (NMs).
This report summarizes survey findings from those APRNs. Where possible, we highlight potential APRN income trends by comparing findings from the current survey (based on 2018 incomes) with those of last year's compensation report (based on 2017 earnings). A separate report describes the survey findings from RNs and LPNs.
Except where noted, annual gross income figures are averages, based on reported wages of full-time APRNs. Interested in commenting on what you see in this report? Go to slide 25 to voice your opinion.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Overall, we saw no large shifts in work setting for any group of APRNs. The acute care hospital is the primary work setting of 78% of CRNAs, 37% of CNSs, 28% of NMs, and 16% of NPs. From 2% to 15% of all APRNs hold positions in academic settings as nursing faculty members. The "other" work setting category includes such diverse healthcare settings as public health, long-term care, hospice/palliative care, school/college health, and the healthcare industry. Like last year, 2% of NPs reported working in retail health clinics.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Our survey revealed that APRNs experienced small but nonsignificant year-over-year declines in their average annual gross incomes. This is the first year that APRNs across the board reported no increase in their yearly earnings, a finding that was echoed in the RN and LPN compensation survey report. CRNAs still took home significantly higher pay than other APRNs, and the annual incomes among full-time APRNs were higher than those reported by RNs, whose average earnings were $80,000 in 2018. (Note: Annual incomes reported here are not adjusted for inflation or cost of living.)
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Here we report annual income just 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 lowest for those working in non–hospital-based medical clinics or offices.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
All NPs are required to earn national certification from an approved certification board. More than one half of NPs (57%) hold the family NP certification and 14% are adult gerontology primary care NPs. According to this year's survey, the highest-paid NPs are those who have earned either the psychiatric/mental health or the adult gerontology acute care certification.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Most APRNs (76%-82%) are employed full-time (at least 36 hours weekly). The proportions of full- and part-time APRNs did not change significantly from the previous year, although a longer-term trend (going back to 2015) suggests a gradual decline in the number of APRNs working full-time and an increase in those working part-time (data not shown).
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
In a reversal from previous years, part-time or per diem ("as needed") NPs reported higher hourly rates of pay than full-time APRNs. The difference was most striking for CRNAs; those working part time earned $19 per hour more than CRNAs who worked full time. And we see an economic advantage to hourly pay compared with a fixed salary. Overall, the annual earnings of APRNs who are paid by the hour were 1%-4% higher than those paid a fixed salary.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Differences in annual earnings varied with the type of APRN employment. NPs employed in a private NP practice generated less income than those employed by a medical group or hospital or those who are self-employed/independent contractors. Overall, however, compared with last year, APRN income fell for both self-employed APRNs and for employees of an APRN practice.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
From 5% to 11% of all APRNs own their own practices, but these rates of practice ownership remained fairly consistent in comparison with last year. CRNAs were most likely to be practice owners, which seems to be economically advantageous; overall, practice owners earned about 9% more than non-owners.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Productivity and/or incentive pay was given to 20%-30% of all APRNs, although CNSs were least likely to receive such pay. NPs and NMs who receive productivity bonuses earn more than those who don't. For example, NPs who received productivity pay earned a mean of $111,000 annually, compared with $107,000 annually for those who didn't receive productivity pay, a difference of 4%. For
NMs, the difference was 7%.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Independent practice is still relatively uncommon for APRNs, although it is an option for many. Currently, 21 states and the District of Columbia have approved "full practice" status for NPs, a provision that allows them to assess, diagnose, interpret diagnostic tests, and prescribe medications independently. Among all but CNSs, 79% reported that they are required to have a collaborating physician and a collaborative practice agreement. Only 55% of CNSs reported having such agreements in place.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
The minimum entry-level educational requirement for APRNs in the United States is the master's degree. In this year's survey, 85% of APRNs held a master's degree and 15% held a doctorate (PhD or DNS). The average annual gross income of APRNs with doctoral degrees was 5% higher than for those with only a master's degree.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Men represent about two fifths (39%) of CRNAs and substantially smaller proportions of CNSs (3%) and NPs (9%). No male NMs responded to this survey.
Men represent about two fifths (39%) of CRNAs and substantially smaller proportions of CNSs (5%) and NPs (9%). No male NMs responded to this survey.
Male APRNs, like male nurses in general, report significantly higher annual earnings than women. Male NPs reported earning 7% more than women, and male CRNAs reported earning 11% more. Although this gap is narrower than last year, it's too early to say whether a trend toward pay equity has started. Furthermore, these gross income differences are only part of the story (see next slide).
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
This graph shows that different work habits of men and women are responsible for at least some of the gender pay differential among APRNs. Men are more likely to work in higher-wage acute care settings. They are more likely to work overtime and supplement their regular APRN income. Men were also more likely to own their own practices, another factor in higher annual income.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
APRN income rises with increasing years of experience, up to a point. Our results suggest that the increase levels off at about 20 years of experience, perhaps because the employee has reached a salary cap after which base pay no longer increases. This year, early-career APRNs with 1-5 years of experience reported higher earnings than the same group reported last year, but this didn't hold true for APRNs with 11 or more years of experience, whose average income dropped over the previous year. We don't know the reason for these fluctuations in reported incomes.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
The regional pattern of differences in APRN annual gross income across the United States was again apparent in this year's survey. Since we began conducting annual compensation surveys, the highest-paid APRNs have worked in the most western (Pacific) region of the United States (California, Nevada, Oregon, Washington, Alaska and Hawaii). The region reporting the lowest wages is the West North Central region (North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas and Missouri). (Note: These incomes are not adjusted for cost of living, which could play an important role in regional differences.)
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Because NPs comprise the majority of APRNs in our survey, this slide shows the average annual earnings of NP respondents only, which were highest in the Pacific region ($125,000) and lowest in the East South Central region ($100,000). Of interest, these average annual regional incomes for NPs are lower than those reported last year.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Annual incomes for APRNs vary not only by region but also by type of community (urban, suburban, ex-urban, and rural). For the most part, the largest proportion of APRNs, across every APRN category, work in more densely populated urban areas, where jobs are more plentiful. Annual incomes trend downward with increasing distance from population centers, with the exception of CRNA salaries. Consistent with previous surveys, CRNAs working in rural areas report the highest annual incomes.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Close to one half (46%) of all full-time APRNs who are paid an hourly wage routinely work overtime. About half of these APRNs work 1-5 overtime hours, and 14% regularly work more than 10 hours of overtime weekly. This overtime is entirely voluntary for 60% of APRNs, and for the other 40%, some or all of these hours are mandatory. In most cases, APRNs are compensated for the extra hours, although 17% report that these hours are unpaid (significantly more than last year), and 5% can take compensation time for the overtime hours worked.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Most APRNs (54%-63%) reported that their annual gross income had increased compared with the previous year, and 31%-36% reported that their income had not changed. Only 4%-11% believed that their annual income had dropped. At first, this seems inconsistent with our finding of an overall lack of wage growth among APRNs reporting their 2018 earnings (see slide 4). However, it's possible that some part of the "increases" seen by more than half of APRNs is actually cost-of-living compensation, which is not considered wage growth.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Depending on the education route from RN to APRN and the final degree earned (master's or doctorate), it can take from 5 to 8 years to complete the APRN's college education, at considerable cost. As a result, up to half of all APRNs are still paying off their student loans. Younger APRNs, as expected, are more likely to have educational loan burdens, yet 1 in 5 APRNs aged 55 and older are still paying off a student loan.
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
A small majority of all APRNs reported that their compensation was fair for the work they do. Compared with last year, however, significantly fewer APRNs believe that they are fairly compensated (61% vs 55%). Men were more likely than women to report being fairly compensated (71% vs 53%). No differences in satisfaction with compensation were found by age, union membership, or length of time practicing. The percentage of those feeling that their compensation is fair ranged from 42% for APRNs working in a school or public/community health setting, to 66% of APRNs working in an industry setting (insurance/health plan or other).
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
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Voice Your Opinion!
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Medscape APRN Compensation Report 2019
Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 6, 2019 | Contributor Information
Voice Your Opinion!
We invite you to comment on this year's survey findings and how well they match your own experience.
Commenting is limited to medical professionals. To comment please Log-in.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
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Laura A. Stokowski, RN, MS
Clinical Editor
Medscape
Mary McBride
Associate Director, Market Research
Medscape
Emily Berry
Editor
Medscape
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