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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Each summer for 6 years, Medscape has surveyed advanced practice registered nurses (APRNs) about their annual earnings and satisfaction with their positions, using income data from the previous year. But this year, it was evident that the pandemic that began a few months before our survey had dramatically altered the professional lives of many APRNs. Some were furloughed, some lost their jobs, and some pivoted to entirely new areas of practice. So in addition to the annual survey questions about earnings, we asked APRNs who responded to our survey how the pandemic had affected them, their livelihood, and their outlook on their profession.

The responses are divided into two reports. In this slideshow, we reveal findings on annual income of APRNs. In a second report, we explore how the pandemic has affected the nation's APRNs.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Practicing APRNs from the United States participated in an 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 July 1 through August 25, 2020, a total of 10,424 nurses met the screening criteria and completed the survey, 3294 of whom were APRNs. This group includes 391 certified registered nurse anesthetists (CRNAs), 2002 nurse practitioners (NPs), 500 clinical nurse specialists (CNSs), and 401 nurse midwives (NMs).

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

(Note: Although this survey was conducted in 2020, respondents were asked to report earnings from 2019. Except where noted, annual gross income figures are averages, based on reported wages of full-time APRNs.)

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

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

About 20% of initial survey takers said they weren't currently employed as APRNs, and therefore they didn't qualify to complete the entire survey. From that group, 1 in 5 cited the COVID-19 pandemic as the reason that they were not working, with 12% retiring earlier than planned. Among APRNs no longer working but not retired, a total of 8% were furloughed, laid off, or fired. Recent reports suggest that most furloughed APRNs have returned to their pre-pandemic positions.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

APRNs were asked about their pre-pandemic work settings. Compared with last year, we've seen very little shifting of work setting among APRNs, with one exception: A significant increase in the proportion of NMs who are hospital based occurred this year, from 26% to 33%. Other, smaller increases shown on this graph weren't statistically significant.

The "other" category on the graph includes a wide range of less frequent work settings for APRNs: long-term care, hospice/palliative care, school/college health, public health, home care, occupational health, and retail clinics.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Compensation for all full-time APRNs increased in 2019 over the previous year. And it clearly pays for RNs to become APRNs. Overall, the annual incomes reported by full-time APRNs were higher than the average earnings ($81,000) of full-time RNs. Median earnings among APRNs were lower across the board this year than the average incomes reported above: CNS ($105,000), NP ($110,000), NM ($111,000), and CRNA ($199,000). (Note: Annual incomes reported here are not adjusted for inflation or cost of living.)

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

This year, based on 2019 earnings, the highest annual incomes of full-time NPs (the largest group of APRNs in our survey) were reported by those who worked in acute-care hospital settings, followed by hospital-based outpatient settings or clinics.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Advanced practice certification is a requirement for NP practice in the United States. A majority (53%) are certified as family NPs, and another 13% are adult-gerontology primary care NPs. When it comes to income, however, the most well paid are the adult-gerontology acute-care NPs and the psychiatric/mental health NPs. Median incomes were approximately $2000 lower than the averages reported here.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

We continue to witness a long-term trend of declining numbers of APRNs working full time (at least 36 hours weekly). In 2015, for example, 85% of NPs worked full time, compared with 79% in 2019. A similar trend was noted among CRNAs (the APRN group most likely to work full time). Although not significant owing to insufficient respondents, the percentage of CRNAs working full time has slowly declined, from 87% in 2015 to 82% in 2019. We don't know the reason for this, but it could be related to large numbers of NPs and CRNAs reducing their work hours as they near retirement.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Whether full or part time, APRNs can be paid via base salary or hourly rate of pay. This year, however, some group sizes were too small to permit us to confidently report average hourly rates of pay for NMs, CNSs, or part-time CRNAs. To have sufficient data for analysis, we combined the data from this year and last year, and calculated average hourly rates of pay for CNSs and CRNAs (shown here), but we aren't able to determine whether CNSs and CRNAs experienced a change in hourly rate of pay since last year. We are unable to provide average hourly rates of pay for NMs this year due to an insufficient number of respondents.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Does total gross income differ between salaried and hourly-paid APRNs? Which group earns more? Once again, our findings show that except for CNSs, hourly pay could be a financial advantage. Annual incomes for full-time APRNs paid by the hour were slightly higher than those paid by fixed salary.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Differences in annual earnings varied according to the type of APRN employment. NPs employed by private NP practices generated less income than those employed by a medical group or hospital or those who are self-employed/independent contractors. Overall, annual income increased among APRNs employed by a medical group or hospital compared with last year. The median incomes were generally lower than the averages reported above: medical group or hospital ($115,000), private APRN practice ($102,000), and self-employed/independent contractor ($117,000).

This year we also asked APRNs whether they worked for the US government. We found that 9% of NPs, 5% of NMs, 7% of CRNAs, and 11% of CNSs were US government employed. Incomes were slightly higher for government-employed APRNs: $127,000 vs $123,000 (data not shown).

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Practice ownership among APRNs is still relatively rare and has not grown year over year. The exception is NMs, among whom practice ownership increased from 11% to 16% in the space of a year. Only 5% of NPs and 6% of NMs own their own practices. Overall, APRNs who owned their practices earned an average of $140,000 annually compared with $122,000 for APRNs who did not own their practices (data not shown).

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

CNSs and CRNAs generated significantly higher annual bonus payments compared with NPs. Male NPs received higher annual bonuses than their female counterparts ($3000 vs $2000).

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

A majority of APRNs report having a formal collaborative practice agreement with a physician. Although nearly half of states do not require such an arrangement, 75% of APRNs overall reported working with a collaborating physician.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

The minimum entry-level educational requirement for APRNs in the United States is the master's degree. In this year's survey, about 80% of APRNs held a master's degree (down from 85% last year) and 17% held a doctorate (PhD or DNS). The economic benefit of a doctoral degree, in terms of annual salary increase, averaged 4%.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Among survey respondents, men represented about 45% of CRNAs and substantially smaller proportions of CNSs (6%), NPs (11%), and NMs (1%).

The gender pay disparity among APRNs persists, especially for NPs and CRNAs, the only subgroups for which we had enough data to analyze. For this year's report, male NPs reported earning 8% more than female NPs, and male CRNAs reported earning 15% more. Both percentages are higher than in the previous year, suggesting that not only is the gap not closing, but it may be widening.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

We've tried to determine the source of the pay differential between male and female APRNs. As this graph demonstrates, men are more likely to work in higher-wage settings, such as acute-care hospitals. Men are also more likely to pursue supplemental income and to own their own practices.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Among all APRNs, income tends to rise with increasing years of experience, but we see evidence of an upper limit: possibly a salary cap after 20 years of practice. Looking at just NPs, earnings level off at an annual gross income of about $115,000 (median, $114,000).

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

We found a distinct pattern in regional earnings for APRNs. Those employed in the westernmost (Pacific) region of the United States (California, Nevada, Oregon, Washington, Alaska, and Hawaii) reported the highest incomes, while APRNs employed in the East South Central region (Tennessee, Kentucky, Mississippi, and Alabama) reported the lowest incomes. Except for the New England, East South Central, and Mountain regions, average regional incomes increased over the previous year. (Note: These incomes are not adjusted for cost of living.)

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | 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 ($128,000) and lowest in the East South Central region ($98,000).

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

Union membership remains fairly uncommon among APRNs. However, the average annual incomes of the 9% of APRNs who were members of unions or collective bargaining units were slightly higher than those of non-members.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

At least half of all APRNs reported an increase in their annual income over the previous year. Approximately 10% reported earning less. Whether those who saw higher earnings in 2019 experienced true wage growth is unknown, because the higher earnings might be due to an increase in cost-of-living compensation.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

More than half of all APRNs reported that they feel their compensation is fair, and this proportion increased over the previous year, from 55% to 63%. CRNAs (the highest earners) most often reported feeling fairly compensated. Among NPs, men (who as a group earned more than women) were more likely to say their compensation was fair. No differences in satisfaction with compensation were evident by age, union membership, or years in practice.

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

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Medscape APRN Compensation Report 2020

Laura A. Stokowski, RN, MS; Mary McBride; Emily Berry | November 20, 2020 | Contributor Information

We invite you to comment on this year's survey findings.

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Medscape APRN Compensation Report 2019

APRN wages are not showing the increases seen in years past. What does this trend signify?Medscape Features Slideshows, Nov 2019
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