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Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023
| Contributor Information
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Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Salaries for advanced practice registered nurses (APRNs) varied due to subspecialty and laws in different states, among other factors. Base compensation increased significantly only for clinical nurse specialists (CNSes) and certified registered nurse anesthetists (CRNAs). Overall, compensation increased for all APRNs except nurse midwives (NMs), with CNSes and CRNAs enjoying the largest increases.
In this report, respondents reported gross income from nursing before taxes. Any annual bonus was not tied to performance metrics but could include a cost-of-living increase.
Gender is based on how nurses self-identified in our survey.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Among APRNs, CNSes and CRNAs saw their 2022 base compensation increase more significantly than their peers did, at 7% and 5%, respectively.
Graig Straus, DNP, APRN, CEN, explains that CNSes tend to specialize in complex fields such as diabetes, cardiology, and oncology that require more expertise, and they work in healthcare networks serving growing markets where there's greater competition for clinicians. All of this translates to higher salaries.
Many CRNAs earn more because they are in high demand to offset a shortage of anesthesiologists, adds Straus, a practice owner who specializes in emergency and family health.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
"An individual's earning power and nursing salaries in general are influenced by whether a state funds healthcare, the population size, the nurse workforce, cost of living, and labor costs," says Charla B. Johnson, DNP, RN, ONC, director of clinical information systems/nursing informatics for a Louisiana health system.
Salaried nurse practitioners (NPs) saw the largest proportional pay increase, 6% on average, followed by NMs with a 5% hike. NP pay could be fueled by intense marketplace demand, with their profession reported as the fastest-growing in the United States by the Bureau of Labor Statistics.
Nursing schools are struggling to keep up with the demand to train new NPs. Responding to that trend, the Department of Health and Human Services recently announced awards of more than $100 million to help expand the nursing workforce. More than half of the funds will be used to train advanced practice nurses.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Overall, nurses paid on an hourly basis earn more than their salaried counterparts, thanks to overtime and the ability to clock hours, Straus says.
"When you're working salary, you're more inclined to utilize the added benefits that come along with it: vacation, sick leave, or any other perks," he says. "With an hourly wage, the more driven one is, the more they can make."
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
"As the need for more healthcare providers has increased, APRNs have stepped up to fill the need," Straus says. "With laws regarding independent practice increasing, the demand for higher compensation is increasing as well."
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Salaried nurses earned 6% more than last year, while hourly nurses earned 8% more.
"COVID saw a rise in pay rates as healthcare networks recognized the amount of work their nursing staff put into their jobs," Straus says. "Also, because of the amount of burnout due to COVID, higher rates were needed to maintain staff."
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Last year's report showed that APRNs supplemented their income in similar ways. CNSes were less likely than advanced practice peers to work extra shifts and more likely to teach classes or to have no supplemental income.
Straus says he supplements his income by teaching, lecturing, and consulting. "I do not necessarily do this as a need for more income," he says. "Rather, I enjoy teaching, and an honorarium or payment is a bonus."
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
NPs may be more evenly divided than their APRN peers about whether they are fairly compensated because their pay varies by environment and work location, Straus believes.
Generally, those APRNs who are paid on the basis of their productivity — relative value units (RVUs) or bonuses — and perform well will view their compensation as fair, he says.
On the other hand, those with locked-in salaries and who are not given productivity incentives may complain about their pay, especially if they feel that they work harder than many colleagues, Straus explains.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Most NPs work in hospital inpatient settings. Hospitals usually offer nurses more opportunities than outpatient settings or clinics do to work longer hours that boost earnings, Straus says. In outpatient settings, a nurse can work only during the hours of operation, he notes.
Also, complex cases and procedures are seen more often in hospitals than in outpatient settings, leading to increases in APRN salaries, Straus explains.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
More than three quarters of the APRNs we surveyed were women. But annual gross income of male CRNAs and NPs — the only groups with enough by-gender income data to report — exceeded that of their female counterparts by 10%-12%. In our prior two reports, the gender gap in income was 9%-14%.
"Although the earning gap between genders is closing, the pace to parity is slow," Johnson says.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
For NPs, earning the same salary on average regardless of degree has more to do with their job than their educational level, Straus believes.
"Having the DNP or master's does not change their role or capabilities of practice," he says. So, equalizing their pay would be justified.
NPs with a doctorate earned about 4% more on average than those with a master's in our previous two reports.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
"It's no surprise that higher-demand specialties for APRNs, such as psychiatric–mental health, are paid higher salaries," Johnson says. With the growing demand for mental and behavioral health services, APRNs are filling the gap in providers with prescribing authority, she says.
Straus adds, "Overall, there is a giant need for psychiatric care, and the lack of providers can warrant an increase in salary for those who provide this care. This would be true for health networks hiring providers, as well."
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Continuous work history and experience, along with years of practice, geographic location, clinical setting, and specialty area, are among the pay differentials for advanced practice professionals, Johnson says.
She believes that seniority often is seen as more important than performance when it comes to APRNs' workplace advancement. "If someone has been there longer, they are next in line [for promotion] even if they don't deserve it."
There's a limit to how much a salary can increase based on experience, wages, or fee scale, Straus says. If a nurse is a union member, "some can max out longevity. Also, there is only so much of an insurance reimbursement that can be utilized to pay for a salary."
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
APRNs who work in hospital inpatient or outpatient settings are typically part of a team with physician oversight, Straus notes. Though more than half of the states allow independent practice, health centers and corporate owners may still place limits on APRNs' abilities, he adds.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
"Unions are known for collective bargaining for better wages and working conditions, but it comes with a cost — and for some, the cost is too high," Johnson says. "To join a union, there are union dues … If the union negotiations require a strike, you do not perform patient care and you are without pay."
Straus says unions tend to lock in rates for both salary and hourly wages. Doing that limits APRNs' earning potential from RVUs or other bonuses.
"I would rather work and get paid for what I am able to accomplish and [based on] my productivity vs a union wage," he says.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
"Insurance reimbursement rates are based upon region," Straus says. "Salaries are based upon region as well. If certain suburban areas fall within urban areas of insurance reimbursement, that leads to a potential for higher payment. Cost-of-living wages are also an important factor to consider."
Compared with their APRN peers, CNSes and CRNAs were more likely to practice in urban than suburban areas.
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
"Which side of the country, which state, and whether someone lives and/or works in a rural vs urban community influence pay," Johnson says. She agrees with Medscape's findings that the highest-paid nurses usually work in western states.
Nursing pay often is based on location and cost of living, Straus adds.
"Also, healthcare laws for nursing are more stringent on the West Coast than they are in other areas," he says. "If the nurses are part of unions or have independent practices, they can demand more money, and the laws will back them for their independence and wage."
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
Higher Salaries for Certain Nurse Specialists: Medscape APRN Compensation Report 2023
Roni Robbins | November 14, 2023 | Contributor Information
RNs and LPNs reveal their annual compensation and work satisfaction, and give perspectives on peers, career paths, and unions, plus other crucial insights.Medscape News Slideshows, Sep 2023
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