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Hope Winsborough | September 29, 2023 | Contributor Information
Compensation is a key factor in overall work satisfaction for registered nurses (RNs) and licensed practical nurses (LPNs). Although compensation for both groups of nurses rose in 2022, factors such as ever-growing staff shortages continue to threaten their job contentment.
In this report, gender is based on how physicians self-identified in our survey.
Some totals in this presentation do not equal 100% because of rounding.
Hope Winsborough | September 29, 2023 | Contributor Information
Gross income rose in 2022 by about 3% for RNs and around 10% for LPNs. But over a 3-year period, RNs' compensation rose about 10%, while it was flat for LPNs.
Donna Barnett, BSN, RN, an obstetric nurse in the San Francisco Bay area, cites two reasons for the bump: "The cost of living has gone up, which warrants a raise, but the nurse's responsibilities have gone up as well."
Miriam Bradley, RN, an admit/discharge nurse in Henderson, North Carolina, says her employer recently gave all nurses a $4-per-hour raise.
Hope Winsborough | September 29, 2023 | Contributor Information
Bradley, who has 38 years of experience, supplements her income by working PRN 1 or 2 days a week as she approaches retirement.
Some respondents accepted offsite temporary, community, or private-duty nursing/nursing-related assignments. Still others looked outside the field to augment their income, by managing rental property or launching a small business, for example, or by setting up a side hustle.
One LPN with 21-plus years of experience notes that her second job pays "more per hour working holidays and weekends" than her much-loved school nurse position.
Hope Winsborough | September 29, 2023 | Contributor Information
Fifty-two percent of RNs and 78% of LPNs we surveyed were paid on an hourly basis.
The average hourly wage rose 15% for full-time RNs and 12% for part-timers compared with our 2021 report. Comparative gains were 12% and 8%, respectively, for LPNs.
Hope Winsborough | September 29, 2023 | Contributor Information
Nurses paid a salary deal can face disadvantages, like more on-call hours and difficulty pursuing a side hustle. But both RNs and LPNs usually benefit from regular, predictable compensation.
Rates vary widely by experience and specialty area, however. With her experience, says Bradley, "I suspect with my current hourly wage, I would make more than my supervisor if I worked 40 hours a week."
Marc Adam, whose Florida-based firm MASC Medical recruits advanced practice RNs (APRNs) for both salaried and temporary positions paid hourly, says temp rates are even higher than those of salaried professionals "because there's a premium that goes along with that."
Hope Winsborough | September 29, 2023 | Contributor Information
The frequency of nurses reporting income gains last year represents a correction, according to Christopher R. Friese, PhD, RN, AOCN, professor of nursing, health management & policy at the University of Michigan.
"RN wages were relatively flat, with maybe 1%-2% growth year after year for the 10 years before the pandemic," he explains. "We were really overdue for improvement in nurse wages — far overdue."
In 2015, "it was reasonable to pay between $85,000 and $90,000," Adam says. "In 2023, if you're paying under $105,000-$110,000, that's bottom of the barrel. It's a low starting base."
Hope Winsborough | September 29, 2023 | Contributor Information
Forty-eight percent of RNs and 45% of LPNs answered yes to this question. In last year's report, 45% of RNs and 38% of LPNs did.
But from Barnett's perspective, "the majority of nurses I've worked with over many years have always felt we are underpaid," especially given "the increased responsibilities, sicker patients, more demands, and poor staffing."
Some respondents resented the earnings of others. A full-time RN in South Carolina doesn't feel well compensated, she says, because "new grad RNs are being highly paid to start with no experience whatsoever!"
An RN in Hawaii says, "I still fail to understand nationwide how hospitals pay their staff horribly but can still cater to travel nurses." On average, RNs make around 50% less than travel nurses, although the pay gap and related expenses vary from state to state.
Two thirds of nurses polled in 2022 by the American Nurses Foundation said increased compensation was the number-one change that would increase their level of work satisfaction.
Hope Winsborough | September 29, 2023 | Contributor Information
Gross income rose by about 13%, on average, over 2020 for RNs working in hospital-inpatient settings, and around 11% and 10%, respectively, in public/community health and hospital-based outpatient workplaces.
One reason, says Friese, is the valuation of nurses post-pandemic. "Health systems recognized the wage data and decided to move" compensation levels.
"A lot of communities also surged funds into public health," he explains, "so you had more funds to hire people or pay more competitive wages" in settings that historically didn't pay well. "Municipalities recognized they needed to step up."
Hope Winsborough | September 29, 2023 | Contributor Information
LPNs benefited from enhanced need for nursing staff in some settings. More post-acute care facilities are competing with hospitals for nurses, thanks to a growing resident population that requires more critical care. At the same time, says Friese, more clinic and community spaces are hiring LPNs.
In addition, says Bradley, "Due to the desperate need for nurses, our hospital just started using LPNs widely in the past 3 years."
Hope Winsborough | September 29, 2023 | Contributor Information
Last year, male RNs earned about 13% more on average than their female counterparts. For LPNs, the gender pay gap was around 11%. In 2020, those differences were around 6% and 14%, respectively.
That widening pay gap could help explain why more male RNs and LPNs said they felt fairly compensated this year.
While men account for nearly 12% of all LPNs, RNs, and nurse practitioners, their success did not go unnoticed. "Men in nursing get paid more and rocket to the top at lightning speed," says an RN respondent in Colorado.
Last year's report noted certain work-related differences that may help explain the gap, such as more men working hourly, taking on extra shifts, or located within an urban setting. Even so, says Adam, "Speaking from the male perspective, I see how unfair it is."
Hope Winsborough | September 29, 2023 | Contributor Information
"Most newer nurses have bachelor's degrees, and many of the older nurses do not," Barnett says. Among those who did not pursue a 4-year degree, many cited the high debt load.
Says Friese, "If they're already working, they may need to do pre-nursing coursework at a community college." They may also need to pay out of pocket, because their employer may not provide reimbursement.
All of which makes taking on more debt to pursue postgraduate education an even bigger gamble. "You'll make more money with a master's," Friese acknowledges, "but a lot of nurses are questioning the value proposition."
Hope Winsborough | September 29, 2023 | Contributor Information
If RNs do advance their education beyond a bachelor's degree, it usually means more money. However, the income advantage shrank slightly last year vs 2020. One possible reason: It's not the only path to income growth.
For one thing, "In hospitals where there is an RN contract in place, all nurses make the same amount whether you have a degree or not," says Barnett.
Also, many nurses are reluctant to take on additional debt that might not be required for career advancement, Friese adds. "A lot of them are making more money as a staff nurse, so why would I go back to graduate school if I'm making money?"
One respondent says she regretted not earning her master's because her former employer paid a higher rate for those with the MSN "regardless of whether or not their degrees were utilized to improve patient care or address failing metrics."
Hope Winsborough | September 29, 2023 | Contributor Information
Several respondents regretted not earning specialty certifications. Those who had gave mixed reviews.
"I do not like how nurses get compensated," says a Massachusetts RN working in a hospital-outpatient setting. "I have over 30 years' experience and am certified, but I get paid the same as someone with 17 years of experience, and [I get] no compensation for my certification."
A part-time nursing educator in Minnesota says she would not specialize in education if given a do-over. "Years of experience, certification, and advance education reap no financial rewards or respect," she says, adding that she receives "horrible pay for large classes of students."
Hope Winsborough | September 29, 2023 | Contributor Information
As you would expect, the longer nurses have practiced, the higher their average salary. The gap between RN pay at 21-plus years vs under 5 years was greater than for LPNs (nearly 26% vs about 8%).
"New hires come in at the same rate as experienced nurses," says an RN in Arkansas. Even with 24 years of experience, one RN in Pennsylvania takes per diem jobs to compensate for her low salary.
Compensation for experience differs by state, says Rayna Letourneau, PhD, RN, executive director of Florida Center for Nursing. In Florida, for example, the average salary difference between RNs with 4 years' experience and those with 20 is 38%, she says.
Hope Winsborough | September 29, 2023 | Contributor Information
Eighty-one percent of RNs and 90% of LPNs told us they were non-unionized. However, union members on average earned more, although the advantage was bigger for RNs on a percentage basis.
Respondents' involvement in and views on unions varied widely.
"My employer continues to denounce the right to strike as abandonment of position, as does the ineffective union," says an RN in Maryland. "If you need a job, you comply."
An LPN in Washington says she and her coworkers are "desperate" to organize and reached out to a healthcare-specific union "after repeatedly expressing our concerns to management with absolutely no favorable response."
Hope Winsborough | September 29, 2023 | Contributor Information
The gap in average pay between urban and rural jobs was wider for RNs than for LPNs.
"Options were limited when I was thinking about a career," says a semi-retired RN in Florida. "I wanted a career where I could get out of a small town and support myself."
Closing the pay gap between urban and rural settings presents an ongoing challenge. Federal efforts to expand the nursing workforce are "really hard to apply for and limited," says Friese, who sees a need for states to step up and give nurses incentive to work in locations where they're needed.
"If we could open that up, we might see nurses more likely to get a graduate degree, more likely to stay in their community."
Hope Winsborough | September 29, 2023 | Contributor Information
On average, RNs in nearly every region enjoyed small compensation increases — a positive trend, given that in last year's report, income didn't increase in certain regions.
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