Pediatric Nurse Practitioner Salary and Practice: Results of a Midwest Metropolitan Survey

Deborah G. Loman, PhD, RN, CPNP; Shu-Ling Hung, MA, RN


J Pediatr Health Care. 2007;21(5):299-306. 

In This Article

Abstract and Background


The St. Louis Association of Pediatric Nurse Practitioners has conducted a local biennial salary, practice, and benefits survey since the mid 1990s. This cross-sectional, descriptive study investigated demographic characteristics, salary, benefits, and practice patterns of pediatric nurse practitioners (PNPs) in the St. Louis area in fall, 2005. The survey was sent to 199 PNPs who lived within 100 miles of Saint Louis, with a return rate of 60%. The mean salary for full time PNPs engaged in practice was $72,788, which was a 6.3% increase from the 2003 survey results. PNPs with more years of experience received significantly higher salaries than those with less experience; however, there was no difference in salary based on type of practice (primary versus specialty care) or type of practice setting. Increasing numbers of PNPs are reporting their practice focus as specialty care (53%) rather than primary care (47%) in this region, with 70% of full time PNPs indicating specialty care. PNPs with less than 3 years experience were working equally in primary and specialty care. Practice challenges such as reimbursement and prescriptive issues were identified. Only 37% of PNPs indicated that they were credentialed by insurance plans. Nurse practitioners may find a local survey helpful as they negotiate changes in their salaries and benefits. Members of advance practice nursing organizations and educators may find the survey process useful as they observe local practice trends over time. It is essential that nursing education and continuing education conferences address the basic and continuing education needs of PNPs in both primary care and common specialty practices.


Since the mid 1990s, there has been an increase in the number of advance practice nurses (APNs) certified and recognized or licensed by the states (Cooper and Aiken 2001, Phillips 2006, U.S. Department of Health and Human Services 2005). With nurse practitioner (NP) status, the individual usually obtains a position with greater responsibility and compensation than that of a registered nurse. However, in the current health care environment, compensation to NPs is influenced by a number of health care system factors as well as by individual experience and performance. There are numerous factors that may limit financial compensation to APNs by health care agencies, such as overhead expenses, reimbursement by third party payers, and number of patient encounters (Hildebrand, 2005).

The individual APN weighs a variety of factors when considering a new position including primary or specialty care, number of work and call hours, specific responsibilities, salary, and benefits (Brown and Olshansky 1998, Buppert 2004). When an APN is considering taking a new position or is renegotiating salary or a contract at the current position, knowledge of the typical salary range and benefits is important for the negotiation process as well as calculating the NP's earnings and share of the expenses (Buppert 1997, Martin and Hutchinson 1997, Tumolo and Rollet 2004). If an increase in salary is not possible, other benefits can be requested such as an increase in paid continuing education time, insurance, vacation time, and/or participation in a 401/403 plan (Miller 2000, Tumolo and Rollet 2004).

It is helpful to have current data available that are specific to the type of NP specialty within one's local geographic area (Hayes et al 2001, Schaffner and Vogt 2004). Many NPs are in settings where there may be only one or two NPs employed in that practice.

Several national surveys of NPs have been conducted. The editors of the journal ADVANCE for Nurse Practitioners have supported a national salary survey of NPs every 2 years since 1997 (Leccese 1998, Leccese 2000, Tumolo and Collins 2002, Tumolo and Rollet 2004, Tumolo and Rollet 2006). The Nurse Practitioner Journal sponsored one in 2002 (Pilla, 2003), and the American Academy of Nurse Practitioners (AANP) has completed three national surveys of NP practice and salary with the most recent one performed in 2004 (Goolsby, 2005).

In the 2005 ADVANCE survey, 9% of the 5,905 respondents were pediatric nurse practitioners (PNPs), as were 12% of the 3,731 respondents in 2003 (Tumolo and Rollet 2004, Tumolo and Rollet 2006). The results were reported by state as well as NP specialty for the United States. However, the results were not reported by specialty within each geographic region. In general, factors associated with a higher salary for NPs included the following: clinical specialty, urban location, male gender, years of experience, level of education, and geographic region (Goolsby 2006, Tumolo and Rollet 2004, Tumolo and Rollet 2006).

The St. Louis area has a strong tradition of PNP practice. Two certificate programs educated PNPs during the 1970s through early 1980s (K. Potts, personal communication, April 25, 2006). The St. Louis chapter of the National Association of Pediatric Nurse Practitioners was formed in 1973 (L. Smith, personal communication, May 26, 2006) and has been active since then. Two universities in the area have educated master's-prepared PNPs since the 1990s. A total of 53% of the PNPs in Missouri reside within 100 miles of St. Louis, and PNPs comprise 13% of the NPs recognized in Missouri.

The St. Louis Association of Pediatric Nurse Practitioners (SLA-PNP) has conducted a biennial salary and benefit survey for the last 10 years. The primary reason for the survey is to gather and share information with the members, since salaries, benefits, and practice patterns can vary greatly from one setting to another. This activity is congruent with one of the purposes of the organization's bylaws, which is to provide information to PNPs who are seeking employment (SLA-PNP, 2005). In addition, this is an opportunity to survey PNPs as to types of activities and programs that the organization should provide.


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