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

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

Disclosures

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

In This Article

Discussion

With a biennial survey, trends can be monitored over time within the community. For instance, the median age category of PNPs was 45 to 49 years in 2005, and this age has remained stable over the past 4 years with the percentage of PNPs less than 40 years ranging from 32% and 35% (Loman 2002, Loman 2004). Recently, certification for the acute care PNP has become available, and the change in these numbers can be noted in the future.

With regard to area of practice, PNPs are increasing their involvement in specialty practice. This represents quite a change over 6 years in the St. Louis area, with 70% of all reporting PNPs indicating primary care as their practice area in 1999 (Loman, 2000) and 30% choosing specialty care, compared with 47% and 53% in 2005, respectively. Most surprising was that 70% of the full time PNPs in 2005 indicated their practice area as specialty care. Are more full time positions in this region being created in specialty care relative to that of primary care settings? Or, can those PNPs who desire part time employment find it more easily in the primary care sector? In the St. Louis area, there are two children's hospitals plus several large community hospitals and PNPs are used both for inpatient and outpatient services.

These findings are consistent with surveys of recent PNP graduates that indicate that a substantial number of PNPs were working in specialty care (Jackson et al 2001, Jackson et al 2003). In a statewide survey conducted in Ohio, 38% of the 200 PNPs reported working in a hospital setting (Schaffner & Vogt, 2004). In the 2005 ADVANCE national survey of NPs, 16% of respondents were practicing in a specialty clinic or practice; yet another 37% reported working in hospitals, emergency departments, or settings other than family practice, internal medicine, women's health, or pediatric practices (Tumolo & Rollet, 2006). In the 2005 ADVANCE study, 9% of the sample were PNPs, yet only 6% worked at pediatric or school practices. Evidently, some of these PNPs were in specialty practice.

Many parents resort to taking their child with an illness or injury to an urgent care center or emergency department because of time or scheduling constraints when the child could have been seen in the primary care office. In addition, there is evidence that PNPs see quite a few children with chronic health care problems such as asthma, obesity, hypertension, diabetes, and others in the primary care setting (Schaffner and Vogt 2004, Swartz et al 2003). Therefore, PNPs can be very useful in a variety of specialty-based practices that care for children.

In the future, it may be difficult to place increasing numbers of PNP students in primary care sites with PNPs if there are more full time PNPs in specialty care. These students may have to use more pediatricians, family NPs, and family practice physicians for preceptors in the primary care setting. It may be helpful for PNP students in primary care programs to routinely spend clinical time in specialty clinics that focus on the care of children with asthma, pulmonary problems, hypertension, diabetes, obesity, and other chronic health problems.

In the St. Louis area study, returned surveys were included even if the respondent was not currently employed as a PNP, because NPs may move from practice to education or other types of employment and later return to work as a PNP. A total of 15 indicated no current APN practice. Of these 15, 4 were employed as a registered nurse, 4 were not in current practice but were engaged in another type of work, 3 were not employed, and 4 were involved in nursing education. With the current nursing faculty shortage, there is intense recruitment of all nurses with masters' degrees to teach in undergraduate nursing programs.

In 2005, 78% of the respondents had obtained their PNP education either through a master's degree in nursing or a post-master's program, compared with 22% from an NP certificate program. This has gradually increased over the past 4 years when 68% were master's-prepared and 32% had received their PNP via a certificate program.

The mean salary for full time PNPs in practice in the St. Louis area was $72,788, which is an increase of 6.3% since 2003. The salary difference from 2003 to 2005 for full time PNPs was statistically significant, t (92) = 2.043, p = .044. The 2005 ADVANCE National Salary Survey of Nurse Practitioners revealed that the average full time salary for all NPs was $74,812, lower for PNPs at $69,234, and for all NPs from Missouri at $71,838 (Tumolo & Rollet, 2006). Thus, the local mean salary for full time PNPs in 2005 was 5% higher than the ADVANCE survey result for NPs in pediatric settings and 1% higher than the amount reported for all Missouri NPs. The higher salaries in our study region may be related to the majority of our respondents who worked in an urban region. In addition, the local 2005 mean salary was 1.7% higher than the AANP salary survey results from 2004 for PNPs (Goolsby, 2006). Interestingly, the local mean salary for full time PNPs in 2003 was only slightly higher (1.7%) than the ADVANCE results for NPs in pediatric settings (Tumolo & Rollet, 2004).

Individual members of SLA-PNP use the data from the biennial survey to assist in their negotiation for salary and benefit compensation with their employer, because the information is current and derived from the St. Louis metropolitan area. This type of survey may be helpful to other APN organizations. It has been suggested that data from an NP salary survey could affect salaries by encouraging NPs to negotiate for a higher salary (Tumolo & Rollet, 2004).

The survey also provides a mechanism to determine education and issue interests to members and enhances awareness of the organization to potential members. Professional nursing organizations must provide tangible benefits and networking opportunities to attract and retain membership (White & Olson, 2004).

It is ideal to work with a colleague with previous research experience to pool resources and expertise. Survey expenses typically include copying costs, postage, stationery, and data analysis. A fair amount of time is required to develop the items for the survey, verify current addresses, organize the mailing, perform data entry, conduct data analyses, and compile the report to the organization. A postcard reminder helps to increase the response rate and is worth the extra cost and time.

A local survey may be meaningful to area PNP students and assist them in the transition from student to APN. Students begin to focus on various role and business issues such as malpractice insurance, negotiating terms of employment, policy, and reimbursement challenges as they near the end of the program (Hamric and Hanson 2003, Hildebrand 2005). Currently, only 31% of the respondents reported having a contract with their employer. Although this may be partially explained by some of the PNPs in specialty practice who are employed by hospitals, it is similar to the proportion reported by PNPs in Ohio (Schaffner & Vogt, 2004). However, it seems low and would be a relevant point of discussion for PNP students. Only 37% of PNPs indicated that they were credentialed by insurance or Medicaid plans. Those who were not credentialed noted that their services were either billed under a physician's name or that they were employed by a hospital and they could not bill separately for care.

A current issue in Missouri is that APNs with prescriptive privileges cannot prescribe controlled substances. Bills to permit this have been introduced during the last two state legislative sessions but have encountered some resistance from the medical community. APNs are in the process of networking, testifying, and educating the legislators.

The limitations of the survey must be acknowledged. The reliability of the survey instrument has not been established. However, most of the items are demographic in nature and are similar to those used in national surveys.

Another limitation was that the sample size of full time PNPs in practice was relatively small (n = 54) and this affects the extent of analysis that can be performed. For instance, there may be other factors that influence salary differences that could be determined with a larger sample size.

Last, the issue of confidentiality must be considered for a local survey. Although the survey instrument contains no identifiers, respondents may be hesitant to provide sensitive data such as salary if they feel their response could be linked to them because of a potentially identifying item such as age or description of their specialty work. For instance, there might be only one PNP in the area that practiced in a particular specialty. Therefore, having a research assistant enter the data helps to ensure the confidentiality of responses. Only 8 people (6.7%) did not report their salary, and this percentage is not uncommon. The salary range method has been used to encourage reporting of salary by respondents.

Therefore, if the local APN organization is focused on a specialty practice such as pediatrics and has the resources to conduct a survey, this may be a useful strategy to obtain local data of interest and value to members. It is also helpful for educators to be aware of the employment opportunities and challenges for PNP graduates to prepare them for the reality of the market place. As the number of PNPs in the United States grows and the recognition of their contributions to health care by the public and by other health care professionals increases, the potential for specialty practice may become more attractive to both PNPs and health care centers. Since the focus of practice by the PNP is holistic care of the child within a family, PNPs can focus on both disease-specific conditions as well as promotion of child health, growth, and development. Perhaps it is time for a national survey of PNPs to investigate the specifics of current practice including specialty area and role functions.

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