Pay Gap Between Male and Female RNs Continues

Troy Brown, RN

March 24, 2015

Fifty years after passage of the Equal Pay Act, male registered nurses (RNs) still earn more than female RNs across settings, specialties, and positions, and that pay gap has not narrowed at all, according to a recent study.

Ulrike Muench, PhD, RN, from the Department of Social and Behavioral Sciences, University of California, San Francisco, and colleagues report their findings in a research letter published in the March 25 issue of JAMA.

Since passage of the Equal Pay Act, the gap between salaries for men and women has narrowed in many occupations, but not nursing.

"[P]ay inequality persists for certain occupations, including medicine and nursing. Studies have documented salary differences across clinical settings for diverse cohorts of physicians and higher salaries for male [RNs]. In nursing, analyses have not considered employment factors that could explain salary differences, have been cross-sectional, and have not been based on recent data," the authors write.

The researchers studied the salaries of male and female RNs over time, using nationally representative data from the last six (1988 - 2008) iterations of the quadrennial National Sample Survey of Registered Nurses (NSSRN), which was discontinued in 2008, and data from the American Community Survey (ACS; 2001 - 2013).

There were 87,903 RNs in the NSSRN sample, of whom 7% were men, and 205,825 RNs in the ACS sample, of whom 10% were men.

Unadjusted male salaries were higher than female salaries every year in both surveys (annual pay difference, NSSRN, $10,775 [95% confidence interval (CI), $10,243 - $11,306; P < .001]; ACS, $9562 [95% CI, $9163-$9961; P < .001]). No statistically significant changes in male vs female salary were observed over time. Regression analysis using the NSSRN estimated an overall adjusted earnings difference of $5148 (P < .001).

The pay gap was $7678 (95% CI, $5319 - $10,037; P < .001) for ambulatory care and $3873 (95% CI, $3144 - $4601; P < .001) for hospital settings. The gap was found in all specialties with the exception of orthopedics, and it ranged from $3792 (95% CI, $802 - $6781; P < .001) for chronic care to $6034 (95% CI, $4175 - $7893; P < .001) for cardiology.

Pay differences were also seen by position, ranging from $3956 (95%CI, $2174 - $5737; P < .001) for middle management to $17,290 (95% CI, $11,690 - $22,891; P < .001) for nurse anesthetists. The model explained half of the variance in salaries (R 2 = 0.46).

"About half of the gap was accounted for by employment and other measured characteristics. This gap is similar in magnitude to the salary differences found for physicians," the authors observe.

The authors note several study limitations, including possible reporting biases with regard to survey data and the paucity of data regarding nursing specialties and positions in the NSSRN.

"The roles of RNs are expanding with implementation of the Affordable Care Act and emphasis on team-based care delivery. A salary gap by gender is especially important in nursing because this profession is the largest in health care and is predominantly female, affecting approximately 2.5 million women. These results may motivate nurse employers, including physicians, to examine their pay structures and act to eliminate inequities," the authors conclude.

One author reported payment for lectures from a variety of organizations, associations, universities, and groups and also reported appointment to chair of the National Health Care Workforce, which was established under the Affordable Care Act, but has not begun any work yet. The remaining authors have disclosed no relevant financial relationships.

JAMA. 2015;313:1265-1267. Abstract


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