Nurses Tell All! Salaries, Benefits, and Whether They'd Do It Again

Carol Peckham


November 17, 2015

In This Article

What Is the Outlook for Nurse Income?

Between the late 1990s and into 2000, in spite of increasing concern over a nursing shortage, nurses' pay did not increase at all. In the following decade, however, wages rose.[14] Between 2000 and 2010, RN salaries increased by about $20,000 and LPNs by $11,500, contributing to an increase in the number of individuals entering the field over that same period.[15]

In keeping with this trend, half (52%) of nurses in the Medscape survey reported an increase in salaries in 2014 compared with 2013. Two thirds of those who had an increase reported that it was due to a raise. Only 15% said that they had an increase because of a promotion or an advancement up the clinical ladder. In free-text fields of the survey, some nurses commented on why their wages had increased. Most attributed increased pay to job changes and others to unions, productivity pay, or working different jobs.

Only 9% of respondents said that their compensation had declined. More than one third (36%) of these respondents attributed the reduction to a job change. About one quarter (22%) of those who experienced a pay decline attributed it to working less, either because of fewer hours, beginning part-time work, a return to school, or less overtime. Twenty-four percent of nurses reported a pay cut. Among the anecdotal complaints about a decline in income were changing tax structures, less overtime, and minimal raises.

With the implementation of the Affordable Care Act (ACA) and its emphasis on expanding primary care services, NP employment is expected to grow by 34% between 2012 and 2022.[5] As part of the ACA, a number of initiatives, such as the patient-centered medical home and accountable care organizations, are also focusing on making NPs full partners with physicians in the care of the patient.

RN employment is also expected to increase by 19% and LPN/LVN employment by 25%, due to a number of factors, including the rise in the elderly population and the number of those with chronic diseases, the financial incentives to dismiss patients from health facilities as soon as possible, and an increase in the number of patients being cared for and treated at home.[1,16]

Nevertheless, the effects of the ACA, according to our survey, have been mostly minimal or negative. In the current survey, the majority of nurses (84% of APNs, 78% of RNs, and 71% of LPNs/LVNs) reported that the ACA had no effect on their income, and when it did, it was more likely to have had a negative effect. More than one quarter (27%) of LPNs/LVNs, 20% of RNs, and 12% of APNs reported a reduction in earnings. Free-text comments from nurses in this survey indicated dissatisfaction with the impact of the ACA, however, particularly with respect to an increased workload with no commensurate increase in pay and fewer benefits. One nurse's comment reflected those of many, "[The hospital] where I work is already buzzing with worry over reimbursement... Bonuses are harder to receive, and raises are less than $0.50. Staffing is always at a minimum, which is the only bitter sweet solace we have—overtime pay is usually an option...Obamacare is forcing [the hospital] to cut costs at every turn to stay out of the red."


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