Nursing Salaries Are Stagnant, New Survey Shows

Troy Brown, RN

October 11, 2018

Nurse income may be falling, according to Medscape's 2018 RN/LPN Compensation Survey of 5011 registered nurses (RNs) and 2002 licensed practical nurses (LPNs). In 2017, for the first time, average annual nurse wages and hourly rates of pay failed to increase significantly. After adjusting for inflation, income may even be falling, according to the report's authors.

The percentage of RNs (56%) and LPNs (46%) who believed they were compensated fairly for their work fell slightly from the previous year.

During previous years, there have been small but steady increases in compensation. Average annual gross income for RNs was $81,000 in 2017 compared with $80,000 in 2016. For LPNs, annual income was $46,000 in 2017 and 2016. Hourly wages in 2017 were $37 for full-time RNs compared with $22 for full-time LPNs.

Nurses in salaried positions — a much smaller group when compared with those in hourly positions — were the only group whose average salaries increased.

The reasons for this lack of wage growth are unclear.

Registered nurses living in the Pacific region (Alaska, California, Hawaii, Oregon, and Washington) of the United States had the highest average annual income, at $102,000 per year, whereas those in the East South Central region (Alabama, Kentucky, Mississippi, and Tennessee) reported the lowest ($69,000 per year) — a difference of 33%. Licensed practical nurses in the New England region (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont) reported the highest annual pay, at $56,000 per year, compared with $42,000 in the South Central region.

Among RNs, income was highest for those working in hospital inpatient and occupational/employee health settings ($84,000) and lowest for those working in school/college health services ($66,000). Licensed practical nurses working in skilled nursing facilities or other long-term care reported the highest annual income, at $48,000, compared with $37,000 per year for LPNs working in school/college health services.

Although more than half of nurses (RNs, 61%; LPNs, 58%) said their income had risen from the previous year, the survey did not show the amount of this increase or the source of the increase — whether it resulted from a raise or from working overtime or extra shifts. Approximately one third of nurses (30% of RNs and 34% of LPNs) reported working extra hours or shifts. To supplement their income, 13% of RNs worked on-call shifts, 12% assumed charge nurse responsibilities, and 11% worked a second job or had a non-nursing income-producing activity.

Most RNs worked for employers that provided paid time off (96%), health insurance (95%), contributions to retirement savings (84%), and education allowance or reimbursement (65%). Almost one third of nurses (RNs, 29%; LPNs, 39%) still had student loan debt.

Where Are the Nurses?

Nurses were most likely to work in hospitals (RNs, 52%; LPNs, 20%), which paid the highest wages. Nurses in the insurance industry and occupational health reported annual income that was comparable to that of nurses in hospitals; however, relatively few nurses work in those sectors.

Most nurses worked in urban areas (RNs, 44%; LPNs, 36%), where incomes were higher (RNs, $84,000; LPNs, $48,000) when compared with incomes in rural areas (RNs, $72,000; LPNs, $42,000).

Gender Disparities Continue

Gender disparities continue, with men in nursing (8% of RNs in the survey) reporting higher incomes than their female counterparts for the 4th year in a row. Among RNs in salaried positions, men earned an average of $89,000 per year compared with $83,000 for women. Among RNs working in hourly positions, men earned an average of $82,000 per year compared with $78,000 for women.

Men's work choices may at least partly explain this gender pay gap. Men more often work in higher-paying healthcare settings such as inpatient units (men, 54%; women, 38%) and in urban (53% vs 44%) compared with rural areas. Men were more likely to say they supplement their regular income by being on-call (26% vs 18%) and working off-shift hours that paid a higher differential (40% vs 29%). Men were also more likely to function as charge nurses (17% vs 12%).

More Nurses Working Overtime

The percentage of nurses who reported working full time fell by 6% and the number of nurses who routinely worked overtime rose. This year, 42% of RNs worked overtime, up from 37% last year.

Men were more likely than women to report working overtime routinely (51% vs 41%) and to work at least 6 hours of overtime when they do (50% vs 38%).

The number of LPNs who worked overtime increased from 45% last year to 50% this year.

Most RNs (94%) and LPNs (92%) were paid for working overtime; however, 3% of nurses in both groups said that instead of being paid for overtime hours they were allowed to take an equal number of hours off.

Union Membership Low

Union membership rose slightly but was still low (RNs, 16%; LPNs, 10%), although nurses who belonged to unions reported higher income (RNs approximately 13% more and LPNs approximately 10% more).

Union membership also differed according to region, with the highest percentage of RNs in the Pacific region (43%) and the lowest among those in the South Atlantic region (Florida, Georgia, North Carolina, South Carolina, Virginia, and West Virginia), at 4%.

Education, Specialty Certification

Just less than half (49%) of RNs said they have a bachelor's degree, falling far short of the nursing profession's stated goal of 80% by 2020. Of the remaining RNs, 26% had an associate degree, 17% had a master's degree, 6% graduated from an RN diploma program, and 2% had a doctoral degree.

Income was highest for RNs with a doctoral degree ($97,000), followed by those with a master's degree ($88,000), bachelor's degree ($81,000), RN diploma ($81,000), and associate degree ($74,000). Diploma nurses are typically older and more experienced than nurses with a bachelor's degree; for this reason, they may have more clinical and administrative experience and their incomes may reflect that, according to the report authors.

The proportion of RNs who hold specialty certifications has not risen significantly from the previous year (53% vs 56%) and 60% of nurses said they were not rewarded monetarily for being certified. Although nurses with specialty certifications earned an average of $84,000 compared with $73,000 for noncertified RNs — a 15% increase — only one quarter said they received a higher annual pay rate, 6% were given a one-time bonus, and 8% received an annual bonus for certification. Certification could result in a higher pay rate by enabling nurses to advance on a clinical ladder.

Specialty certification is not required in most healthcare organizations and it is associated with significant expense for nurses. Many nurses purchase certification exam guides or take special exam preparation classes, and there are fees for the certification exam. In addition, certification renewal and continuing education credits needed for maintenance of specialty certification also cost money.

Half of RNs Belong to a Professional Society

New on this year's survey was a question about whether nurses belonged to a professional nursing society or association. Examples include general nurse groups such as the American Nurses Association and specialty groups such as the Emergency Nurses Association. Approximately half (53%) of RNs said they belonged to a professional nursing society and that percentage increased with years of experience. Registered nurses in academic settings reported the highest level of membership in professional organizations. The authors write that other data indicate that 12% of RNs and 5% of LPNs have job benefits that include professional society memberships.

Only 16% of LPNs belong to such groups, and this may reflect decreased opportunities rather than motivation. Licensed practical nurses are not allowed to join the American Nurses Association, although some associations permit LPNs to become affiliate members. The National Association of Licensed Practical Nurses is available for LPNs; however, the lack of career ladders and promotion opportunities may make such memberships less attractive for LPNs compared with RNs.

This year, nurses were also asked whether they carry their own malpractice insurance. Most employers provide liability coverage for nurses working within their scope of practice; however, 29% of RNs and 16% of LPNs also have their own insurance.

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