Nurse Practitioners See Largest Pay Bump Among APRNs

Marcia Frellick

November 30, 2018

Nurse practitioners (NPs) saw the biggest gross pay increase — 6% — among advanced practice registered nurses (APRNs) in 2017, according to the latest Medscape APRN Salary Report.

Next highest were certified registered nurse anesthetists (CRNAs) with a 5% bump, nurse midwives (NMs) at 4%, and clinical nurse specialists (CNSs) with a 1% rise.

CRNAs again had by far the highest average annual pay at $192,000. They were followed by NPs at $112,000, NMs at $107,000, and CNSs at $103,000.

Incomes were up from last year for between 52% and 62% of APRNs. Only 5% to 11% reported decreased income.

Pay Satisfaction Varies

Satisfaction with compensation varied from 45% of those who work in retail clinics reporting they were satisfied to 74% of APRNs who work in an industry or insurance setting reporting they were happy with pay.

Medscape asked APRNs to complete an online survey on annual earnings as part of a larger survey of all registered nurses and licensed practical nurses.

Of the 10,282 nurses who met the screening criteria and responded to the survey, 3271 were APRNs and included 2006 NPs, 501 CNSs, 375 CRNAs, and 389 NMs.

A separate report published in October details findings for RNs and LPNs.

This year's survey also looked at what certifications NPs have and how those affect income. The most common certification was family NP (held by 55%) followed by adult-gerontology primary care (12%). Those who were certified in psychiatric mental health had the highest income ($120,000) and those with a pediatric primary care certification made the least ($108,000).

Men Continue to Make More

The gender gap has not narrowed in this year's report. Male NPs make 15% more than their female counterparts ($127,000 vs $110,000) and male CRNAs make 14% more ($205,000 vs $180,000). Only 1% of midwives are male and only 5% of CNSs are male, so numbers were not high enough for comparisons in those categories.

Some work characteristics may help explain the gap. Men were more likely to work in a high-paying acute-care hospital setting (61% vs 45%), routinely work overtime (60% vs 40%), supplement their regular income (62% vs 49%), and own their own practices (13% vs 5%).

Among all respondents asked whether overtime was compensated, 86% said it was paid, 9% said it was not paid, and 5% said it was not paid but time off was offered.

NP Pay Rises With Experience, But Only to a Point

The survey asked about pay increases relative to experience and data was sufficient for comparisons only for NPs. The increases relative to experience appeared to max out at 20 years for that specialty. Average pay was $106,000 for 1 to 5 years' experience, $111,000 for 6 to 10 years, $123,000 for 11 to 20 years, and then decreased slightly to $122,000 for 21 years or longer.

The minimum educational level for APRNs is a master's degree. In 2017, 85% of APRNs had master's degrees and 15% had a doctoral degree (PhD or DNS). Those with doctorates made an average 4% more.

By region, APRNs made the most ($136,000) in the Pacific region (Washington, Oregon, California, Alaska, and Hawaii). They made the least in the region containing Mississippi, Alabama, Tennessee, and Kentucky ($111,000).

So many states require collaborating agreements with physicians that most APRNs (75% - 79%) do not work independently. CNSs are the exception, and 43% report practicing independently. Among CRNAs, 25% work independently; and 21% of NPs and midwives practice that way.

This year, the survey asked whether APRNs carried malpractice insurance on top of professional liability insurance offered by their employers. Midwives were the least likely to purchase this insurance (4%) and CNSs were the most likely (38%), followed by CRNAs at 24% and NPs at 20%.

The survey was conducted in 2018, but the APRNs were asked to report income from 2017.

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