APRN Annual Pay Down Slightly:
Medscape Survey

Megan Brooks

November 08, 2019

Advanced practice registered nurses (APRNs) experienced a small but nonsignificant decline in their average annual gross income in 2018 compared with 2017, according to the latest Medscape APRN Salary Report

Notably, it's the first year that APRNs across the board reported no increase in their yearly earnings, a finding echoed in Medscape's separate salary report on registered nurses (RN) and licensed practical nurses (LPN) released last month.

This year, a total of 3545 APRNs completed the online survey, which included 2001 nurse practitioners (NPs), 626 clinical nurse specialists (CNSs), 460 certified registered nurse anesthetists (CRNAs), and 458 nurse midwives (NMs).

Highest Annual Pay?

In 2018, CRNAs (once again) had the highest average annual pay at $188,000 (down from $192,000 in 2017). They were followed by NPs at $108,000 (down from $112,000 in 2017), NMs at $107,000 (same for both years), and CNSs at $102,000 (vs $103,000 in 2017).

Annual income for NPs, who make up the largest group of APRNs in the survey, was highest in 2018 for those working in acute care hospital settings ($116,000) and lowest for those working in non–hospital-based medical clinics or offices ($106,000).

Overall, there was no large shift in work setting for any group of APRNs. The acute care hospital remains the primary work setting for 78% of CRNAs, 37% of CNSs, 28% of NMs, and 16% of NPs. Like last year, only 2% of NPs reported working in retail health clinics.

Most APRNs (76%-82%) work full-time (at least 36 hours weekly) and the proportions of full- and part-time APRNs did not change significantly in 2018 from 2017, although a longer-term trend (going back to 2015) suggests a gradual decline in the number of APRNs working full-time and an uptick in those working part-time.

In a reversal from prior years, part-time or per diem ("as needed") NPs reported higher hourly rates of pay than full-time APRNs. The difference was most striking for CRNAs; those working part-time earned $19 per hour more than CRNAs who worked full-time. There is also an economic advantage to hourly pay, with annual earnings of APRNs who are paid by the hour 1% to 4% higher than salaried APRNs.

The survey also asked about NP certifications and how they affect income. The most common certification was family NP (57%) followed by adult-gerontology primary care (14%). NPs certified in psychiatric/mental health or adult gerontology acute care had the highest income ($114,000) and those with a women's health certification made the least ($98,000).

Men Still Make More, but Gap Narrowing

Male APRNs, like male nurses in general, earn significantly more annually than their female peers. In 2018, male NPs earned 7% more than women ($116,000 vs $108,000) and male CRNAs earned 11% more ($199,000 vs $180,000). This gender pay gap is narrower than last year, but it's too early to say whether a trend toward pay equity has started.

Different work habits of men and women are responsible for at least some of the gender differential among APRNs. Men are more likely to work in a higher-paying acute-care hospital setting (48% vs 27%), routinely work overtime (61% vs 42%), supplement their regular income (63% vs 49%), and own their own practices (10% vs 5%).

The survey also shows that APRN income rises with increasing years of experience, up to a point. The increase levels off at about 20 years of experience, perhaps because the employee has reached a salary cap after which base pay no longer increases.

This year, early-career APRNs with 1 to 5 years experience made a bit more than the same group last year, but this didn't hold true for APRNs with 11 or more years of experience, whose average income dropped somewhat over the prior year. The reasons for these fluctuations are unclear.

Small Majority Satisfied With Pay

Regional differences in APRN annual gross income were apparent again in this year's survey, with the highest-paid ($130,000) APRNs working in the western (Pacific) region of the US (California, Oregon, Washington, Alaska, and Hawaii). For NPs, this region was also highest ($125,000)

The lowest-paid ($112,000) APRNs work in the West North Central region of the country (North and South Dakota, Minnesota, Nebraska, Iowa, Kansas and Missouri). For NPs in this case, the lowest pay ($100,000) was in the East South Central region (Alabama, Mississippi, Tennessee, and Kentucky).

Differences in annual earnings also varied by type of APRN employment. NPs employed in a private NP practice made less money than those employed by a medical group or hospital or those who are self-employed/independent contractors. Overall, however, compared with last year, APRN income fell for both self-employed APRNs and for employees of an APRN practice.

A small majority of all APRNs felt that their compensation was fair for the work they do. Compared with last year's survey, however, significantly fewer APRNs believe that they are fairly compensated (61% vs 55%). Men were more apt to feel satisfied with their pay (71% vs 53%).

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