RN Pay Remains Stagnant; LPNs Fare a Bit Better

Megan Brooks

October 29, 2020

Wages for registered nurses (RNs) remain stagnant and COVID-19 has prompted somewhat of an exodus, voluntary and involuntary, from the nursing profession, according to the Medscape RN/LPN Compensation Report 2020 .

Nearly one fourth of nurses not currently employed in nursing cited COVID-19 as the reason for leaving the profession, with 18% retiring earlier than planned; 5% of RNs and 9% of licensed practical nurses (LPNs) were furloughed or laid off because of the pandemic.

For this year's survey, 5130 practicing RNs and 2000 practicing LPNs from across the country reported their earnings for the calendar year 2019, with the key caveat that the full effects of the pandemic on annual income for RN/LPNs won't be known for at least another year.

Including wages in 2019, average annual earnings for full-time RNs has remained statistically unchanged for 5 years: $78,000 (2015), $80,000 (2016), $81,000 (2017), $80,000 (2018), and $81,000 (2019).

LPNs have fared better over the years, with their wages consistently increasing since 2017: $46,000 (2017), $48,000 (2018), and $50,000 (2019). Mean earnings in 2019 were $79,000 for RNs and $48,000 for LPNs.

The highest-paid RNs and LPNs work in the Pacific region (California, Oregon, Washington, Alaska, and Hawaii) while the lowest-paid nurses work in the East South Central area of the country (Alabama, Kentucky, Mississippi, and Tennessee) and West North Central region (North and South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri). Average annual pay for full-time RNs and LPNs drops as the type of community shifts from urban to rural.

After several years of declining satisfaction with pay, this year 57% of RNs and 45% of LPNs felt their 2019 compensation was fair, a significant increase among RNs over the previous year.

Where They Work

The primary employment setting for RNs is the acute-care hospital. Compared with last year's report, the proportion of hospital-based full-time RNs has increased (43% vs 37% in the 2019 report).

In contrast, only 6% of LPNs work in acute-care hospitals. Instead, LPNs are concentrated in ambulatory care settings; more than 1 in 4 work in skilled nursing/long-term care facilities.

Most RNs (77%) and LPNs (81%) work full time, with no marked trend toward more part-time work this year relative to previous years.

Most RNs (61%) are paid by the hour, while 39% are salaried. For full-time RNs paid by the hour, the average hourly wage is $38, similar to last year's finding. Part-time RNs make $40 per hour.

Among LPNs, 83% are paid hourly and only 17% have salaried positions. Full-time LPNs make $24 an hour, up slightly from $23/hour a year ago. Part-time LPNs also make $24 an hour.

Annual income for salaried and hourly RNs is $84,000 and $79,000, respectively; for LPNs, it's $53,000 and $49,000, respectively.

Full-time RNs who work for healthcare industry companies (insurance/health plans, $89,000) and hospitals ($84,000) report the highest earnings, whereas those who work in public health settings ($71,000) and schools ($67,000) report the lowest.

For full-time LPNs, skilled nursing facilities pay the most ($54,000) and school health services the least ($36,000). However, the average income for LPNs in skilled nursing and home health settings, as well as hospital-based outpatient clinics and non-hospital-based medical offices, increased over the past 2 years.

Gender Earnings Gap Persists

Male nurses continue to represent just 10% of RNs and 9% of LPNs, which hasn't changed much in recent years. Yet the annual income of full-time male RNs and LPNs continues to exceed that of their female colleagues, a pattern relatively unchanged for the past 4 years. This year, annual income for full-time male RNs is $85,000 vs $81,000 for female RNs. Corresponding income for male and female LPNs is $55,000 and $49,000.

The gender earnings gap persists in terms of annual income, whether nurses are paid a salary or an hourly wage. Among RNs, salaried men early 11% more annually than salaried women and hourly men earn 6% more annually than hourly women. Among LPNs, men earn 15% more annually than women.

The average hourly wage for male and female RNs is identical ($38), which suggests that if men who are paid hourly earn 6% more annually than women, factors others than the hourly pay rate must be responsible for the pay gap.

Differences in work characteristics of RNs might help explain the finding that men make more than women in nursing. As has been shown before, men are more apt than women to be paid hourly (68% vs 55%), work on inpatient hospital units (56% vs 41%), work more high-differential shifts (48% vs 31%), and take on the role of charge nurse (17% vs 12%).

Higher Degree, Higher Pay?

More than half (53%) of RNs responding to this year's survey have a bachelor's degree, up from 49% last year, although fewer have an associate degree (24% vs 26%). Again this year, 17% of RNs hold master's degrees and 2% hold doctoral degrees. 

Nurses often wonder whether it's worth it financially to get a higher nursing degree. Medscape's annual surveys have typically shown that nurses' earnings jump predictably with each higher step in education. This year, the increase was 14% between the bachelor's ($80,000) and master's ($91,000) levels, but nurses with a doctoral degree earned only 2% more ($93,000).

More than half of RNs (52%) surveyed have a specialty certification and 40% of these nurses were financially rewarded for being certified; about one quarter received higher annual pay (average $10,000), 6% received a yearly bonus, and 7% received a one-time bonus.

Average annual income for certified RNs is $86,000 vs $76,000 for noncertified RNs; men who are certified earn more than women who are certified.

Continuing the trend from previous surveys, annual income rises with additional years in practice for both RNs and LPNs. Nurses with the most experience have the highest income and those with the least experience have the lowest. However, for early-career nurses and those with less than 10 years' experience, income has been trending up for the past few years.

The full report is available online.

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