November 17, 2015; Fierce Healthcare

A recent press release announcing the Medscape Nurse Salary Survey has disquieting news for nonprofit hospitals and clinics as well as their patients.

More than 8,200 advanced practice nurses (APNs), registered nurses (RNs), and licensed practical nurses (LPNs) were surveyed. Annual salary ranges varied from the low $40,000s for LPNs, $79,000 for RNs, and up to $170,000 for APNs. Not surprisingly, LPNs were most likely to express dissatisfaction with their educational attainment and career choice. From the press release:

The vast majority of nurses—68% of APNs, 78% of RNs, and 88% of LPNs/LVNs—indicate dissatisfaction with their practice setting, with only 32% of APNs, 22% of RNs, and 12% of LPNs stating they would choose the same setting again. Those who work in non-hospital-based medical office or urgent care clinic settings are more satisfied (43%) than their peers working in hospital settings, while satisfaction is lowest in nursing homes (21%) and working for the government, which includes the military (23%).

Many nurses in all categories would choose another career path if they had the option of starting over. “Only 60% of APNs, 56% of RNs, and 48% of LPNs would choose nursing as a career again.” RNs and LPNs also expressed a desire for more education as a tool for career advancement. However, as the Medscape press release points out, moving to the next level of nursing education can be a $50,000–$100,000-plus financial commitment, with a relatively low corresponding salary differential under $10,000 a year.

The chronic and current shortage of practicing nurses (500,000 trained nurses in the U.S. are no longer practicing) seems to be less a matter of pay, based on the Medscape study, but one of working conditions. As hospitals shift work hours and patient care teams to minimize costs as they adjust to lower financial revenue margins, nurses face uncomfortable hours, including mandatory overtime, while simultaneously needing to care for more patients each shift.

Nonprofit hospitals, clinics, and other employers of nurses are challenged to keep their nursing staffs engaged and committed to their positions without having the simplistic remedy of increased pay. This challenge is similar to that facing employers of physicians, as NPQ reported a year ago. Based on the evidence, nonprofit healthcare managers and administrators need to address provider morale and esprit de corps along with cost containment and accommodation of the emerging population health model of the Affordable Care Act to build and retain key employees.—Michael Wyland