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ADVANCE is currently collecting data for the 2009 National Salary and Workplace Survey of Nurse Practitioners. Nurse practitioners, fill out the new survey here.
Read the results of the 2007 survey here.
Today's nurse practitioners are more educated and perform more procedures than at any time in their 40-year history. They work more independently, in more specialties and in more settings. And as they demonstrate more vividly their value and cost effectiveness, they're being paid closer to what they're worth - or they're paying themselves.
The 2005 National Salary Survey of Nurse Practitioners shows that the average annual full-time salary for a nurse practitioner has reached $74,812. That's an 8.1% increase over the average just 2 years ago (Table 1), when the last survey was conducted. The average part-time wage rose more dramatically, by 8.6%, to $36.80 an hour (Table 2).
The 2005 National Salary Survey of Nurse Practitioners calculated exclusive data from 5,905 surveys completed between July and October 2005. The analysis of this data, presented in word and visual forms in this article, will help nurse practitioners assess their market value in the varying circumstances they work in today.
The tables accompanying this article break down NP compensation by practice setting, experience, education and gender. Geographic differences are reflected in tables that indicate pay rates by region, state and population setting. Average salaries for select cities are included to illustrate the range of compensation for nurse practitioners - even within the same state. Other tables compare NP salaries with those of other master's-prepared professionals, and they list the characteristics of the NPs who responded to the survey.
ADVANCE for Nurse Practitioners has conducted the National Salary Survey of Nurse Practitioners biennially since 1997. It is one of the journal's most anticipated and widely read projects, and its findings are cited in numerous articles and reports about the NP profession. Data from this and past surveys are available online at www.advanceweb.com/np. The next survey will be conducted in late 2007 and published in 2008.
Salary vs. Worth
Our data show that nurse practitioners are earning more than ever, and that their salaries compare favorably with those of other professionals who have master's degrees (Table 3). But should NPs be earning even more?
Maybe, says health care employment specialist Carolyn Buppert, NP, JD, of Annapolis, Md. Whether nurse practitioners are earning what they're worth to a practice depends on individual efficiency and employer needs, she explains.
NPs can get a general idea of their worth to a practice by determining the amount of annual revenue they bring in. "When I evaluate the productivity numbers for practices that employ NPs, invariably there will be NPs who bring in less than $200,000 a year and NPs in that same practice who bring in more than $375,000 a year. The NP who brings in $375,000 generally is going to be seen as the more valuable," Buppert says.
"However," she adds, "there may be nonmonetary factors that make the NP who generates only $175,000 valuable." For example, an NP might generate revenue indirectly by performing essential services that aren't reimbursed by insurance in order to free up other providers to see more patients.
Several survey respondents said they felt undervalued because they could earn more working as RNs than as NPs. This is a result of supply and demand, Buppert explains. If hospitals have to pay more for an RN to work the night shift, they will.
But working as an NP has advantages apart from pay. "There's a value to working in an advanced role and working daytime, weekday hours," she says.
Practice Ownership Pays
With an annual salary topping $90,574, independent practice registered as the most lucrative work setting for nurse practitioners (Table 4). Promising revenue, expanding scopes of practice and increasing business opportunities seem to be luring more NPs to open their own practices. Between 2003 and 2005, the percentage of nurse practitioners who identified themselves as practice owners doubled from 1% to 2% of survey respondents.
While entrepreneurship has many advantages, Jean Aertker, NP, owner of Tampa Occupational Health in Tampa, Fla., cautions that practice ownership isn't for everyone. "I have concerns about newbie grads opening their own practices without worldly experience," Aertker says. "What percentage of these practices flop, and what image does that project to the community about nurse practitioners?"
And although practice owners can eventually pocket some good money, expect a few years of no or low wages to reach a salary that could be considered attractive. The lowest salary reported in the 2005 survey - $15,000 a year - belonged to an NP practice owner.
"It took my partner and me 3 years to get into the high salary range, and our situation was unusual in that our practice paid off all debts and was in the black by the third month of operation," Aertker says.
Still, NP practice owners generally report that professional independence, freedom to set their own hours and the potential for high income make the venture worthwhile.
Other practice settings that made a strong showing in terms of salary were in the acute care realm: emergency department ($84,835), surgery ($84,084), neonatal unit ($81,511) and hospital ($79,393). Gerontology and specialty settings were also on the high end of the spectrum, providing annual averages of $77,020 and $76,006, respectively.
According to Wendy Wright, NP, senior lecturer for Fitzgerald Health Education Associates, nurse practitioners in acute care and specialty settings tend to earn more for two reasons: higher liability risk and higher reimbursement rates.
"Specialties require more than just seeing patients in the office - there tend to be more procedures involved. For example, when patients go to a pulmonology office, they're going to have pulmonary testing done. That generates revenue," says Wright, an adult and family nurse practitioner at Merrimack Village Family Practice in Merrimack, N.H. "Whereas in family practice, your highest reimbursement is about $150 for a physical."
Primary care settings weighed in at the mid- and low end of the salary scale, but the lowest average salaries were reserved for those in the academic ($66,925), school clinic ($64,474) and college health ($61,400) settings.
Allen Prettyman, NP, an instructor in the NP program at the University of Delaware in Newark, Del., acknowledges that the shorter 9-month academic year worked by many faculty members in academic settings could account for the lower salaries. Even so, the strict stndards and high expectations for nursing professors should garner salaries higher than they do, he says.
But even this cloud has a silver lining.
"The question often asked is, 'Why would I leave a position and take upwards of a $20,000 pay cut to come to academia,'" Prettyman reflects. "My answer is that academia offers a high degree of professional freedom to explore and develop areas of interest. It also provides a less restrictive working schedule. Many times, it will also provide a funding mechanism to pursue a doctoral degree. Therefore, the job benefits can make up for the low salary rates."
More Is More
As in past surveys, our 2005 data show that more education and experience correlate with higher salaries. A doctoral degree can add more than $6,500 annually to the salary of a master's-prepared nurse practitioner ($81,440 for the doctorate; $74,777 for the master's degree) and almost $10,500 to the salary of an NP with a bachelor's degree ($70,961) (Table 5). Interestingly, survey respondents who indicated an associate's degree as their highest level of education earned more ($73,030) than those with a bachelor's degree. Experience probably explains this counterintuitive finding: NPs practicing with an associate's degree alone have likely been in practice for a long time. More than $7,000 separates the more experienced ($78,354) from the newest ($71,138) NPs (Table 6).
The gender gap increased since our last survey. More than $8,650 separates the salaries of men ($82,647) and women ($73,986) in the profession (Table 7). That's an 11.7% difference and higher than the 10% difference between men's and women's salaries documented in the 2003 survey.
Buppert isn't surprised: "I have no data to back this up, but my impression - developed from advising hundreds of NPs in their salary negotiations - is that male NPs are stronger negotiators. [They] tend to ask for compensation based on their productivity rather than a set salary. They set compensation goals for themselves. They monitor their numbers. They make sure everything is in writing."
But women shouldn't despair - they can become better negotiators. "It's a skill just like anything else," Buppert reasons.
Geographic Hot Spots
If salary is your only gauge and you're looking to move where the money is, consider the Pacific and Western regions of the United States, where salaries average more than $80,000 a year (Table 8). More specifically, contemplate California, Arizona or Nevada, where NPs report average salaries of $86,674, $83,986 and $83,754, respectively (Table 9). Across the country, Washington, D.C., is close behind, offering an average annual salary of $83,726. Salary averages for specific cities within certain states are provided in Table 10.
When considering average salary by urban, suburban and rural settings, nurse practitioners working in cities earn the most - an average of $76,570 per year (Table 11). Practices in suburban areas pay a little less ($74,733), and rural areas once again provided the lowest average salaries to the NPs who work there ($71,725).
Survey Methods
ADVANCE for Nurse Practitioners published its fifth national salary survey questionnaires in the July, August, September and October 2005 issues and online at www.advanceweb.com/np. A record 5,905 nurse practitioners responded to the survey.
To ensure the accuracy and validity of our data, ADVANCE did not tabulate any surveys filled out by respondents who were not nurse practitioners, such as clinical nurse specialists or nurse midwives who were not also certified as NPs. To further ensure that average salaries were calculated accurately, we averaged the salaries of full-time and part-time NPs separately.
William B. Smith, executive director of the American Statistical Association, confirmed the validity of our survey methods.
Soaring or Stagnating?
Will NP salaries continue to rise? Although this is the highest average annual NP salary we've recorded over the years, the 8.1% increase is smaller than the 9.6% jump recorded for the 2003 survey.
Buppert predicts that salaries will level off in the next 2 years as a result of lower third-party reimbursements. But NPs shouldn't take it personally: "Physicians who own practices aren't bringing in much more than last year, so they don't feel that they can give NPs significant raises. Growth in physician compensation has been stagnant as well."
Table 12 Salary Survey Respondents Breakdown by Percentage
Jolynn Tumolo is the managing editor and can be reached at jtumolo@merion.com. Jill Rollet is the associate editor and online edition editor and can be reached at jrollet@merion.com.
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