Monday, October 13, 2008

Good money as a nurse.

Listen up.

Kim from emergiblog pointed to an article here about why nurses don't stay in nursing. Go check it out first.

Kim asks us whether or not we've "bought in" to nursing. She loves nursing; I get that. She is committed to it; I get that. I respect these views. I love nursing, too. Her question is: have I "bought in?" It's a broad question, and I suspect she's asking Will I leave this profession in five years? I don't know, maybe. There's great stuff about it. There's very stupid stuff about it, too.

I got a lot of jest and harrassing when I left the ICU to dialysis. Snickers of: "Ah, she took the lure of the money." "I thought you wanted to be a *good* nurse." "Isn't that boring?" But a lot....A LOT of the jesting was rooted in cracks about the money. I want to speak to Kim's open-ended question and to the jesting about money I got.

Have I bought into antiquated ideas about self-sacrifice? No. Have I bought into the idea of more education for lower pay? No.

Personally, I find that entire system retarded. I'm sure Kim does, too. I'm going to offer one primitive solution to the problem, however. One bedside nurses who do not believe they hold any fiscal power can do to help themselves. But it can help you, and can help your fellow nurses, too.

My idea is: Talk frankly about money. Simple, huh? And yet, completely taboo in American society.

Here's the problem:

I work for a paycheck, period. I'm a buddhist, I don't get a saintly reward for my butt-wiping today. For all the times a physician tears into me for insisting on pain medication for a patient. I happen to like my work, but would I do it for free? Are you insane? It's HARD WORK.

You don't work because you're a good person. You work for a paycheck. You are in all likelihood a good person who works for a paycheck, but you don't work for the sheer joy of dragging your butt out of bed in the morning. Because you work hard, too. With body fluids. And people who call you four-letter-words. And do not have manners.

WHAT IS WRONG WITH NURSING THAT WE EVEN HAVE THIS MYTH THAT WE AREN'T WORKING FOR A LIVING? The myth is that we do it for fulfillment. Great. Why is fulfilling mutually exclusive to well-paid? Trouble is....If nobody can be blamed for that stupid idea, why do RNs not hold those cutting squeaky checks accountable for believing it?

Here's my rationale:

I learned many lessons in computer consulting. One of them was I learned to talk about my billable rate/salary. I think it's something many men, regardless of profession, do and understand. Talking about the salary. It's how, in computers, you know what the going rate is. How much do I charge for my services? Well that guy's makin this amount and he's out of school and knows nothing and nobody, and this guy's got ten years on me, so somewhere down the middle might be a start. Factor in such things as whether or not I've got competition, whether or not I'm trying to underbid or whether I expect my client to agressively haggle my price.

Talking about the money is expected in IT. No one functions without it. It's frequently handled with some subtlety....there's typically contract obligations about discussing your rate. But you can talk about the rate you got from your last client. And you can say whether, with this client, you're doing better or worse. You can mention whether or not there are perks.

Women often don't do this.

It's stupid of us.

Nurses don't usually do this (though I notice male nurses more often do). I don't get why. CNOs talk. Why shouldn't they? It is my belief that in my region, this network is a large part of the reason that salaries are so uniform across the region's hospital systems. They have information. So should you.


I am under a contractual obligation to not tell you my new pay rate. So I won't.

So lemme tellya some facts about the hospital system I just came from. I live in Colorado, and my state pays BADLY across the board. Because it's so great to live here. Doesn't matter if you're a staff nurse, nurse practitioner, or traveler nurse. Travelling nurses often have the advantage that they can hop onto their company's website and compare payscales across the country. I love these guys, because they're happy to share this information with me. Ask a traveller not what s/he's makin, but what travellers expect to make in your city and in other cities s/he's been to. You should know.

New grads were offered $22/hr last year in the two biggest hospital systems in town. The nonprofit in this town (not surprisingly) pays a pittance better than the for-profit. At the nonprofit, there's a salary cap on experienced nurses at $38/hr. (Don't know the other's cap.) Raises are neither competitive nor performance-based. Expect 3% annually if you showed up most of the time, and there is no automatic cost-of-living.

In 2006, I started at a base of $20/hr. Who knows if this trend of roughly a buck a year better new grad offering will continue. Nurses already at the bedside who have experience do not keep up with a 3% flat increase. A new grad hiring in would have surpassed my base rate by next year, had the trend continued.

And don't think that didn't make me sore. New grads should make good money; I don't begrudge them a good starting rate. Experienced nurses should make more.

Want to know what payraise to expect when you're interviewing? Few interviewers or managers will tell you because they can't promise or it becomes contractual. Tell your interviewer you'd like to shadow a nurse on the unit you are shopping to work for. Then ask him or her. (Perhaps for a pay range if that's an easier question, or the typical annual percent for raises then you do the math.) If she prefers not to discuss her pay, ask another nurse you bump into in the med room.

This needs to be normal for us. We all win when it is.

Travelers can expect about three bucks an hour or so more than the poor slobs who work as staff. With no benefits. It's almost not worth it, unless you really are here to ski/board. Stiff competition to travel in Colorado in the winter months.

Expect a night shift differential of $5/hr, double what some places pay. Expect to be nickel and dimed where that night diff ends up being only 7.5 hours of a 12 hour shift or some crap. Ask the details. Expect $2.50/hr for weekends (and that seems common). Again, look for fine print on what 'a weekend' means. Often, how the business defines weekend is not what a normal person calls a weekend.

Same thing for holiday. Don't believe the allure of Double-Time For Holidays when you work night shift. It's typically half of what you think it is. Four hours on Christmas night and eight of Christmas Eve, so you'd have to work both to get your full double-time. Human resources only does these deeply-stupid sounding schemes to save money only because we don't hang them from the rafters by their ties for it.

Why don't we mention to them that we can? We know CPR and they don't. We won't let them hang until the point that their airways are r e a l l y compromised, right?

I am not aware of any hospital in town but (possibly) one who offers a diff based on your education (ADN v. BSN). I don't know how much it is, but they do have a structured clinical ladder that includes education and meeting-attending. Some hospitals pay tuition benefits, but ask how much and then compare to the cost of a credit hour. (You may find a gap.)

At least one managerial position in my system offered between $25 and $36/hr based on experience, requiring 24h pager. (I actually laughed, and no, my girlfriend of 25+ years experience including strong managerial background plus BSN and two credentials didn't take the job.) (Are they mad?)

I am not aware of sign-on bonuses currently offered in the biggest hospital systems in town. I suggest you ask about bonuses during your interview process because if you don't ask, it will never be offered. The worst that you can hear is 'no.' Because you know they want to hire you, so you have nothing to lose and potentially a lot to gain.

Rumormill has it, the best paid hospital nurses work for local government. Rumormill also has it that those nurses love their benefits. The local government's hospital website LISTS base offerings. It is the best paid hospital system, by average, in the region.

I know of no hospitals except possibly pediatrics in town that pays for specialties, such as critical care.


I went to work for a private company that offered a salary based on my years as a nurse. I left my base AND my night differential behind and am still ahead.

Most surprisingly to me, my organization has clinical measurements for GOOD PATIENT OUTCOMES, and the employees at my hospital ARE PAID BONUSES WHEN PATIENTS DO WELL CLINICALLY. How cool is that?

Nurses at my new company are sometimes embarrassed about this when they talk about it in my orientation, feeling like we shouldn't be so happy about our bonuses.





If our patients are clinically doing BETTER, and are FEELING BETTER, are able to lead fuller and healthier lives, that means we are DOING OUR JOBS WELL. How exactly is it wrong for us to get a bonus for a job fantastically done? Is the only thing motivating me money? Of course not. I'm a nurse for chrissakes. If I wanted money, I'd have gone to be a specialty surgeon. I want my patients to do better because I like them. But that my company pays me a bonus for doing a good job means that I am MUCH happier doing my good work for that company rather than some schmuck hospital Scrooge that's gonna nickel and dime my overtime on Christmas.

What could be better? Heck, yes, that makes me likely to stay working as a nurse five years from now. Not only that, but likely to work as a nurse working for this company. Essentially, if my patients get better, I make more money. But I make a good salary no matter what (because patients are patients, and my company appears to understand that concept, too.) What a thunderingly win-win wonderful idea.


Why do I tell you all these things? Because it's the most normal thing in the world to want to do good work in your community, be a leader in your world and promote the health and well being of others. And also want good food on your table for your own family, gas in your tank, money to vacation, and some socked away to retire upon, much less all that you owe paid off.

So that's my big idea: Talk (mindfully) about your salary. And for god's sake, when you go shopping for your next job....remember that YOU are shopping, and get a good deal for yourself.

Don't simply buy in.

Be an educated consumer instead.


Kim said...

I LOVE IT!!!!!!!!!!!!!!!

Money has never been an issue for me because I work in the San Francisco area and my pay is $61.00 base.

That was NOT a typo!

So I have the luxury of making decent money, but I'm at the top of the scale, too.

You have GOT to send this to Mother Jones for Change of Shift! It's great! And we should NOT be ashamed of asking for a decent salary.

For the record, dialysis scares the hell out of me and I have a lot of respect for dialysis nurses. I don't know that I could do that.

Drunkbunny said...

I'm an RN and I live in Aurora, CO. I loved your article and you're totally blogrolled and on my RSS feed.

If you want to compare notes and particulars, to to my website and leave a comment with your email (not published). I'll email you and we can talk salaries/careers. :)

By the way, I was a medical writer and applied for a medical writing job for a hospital website that rhymes with Hashional Newish. They wanted me to take a 10% CUT in pay to come to them with my three years of publishing experience and 15 years medical experience. Why? "Well, we're a non profit organization!" My reply, "You may be non-profit, but I'm not!"

AnnieC said...

Excellent advice! I am debating whether to continue my education in Nursing or Respiratory Therapy...either way, negotiating the best pay for myself will be essential as I am older and need to play a bit of financial catch-up. Thanks so much!

P.S. I am a Dialysis Tech and if I decide to go the Nursing route I plan to become a Dialysis Nurse. I am soo delighted to hear you love your job!!!

RehabNurse said...

Great article!

I totally agree that nurses have to be more mercenary if they need money.

Why do I have to be charitable at work and not when I choose? Even non-profits have to make money to stay in business, and it should not be off the backs of their employees.

I can be a whole lot more charitable when I make more money! I like choices and higher pay helps me to make those choices.

NurseExec said...

Wow. Just WOW! I never did get the whole "I'm here because I love people" mentality--I like nursing, but hell, I have to make a living. Did money factor into me taking a DON job? Of course. I got a 25K a year raise, and granted, the responsibility is immense, but I like the job, AND the money.

BTW, my first job was at Lutheran. I've added you to my blogroll at

I've also added you to my reader. Great stuff.

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