For several years, Russell Atkins, RN, CEN, earned about $100,000 annually as a traveling nurse working in EDs and ICUs, but beginning in 2009 he started seeing a disturbing trend. The job assignments in higher-paying states such as California and Massachusetts were increasingly rare, and his hourly wage dropped roughly 20% within a year.
Desperate to provide for his wife and two children, Atkins could no longer afford the unpredictable assignments. He accepted a lower-paying, but permanent, job in his home town of Bastrop, La.
Atkins is not alone. Most nurses throughout the country are feeling the impact of significant national factors, such as the recession and healthcare reform, that are changing the landscape of nursing jobs.
Nurse salaries and really salaries for any profession are generally determined by supply and demand, said Joanne Spetz, PhD, a noted healthcare and nursing economics researcher and professor at the Institute for Health Policy Studies, University of California, San Francisco. What weve been seeing in California is that the wages of nurses really flattened out and may have even dropped in the past four years after a period of rapid wage growth.
According to data from a 2012 survey from the California Board of Registered Nursing, the annual salary of nurses in California increased from $45,073 to $81,428 between 1997 and 2008. In the past five years, however, salaries flattened and even dropped between 2010 and 2012.
RNs across the nation are experiencing a similar trend, according to data from the U.S. Bureau of Labor Statistics. Starting in 2009, the median annual wage increases were 2% or less, compared with double or triple that percentage the previous five years. Between 2011 and 2012, the latest data available, the median annual wage for RNs nationally increased only 1%, from $69,110 to $69,935. Data from the American Association of Colleges of Nursing shows that nurse faculty salaries are stagnating as well.
Although many hospitals have become more conservative in hiring nurses, Spetz suggested there are strategies nurses can use to increase their chances of securing a desirable position in the long run. I know a lot of new graduates like to look for the perfect job, but if the labor market is tight in your area, just get a job because some experience will make you more competitive and help you get that perfect job in the future, she said. If you are an associate-degree graduate and can go back to school, do it.
For Atkins, the willingness to be flexible paid off in the short term. After a year as director of an ED in Louisiana, he was recruited to fill an interim ED director position at a larger hospital system in Missouri. Although the position was short-term, he hoped the experience would help him eventually land a position in California. Then the call came: A traveling company recruited him for an interim position in California. This interim position eventually turned into a full-time permanent role as house and bed control supervisor at Kaiser Permanente in Hayward, Calif., with an annual salary well above any of his previous salaries.
During my previous director roles, I tried to learn everything possible about budgets, audits and the hospital, such as how to set up an incident command center and emergency response teams, Atkins said. Now I absolutely love my job, and my hours allow me to be home with my children in the evening.
Forces at work
While recessions and salary changes tend to be cyclical, the future is less predictable with the convergence of several national trends.
The first factor is the real impact healthcare reform will have, and a lot of that is relatively unknown, said Terry Bennett, RN, MS, CHCR, president of the National Association for Health Care Recruitment, based in Lenexa, Kan. Organizations are struggling to predict the impact of decreasing physician and Medicare reimbursements, and they are really trying to maintain financial security. They are not giving the same type of market adjustments that they used to [give nurses], and some are decreasing the amount of merit increases given to nurses.
In addition, the supply of nurses has increased in the past decade as a growing number of nursing school graduates join baby boomers still on the job, Spetz said. The baby boomers have been more career-focused than any generation preceding them, she said. They might not want to fully retire even if the recession lifts.
However, other factors could increase demand for RNs and drive up salaries. What we would expect is that as the economy improves and as the Affordable Care Act allows more people with insurance to seek healthcare, we would see demand for nurses go up, said Spetz. Also, as baby boomers age and require more healthcare, this could also drive up demand for services.
Nurse staffing ratio laws also may increase the number of positions available in hospitals, said Brannen Betz, general manager of Aureus Medical Group, a national nurse staffing company. According to the American Nurses Association, 15 states have enacted legislation or adopted regulations to address nurse staffing. Many states are moving toward mandating nurse-to-patient ratios, and this could be the best thing that happens to nurses, Betz said.
As healthcare employers prepare for these changes, nurses can position themselves to stand out from their competition.
We are no longer just putting someone in the job because they have a credential, said Julie Hill, RN, BSN, CHCR, RACR, recruitment coordinator for Georgetown Hospital System in South Carolina and vice president of NAHCR. Now we have a larger applicant pool, so we can select the best nurse for the job. Many hospitals use behavioral assessment tools so they can make sure that an individual has the positive service attributes that lead to good hospital consumer assessment scores and less likelihood of turnover.
Georgetown uses a behavioral assessment tool combined with a separate reference assessment tool, Hill said. Hospitals are looking for nurses who are flexible, customer-focused, compassionate, have a strong work ethic and work well with team members, she said.
Nurses with specialty training also are in higher demand, said Kay Cowling, CEO of Fastaff Travel Nursing, based in Denver. Nurses with experience in ORs, labor and delivery, cardiovascular ICUs or pediatric areas have more options, Cowling said. RNs who know how to use electronic health record systems also have an advantage in the job market, she said.
Advanced education also can open doors, said Jean Moore, RN, MSN, director of the Center for Health Workforce Studies at the SUNY Albany School of Public Health. The demand for nurse practitioners will grow as we face an emerging primary physician shortage.
Nurse practitioners also earn significantly more than most RNs. According to the BLS, their mean annual wage in 2012 was $91,450. Nurse midwives earned $91,070 and nurse anesthetists earned $154,390.
For those who cannot pursue higher education, Atkins story suggests that an ideal job can be secured through other routes. A willingness to relocate, which put him in situations where he was forced to learn new skills, provided clear advantages. As nurses, we need to be willing to try new things and work in new types of settings and with different types of technology, Bennett, NAHCR president, said. Take advantage of opportunities to learn within your current setting or try to prepare for new settings that may become available.
(Please click pdf links below to view or download nursing salary charts related to this story.)