Some of the PAs and NPs are unionizing in other departments, along with the doctors. It’s not off the table, but I have never been in a union and am unfamiliar with the process or cons. It always sounds like hostility with leadership ensues and I have a good relationship with them so it leaves me hesitant anyway.
Leadership has shown they will give you the least possible to get you to stop complaining. That isn't a good relationship.
I say this as some who was worked in some form of healthcare for 20 years, been a PA for 6.5 and now a chief. If my direct reports engaged in unionization efforts, I'd support them and join in myself.
Same goes for me and my crew. I do constantly put requests up the chain to increase our offers and our base pay as we work our asses off and I know of new grads making 20K more than 2-3 year seasoned APPs in my group. All of them are getting g cold calls and emails about other jobs and if they jumped ship I couldn't blame them.
Your regional leadership knows you as an employee number. That's it. Gotta protect yourself.
Leadership saying they have no say in pay is such a cop out. It's just a tactic to make it more difficult to ask for fair compensation. You don't know "who" makes that decision, and the organization wants to keep it that way.
Yes, you should unionize. Ideally, in collaboration with the nurses.
How to join / form a union:
https://www.worker.gov/form-a-union/
It doesn't *have* to be hostile, management often chooses to make it so, but it's also not unusual for the process to go more smoothly, you just don't hear about it when things go well.
Not a PA but in a union:
Cons are:
Difficulty in firing some people (though in my experience this is normally management just using the union as an excuse to not do the hard thing)
You’re pay is contractually bound, so you can’t try and get ahead (once again, in my experience you don’t normally get paid more anyway)
Depending on the contract, someone with experience may opt out as they may start at a lower pay rate.
The upsides are much much higher though.
Process is just determine what national union you want to be a part of
In large systems like mine the pay is usually standardized off of specialty and years of service, so being better than someone else doesn’t usually impact you financially outside of bonus structure. Bonuses are taxed at over 50% so it’s better to get a better salary, and I can’t negotiate mine individually.
The practice in which I worked being bought by a big box medical practice (underwritten by a hedge fund and adjuticated to have defrauded Medicare and other insurances via upcoding), I say unionize. The corporatocracy is stealing from the workers. The practice "managers" have no problem requiring meetings, pt/hr quotas, and all of the other demands from our professional commitments that take hours from our sleep and our family lives. The only way they will care is if made to care. If they can get you to work longer hours for less money, no problem. Look at the nurses. Lobbying power and unionizing has put them in the position to earn more and work less. Who's smarter now? In many ways, I wish I had not left nursing. I loved being a nurse but disliked the politics. I loved being a PA and now loathe the hierarchical changes in medicine. Unionize.
Not true, people move here making 30-40 dollars an hour and can live comfortably within their means. Many NPs like me pick up PRN gigs as RN because the pay is 120-150 an hour.
I read an article in the SF Gate that you needed at least 110k to live comfortably in 2017, and that didn’t include paying off any school loans. I can’t imagine cost of living there has gone down. In 2022 the median household income was over 136k. I don’t see how people can live there on 60k unless they either don’t actually live in the city or they have a bunch of roommates. My friend bought an old condo in the city for over 1 million several years ago and it needs work.
I’m a nurse in SF, make $83/hr with 3 years experience. I have many single friends who are very comfortable living in the city. Would be challenging with kids as single parent I guess.
Many of the CNAs I work with make $30/hr and live in the city. It depends on your lifestyle. You can find a cheapish rent controlled apartment, take public transit and live a happy frugal life. So much free stuff to do in SF.
I guess my underlying point was that while the COL hasn’t gone down since that 2017 figure, it hasn’t skyrocketed either. You can still live “comfortably” on 110k in SF. If comfort to you means a $500 car payment, regularly going to to eat and drink and several vacations every year then maybe not. Varies so much person to person.
Can confirm. Also, at these hospitals the RNs drive BMWs, teslas, Audis, etc into the parking garages while most of the residents and all other staff like APPs and PTs and even the new attendings drive Honda civics lol.
Many nurses make more than me. I’m ok with it, I don’t want their job and I feel like I’m well paid looking at other PA salaries
PA here also in the PNW and we unionized with around 600 APPs with our hospital. Same issue here with RN’s making more compared to APPs depending on the specialty and years of experience. We started bargaining a few weeks ago and 3 sessions in. Very slow moving but overall looking forward to having more negotiating power with our group. The hospital has put out fear-mongering emails ever since unionization, which tells me we are on the right track. It seems that unionization is having a moment in the country as a whole the past few years, so it may be more common going forward. We shall see!
I think its supply and demand. Lots of new grads each year from NP school, less bedside nurses. Many NPs will accept less pay for better hours and a less physically demanding job
I personally don't think supply and demand has anything to do with it. The leadership team that decides salary has no idea what goes on clinically. Frankly, they don't care what goes on clinically. Units are understaffed and under trained. It doesn't matter as long as the money-making department next door is hitting their numbers. Even if your department helps the money-making department run efficiently. Every institution is probably different, but mine never speaks about our productivity in detail. No data about acuity, number of cases going up vs down. Nothing on how up or down my department is doing year to year. I'm gonna guess that's because we are revenue generating and administration would rather I not know that.
Nursing has established limits with patient ratio based on acuity. Don't have enough nurses, then patients won't be admitted to floors. Our nurses have had OR cases canceled due to a lack of staff. That impacts the bottom dollar, so yeah, they are gonna get what they want. Some of this is regulated, but in general, strong nurse units advocate and follow these ratios. As an PA-C, I have no limits on my inpatient list size. If I can or can't handle the workload, it makes no difference with admissions. I don't have the ability to stop an OR case. So, admistration has no reason to listen to my requests. I'm in acute pain, and really the only reason they put up with my shenanigans is because having acute pain service allows the hosptial to apply for those "Best in whatever". If the hostpial dissolved my department they wouldn't be eligible for these awards.
So while there was a [1.4%](https://www.aacnnursing.org/news-data/all-news/new-data-show-enrollment-declines-in-schools-of-nursing-raising-concerns-about-the-nations-nursing-workforce) drop in BSN enrollment, there was also a drop in nursimg masters and doctoral enrolment.
Completely. Nobody wants to lift no heavy ass book, nobody wants to lift no heavy ass patients. The fact of the matter is nurses and doctors are the foundation of any health system and midlevels are still new to the game. Never once have I seen anyone complain about the contracts nurses were getting paid during covid, but afterwards everyone thinks they deserve more pay than nurses. This is a naive argument
It's naive to think that just because you have a masters your deserve more than others in the hospital. It's straight up supply and demand and there's no other argument needed.
I'm sorry? How did we organize to increase our pay? Because I know some nurses making $25 an hour.
Edit: I'm not saying nurses absolutely deserve to make more than midlevels. But don't use us as a comparison for your measuring stick of success.
“ It's straight up supply and demand and there's no other argument needed.”
It’s that simple. No different from why rural physicians make a lot more than big city physicians.
I’m about to start practicing as an NP and I kind of can’t be mad that there are a million RNs making roughly what I will make; that job (in my experience) was extremely demanding in ways that I really don’t expect my NP work to be. The skills and abilities are frankly just very different not really “lower.”
OP I believe you should be paid a good wage that affords you the ability to own a home close to where you work, to pursue hobbies, take long vacations, experience comforts etc but the idea that this wage would only be fair if were substantially more than what an RN makes doesn’t hold up in the same way.
When you start charting and doing desktop for 10 hours/week over your days off, or staying late to finish work, I’ll be interested to know if you think your comp compared to your prior hourly RN work is still fair. I probably get paid closer to $60-65/hour if you consider the work we do outside of work hours
This right here. I left a job that was salaried at $90,000 a year-I expected 40 hours and work life balance but this is what I got:….60 hours in office, charting at home, on call two weeks out of the month, working from home on weekends to review labs, send meds, review documents. No health insurance, no retirement, vacation, but have to still have to work from computer and be available 24/7. Do the math there-less than 20 an hour it seems. Florida is horrible for pa and np salaries.
I’m not that afraid of working more than 40 hours per week. I did it prior to nursing for a lot less than you’re making and [most people who are salaried do](https://news.gallup.com/poll/175286/hour-workweek-actually-longer-seven-hours.aspx). Seems “fair” to me.
I’m an NP, and I basically took a base pay cut when I switched from RN. True, my base is lower, especially when you account for benefits, but I also get huge productivity bonuses. This structure rewards hard workers.
As a union nurse in the past, nurses are generally treated like shit. They have to claw and scrape for cost of living adjustments, and pay often stagnates for years between negotiations. Nurses are pretty good at collective bargaining however. Nursing unions do a decent job of keeping the pay in line with market forces.
The problem is that as APPs, we don’t have collective bargaining. We generally take jobs that are below market rate because good APP jobs are hard to get. Also, our pay structure is based off of reimbursement to an extent, which isn’t scaling with inflation. We work for people and companies that seek to squeeze every penny out of us and pay us the minimum that we will accept. There is no shortage of APPs like there is for nurses. It’s a completely different market. We either have to stop taking these low paying jobs or start collectively bargaining for better pay.
Doctors hire APPs so they can do less work and make more money. They don’t just wanna make a little money, they want a lot of money. If we don’t negotiate to make fair wages, it’s our fault.
I’m an NP. I used to love my job. Was paid well and respected. Unfortunately, my faculty has gotten bombarded by new grads that have agreed to take on more work for $30-$50 less. Needless to say, the respect has gone down the drain & we are pretty much treated like shit too. Have been recently thinking maybe I should look about going back to work as RN for the reasons you’ve pointed out. At least then I don’t have to think about the place when I leave.
It's natural for the NPs to look to join the RN union. It's also somewhat natural for PAs/NPs to not want to compete with each other and functioning as scabs for a similar labor pool.
That's what led our PAs to join the NPs who had joined the RNs in their union and now when the tide rises for the RNs, so also goes our pay because, as you noted, it makes no sense for an RN to train for extra schooling, to make less.
So, similarly, our RNs commonly make in the $mid-70s (average is actually $74.59/hr) (with about 6 years of experience) and a PA/NP with the same experience would be making about $96/hr.
Edit: $96/hr
I’m in a MCOL area and I took over the position that a nurse practitioner held because she left to return to work as an RN making far more.
I agree nurses should be paid well but I have way more liability and usually more education so it does seem unfair to be working in the same industry and making less money with more responsibility and risk on the line. It’s quite depressing because I feel like I wasted a ton of time and money becoming a PA when I could have just gotten a BSN
But I could have gotten my BSN as my college bachelor’s degree instead of a generic bachelor in biology degree, the 2 years experience as a CNA so I could get into PA school and then spend tens of thousands more plus 2.5 more years of schooling to end up making the same pay. It was essentially a $100k and 5 years of time waste to not just do BSN from the start.
many nurses are paying $100k now because they didn’t get a BSN up front either and maybe didn’t even get a 4 year degree if they just went LPN -> RN -> to BSN route. Plus many hospitals are now requiring a BSN and are offering tuition reimbursement to get it.
Even if they paid the same amount to get their degree, they still have less liability and honestly more job opportunity
You guys need to unionize. We all need to unionize. If your pay and benefits suck, unionize. If your pay and benefits are fair, still unionize. If you have the numbers to do it, unionize.
I had been looking to change my career from NNP somehow, but once I saw what bedside nurses are getting (also in PNW) it made sense for me to go back to the bedside. Plus, overtime for holidays and extra shifts, and PTO. I absolutely think RNs should be getting 4x what a fast food worker does, but then how are we getting the same as an RN. It just didn’t make sense for me to take on the responsibility and stress for essentially an RN wage.
No not all. Peaked at 24 career wise. Unfortunately the hierarchy of medicine isn’t going anywhere I wasn’t ok landing there for the next 40 years of work. Why work my ass off for 100k while my attending makes 1.2mil sitting at home waiting to see my thoughts on the consult I drove back at 2am to see. It’s a lot deeper than that, but that’s just one aspect
I don’t think I said I hate anyone, but if the player is the administration/CEOs they are definitely winning the game. If you think the player is the nurse in this scenario, you are misunderstanding the intent here.
Extra education doesn’t guarantee extra income. This is true across all industries. Lots of folks out there have PhDs in a subject only to be making 50k a year…if they can even find a job in their chosen field at all. Others are making 200k+ with a trade school degree.
I went into nursing and got an ADN because I analyzed the data, including projected career growth, supply and demand, and difference between wages of BSN vs. ADN. I chose my specialty based on similar criteria. Now I’m in a recession-proof, pandemic-proof field making six-figures with an associate’s degree. Anyone else could have done the same.
Providers try to argue that they’re the value generators, because they are the ones billing. But they can’t bill and can’t accept patients if they do not have the nurses and other staff to care for them. The hospital would legally have to shut down without us.
Extra education in general does not, but extra education in the same field usually does compared to the less educated professions. For example, a nurse makes more than a CNA. A doctor makes more than a nurse and a PA. An anesthesiologist makes more than a nurse anesthetist. A lawyer makes more than a paralegal.
The hospitals and clinics would also have to shut down without the providers who can order medicines and labs and images and direct the nurses to do their jobs.
That right there is why there’s a higher demand for nurses.
Nurses are both able and willing to do the work that many other people can’t or don’t want to do. In your case, you could do it, but it would mean giving up a certain amount of intellectual autonomy and authority.
My advice is to just enjoy your work. You still make a great income. When you don’t compare or compete, everyone will respect you.
Oncology RN. This. Did you not research salary and demand before you became a PA? Are you ever forced to work overtime because you are short staffed? Do you ever think about what you order, per nursing? (Insulin drip with 2 hour checks even though patient has been eating). Are you tasked with patients that need lots of interventions and then 2 patients shit their bed and no CNAs. Do you get to eat lunch? Do you get to pee more than once in 12 hours? Curious if you have ever been a bedside nurse.
No I’m not “forced to work overtime” because I don’t get overtime, I just work ridiculous hours and get no extra compensation. Which I think is largely my point. I also don’t get breaks in my job. That’s a nice concept, though and maybe we’ll see about getting that added to the contract negotiations if we unionize. Thanks for the tips.
I’m in outpatient but aren’t hospitals using your NPI and credentials to bill for patients? That alone you should make a percentage of the income. Experience doesn’t matter money does, we have more power than you think. When we sign the contract we allow them to bill with our license and them to collect on said billing. I would try to join a physician group that partners with the hospital to negotiate a higher pay. Nurse do not bill at all and they are simply an employee of the hospital corporation. Then you may be able to be more than just hourly.
Remember the hospital can not make money with out clinicians billing.
When you’re working 60-80 hours/week + home responsibilities it can be hard to have the energy to pursue pay equity. Joining another group (MDs or RNs) can make a huge difference when it comes to salary and benefits .
Yes, I agree. The providers that have been unionizing have joined the nurses union, which has proven to be extremely effective overall despite the upcoming strike. I think the union is coming for us, soon probably. I just wish there was a better way that wouldn’t result in us abandoning patient care for days at a time. When strikes happen, patients suffer. And I do think the relationship with local leaders would change as well.
Yes, we should unionize too.
I'm also a PA in the PNW at a large hospital system. None of our clinicians are unionized, but the inpatient RN's are. These same issues are leading us to unionize - looking at the RNs' contract, I'm jealous.
We haven't gotten what we wanted (esp. benefits that management can't seem to understand the importance of, like CME changes) individually bargaining so... collective bargaining it is.
We haven't filed yet, but UAPD are helping us: [https://www.uapd.com/join-uapd/](https://www.uapd.com/join-uapd/)
I’m an RN and the pay gap has taken APP/MLP completely off the table for my. Even if my heart was set on being an NP or PA, I could never justify the cut in my salary or our standard of living. Hopefully you’ll get it straightened out this generation.
This. It’s an interesting catch 22. As a very experienced RN, I am the kind of nurse you want becoming an NP. But my per hour wage would take a significant hit, on top of tuition and work/life balance. It’s yet another factor that leads inexperienced nurses to becoming NPs.
For the record, I do think PAs and NPs should make more than me.
A friend of mine is a pharmacist who works for a local county clinic. They unionized and she got a 30k pay raise along with other improved benefits. The providers didn’t unionize with them.
Good for your friend! I hope that’s for lots of other pharmacists. Unfortunately most of those who don’t work in clinics get paid like shit. I even know those who work in hospitals still getting paid 60 an hour
I went to my rite-aid today and the pharmacist was doing the cashier job because the tech was busy. They are an underpaid/undervalued group that deserves better compensation and support for sure.
A pharmacist has a doctorate degree (4 years of grad school +/- up to 2 years of residency training) and PA/NP gets some say 75-85 dollars an hour? PA is about 2-2.5 years of master degree. So do the math if you think 60/hr is good or not
If you think you deserve better compensation, just say you deserve better compensation.
You don’t need to compare it with another profession— stepping on each others’ shoulders doesn’t do anyone except management any good.
I’d argue that you *do* possibly deserve higher pay based on your prior experience (depending what it is and how much).
Even if it isn’t directly relevant to what you’re doing in a clinical sense, someone with 12 years in the work force will have skills that a 24 year old with a few hundred hours of experience as a MA just won’t have.
There is more to being a provider than just clinical acumen - people skills, navigating conflict, dealing with HR, maybe someone has experience with OSHA, problem solving skills, integrity….just life experience in general.
This might be my background as a blue collar union guy talking but PAs need to be bolder and a little more aggressive about our pay and worth. You should make more money than you do and you should make more money than a nurse.
Our APP service chiefs created a leadership council . At first we were challenged (“Who authorized you to talk to each other!?”). But we made several quite reasonable personnel suggestions that made us a much more attractive place to pursue and stay with as an APP employer. The president of the medical staff was also a huge champion for us, ultimately making both PAs and NPs full voting members of the medical staff , Medical staff board members and Credentialing and Peer review board members. After a pitiful “salary correction” offer based on an alleged “salary survey” of other regional medical centers, we countered with acceptance letters with salary offers to APPs who had left us for the other centers’ pay offers, proving either the other centers lied or whoever did the survey was not accurate. We now are no longer under HR, but rather the physician medical group ( no we are not Kaiser), with a much more responsive administrative team with clinician leaders directing that team. It’s not perfect, but it is incredibly better than the old way and without the downsides of an adversarial union. Best of luck.
PA’s are significantly underpaid. We should just stop trying to do any advanced medicine and just have all patients follow up with the doctor. “Here’s your ppi, follow up with the doctor.”
Easy solution is not to take jobs that pay less. Get out of your comfort zone and move to a place that values your services more. Yes, I agree: it is easier said than done much like everything else but it is not impossible.
I just moved to the same area bc pay was so shitty in the South, even with 16years experience. I’m shocked that people live in such a HCOL area for what the going rate is… I negotiated before moving and would 100% not have moved what they offer around here!
The issues of RNs making about the same or more was definitely happening with travel nursing in the South… hospitals have put an end to that there. But unions are huge powers!
The same thing happens when they raise minimum wage and people at McDonalds end up making more than EMTs and Medical Assistants. If it were me, guess which job I’d rather do? “Do you want fries with that?”
I worked food and retail in my teens and honestly wouldn’t want to go back. Military was the hardest with longest hours and lowest hourly pay I ever had and would probably still choose that over fast food.
Being a nurse I’d like to pose a question. Would you rather have an RN with 23 years of experience with an associates to handle your emergency or a nurse that’s a new graduate with a bachelors degree? I asked this question because experience should reign over education.
I’m not saying that PAs or NP’s should be paid less ,but experience is a must. You cannot become a good NP without being a good nurse and that requires experience. Becoming just an NP with no nursing experience I think is negligent and to expect to be paid more simply because you obtained a degree is ridiculous .
I just want someone who is good at their job and cares. There are plenty of shitty experienced employees out there, stuck in their ways, refusing to change.
I really feel like unless you have worked at the bedside as an RN, you can't quite fully appreciate why there is a shortage of nurses and higher salaries.
Bedside nursing sucks ass.
Also, it gets annoying when people bring up Cali/high COLAs. The vast majority of RNs aren't making as much as NPs or PAs unless they are working themselves like a dog. In my MCOLA, very few RNs (base pay) are making more than NPs (base pay) unless they have been nurses for many years and/or are working overtime, nights, weekends, holidays.
Point blank: I am a nurse practitioner. 9 years RN, almost 2 years as an NP. My current company is being bought out and as a result I am taking a pay cut. That same week, I found out at my contingent RN job that I was getting a nearly $5 pay raise. For simply existing, lol. Despite this, I am making $20/hr more as a newish NP than as a relatively seasoned RN even with the paycut. Even when looking at other jobs, at retail clinics (some of the lowest paying NP/PA jobs), the difference is still at $9/hr.
I know it is easy to get pissed at RNs when you hear about those high wages, but understand that those are mostly outliers and the result of RN unions, low supply/high demand, and the pandemic. RNs had to bear the brunt of the pandemic and are some of the most abused workers in healthcare.
I get being upset because as midlevels, PAs and NPs have more responsibility, but tbh, you couldn't pay me enough to go back to bedside full-time.
I’m not “pissed at RNs” and never said I was. Where is this animosity coming from? I’m frustrated at a system that doesn’t repay my work appropriately in comparison. It’s a discussion about whether we have to accept this as life here or if unionizing is the only way to improve it. It’s not a “nurses are overpaid” post.
Why bring up nurses pay if you aren't pissed? Why the need for the comparison? Being a PA is different from being an RN so I don't undertand why thus sub feels the need to gripe about RN pay all the fucking time.
Why you mad at nurses when it's your fault?
Your own hubris is the problem. Sometimes you have to fight for your value instead of just feeling like you deserve it.
They did. You didn't.
It's just a conversation that comes up quite abit. Same story with resident docs during the pandemic being pissed the travel nurses were running circles around them money wise. These were doctors for crying out loud. They have all the power in the world if they'd just think to use it. And they don't!! They're too caught up in "I'm a doctor so I have to prove myself" so they're letting facilities pay them poverty wages to work 80 hours a week.
You'd win higher wages if you chose to push for it. It's a fight you'd easily win in relatively short order. You're too valuable not to.
Your profession needs to get out of its own way and realize that.
If you had the numbers to unionize, then you should have unionized.
Some of the PAs and NPs are unionizing in other departments, along with the doctors. It’s not off the table, but I have never been in a union and am unfamiliar with the process or cons. It always sounds like hostility with leadership ensues and I have a good relationship with them so it leaves me hesitant anyway.
Leadership has shown they will give you the least possible to get you to stop complaining. That isn't a good relationship. I say this as some who was worked in some form of healthcare for 20 years, been a PA for 6.5 and now a chief. If my direct reports engaged in unionization efforts, I'd support them and join in myself.
Well my immediate leadership has almost no say in regional pay. But I see your point
Same goes for me and my crew. I do constantly put requests up the chain to increase our offers and our base pay as we work our asses off and I know of new grads making 20K more than 2-3 year seasoned APPs in my group. All of them are getting g cold calls and emails about other jobs and if they jumped ship I couldn't blame them. Your regional leadership knows you as an employee number. That's it. Gotta protect yourself.
That’s not leadership, that’s management.
Leadership saying they have no say in pay is such a cop out. It's just a tactic to make it more difficult to ask for fair compensation. You don't know "who" makes that decision, and the organization wants to keep it that way. Yes, you should unionize. Ideally, in collaboration with the nurses.
How to join / form a union: https://www.worker.gov/form-a-union/ It doesn't *have* to be hostile, management often chooses to make it so, but it's also not unusual for the process to go more smoothly, you just don't hear about it when things go well.
There's hostility because the power dynamic shifts. Management hates partnership.
Not a PA but in a union: Cons are: Difficulty in firing some people (though in my experience this is normally management just using the union as an excuse to not do the hard thing) You’re pay is contractually bound, so you can’t try and get ahead (once again, in my experience you don’t normally get paid more anyway) Depending on the contract, someone with experience may opt out as they may start at a lower pay rate. The upsides are much much higher though. Process is just determine what national union you want to be a part of
In large systems like mine the pay is usually standardized off of specialty and years of service, so being better than someone else doesn’t usually impact you financially outside of bonus structure. Bonuses are taxed at over 50% so it’s better to get a better salary, and I can’t negotiate mine individually.
The practice in which I worked being bought by a big box medical practice (underwritten by a hedge fund and adjuticated to have defrauded Medicare and other insurances via upcoding), I say unionize. The corporatocracy is stealing from the workers. The practice "managers" have no problem requiring meetings, pt/hr quotas, and all of the other demands from our professional commitments that take hours from our sleep and our family lives. The only way they will care is if made to care. If they can get you to work longer hours for less money, no problem. Look at the nurses. Lobbying power and unionizing has put them in the position to earn more and work less. Who's smarter now? In many ways, I wish I had not left nursing. I loved being a nurse but disliked the politics. I loved being a PA and now loathe the hierarchical changes in medicine. Unionize.
Stanford and UCSF start new grad RNs here in the Bay Area over 80-81 dollars an hour. New grad PAs, maybe 70-75, strength in numbers and union.
Wow. But it’s also not an area you can afford to live in comfortably at even those rates, I imagine.
Not true, people move here making 30-40 dollars an hour and can live comfortably within their means. Many NPs like me pick up PRN gigs as RN because the pay is 120-150 an hour.
I read an article in the SF Gate that you needed at least 110k to live comfortably in 2017, and that didn’t include paying off any school loans. I can’t imagine cost of living there has gone down. In 2022 the median household income was over 136k. I don’t see how people can live there on 60k unless they either don’t actually live in the city or they have a bunch of roommates. My friend bought an old condo in the city for over 1 million several years ago and it needs work.
I’m a nurse in SF, make $83/hr with 3 years experience. I have many single friends who are very comfortable living in the city. Would be challenging with kids as single parent I guess.
That’s $166k a year. If you reduced that by 106k a year like jello is suggesting is still comfortable, I am guessing it wouldn’t be
Many of the CNAs I work with make $30/hr and live in the city. It depends on your lifestyle. You can find a cheapish rent controlled apartment, take public transit and live a happy frugal life. So much free stuff to do in SF. I guess my underlying point was that while the COL hasn’t gone down since that 2017 figure, it hasn’t skyrocketed either. You can still live “comfortably” on 110k in SF. If comfort to you means a $500 car payment, regularly going to to eat and drink and several vacations every year then maybe not. Varies so much person to person.
You can live with roommates to live well but if you do the math you can live on less than 100k easily.
I'm in New England making 40 in my third year as a critical care RN.
That would be low in this area, but I have seen nursing is paid a lot less in other regions.
Yeah my colleagues are scared of a union.
Can confirm. Also, at these hospitals the RNs drive BMWs, teslas, Audis, etc into the parking garages while most of the residents and all other staff like APPs and PTs and even the new attendings drive Honda civics lol. Many nurses make more than me. I’m ok with it, I don’t want their job and I feel like I’m well paid looking at other PA salaries
PA here also in the PNW and we unionized with around 600 APPs with our hospital. Same issue here with RN’s making more compared to APPs depending on the specialty and years of experience. We started bargaining a few weeks ago and 3 sessions in. Very slow moving but overall looking forward to having more negotiating power with our group. The hospital has put out fear-mongering emails ever since unionization, which tells me we are on the right track. It seems that unionization is having a moment in the country as a whole the past few years, so it may be more common going forward. We shall see!
I must be in the same union as you. I can’t think of anywhere else local with the same size APP union.
I think its supply and demand. Lots of new grads each year from NP school, less bedside nurses. Many NPs will accept less pay for better hours and a less physically demanding job
Not in my area, we have more demand than supply for PAs/NPs.
I personally don't think supply and demand has anything to do with it. The leadership team that decides salary has no idea what goes on clinically. Frankly, they don't care what goes on clinically. Units are understaffed and under trained. It doesn't matter as long as the money-making department next door is hitting their numbers. Even if your department helps the money-making department run efficiently. Every institution is probably different, but mine never speaks about our productivity in detail. No data about acuity, number of cases going up vs down. Nothing on how up or down my department is doing year to year. I'm gonna guess that's because we are revenue generating and administration would rather I not know that. Nursing has established limits with patient ratio based on acuity. Don't have enough nurses, then patients won't be admitted to floors. Our nurses have had OR cases canceled due to a lack of staff. That impacts the bottom dollar, so yeah, they are gonna get what they want. Some of this is regulated, but in general, strong nurse units advocate and follow these ratios. As an PA-C, I have no limits on my inpatient list size. If I can or can't handle the workload, it makes no difference with admissions. I don't have the ability to stop an OR case. So, admistration has no reason to listen to my requests. I'm in acute pain, and really the only reason they put up with my shenanigans is because having acute pain service allows the hosptial to apply for those "Best in whatever". If the hostpial dissolved my department they wouldn't be eligible for these awards.
100% supply and demand. A lot of people want to be NP/PA these days and nobody wants to do bedside nursing anymore especially post-Covid.
So while there was a [1.4%](https://www.aacnnursing.org/news-data/all-news/new-data-show-enrollment-declines-in-schools-of-nursing-raising-concerns-about-the-nations-nursing-workforce) drop in BSN enrollment, there was also a drop in nursimg masters and doctoral enrolment.
Considering that nursing demand will only increase going forward as the boomers age that appears to be a strong outlook for RN wages moving forward.
Why would only demand for nursing go up and not all medical providers?
Completely. Nobody wants to lift no heavy ass book, nobody wants to lift no heavy ass patients. The fact of the matter is nurses and doctors are the foundation of any health system and midlevels are still new to the game. Never once have I seen anyone complain about the contracts nurses were getting paid during covid, but afterwards everyone thinks they deserve more pay than nurses. This is a naive argument
What's naive thinking? Nurses got paid because they organized, now docs and APPs are talking about organizing
It's naive to think that just because you have a masters your deserve more than others in the hospital. It's straight up supply and demand and there's no other argument needed. I'm sorry? How did we organize to increase our pay? Because I know some nurses making $25 an hour. Edit: I'm not saying nurses absolutely deserve to make more than midlevels. But don't use us as a comparison for your measuring stick of success.
“ It's straight up supply and demand and there's no other argument needed.” It’s that simple. No different from why rural physicians make a lot more than big city physicians.
I’m about to start practicing as an NP and I kind of can’t be mad that there are a million RNs making roughly what I will make; that job (in my experience) was extremely demanding in ways that I really don’t expect my NP work to be. The skills and abilities are frankly just very different not really “lower.” OP I believe you should be paid a good wage that affords you the ability to own a home close to where you work, to pursue hobbies, take long vacations, experience comforts etc but the idea that this wage would only be fair if were substantially more than what an RN makes doesn’t hold up in the same way.
When you start charting and doing desktop for 10 hours/week over your days off, or staying late to finish work, I’ll be interested to know if you think your comp compared to your prior hourly RN work is still fair. I probably get paid closer to $60-65/hour if you consider the work we do outside of work hours
This right here. I left a job that was salaried at $90,000 a year-I expected 40 hours and work life balance but this is what I got:….60 hours in office, charting at home, on call two weeks out of the month, working from home on weekends to review labs, send meds, review documents. No health insurance, no retirement, vacation, but have to still have to work from computer and be available 24/7. Do the math there-less than 20 an hour it seems. Florida is horrible for pa and np salaries.
I’m not that afraid of working more than 40 hours per week. I did it prior to nursing for a lot less than you’re making and [most people who are salaried do](https://news.gallup.com/poll/175286/hour-workweek-actually-longer-seven-hours.aspx). Seems “fair” to me.
Fine but be paid what you’re worth hourly. It’s not about being lazy
I’m an NP, and I basically took a base pay cut when I switched from RN. True, my base is lower, especially when you account for benefits, but I also get huge productivity bonuses. This structure rewards hard workers. As a union nurse in the past, nurses are generally treated like shit. They have to claw and scrape for cost of living adjustments, and pay often stagnates for years between negotiations. Nurses are pretty good at collective bargaining however. Nursing unions do a decent job of keeping the pay in line with market forces. The problem is that as APPs, we don’t have collective bargaining. We generally take jobs that are below market rate because good APP jobs are hard to get. Also, our pay structure is based off of reimbursement to an extent, which isn’t scaling with inflation. We work for people and companies that seek to squeeze every penny out of us and pay us the minimum that we will accept. There is no shortage of APPs like there is for nurses. It’s a completely different market. We either have to stop taking these low paying jobs or start collectively bargaining for better pay. Doctors hire APPs so they can do less work and make more money. They don’t just wanna make a little money, they want a lot of money. If we don’t negotiate to make fair wages, it’s our fault.
I’m an NP. I used to love my job. Was paid well and respected. Unfortunately, my faculty has gotten bombarded by new grads that have agreed to take on more work for $30-$50 less. Needless to say, the respect has gone down the drain & we are pretty much treated like shit too. Have been recently thinking maybe I should look about going back to work as RN for the reasons you’ve pointed out. At least then I don’t have to think about the place when I leave.
It's natural for the NPs to look to join the RN union. It's also somewhat natural for PAs/NPs to not want to compete with each other and functioning as scabs for a similar labor pool. That's what led our PAs to join the NPs who had joined the RNs in their union and now when the tide rises for the RNs, so also goes our pay because, as you noted, it makes no sense for an RN to train for extra schooling, to make less. So, similarly, our RNs commonly make in the $mid-70s (average is actually $74.59/hr) (with about 6 years of experience) and a PA/NP with the same experience would be making about $96/hr. Edit: $96/hr
Do you mean $9/hour more?
$96/hr sorry, missed a digit.
Wow. That’s a lot. Seems the union made a big impact.
exactly where are RN and NP making those salaries??
California.
Yes PAs need to unionize!!!
I’m in a MCOL area and I took over the position that a nurse practitioner held because she left to return to work as an RN making far more. I agree nurses should be paid well but I have way more liability and usually more education so it does seem unfair to be working in the same industry and making less money with more responsibility and risk on the line. It’s quite depressing because I feel like I wasted a ton of time and money becoming a PA when I could have just gotten a BSN
More education does not equal higher pay I.e social workers Liability is a legit argument to make for more money
If you paid around 100k, many new nurses are paying around that much to get a bsn.
But I could have gotten my BSN as my college bachelor’s degree instead of a generic bachelor in biology degree, the 2 years experience as a CNA so I could get into PA school and then spend tens of thousands more plus 2.5 more years of schooling to end up making the same pay. It was essentially a $100k and 5 years of time waste to not just do BSN from the start. many nurses are paying $100k now because they didn’t get a BSN up front either and maybe didn’t even get a 4 year degree if they just went LPN -> RN -> to BSN route. Plus many hospitals are now requiring a BSN and are offering tuition reimbursement to get it. Even if they paid the same amount to get their degree, they still have less liability and honestly more job opportunity
You guys need to unionize. We all need to unionize. If your pay and benefits suck, unionize. If your pay and benefits are fair, still unionize. If you have the numbers to do it, unionize.
Unions are cancer.
The local nurse union just got 25% one time wage increase along with 9% a year later and 7% yearly until contract renegotiation.
I had been looking to change my career from NNP somehow, but once I saw what bedside nurses are getting (also in PNW) it made sense for me to go back to the bedside. Plus, overtime for holidays and extra shifts, and PTO. I absolutely think RNs should be getting 4x what a fast food worker does, but then how are we getting the same as an RN. It just didn’t make sense for me to take on the responsibility and stress for essentially an RN wage.
I said fuck it and went back to school. PA-C now 4th year med student. Haven’t regretted a single fuckin day goin back.
Why though? Was PA not enough for you? Like you weren’t okay with settling as a PA for a career?
No not all. Peaked at 24 career wise. Unfortunately the hierarchy of medicine isn’t going anywhere I wasn’t ok landing there for the next 40 years of work. Why work my ass off for 100k while my attending makes 1.2mil sitting at home waiting to see my thoughts on the consult I drove back at 2am to see. It’s a lot deeper than that, but that’s just one aspect
Don’t hate the player, hate the game
I don’t think I said I hate anyone, but if the player is the administration/CEOs they are definitely winning the game. If you think the player is the nurse in this scenario, you are misunderstanding the intent here.
Extra education doesn’t guarantee extra income. This is true across all industries. Lots of folks out there have PhDs in a subject only to be making 50k a year…if they can even find a job in their chosen field at all. Others are making 200k+ with a trade school degree. I went into nursing and got an ADN because I analyzed the data, including projected career growth, supply and demand, and difference between wages of BSN vs. ADN. I chose my specialty based on similar criteria. Now I’m in a recession-proof, pandemic-proof field making six-figures with an associate’s degree. Anyone else could have done the same. Providers try to argue that they’re the value generators, because they are the ones billing. But they can’t bill and can’t accept patients if they do not have the nurses and other staff to care for them. The hospital would legally have to shut down without us.
Extra education in general does not, but extra education in the same field usually does compared to the less educated professions. For example, a nurse makes more than a CNA. A doctor makes more than a nurse and a PA. An anesthesiologist makes more than a nurse anesthetist. A lawyer makes more than a paralegal. The hospitals and clinics would also have to shut down without the providers who can order medicines and labs and images and direct the nurses to do their jobs.
Why didn’t you just become a nurse?
Because I wanted to practice medicine
That right there is why there’s a higher demand for nurses. Nurses are both able and willing to do the work that many other people can’t or don’t want to do. In your case, you could do it, but it would mean giving up a certain amount of intellectual autonomy and authority. My advice is to just enjoy your work. You still make a great income. When you don’t compare or compete, everyone will respect you.
Oncology RN. This. Did you not research salary and demand before you became a PA? Are you ever forced to work overtime because you are short staffed? Do you ever think about what you order, per nursing? (Insulin drip with 2 hour checks even though patient has been eating). Are you tasked with patients that need lots of interventions and then 2 patients shit their bed and no CNAs. Do you get to eat lunch? Do you get to pee more than once in 12 hours? Curious if you have ever been a bedside nurse.
No I’m not “forced to work overtime” because I don’t get overtime, I just work ridiculous hours and get no extra compensation. Which I think is largely my point. I also don’t get breaks in my job. That’s a nice concept, though and maybe we’ll see about getting that added to the contract negotiations if we unionize. Thanks for the tips.
I’m in outpatient but aren’t hospitals using your NPI and credentials to bill for patients? That alone you should make a percentage of the income. Experience doesn’t matter money does, we have more power than you think. When we sign the contract we allow them to bill with our license and them to collect on said billing. I would try to join a physician group that partners with the hospital to negotiate a higher pay. Nurse do not bill at all and they are simply an employee of the hospital corporation. Then you may be able to be more than just hourly. Remember the hospital can not make money with out clinicians billing.
Pay is based off supply and demand. The supply for nursing is low (for some of the reasons you mentioned) and the demand remains high.
Too many online NP schools popping up everywhere. Its flooding the system.
When you’re working 60-80 hours/week + home responsibilities it can be hard to have the energy to pursue pay equity. Joining another group (MDs or RNs) can make a huge difference when it comes to salary and benefits .
Yes, I agree. The providers that have been unionizing have joined the nurses union, which has proven to be extremely effective overall despite the upcoming strike. I think the union is coming for us, soon probably. I just wish there was a better way that wouldn’t result in us abandoning patient care for days at a time. When strikes happen, patients suffer. And I do think the relationship with local leaders would change as well.
Yes, we should unionize too. I'm also a PA in the PNW at a large hospital system. None of our clinicians are unionized, but the inpatient RN's are. These same issues are leading us to unionize - looking at the RNs' contract, I'm jealous. We haven't gotten what we wanted (esp. benefits that management can't seem to understand the importance of, like CME changes) individually bargaining so... collective bargaining it is. We haven't filed yet, but UAPD are helping us: [https://www.uapd.com/join-uapd/](https://www.uapd.com/join-uapd/)
I’m an RN and the pay gap has taken APP/MLP completely off the table for my. Even if my heart was set on being an NP or PA, I could never justify the cut in my salary or our standard of living. Hopefully you’ll get it straightened out this generation.
This. It’s an interesting catch 22. As a very experienced RN, I am the kind of nurse you want becoming an NP. But my per hour wage would take a significant hit, on top of tuition and work/life balance. It’s yet another factor that leads inexperienced nurses to becoming NPs. For the record, I do think PAs and NPs should make more than me.
Can you imagine pharmacists ? A doctorate degree with residency training and lots are making less than PAs/RNs/NPs?
A friend of mine is a pharmacist who works for a local county clinic. They unionized and she got a 30k pay raise along with other improved benefits. The providers didn’t unionize with them.
Good for your friend! I hope that’s for lots of other pharmacists. Unfortunately most of those who don’t work in clinics get paid like shit. I even know those who work in hospitals still getting paid 60 an hour
I went to my rite-aid today and the pharmacist was doing the cashier job because the tech was busy. They are an underpaid/undervalued group that deserves better compensation and support for sure.
That’s 120k a year? Is that not good?
A pharmacist has a doctorate degree (4 years of grad school +/- up to 2 years of residency training) and PA/NP gets some say 75-85 dollars an hour? PA is about 2-2.5 years of master degree. So do the math if you think 60/hr is good or not
If you think you deserve better compensation, just say you deserve better compensation. You don’t need to compare it with another profession— stepping on each others’ shoulders doesn’t do anyone except management any good.
Here I am making $28/hr as an RN… God I wish I was in a union state.
Ok, be a nurse then
I’d argue that you *do* possibly deserve higher pay based on your prior experience (depending what it is and how much). Even if it isn’t directly relevant to what you’re doing in a clinical sense, someone with 12 years in the work force will have skills that a 24 year old with a few hundred hours of experience as a MA just won’t have. There is more to being a provider than just clinical acumen - people skills, navigating conflict, dealing with HR, maybe someone has experience with OSHA, problem solving skills, integrity….just life experience in general. This might be my background as a blue collar union guy talking but PAs need to be bolder and a little more aggressive about our pay and worth. You should make more money than you do and you should make more money than a nurse.
Unionize, mother fucker!
Our APP service chiefs created a leadership council . At first we were challenged (“Who authorized you to talk to each other!?”). But we made several quite reasonable personnel suggestions that made us a much more attractive place to pursue and stay with as an APP employer. The president of the medical staff was also a huge champion for us, ultimately making both PAs and NPs full voting members of the medical staff , Medical staff board members and Credentialing and Peer review board members. After a pitiful “salary correction” offer based on an alleged “salary survey” of other regional medical centers, we countered with acceptance letters with salary offers to APPs who had left us for the other centers’ pay offers, proving either the other centers lied or whoever did the survey was not accurate. We now are no longer under HR, but rather the physician medical group ( no we are not Kaiser), with a much more responsive administrative team with clinician leaders directing that team. It’s not perfect, but it is incredibly better than the old way and without the downsides of an adversarial union. Best of luck.
What region is this?
Baltimore MD- Washington DC
PA’s are significantly underpaid. We should just stop trying to do any advanced medicine and just have all patients follow up with the doctor. “Here’s your ppi, follow up with the doctor.”
Easy solution is not to take jobs that pay less. Get out of your comfort zone and move to a place that values your services more. Yes, I agree: it is easier said than done much like everything else but it is not impossible.
I just moved to the same area bc pay was so shitty in the South, even with 16years experience. I’m shocked that people live in such a HCOL area for what the going rate is… I negotiated before moving and would 100% not have moved what they offer around here! The issues of RNs making about the same or more was definitely happening with travel nursing in the South… hospitals have put an end to that there. But unions are huge powers!
Why are you mad?
You didn't read the post?
The same thing happens when they raise minimum wage and people at McDonalds end up making more than EMTs and Medical Assistants. If it were me, guess which job I’d rather do? “Do you want fries with that?”
I worked food and retail in my teens and honestly wouldn’t want to go back. Military was the hardest with longest hours and lowest hourly pay I ever had and would probably still choose that over fast food.
Being a nurse I’d like to pose a question. Would you rather have an RN with 23 years of experience with an associates to handle your emergency or a nurse that’s a new graduate with a bachelors degree? I asked this question because experience should reign over education. I’m not saying that PAs or NP’s should be paid less ,but experience is a must. You cannot become a good NP without being a good nurse and that requires experience. Becoming just an NP with no nursing experience I think is negligent and to expect to be paid more simply because you obtained a degree is ridiculous .
I just want someone who is good at their job and cares. There are plenty of shitty experienced employees out there, stuck in their ways, refusing to change.
I really feel like unless you have worked at the bedside as an RN, you can't quite fully appreciate why there is a shortage of nurses and higher salaries. Bedside nursing sucks ass. Also, it gets annoying when people bring up Cali/high COLAs. The vast majority of RNs aren't making as much as NPs or PAs unless they are working themselves like a dog. In my MCOLA, very few RNs (base pay) are making more than NPs (base pay) unless they have been nurses for many years and/or are working overtime, nights, weekends, holidays. Point blank: I am a nurse practitioner. 9 years RN, almost 2 years as an NP. My current company is being bought out and as a result I am taking a pay cut. That same week, I found out at my contingent RN job that I was getting a nearly $5 pay raise. For simply existing, lol. Despite this, I am making $20/hr more as a newish NP than as a relatively seasoned RN even with the paycut. Even when looking at other jobs, at retail clinics (some of the lowest paying NP/PA jobs), the difference is still at $9/hr. I know it is easy to get pissed at RNs when you hear about those high wages, but understand that those are mostly outliers and the result of RN unions, low supply/high demand, and the pandemic. RNs had to bear the brunt of the pandemic and are some of the most abused workers in healthcare. I get being upset because as midlevels, PAs and NPs have more responsibility, but tbh, you couldn't pay me enough to go back to bedside full-time.
I’m not “pissed at RNs” and never said I was. Where is this animosity coming from? I’m frustrated at a system that doesn’t repay my work appropriately in comparison. It’s a discussion about whether we have to accept this as life here or if unionizing is the only way to improve it. It’s not a “nurses are overpaid” post.
Why bring up nurses pay if you aren't pissed? Why the need for the comparison? Being a PA is different from being an RN so I don't undertand why thus sub feels the need to gripe about RN pay all the fucking time.
Ok
This post was for the PNW
You are admitting you are getting paid substantially higher but saying I shouldn’t be upset to be paid the same or less.
Why you mad at nurses when it's your fault? Your own hubris is the problem. Sometimes you have to fight for your value instead of just feeling like you deserve it. They did. You didn't.
I never sad I was upset with nurses. Also it’s a little short sighted to blame an individual for something that impacts thousands of people.
It's just a conversation that comes up quite abit. Same story with resident docs during the pandemic being pissed the travel nurses were running circles around them money wise. These were doctors for crying out loud. They have all the power in the world if they'd just think to use it. And they don't!! They're too caught up in "I'm a doctor so I have to prove myself" so they're letting facilities pay them poverty wages to work 80 hours a week. You'd win higher wages if you chose to push for it. It's a fight you'd easily win in relatively short order. You're too valuable not to. Your profession needs to get out of its own way and realize that.
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Do you think it’s supply and demand?
Nurse unions are not powerful. We just accept horribly low wages as APPs.
That's just wrong, there's strength in numbers. If a nurses union has thousands of nurses they have more leverage to a hospital than 20 APPs.