Nursing has faced challenges for several years now, and COVID-19 has only added new ones. Nurses at all levels of practice are under tremendous stress. However, when it comes to compensation, advanced practice registered nurses (APRNs) are still doing well, though an increasing share feel they aren’t being paid enough.
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Medscape’s 2021 APRN Compensation Report surveyed more than 3000 professionals, including nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), clinical nurse specialists (CNSs), and nurse midwives (NMs), about their compensation. CRNAs, CNSs, and NMs were more likely to work in acute care hospital settings. NPs were more likely to work in outpatient clinics, both hospital-based or non-hospital-based.
The survey was conducted in 2021, with respondents reporting income from 2020.
Income Increase
On average, the financial outlook for APRNs is good. Total 2020 gross income increased from 2019 in all groups except NMs, and their income remained, on average, unchanged. At least half of the survey’s respondents reported an increase from their 2019 income, though the pandemic did take a bite in some areas. For example, CRNAs were more likely to report reduced hours when elective surgeries were postponed.
Average gross income across all APRN specialties was $139,000, with CRNAs making the most, at $211,000, and CNSs bringing in the least, at $112,000. NMs averaged $118,000, while NPs grossed $116,000. All APRNs made considerably more than the average RN pay of $83,000, making an advanced practice degree a lucrative career move for nurses.
Average earnings of NPs varied by specialty. The majority (63%) of NPs are certified in family practice; their average income for 2020 was $114,000. The most well paid were the 8% of NPs specializing in psychiatry/mental health, pulling in $128,000 on average in 2020.
Compensation Varies Depending on Gender, Location
Advanced degrees made a difference, but not much. Eighty-one percent of this year’s respondents held a master’s degree, and 17% held a doctorate (PhD or DNS). Among NPs, those with doctorates made about 5% more than those with master’s degrees.
Gender, however, did make a difference. The profession is still mostly female. Men represented 37% of CRNAs and fewer than 10% of the other specialties. Male CRNAs and NPs (the only groups with enough respondents for analysis) earned 11% to 12% more than women in the same roles. While the reason for the pay gap is unclear, the survey did find that male APRNs were more likely than female APRNs to work in acute care hospitals (61% vs 46%) and to supplement their incomes (56% vs 43%). In addition, men were more likely to own their own practices (9% vs 5%), though that was rare for APRNs overall.
Regarding compensation, it matters where nurses live. In keeping with previous Medscape surveys, this year’s results found that APRNs working in the Pacific Region of the US (California, Oregon, Washington, Hawaii, and Alaska) reported the highest incomes ($140,000). Those in the East South Region (Tennessee, Kentucky, Mississippi, and Alabama) reported the lowest ($104,000), though it’s worth noting that these incomes are not adjusted for cost of living. Also of note, nurses working in urban areas earned more than those working in rural areas.
Fewer than 10% of respondents belong to unions or other collective bargaining organizations. Those who do, however, made more money last year than their non-organized counterparts — $136,000 vs $127,000.
While compensation rose slightly, satisfaction with that pay did not. More than half of the APRNs surveyed felt that their 2020 compensation was fair. However, this represents a decrease (from 63% to 57%) from 2019.
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