The career path to becoming a nurse practitioner is filled with decisions and options. One of the first decisions is how to get the level of education you need for your nursing career. To become an NP, you must first obtain a bachelor’s degree, then a master’s degree, but how you go about this is entirely up to you.
The nursing career field is filled with a variety of job opportunities and paths. Some start by becoming a licensed practical nurse (LPN). Others obtain a BSN degree to become a registered nurse, then continue their nursing education. No matter what direction you take to become a nurse practitioner, the journey must culminate in a master’s degree.
While it is possible to move directly from a bachelor’s to a master’s degree, it is advisable to work as a registered nurse for a year or two to gain valuable experience as a healthcare professional. As you settle into your nursing career, your decision-making skills will continue to be honed and tested.
This is especially true as you evaluate the best place to work. Whether you are looking ahead to graduation or looking for your first job as a nurse practitioner, it’s helpful to know what you can and can’t negotiate when it comes to your benefits package, your salary, and how many hours you’ll work.
A Benefits Package Is More Than Just an Annual Salary
Compensation is the total cash and non-cash payments an employee receives in exchange for their hours, skill, and expertise. It’s more than a regular annual salary or hourly wage; compensation can include vacation time, stock options, malpractice coverage, stipend or allowance for continuing education, bonuses, number of hours worked, and health benefits.
Compensation outside of an annual salary is typically referred to as a benefits package. Nurse practitioners who join a medical practice or hospital receive a benefits package that may include these items and more. The breadth and depth of your benefits package depend on a number of factors, including your ability to negotiate.
What to Negotiate In Your Benefits Package
There are a number of benefits you can negotiate as a part of your nursing job. The most common is the annual salary, which we’ll discuss later, but benefits packages also include vacation time, health insurance, disability, life insurance, and retirement benefits. In addition to these common benefits, there are some not-so-common benefits to be aware of.
As a nurse practitioner, you should take note of these benefits, so you know what to negotiate for. One of the advantages of working with an experienced recruiter is their expertise and coaching. They can help you negotiate a fair and equitable benefits package.
Administrative Time
This is time the practice gives you within your workday where you are not scheduled to see patients. Nurse practitioners can use these hours to check lab results, call patients, catch up on charting, collaborate with providers, or spend additional time with a patient who has a sensitive diagnosis.
A benefit you may want to negotiate is the ability to use your administrative time remotely. This would allow you to use your administrative time away from the office. Certain apps allow you to call your patients from your personal phone and your work phone number will display on their phone. Negotiating remote administrative time could help you maintain a work-life balance, reducing the potential for burnout.
Education
This is an often-overlooked benefit that you can negotiate. The fees for continuing education courses can quickly add up. However, tuition reimbursement falls under an education allowance. Hospitals sometimes have this as part of their benefits package, but private practices may not. If you don’t see tuition reimbursement in your benefits package, ask about it. Federally Qualified Health Centers (FQHCs) typically offer tuition reimbursement as well.
In addition to continuing education courses, attending conferences provides you with new knowledge and expertise that you can apply to your patient population. Consider negotiating for conference registration fees, transportation, and meals. Ask for time off to attend conferences separate from the standard paid time off. The cost of staying current can accumulate, so ask about having it covered and written into your contract.
Malpractice Insurance
Most larger institutions offer medical malpractice insurance or medical professional liability coverage. However, smaller entities may not. If you work for a private practice or small clinic, request that medical malpractice insurance coverage is included in your benefits package. If you have access to a policy outside of work, you might consider giving up malpractice insurance in the negotiation to acquire another benefit that is more valuable to you.
Orientation Schedule
When first starting your job as a nurse practitioner, it’s helpful to have an orientation schedule that allows you to shadow another healthcare professional, such as an NP, MD, or PA. This helps you acclimate to the patient flow, clinic operations, and common practices. This is especially important when you are starting a new area of medicine or are a new graduate.
Request additional days to learn the electronic medical record and understand the roles of others in the office, including the nursing manager, the office manager, and other specialists and technicians. Be sure to take the time to get to know the people working these jobs as well. Each one is vital for the success of your nursing job.
Since working as a nurse practitioner is different from a clinical rotation, it’s wise to request your patient schedule be modified to accommodate this learning period. As you navigate a new charting system, electronic prescriptions, and a little self-doubt, it’s difficult to accomplish everything needed in the 15-minute time slot you’re given for an acute visit.
Negotiate for a modified schedule for the first month. This will let you start with double the amount of time normally given to acclimate. Your goal is safety and patient-centered care, so it’s important to point out that no one in the practice will win if you are running an hour behind.
Negotiate Your Salary As Part of Your Benefits Package
As with other aspects of a nurse practitioner’s compensation, your nursing salary is both negotiable and dependent on several different factors. Some of those factors include the location of the practice, your nursing specialty, your experience, and your ability to negotiate.
According to the Bureau of Labor Statistics (BLS) the median annual salary for nurse anesthetists, nurse midwives, and nurse practitioners is $115,800, which equals an hourly wage of $55.67.
Plus, an annual national survey by The American Association of Nurse Practitioners finds the average salary range for nurse practitioners is greater than inflation. Members of the association can access this survey’s findings.
While many new graduates are determined to negotiate their salary, few actually do. This is because it’s hard to have a tough talk about money. But that’s where an experienced recruiter can come in hand. They have years of experience negotiating for equitable full-time and part-time nurse practitioner salaries.
Determine Your Worth to the Practice
Before you can negotiate your annual salary, you need to understand how the practice or hospital plans to financially compensate you. A nurse practitioner position may be salaried, paid an hourly rate, or paid by the patient contract.
Next, it’s time to determine your financial worth to the practice. You can do this by examining how the practice is reimbursed, your anticipated patient load, and whether you are full-time or part-time.
The American Association of Nurse Practitioners offers an equation that can help you figure this out. A physician’s relative value scale is 48% overhead, 48% cost for service, and 4% malpractice. A nurse practitioner’s overhead cost is approximately the same and malpractice is slightly less.
This leaves the remaining cost for service to equal 100%. A private practice often seeks a 20% profit rate. This gives you an opportunity to estimate your net worth. If your salary expectation is higher, the practice won’t be able to afford you.
Another thing to consider is the additional compensation you may receive for overtime, on-call hours, and hospital rounds. Also, consider if the practice does revenue-sharing or bonuses.
Salary Research Helps Set Your Boundaries
While it’s helpful to know the average salary and hourly rate for nurse practitioners across the United States, it’s too broad to use in negotiations. You’ll be paid based on your geographical location, skill, and expertise.
That’s why you should look at the average salary for nurse practitioners with your level of experience in your area. Having a good idea of the average salary as well as the nurse salary range can help tell you where your salary might land.
Knowing the average annual salary of others in your specialty and city can help set the boundaries for your negotiation. The city and state where you live can make a dramatic difference as the cost of living is factored in.
For example, according to the Bureau of Labor Statistics, average salaries in New York are $119,496 each year, while more rural Alabama draws an average annual salary of $96,470.
As you consider the annual salary or hourly rate you want to negotiate for, remember on-call hours and the potential for working evenings, weekends, or nights. Each of these commands a higher pay rate.
Use these numbers to provide a sense of what to expect. Remember, a quality company will value, respect, and reward your skill and expertise.
Nurse practitioners across all specialties are in high demand, so your potential future employer should offer a salary that is commensurate with your value and years of experience.
They may begin low with the intention of negotiating. However, if they are unwilling to negotiate for a salary that is at least average in your area, it may be best to keep looking.
Get Ready to Negotiate
Salary negotiations can be challenging. Sometimes people are afraid an employer will harbor resentment or be offended by a request. However, a survey by Salary.com found that 73% of employers are not offended when people negotiate, 84% expect their job applicants to negotiate, and 87% have never rescinded a job offer when an employee negotiates.
These are important statistics as they indicate far greater than the majority of employers believe negotiation is part of the hiring process. When you’re ready, it’s also crucial to have a strategy in mind to negotiate your terms. A solid approach indicates you’ve done research and found the salary range for similar positions.
Quote that range and indicate you have several other attributes that increase your value. At this point ask your prospective employer to consider the specific salary you desire. They may make a counter-offer, indicating you might need more orientation or training to assume the salary you requested.
You can counter with another number, or you can negotiate a re-evaluation and salary increase in 6 months if you achieve specific goals. Although you come to a verbal agreement, be sure you review your contract thoroughly before signing. If you have any concerns, it may be a good idea to hire a lawyer to review it. Salary negotiations can be more challenging than patient care, but with expert help, it’s more likely you’ll be satisfied with the final result.
Can You Negotiate How Many Hours You’ll Work?
As a nurse practitioner, the number of hours you’re contracted to work and the number of hours you actually work can vary. It depends on a number of factors, including the practice, geography, staffing needs, overtime, and specialty. Patients and unexpected situations do not always fall neatly into a 9 to 5 work schedule.
If you’ve been contracted as a full-time employee with a practice, clinic, or healthcare facility, you can expect to work at least 40 hours a week. However, like most salaried employees, these hours can fluctuate and bleed into 50 hours, especially if there are staffing shortages or emergencies. And, unfortunately, the number of hours you work and the fluctuation of the hours are non-negotiable.
Location
Nurse practitioners who work in a hospital may have more dependable hours, but the hours in a shift can range from 8 to 12 hours. Unexpected emergencies or employee shortages can also cause hospital NPs’ hours to fluctuate.
Clinics and doctor’s offices usually have more standard and dependable hours. Yet, emergencies happen at the office too. NPs working with a practice may need to take on-call hours each week as well. Although you may have a set schedule, it’s important to be flexible, since maintaining patient standards isn’t usually predictable.
One study analyzed the work schedules of 9,010 NPs and found those working in a hospital or long-term care setting tended to consistently work more than 40 hours per week. The data also showed in the hospitals where electronic records were used, the NPs spent more hours working.
Specialty
As a nurse practitioner, your hours also vary based on your specialty. Much like travel nurses, your work environment will dictate the number of hours you’ll spend working. As a hospitalist, you may be contracted to work 12-hour shifts 3 times a week, and each 12-hour shift may end up being 13 or 14 hours before your work is completed. Or hospitalists may work 7 days on, 7 days off.
Nurse practitioners whose specialty keeps them in the office or clinic for the most part, such as dermatology, will find their hours are more predictable. If you’re seeking more predictable hours and a set schedule, then working in a private practice is the best option.
Do You Have the Best Job in Healthcare?
With a growing physician shortage, nurse practitioners continue to be in-demand and that demand is expected to grow. In addition to being highly sought-after, working as an NP puts you in a position where patients and other healthcare providers value your expertise. Plus, even in a sluggish economy, nursing salaries aren’t decreasing.
As a nurse practitioner, you are in a unique position to affect patient care and positively impact people’s lives. The combination of your nursing salary, benefits, and hours creates an environment where you’ll be able to balance your work and life. Just be sure you know how to negotiate, so you can live the life you want.
