April 20, 2007, 1:04 pm

Money Honey, You Ain’t Got No Respect



It’s the return of the disembodied “head” nurse!

How would you like that mug staring at you at 0400?

Maybe it just creeps me out because Barbara Stanwyck creeps me out.

It was “The Thorn Birds” that did it. Watching her go after Richard Chamberlain was just… wrong!

I wanted Richard Chamberlain.

Big time!

What a hunk!

I subsequently found out that he pitches for the other team, if you get my drift.



Joint Commission says we can’t put anything on the tops of our cupboards. Big signs all over the department. Pretty soon they are going to be dictating the color of our underwear. Wouldn’t want to be the commissioner with that survey assignment!


Some where along the line, nursing got screwed up.

It’s backwards.

Specifically, the financial compensation aspect of the nursing profession.

This is what goes on in my brain at 0400 with no patients in the department.

I don’t get it…..

  • A hospital will advance a new hire rapidly up the pay scale, and then stop their most experienced nurses cold around the seventh step. To get to the eighth step, you must work an additional ten years. The final step comes after you have been in the same facility for over twenty-five years!

Who made up this system of financial compensation? Doesn’t it make more sense to reward the nurses who have spent the majority of their careers at the same institution? Make the new hires work a few years before advancing and give the older staff nurses the yearly step increase, and keep it increasing past nine steps. Wouldn’t that make more sense when it comes to retention?

  • Take these lovely sign-on bonuses, which I have received in the past. The hospital pays a $10,000 sign on bonus (for example) to a new hire, but no bonuses to the nurses who have stuck it out through all the horrible low staffing periods. After all, isn’t that why you to have to pay sign-on bonuses to begin with?

What if all those sign-on bonuses were paid to the existing staff after “x” number of years of employment?

  • The pay recieved as an RN is not commensurate with the level of education.

For example, I am an ADN grad and proud of it! But why do I make more than someone with a PhD in Nursing Science who is teaching? I’m talking almost twice as much. Why do I make more than my manager – I always have! Why do I get paid as much as someone with an MSN who is a clinical nurse specialist? Even if we are doing the same work, the MSN brings more education and (possibly) experience to the table.

I’m not trying to dredge up the entry-level-for-nursing debate here, believe me. I have just observed that no matter what your nursing degree, if you leave the bedside your pay will drop dramatically. If you stay at the bedside, you receive no additional compensation for your increased knowledge and/or education.

Where is the incentive to obtain more education; to go get that BSN or go for that MSN?

I can tell you from my personal experience that the incentive is not money. I’m putting out major bucks to obtain a degree that will not help me financially one iota.

But what if that advanced degree did increase my earning potential? Would I have gone back ten years ago? Twenty years ago?

How many more nurses would chose to go back to school if they had a financial incentive? How many more would choose RN-to-BSN programs or go back for that MSN if they knew it made a difference at the bedside?

I don’t have the answers.

It was just something to mull over at 0400 with no patients in the department….


  • girlvet

    April 20, 2007 at 5:30 pm

    The whole step thing does stink. I am at the 15 year step and my next step raise is at 20 years! Lets see I work part time and I should get another step raise in about 8 years! I think they figure they already have you after 15 or 20 years and that they have to give incentive to the new nurses to stay. Nursing is the reverse of any other job where experience and skill are rewarded financially.

  • Candy

    April 21, 2007 at 2:03 pm

    You have finally rendered me speechless (and this is as nearly impossible as you being rendered thus). I could not possible agree more.

    Herein lies the largest problem faced by the profession. Forget sign-on bonuses — most faciities don’t even offer them anymore. Pay scales always favor the short-timer, and until recruiters and managers learn that, they’ll be filling slots with per diem RNs and travelers. So much for continuity of care. Did you know that it averages (no joke) $50,000 per international hire and $25,000 per US hire per nurse when you count every dollar spent? Imagine what those pennies could be doing in a retention fund instead…

    We scream for nurses to be professional, to value “life-long learning,” to go for certifications and credentials — all based on the premise that, as porfessionals, they should WANT to attain the highest level of education and specialty certification possible. Some facilities even help pay for the continued education and certification — but that’s the end of the money line.

    Next, we try to tempt bedside nurses and/or managers into becoming nursing school faculty by offering to “forgive their loans” when they go back to school to earn MSNs. SONs don’t even pretend they will pay nurses as much as they could make (working 2 or 3 12s) in Superior Nursing Facility or even Less Superior Nursing Facility. They should work for less money simply because they are dedicated nurses who want to ensure there will be nurses at the bedside when they’re in the bed. As my dad used to say, I’ve heard a duck fart under water before.

    If you are a teacher with a master’s degree, your salary reflects that higher level of education, even if you do the same thing as a teacher without the degree. A doctor of audiology makes more than an audiologist with an MS. Why doesn’t the same apply to nurses? One answer (and I’m stepping on toes) is that in union environments, anyone doing the same job must receive the same pay. Another is that 70 percent of nurses (in California, at least) come from ADN programs. BSNs haven’t been very vocal about demanding a salary jump for their advanced education. In a perfect world (OK, MY perfect world), every RN would go through an ADN program and receive a 2-year preliminary license, like teachers do. During the 2 years, no matter where they worked, they’d be in an internship program which would include didactic and clinical training and a public health component. They would get paid fulltime pay and work half time. At the end of the internship, they’d sit for the NCLEX, become a full-fledged RN and have their BSN. They would work full time
    and earn more per hour than they did during their internship.

    For some, the BSN would be the terminal degree. Others would continue on to an advanced degree: MSN (in education or management), NP or CNS (the advanced degree for clinical practice). Some may continue on to get a DNSc or the new DNP. At each step, their salary would reflect their new level of education and they would be rewarded for their commitment, not only to their facility, but to their profession.

    I realize this will never happen. It’s a sad realization for me.

    I said I was speechless, but I guess what you said opened the flood gates. This situation will not change until all nurses look at themselves as professionals, and demand that they are treated that way. That means if you have the lowest entry level degree, you don’t make as much as someone with more education. If you have more experience, you make more money. If you have contributed significantly to the life of the institution at which you work by staying there for a long time, you are compensated for that with commensurate raises annually, not with step increases at 10, 20, or 30 years.

    I’m getting off the soapbox now and putting away my whips and bullhorn.

  • Margaret

    April 24, 2007 at 11:21 am

    I have to disagree with you on the “unequal pay for the same work” idea. I like Candy’s idea of the progressive career. It would offer young people a career path with upward mobility and opportunity throughout their careers instead of a single-level job. Now if only the outside world would see it that way. BTW, I do want to point out that many people in academia make less money than their peers in commercial ventures with similar education levels.
    I want equal pay for equal work, and that has nothing to do with any union. Employers will continue to offer qualified RNs the same amount of money for the same work and as long as MSN nurses decide to apply for, or remain in, those positions, that’s their choice. I don’t think that anybody should get paid more in any position just because they have a higher-than-required education.
    Your statement: “The pay received as an RN is not commensurate with the level of education” can also be read be the other way around: these nurses are now overqualified for the level of work they do. At that level of education they ought to be in management, or in Advanced Practice Nursing, not on the floor doing the same work as a new grad. There is a salary cap for most professions; nursing is not unique in that.
    If an RN with an ADN degree does the same job as an RN with a BSN degree and they perform at the same level and both achieve the required results, they deserve the same pay.
    Now, if ADNs could not be charge nurses because that position requires additional education, (like public health nursing already does in many places) I can understand that. That would raise the bar and be an incentive to go back and get that higher education. But I disagree with the notion that just because somebody has more than the required level of education they should get paid more money for the same work. That’s just not right.

  • S. R.

    April 24, 2007 at 11:36 am

    Margaret is right, and I am a BSN (and new grad to boot for at least a few more months). ADNs and imported nurses do the same job as I do. We carry the same patient load. Even some of them are charge nurses. In fact, every charge nurse on my shift is in one of these two groups. There are no BSNs as charge nurses. That being said, none of them want to be charge nurses anyway. They’d rather take a patient load, for what its worth.

    According to a radio ad I heard yesterday, I could make $10 more an hour by laying plaster in new houses. You need more men in nursing because women take too much shit from unruly patients, doctors, and managers. Men lose their tempers with this BS. Not to be sexist, just what I’ve experienced, as I’ve lost my temper with some ridiculous situations myself.

  • Laurie

    April 25, 2007 at 6:58 pm

    There are a number of studies that indicate that hospitals staffed with a higher number of BSN nurses have improved post-op healing rates (fewer complications), a lower incidence of hospital-acquired pneumonia, and a lower inpatient death rate. That should make them worth a higher salary as far as I’m concerned.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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