Nurse Salaries in Washington DC and Nationally

Nursing Economics, Sept, 2000 by Jennell P. Charles, Sharon Piper, Sharon K. Mailey, Paula Davis, Judith Baigis

IN THE DISTRICT OF COLUMBIA, representatives of all the major health care providers and all levels of nursing education programs have been working together under the auspices of the Robert Wood Johnson Foundation (RWJF)-funded District of Columbia (DC) Consortium for Nursing Education and Practice (DCCNEP). One aim of the consortium has been to implement a nursing workforce data collection and forecasting system. Prior to this DCCNEP initiative, no mechanism existed to collect DC-wide nursing workforce data systematically and to share it with educational, practice, policy and government bodies for their planning purposes.

A direct data collection system was selected over a national forecasting model of registered nurses (RNs) and licensed practical nurses (LPNs) or a provider-based algorithm that employed facility characteristics to predict demand for nursing personnel.

Both of these approaches were deemed unreliable because the District of Columbia is overstaffed compared to the rest of the nation (Public Policy Institute AARP, 1998). Therefore, U.S. parameters do not pertain to the District of Columbia and a national forecasting model of RN data underestimates the actual number of RNs in DC. The purpose of this article is to present the results of one aspect of the DCCNEP direct data collection system: salaries by nurse type, work setting, and educational preparation; and make comparisons as appropriate with data collected by a national survey.

Nurses and Wages

Over the last 10 years, revolutionary and unprecedented changes have occurred in the health care system of the United States largely due to issues of resource utilization and cost-containment measures. Nurses provide the largest percentage of the health care labor force; and, with RNs holding over 1.9 million jobs in 1996, they are a critical mass within the health care arena (U.S. Department of Labor, 1999). Largely for this reason, nurses have been particularly affected by recent changes in the health care delivery system. The Nurses Worklife and Health Study of over 4,000 RNs reported reduced RN staffing, increased use of unlicensed assistive personnel, increased workload, decreased quality of care, decreased job security, and decreased morale (Corey-Lisle, Tarzian, Cohen, & Trinkoff, 1999). Based upon a report by the Institute of Medicine (IOM), "there is a high level of uncertainty and concern about what is happening to nursing staff in terms of their physical, psychological, and economic well-being" (IOM, 1996, p. 2).

AS A MEANS of cost containment, the influx of managed are strategies in the late 1980s and 1990s has had a significant impact on nursing salaries. Downsizing within hospitals has led to changes in nurse staffing, including employment shifts from hospital to nonhospital settings which has been a major contributor in reducing wage growth for RNs (Buerhaus, 1993; Buerhaus & Staiger, 1996). Prior to 1991, a rapid increase in wages for RNs was seen, with wage growth in nursing exceeding that of wage growth in other industries (Buerhaus & Staiger, 1996). From 1991 to 1996, however, a slowing in the rate of wage growth for RNs has been reported in the literature (Brewer, 1998; Brider, 1993, 1992; Buerhaus & Staiger, 1996; Moses, 1997; "RN Pay Hikes," 1996; Sachs & Spreier, 1996; University of Texas Medical Branch at Galveston, 1994). According to an American Journal of Nursing survey, wages may have actually decreased 1.1% for all RN positions in 1996 ("RN Pay Hikes," 1996).

Since 1997, however, wages for nurses may be increasing once again. The Bureau of Labor Statistics reports current earnings for RNs are above average, particularly for advanced practice nurses who have additional education or training (U.S. Department of Labor, 1999). For full-time RNs the median annual salary in 1996 was $33,450; nurse practitioners, $66,800; nurse midwives, $70,100; and salaries reported in January 1997 for nurse anesthetists were about $82,000 (U.S. Department of Labor, 1999).

A 1997 survey by the American Association of Colleges of Nursing of full-time nursing faculty showed a modest rise in faculty salaries of 3.4% across faculty ranks (Mezibov, 1998a). Based on a calendar year, 1997-1998 average salaries for faculty with doctorates ranged from $55,722 for assistant professors, $64,487 for associate professors, and $78,709 for full professors.

Nurse wages also vary according to skill level. RN wages grew from $17.57 per hour in 1977 to $24.69 per hour in 1996; whereas, wages for LPNs grew from $12.51 per hour to $15.34 per hour (Buerhaus & Staiger, 1996; Spetz, 1998). This growth in LPN wages took place despite a steady decline of employment of LPNs (Buerhans & Staiger, 1996). In contrast, over this same time period, the wages of nurse aides (NAs) dropped from $10.53 per hour to $10.35 per hour and have remained relatively stable (Spetz, 1998). Though aides have experienced very little growth in wages, their rate of employment has substantially risen since 1983 (Buerhaus, 1998).