My Nurses Makes $2/Hr More Than I do, Should I Care?

[thulegreen1101]

I work in a very high volume high acuity rural ER in WI as a 2nd coverage provider. I.e. when there are two codes at one time, I am responsible for managing one of them. I am required to be certified in ATLS, PALS, NRP, BLS, and ACLS and independently manage codes, trauma, etc. especially if my physician is occupied with another high acuity patient. I am 3 months into this job, I make $56 an hour. PAs who work at med express in an urban area 2 hrs away make more than I do and I just found out that my nurses at the ER make $58 an hour. (as part of a recent pay raise for retention pay). I know that COVID has really taken a toll on our nursing staff and they certainly deserve more compensation. But I am also held accountable with higher responsibility and I am ultimately responsible for making decisions for patient care. Should I address this with HR? I live in an area where there are still limited ER positions, this is a job I really enjoy, and I am learning a lot, but I also feel deflated and taken advantage if. 

Edited January 19, 2022 by thulegreen1101

[mgriffiths]

Should you earn more?  ABSOLUTELY!

Why should you earn less than the people fulfilling your orders?  That makes zero sense. Plus, as you said you are the one with higher responsibility and patient decision making.

With that said...nurses are like unicorns right now and so what should be doesn't always occur.  The law of "supply and demand" is at work here and how does the supply of providers compare to the supply of nurses.

Just for comparison's sake...I just had my base salary cut $8,500.  Technically my RVU bonus threshold was decreased as well, so assuming my productivity stays the same I will earn the same.  But, my options are to either deal with it or leave.  I'm looking into leaving...but I already was looking and this just sped up my timeline.

[TeddyRucpin]

1 hour ago, thulegreen1101 said:

I work in a very high volume high acuity rural ER in WI as a 2nd coverage provider. I.e. when there are two codes at one time, I am responsible for managing one of them. I am required to be certified in ATLS, PALS, NRP, BLS, and ACLS and independently manage codes, trauma, etc. especially if my physician is occupied with another high acuity patient. I am 3 months into this job, I make $56 an hour. PAs who work at med express in an urban area 2 hrs away make more than I do and I just found out that my nurses at the ER make $58 an hour. (as part of a recent pay raise for retention pay). I know that COVID has really taken a toll on our nursing staff and they certainly deserve more compensation. But I am also held accountable with higher responsibility and I am ultimately responsible for making decisions for patient care. Should I address this with HR? I live in an area where there are still limited ER positions, this is a job I really enjoy, and I am learning a lot, but I also feel deflated and taken advantage if. 

Yes, you should not be making less than an in-house RN. You're underpaid as is. It's a bit different for the travel ___ as they are all making a killing.

[kettle]

3 hours ago, TeddyRucpin said:

Yes, you should not be making less than an in-house RN. You're underpaid as is. It's a bit different for the travel ___ as they are all making a killing.

I agree with this. I would not work for less than the highest paid RN on staff that is clinical. During covid wages dipped and hospitals thought that during this influx of patients they could keep doing that. Look for other jobs, find one, get an offer and use it for leverage at your current job or take it

[mgriffiths]

5 minutes ago, kettle said:

Look for other jobs, find one, get an offer and use it for leverage at your current job or take it

While I agree with the premise, it often doesn't work well to give an ultimatum and to have another job in hand is the equivalent.  Furthermore, hospital employers are more and more going straight off salary data surveys and being rigid with compensation.  As I alluded to above...this just literally happened to me.  There is no wiggle room.  Multiple physicians have left because of it and I know of many PAs and NPs who are currently looking...myself included.  But, if all the employers in a region go off salary data surveys...looking doesn't help much.

[Apollo1]

It depends on who your employer is. Are you part of a CMG, SDG or directly employed by the hospital? If you fall under the first 2, nursing pay won't be a factor in whether they pay you more. If the latter, your pay is the unfortunate byproduct of C-suite execs panicking over this temporary nursing diaspora; you may be able to negotiate for more, but supply-and-demand (as others have already stated) is what you'll be arguing against.

Edited January 20, 2022 by Apollo1

[Cideous]

Sickening.

[MediMike]

There are people in finance and IT making a s!&T more money than anyone in our fields be they primary or specialty and nobody seems to care.  There is a massive nursing shortage and no shortage of PAs, especially in the ED. I'd worry about making similar money in comps to other PAs in the region, ED PAs specifically. 

[ShakaHoo]

We should all care (healthcare workers in general)

Set a national walkout day, wait for our wages to be increased. 
 

The rest of the world does it, why shouldn’t we?

[kettle]

2 hours ago, ShakaHoo said:

We should all care (healthcare workers in general)

Set a national walkout day, wait for our wages to be increased. 
 

The rest of the world does it, why shouldn’t we?

And then who takes care of the ill and hurt people? I'm all for fair wages but I'm more for helping others

[Mayamom]

$56 per hour and you are running codes.   No thank you.  What are the docs making??

[TeddyRucpin]

9 minutes ago, Mayamom said:

$56 per hour and you are running codes.   No thank you.  What are the docs making??

Hopefully not less than the nurses lol. 

[iconic]

There's a ton of new grad PAs dying to take your position

[BrianR]

Wow.  No offense, but that's what I was making 20 or so years ago, in a low volume, high acuity single provider shop.  That's ridiculous.  Are you working for a hospital, a local group, or one of the large CMGs?  Personally, I always did far better negotiating with a hospital or local group.  The CMGs were typically "take it or leave it."  Do you have access to the financials, to see what's billed and generated in your name?  If so, that could support your case for an increase.  

Or you could try this approach:  "When I was hired three years ago, my job description and responsibilities were xxx.  Now, here's a list of the additional responsibilities that have been added, as well as new barriers I face to get the job done.  I would like to discuss a pay adjustment."  I actually read that somewhere on a nursing blog, but I liked the verbiage.  You might get turned down, but you certainly won't get anything if you don't ask, and support your request with facts, not emotions.

Also, as someone else mentioned, what are the docs earning?  Most places, it's easy enough to find out.  People like to talk.  If there's more than a 50% differential, make the case that you're certainly generating more than 50% of the revenue of a doc (assuming that to be true) and should be compensated in an appropriate manner.  

Part of the problem is that as long as PAs are willing to work for that rate, why should the employer pay more?  Health care organizations are like any other business these days, looking to get the most out of their employees for the least amount of money.  Of course, we can all moan about how it's unfair, you shouldn't work for that, but the bottom line is that everyone has bills to pay, and you have to do what's best for your personal situation, not what SGOTI says you should do.  

I'd be willing to bet the C suite folks at that hospital are still getting their bonuses and aren't seeing any pay cuts.  Probably not a good negotiating point though...

[newton9686]

Yeah, I think the bigger issue here is you are being underpaid drastically while the nurses are probably being paid fair market value given the current nursing shortage. However I know for a fact most of these rural ERs are hurting to find PAs with experience so I would ask for a raise. No reason you should not be paid atleast 65+. Still less than many travel nurses but at least puts you on par with the staff nurses. 

[thulegreen1101]

Thank you all for your support and responses this is very helpful. I work for the hospital. Although I agree that many new grads would jump at the chance for this job, I also don't think this is the best for patient care. Sure, there are new grads out there who are ready to jump into a high acuity second coverage position, but for most, it takes time and experience, further training etc. to get to that level. I think the greater issue is that we need stronger advocacy for our profession and our skillset. We are undervalued, in general, as ER PAs in particular. Would love to hear more feedback if folks are willing to share. Thank you. 

[TeddyRucpin]

1 minute ago, thulegreen1101 said:

Thank you all for your support and responses this is very helpful. I work for the hospital. Although I agree that many new grads would jump at the chance for this job, I also don't think this is the best for patient care. Sure, there are new grads out there who are ready to jump into a high acuity second coverage position, but for most, it takes time and experience, further training etc. to get to that level. I think the greater issue is that we need stronger advocacy for our profession and our skillset. We are undervalued, in general, as ER PAs in particular. Would love to hear more feedback if folks are willing to share. Thank you. 

Right; however, this pay stinks for an ER PA, especially for someone who is not brand new. You should be making much more than ~$105K a year.

[MediMike]

6 minutes ago, thulegreen1101 said:

Thank you all for your support and responses this is very helpful. I work for the hospital. Although I agree that many new grads would jump at the chance for this job, I also don't think this is the best for patient care. Sure, there are new grads out there who are ready to jump into a high acuity second coverage position, but for most, it takes time and experience, further training etc. to get to that level. I think the greater issue is that we need stronger advocacy for our profession and our skillset. We are undervalued, in general, as ER PAs in particular. Would love to hear more feedback if folks are willing to share. Thank you. 

I don't think you're undervalued I think you're undercompensated. They know your value as you are acting as a fully functioning ED provider from the sounds of it. 

I'm sure some of it is supply and demand, there are plenty of PAs who want your job. 

I work ICU, but my wife works ED in western WA, she made $68/hr a year out of school (2016) dropped to per diem and was making $90. 

Agree with the above that the RNs are likely making the appropriate wage for the market.

[newton9686]

I will say though finding an ER position where you feel like you have the scope, acuity and respect you want is a little bit like finding a needle in a haystack. There's just a lot of ego in my experience in the ER (and frequently the hospital in general) which frequently translates to PAs not practicing at the top of their license. Therefore you find lots of ER jobs despite your training and experience where the expectation is for the  PAs  to see all the 4s and 5s so the physician and residents can handle the higher acuity 1s and 2s with less distraction. Some may disagree with me but I personally would rather see 1s and 2s in a hospital with a great culture making 56 an hour than make 75 an hour doing psych clearances and ankle sprains in a hospital with a bad culture. So if you are generally happy and fullfilled with your role, its a good culture but you just don't make what you deserve I would go to HR or leadership and see if you can get a bump in pay. And if they wont budge, start looking for some different PRN opportunities where you could make more and have the same scope. But I wouldn't quit just because a nurse is making more than you. Life is too short for that and it is way to hard to find the ideal job in medicine, especially as a PA in the ER. Because if I was being honest if I had found that ideal job as a PA in the hospital where I had the scope, acuity, training opportunities and respect I wanted, I would have taken far less than 56 an hour in a heartbeat. I love money and I'm not advocating for taking less than you are worse, but I am also saying 56 an hour would of been a lot better financially than the 60K a year I am paying to go back to medical school when I couldn't find that perfect opportunity in the hospital for me. 

[EMEDPA]

An experienced EMPA should not make less than $65/hr. Someone doing high acuity/solo coverage should be in the range of 80-100/hr before shift differentials and holiday pay. 

I am very fortunate at all 4 places I work at. Since covid started, I have gotten significant raises at 3 out of the 4 places I work and one started paying $300/day to take call for sick colleagues and 1.5x pay if I come in. 

56/hr is ridiculous even for UC. 

[EMEDPA]

5 minutes ago, newton9686 said:

I will say though finding an ER position where you feel like you have the scope, acuity and respect you want is a little bit like finding a needle in a haystack. There's just a lot of ego in my experience in the ER (and frequently the hospital in general) which frequently translates to PAs not practicing at the top of their license. Therefore you find lots of ER jobs despite your training and experience where the expectation is for the  PAs  to see all the 4s and 5s so the physician and residents can handle the higher acuity 1s and 2s with less distraction. Some may disagree with me but I personally would rather see 1s and 2s in a hospital with a great culture making 56 an hour than make 75 an hour doing psych clearances and ankle sprains in a hospital with a bad culture. So if you are generally happy and fullfilled with your role, its a good culture but you just don't make what you deserve I would go to HR or leadership and see if you can get a bump in pay. And if they wont budge, start looking for some different PRN opportunities where you could make more and have the same scope. But I wouldn't quit just because a nurse is making more than you. Life is too short for that and it is way to hard to find the ideal job in medicine, especially as a PA in the ER. Because if I was being honest if I had found that ideal job as a PA in the hospital where I had the scope, acuity, training opportunities and respect I wanted, I would have taken far less than 56 an hour in a heartbeat. I love money and I'm not advocating for taking less than you are worse, but I am also saying 56 an hour would of been a lot better financially than the 60K a year I am paying to go back to medical school when I couldn't find that perfect opportunity in the hospital for me. 

Agree. Happiness and respect is worth a lot. I wouldn't leave any of my current jobs if they mandated a 50% hourly pay cut. I could make a lot more doing inner city fast track seeing 4/hr and working for RVUs, but I would be miserable. I am done with that. 

[MediMike]

There's also the COL adjustment for rural Wisconsin.  I have no idea what that would be, and while I agree with @EMEDPA we're both coming from the upper left hand corner of the country where COL is up a bit compared to everywhere else.

I would definitely ask HR for more, but in a way that compares yourself to other PAs or (maybe) MDs.

[Cideous]

My first job was $55/hr 26 years ago.  I mean damn, come-on guys?

[MediMike]

3 hours ago, Cideous said:

My first job was $55/hr 26 years ago.  I mean damn, come-on guys?

Dam you made $110k/yr in 1996? That's pretty nice.

[Cideous]

I did Emergency Medicine.