How to Negotiate a Nursing Salary

May 26, 2022

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When seeking employment, nurse practitioners (NPs) look for a position that best fits their skills, interests, and experience. After the interview and job offer, a crucial part of the job search process begins: the contract negotiation.

This can be an intimidating process. NPs tend to focus on patients rather than themselves, whether they’re new to the field or seasoned veterans, but contract negotiation is a crucial component of the hiring process. Not negotiating a fair and equitable compensation and benefits package may impact how an individual feels about the job over time, giving rise to dissatisfaction and resentment.

Fortunately, nurses don’t have to enter negotiations without a strategy. These tips and tactics can make it more likely for you to reach an NP salary that works for all parties.

Nurse Practitioner Contract Negotiation

After receiving a job offer, the first step in how to negotiate a nursing salary is to gather information about the position and the employer. Here are some questions to consider from the American Association of Nurse Practitioners (AANP) when negotiating an NP employment contract:

Is the position salaried or paid per hour, per day or per patient?
What’s the value of the services you’ll provide in terms of practice charges for each patient visit?
What’s the value of the services you’ll offer in terms of your net worth to the practice?
What will the patient load be on a daily or weekly basis?
What benefits are included? Health insurance, vacation, sick time, travel allowance, malpractice insurance and continuing education allowance are all negotiable.

Last, determine the practice’s expectations for the position and whether they’ll cover the scope of your NP training and experience. The position shouldn’t entail tasks and responsibilities beyond your expertise.

Effectively negotiating an NP contract can play a key role in finding a position that’s rewarding in career advancement and financial compensation.

Researching Salary Averages

The simplest way to determine what your salary should be is to compare salaries for your position. The website Money Under 30 lists several web-based options for analyzing salary rates to help determine an appropriate amount. However, some options like Glassdoor and Payscale base their data on self-reporting, which can bring their reliability into question. Salary information on these sites tends to be more trustworthy for positions that have specific job duties and requirements, such as licensing and certification.

The U.S. Bureau of Labor Statistics (BLS) provides a financial baseline for NP positions. According to the BLS, the mean annual salary for NPs was $114,510, or an hourly rate of $55.05, as of May 2020.

These are the median salaries for NPs paid by the profession’s top employers.

Outpatient care centers: $123,850
General medical and surgical hospitals: $118,210
Other health practitioner offices: $112,040
Physicians’ offices: $111,310
Colleges, universities and professional schools: $108,060

The BLS lists the five states with the highest mean annual salaries for NPs.

California: $145,970
New Jersey: $130,890
Washington: $126,480
New York: $126,440
Massachusetts: $126,050

These are the five states with the lowest average NP salaries.

Tennessee: $99,370
Alabama: $99,790
Florida: $101,060
South Carolina: $101,190
Kentucky: $102,460

Researching Employers’ Compensation Strategies

To research the value of the benefits you’re offered during an NP contract negotiation, you can use a tool such as the 2021 Advanced Practice Salary Guide from job search firm DirectShift. The guide, which is available for download after completing a survey, contains several metrics that can help NPs make comprehensively informed decisions, such as:

Benefits information, such as health care, paid leave and 401(k)
Continuing education funds information
Median annual salary by specialization
Salary by role (lead, manager, director, C-suite executive)

Understanding Compensation Types

The compensation structure for NPs and other advanced-practice providers (APPs) continues to evolve as these positions play key roles in an expanding range of health care settings. While the COVID-19 pandemic disrupted this evolution, pre-pandemic trends suggest the potential for robust growth in a post-pandemic environment.

For instance, the 2021 Advanced Practice Provider Compensation and Productivity Survey produced by workforce strategists SullivanCotter reports the growth in the number of APPs that year exceeded expectations by 1%. (Growth also exceeded expectations by 6% in 2020, 7% in 2019 and 8% in 2017.) The increased reliance on advanced-practice nurses as leading members of health care teams has led to innovative, incentive-based bonuses and other compensation based on performance.

Incentive plans for advanced-practice nurses who work in clinical settings are usually based on a handful of metrics. One of these is the work relative value unit (wRVU) used by Medicare to determine reimbursements. Other metrics measure the value of care versus quality of care and the quality of the patient experience.

AANP outlines the seven benefits NPs should negotiate.

Health insurance
A minimum of three to four weeks of vacation
Sick leave
Continuing education allowance
Malpractice insurance
Membership in at least one professional organization
An office subscription to an appropriate NP journal

AANP also suggests that if an NP’s role includes house calls, the NP should also negotiate for a travel allowance.

Negotiating for a New Position vs. Renegotiating a Current Position

A strategy employed by many NPs who are considering a new job is to use the information they gather about their potential new position to renegotiate their NP contract with their current employer. Health care recruitment firm CompHealth offers six tips for NPs and physician assistants who are preparing to renegotiate their employment contracts.

Be prepared to have your request denied by your employer. Remember that the best way to get what you want is to ask for it and advocate for it.
Collect plenty of data about your work. Have a clear idea of the salary and benefits you believe you’ve earned and be ready to explain why you deserve them.
Consider the value of non-cash benefits, such as increased paid time off, bonus structures and reimbursement for professional expenses.
Don’t feel rushed to accept or decline an offer when you receive it. Take the time you need to review the plan, compare it to other potential offers and prepare to make a counteroffer.
Always keep a sunny, optimistic attitude about the negotiation, whether it’s for a new contract or to rework an existing one. Keep in mind that a good contract benefits both parties.
Have a bottom-line figure in mind for your salary and be prepared to walk away from the negotiation if the other party isn’t prepared to meet it.

Resources to Prepare for a Nurse Practitioner Contract Negotiation

Nurse Practitioner Business Owner, “Clinicians Business Tip: Contract Basics” — The terms that are included in a typical NP contract are described from a non-attorney’s perspective.
SalaryExpert, Nurse Practitioner — Entry-level, average and senior NP salary estimates are updated daily, and salary potential is calculated for the next five years.
CompHealth, How to Negotiate a PA or NP Contract — Get familiar with the language and process of negotiation, including typical contract details, non-negotiable items, common mistakes to avoid and best practices.

Nurse Practitioner Contract Negotiation Tips and Resources

Once the objectives for your NP contract negotiation are clear and you understand the issues that must be addressed, the next step is to list the contract terms that must be met.

The Houston Chronicle lists the contract elements that NPs may consider deal-breakers.

For NPs negotiating their first contract, it may be a minimum acceptable salary.
Conversely, for experienced NPs who are more flexible about salary, having a flexible schedule or more time off may be their contract priority.
In addition to researching the prospective employer, be sure to confirm that you possess all licenses and certifications required to practice in the state in which the employer is located.

Tips for Negotiating a Fair Pay Rate

The salary NPs negotiate as part of their employment contract will be based on their value to the employer, so be prepared to demonstrate that your productivity and the value you bring merit the salary figure you propose in your NP contract negotiations.

These are among the factors commonly considered in determining an NP’s pay rate.

Patient load: AANP’s employment negotiations’ guide emphasizes the value that NPs and other APPs bring to their employers. They reduce the number of medical complications in patients, shorten the time patients are admitted or treated, and improve patient satisfaction.
Job duties: Determine whether the employer measures NP productivity by wRVUs, and if so, how they’re calculated.
Practice capabilities: Let the employer know that you have the certifications, experience, skills and other qualifications the position requires.

Tips for Negotiating Benefits

Health insurance, paid time off and other benefits are all negotiable, although doing so requires that you collect information to bolster your case for added benefits. One way to do so is to solicit multiple job offers and compare the benefits packages they include. Use a side-by-side comparison to indicate to a prospective employer what others are offering and ask them to match or exceed those offers.

Taking a Collaborative Approach to Negotiation

When dealing with potential employers, always maintain a positive outlook and exhibit the cooperative and enthusiastic demeanor you’ll bring to the job. Most employers will appreciate the fact that you’ve done your research and are prepared with information about comparable salaries and other benefits for the region and the characteristics of the position.

Responding to Questions Pertaining to Salary

At the start of the negotiation process, the employer is likely to ask you about your salary requirements. For newly licensed NPs with limited work experience, it’s often best to respond by saying you’re not sure and to counter by asking the employer about an appropriate salary range. Be cautious about offering a starting salary figure early in the negotiation. You may find yourself locked in before other important terms of the contract can be negotiated.

Confirm with the prospective employer that you’ll be eligible for annual raises and salary adjustments based on inflation or merit. Ask the employer how they’ve handled NP pay raises in the recent past. Also ask about the policy for shift differentials and higher pay for working in acute care and other health care environments.

Listening for Salary Clues During the Interview

The information the prospective employer volunteers during the contract negotiation provides insight into the metrics it uses to set salaries and measure NP performance. The answers to these questions you ask during the negotiation will help you understand how the employer measures NP performance.

Does the organization bill for the work done by NPs? In other words, do NPs generate revenue for the employer?
If the employer uses wRVUs to measure performance, how are they calculated?
Are NPs required to bill under their own National Provider Identifier (NPI) number? (The Centers for Medicare and Medicaid Services explains how to apply for an NPI.)
Is the NP starting salary adjusted based on the cost of living in the local market?

Resources for Nurse Practitioner Contract Negotiation Tips

The People Development Magazine, “Contract Negotiation Tips for Nurse Practitioners” — These tips emphasize preparation and market research and discuss the importance of self-reflection to determine the skills an individual can leverage during the negotiation process.
The Atlanta Journal-Constitution, “It (Almost) Never Hurts to Ask: Negotiating Your Nurse Salary” — Topics covered include determining salary goals prior to negotiation, understanding an employer’s pay structure, sharing experience and using empathy while negotiating.
National Association of Pediatric Nurse Practitioners, Negotiating Salary and Other Benefits — The advice covers the importance of negotiating benefits such as vacation time and schedule flexibility as part of the contract. It also discusses how experienced individuals may be able to turn negotiation into an early performance review.

What Is a Nurse Practitioner’s Salary?

NP salary structures differ based on several key factors, according to CompHealth. The type of practice plays a key role here, as an individual’s salary may differ in the following settings:

Hospital
Outpatient clinic
Urgent care facility
Public health environment

Other factors that may impact the type of salary an individual may receive include the following:

Employer type: There may be salary differences among those who work in medical groups, in private practices or as independent contractors.
Location: Salary may vary from state to state and between urban and rural areas.
Gender: Unfortunately, a gender gap in pay still exists in the nursing field, as male NPs typically earn more than female NPs.

Skill-Based Factors That Influence Nurse Practitioner Salaries

An NP’s salary can be based on several factors, including education level, years of experience, licenses and credentials, and job location. However, it can also be based on specific skills.

The compensation website Payscale reports on the skills that have the most impact on NP salaries (percentage increase over the average salary for all NPs).

Gynecology: 8%
Diagnosis and Treatment Planning: 8%
Interventional Radiology: 8%
Medicine and Surgery: 7%
Intensive Care Units: 6%
Allergy Testing: 6%
Occupational Health: 5%
Acute Care: 5%
Palliative Care: 5%
Neuroscience: 5%

Comparing Salaries Based on Nurse Practitioner Specialty

One of the factors that has the greatest influence on an NP’s salary is the area of practice. Payscale’s survey-based salary reports reveal that some NP specialties typically command a higher median annual salary than others.

The approximate average annual salary for some of these specialties, as of March 2022, are:

Psychiatric Mental Health: $112,400
Neonatal: $108,900
Adult Gerontology Acute Care: $96,100
Adult Gerontology Primary Care: $89,500
Acute Care Pediatric: $90,000
Family: $97,800
Primary Care Pediatric: $92,700

Using Salary Calculators to Determine Accurate Salary Ranges

One of the most effective ways to determine an appropriate salary range during an NP contract negotiation is by using a salary calculator such as Job Search Intelligence.

Select the state and region where the employer is located.
Use the menus to choose the number of years of work experience the position requires and your highest level of education.
Select the school you graduated from and the state in which you last attended school.
Choose your major and then one of three values indicating how relevant your degree is to the job you’re considering (very, somewhat or not at all).
Select your GPA.

The salary calculator returns entry-level salary information for the position and location, as well as the salary of top earners in the area, the median salary for the occupation and the salary the calculator believes an employer is likely to offer you. The figure excludes benefits and other forms of compensation.

Analyzing Compensation Trends in Specific Job Markets

As demand for NPs and APPs increases in all practice settings, incentives represent a larger share of their total compensation, as SullivanCotter notes. The median annual incentive-based salary increased for all NP specialties between 2018 and 2021.

Resources for Determining Nurse Practitioner Salaries

S. Bureau of Labor Statistics, Nurse Practitioners — NP salaries are broken down by state and regional/metropolitan areas.
Association of periOperative Registered Nurses, AORN Compensation Calculator — This tool helps NPs and other advanced-practice nurses determine a fair salary based on more than a dozen factors, such as years of experience, education level, location and setting of the employer.

Ensuring Fair Nurse Practitioner Compensation

No matter your level of experience, effective contract negotiation is key to finding success in any NP position. Determining a fair level of compensation for a prospective job — and knowing how to ensure you receive that fair compensation — sets the stage for a rewarding career, regardless of the path you choose.

When planning for your next salary discussion, keep in mind that employers value specialized skills. Programs like Duquesne University’s online post-master’s nursing certificates can give nurses an edge in negotiating competitive salaries. Learn more about how Duquesne can help advance your career.