Medscape members were invited to participate in a 10- to 15-minute online survey asking about salaries and benefits, August 12, 2015 through October 2, 2015. Respondents were required to be working in the United States as a nurse, and 8256 nurses met the screening criteria and completed the survey. We included licensed practical/vocational nurses (LPNs/LVNs), registered nurses (RNs), and advanced practice nurses (APNs). APNs include nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists. (Note: LPNs are referred to as "licensed vocational nurses" (LVNs) in some states, but the positions are similar. We combine LPNs/LVNs in this survey).

In the Medscape survey, the average annual gross salary (before taxes) for RNs is $79,000. This is $16,000-$91,000 a year less than the compensation for APNs, which, depending on specialty, is between $95,000 (clinical nurse specialist wages) and $170,000 (nurse anesthetists). However, nurse anesthetists comprise only 0.1% of all nurses in the United States. LPNs/LVNs make the least—only $46,000.

It is hardly surprising that APNs in general are more satisfied with their compensation than RNs and LPN/LVNs, and that the higher the compensation among specific APN specialties, the higher the satisfaction levels. So it is not shocking that nearly three quarters (73%) of nurse anesthetists—the highest-paid nurses—are the most content with their salary, substantially more so than all respondent groups. Among APNs, clinical nurse specialists are the lowest paid and least satisfied (54%) with their compensation. Of interest, however, this level of satisfaction is nearly the same as that reported by RNs (53%), although the latter make $16,000 less than clinical nurse specialists. Less than one half (43%) of LPNs/LVNs are content with their wages.

As in far too many professions, a gender disparity favors men. Our survey findings indicated that male nurses tended to have higher salaries than their female peers, with similar differences among all nursing groups: APNs and RNs (men making 9% more than women) and LPN/LVNs (men making 6% more). The disparities reported from this survey are supported by a 2015 JAMA study,^[1] which found that the salary gap between male and female nurses was similar to the gender gap among physicians. Furthermore, the differences in pay had not changed significantly since the passage of the Equal Pay Act 50 years ago. The authors stated, "A salary gap by gender is especially important in nursing because this profession is the largest in health care and is predominantly female."^[1,2]

According to the US Census Bureau, in 2011 there were 3.2 million female and 330,000 male nurses.^[3] (The overall percentages of male and female nurses in the Medscape survey also resembles that of the general nurse population—about 10% and 90%, respectively.)

Note that the Medscape data use responses from full-time nurses only, so the results are not biased by the possibility of more part-time work by women or men. Of further note, when APN salaries are grouped in this report, we did not include nurse anesthetists, whose percentage in this survey was disproportionately greater than the number of nurse anesthetists in the general nurse population. (And their salaries are much higher.)

As reported, APNs not only make considerably more than RNs, but when the percentage differences between what they made at the youngest and at the oldest ages are compared, APN income increases at a greater rate over time: 15% vs 11% for RNs. (No LPNs/LVNs who were in the youngest and oldest age groups responded to this survey.) RNs are working longer than in previous decades. A 2014 study reported that between 1991 and 2012, 74% of nurses were still working at age 62 years and 24% at age 69 years. In the previous 20-year period, only 47% were working at age 62 and 9% at age 69.^[4]

Among full-time RNs, those who live in the West make the most ($105,000), followed by RNs in the Northeast ($87,000). RNs who live in the North Central and the Southeast are at the bottom in compensation ($69,000 and $74,000, respectively).

Among full-time APNs who answered this survey, those who work in the far West also make the most ($120,000), followed by those in the Northwest ($108,000). As with RNs, those who make the least live in the Southeast ($95,000) and North Central region ($94,000).

The US Bureau of Labor Statistics (BLS) reported that the highest-paid RNs, with a median wage of $68,540 in 2012, were working in the government (these data included part-time workers).^[5] The Medscape report used only full-time compensation; RNs working as contract workers (including those who worked for agencies or were travel nurses) made the most, at $95,000, whereas those in the government (which included the military) made $93,000. Hospitals, where the majority (61%) of RNs work,^[4] were third (at $83,000 for inpatient care) and fourth (at $79,000 for outpatient settings) in compensation levels. (Note: The number of LPN/LVN respondents was insufficient to reliably report their results for this question.)

APNs who work in long-term care (including nursing homes) and in the government, including the military, make the most ($106,000), but are followed very closely by those doing inpatient work in hospitals ($105,000). No full-time APNs responding to this survey reported agency or contract work. According to the latest BLS report, nearly one half of APNs work in medical offices, and most of the others in hospitals.^[6]

The higher salaries paid for advanced degrees compared with lower degrees is expected. The push for higher degrees for RNs and APNs entering practice, however, is not without challenges. For RNs, the cost of a BSN degree can be up to $100,000 more than the cost of an associate degree, although the annual salary difference in this survey is only $6000.^[7] Some nurses believe that the salary difference ($9000 in Medscape's survey) between a master's and a doctoral degree does not compensate for the added educational cost.^[8]

One quarter of all nurses work some overtime, and of those who do, 62% work less than 5 extra hours a week. About one quarter (24%) of nurses who work overtime spend an extra 6-10 hours per week, and 14% extend their work time beyond 10 hours weekly. Overtime work is often used as solution for understaffing and variations in patient load, which can have a negative impact on both nurses and patients.^[9] The American Nurses Association recommends limiting work weeks to 40 hours within 7 days and work shifts to 12 hours.^[10]

Fifty-seven percent of nurses who reported that they were contract, travel, or agency workers routinely work overtime. About one third (34%) of nurses in hospitals inpatient care worked beyond regular hours. Percentages of overtime work were lowest in public and occupational health (6%) and educational settings (10%), and among academic faculty (11%).

For RNs paid hourly, rates were highest in hospital settings: $39.60 for inpatient care, followed by $38.30 per hour for outpatient care, which includes clinics. The lowest hourly rates were $28.60 for nursing work in public and occupational health and in non–hospital-based medical settings. Hourly rates for APNs are significantly higher in all settings, with exception of faculty positions, where the difference is less: $37.60 for RNs and $40.50 for APNs. (Note: The number of LPN/LVN respondents was insufficient to reliably report their results on this question.)

Over one half (52%) of nurses reported an increase in salaries in 2014 compared with 2013. Only 9% said their compensation had declined. Between the late 1990s and into 2000, despite increasing concern about a nursing shortage, nurses' pay did not increase at all. In the following decade, however, wages rose.^[11] Between 2000 and 2010, RN salaries increased by about $20,000 and LPNs by $11,500, contributing to an increase in the number of nurses entering the field over that same period.^[12]

More than one third (36%) of nurses who experienced a decrease in salary related it to a job change. About 22% of this subset of nurses experienced a decline in pay because they worked less time—they worked fewer hours, began part-time work, returned to school, or had less overtime. Twenty-four percent experienced a pay cut. Twenty-two percent chose "other." Many of the verbal responses to that option indicated that salary decreases were due to location or practice changes or increases in health insurance costs.

An increase in pay for two thirds of nurses (slightly over one half of all nurses who responded to the survey) was due to a raise. Eighteen percent earned more in 2014 than in 2013 either because they began working full-time, took on an additional job, or worked more hours. Fourteen percent received a bonus. Only 15% of nurses who said they had an increase (about 8% of all nurses) had been promoted or advanced up the clinical ladder.

Forty-three percent of nurses reported some form of supplemental income. In this Medscape survey, 15% of nurses reported that they took on another job and 17% said they worked extra hours, which included working night shifts, weekends, and holidays. Nine percent received extra pay for on-call shifts, 6% acted as preceptors, and 5% took on charge nurse work. Overall, of those who reported that they had supplemental income in 2014, the increase between 2014 and 2013 was less than 5% for nearly three quarters (72%). Only 10% of these nurses had an increase of 11% or more.

According to this survey, most full-time nurses get some kind of paid time off (vacation, sick days, personal/professional time off), although fewer LPN/LVNs (84%) get time off than RNs (93%) and APNs (91%). Only about three quarters of LPN/LVNs (74%) get health insurance that is employer-subsidized, in part or in full, compared with 88% of RNs and 85% of APNs. For 71% of APNs, their employer covers their liability insurance, compared with only 13% of RNs and 11% of LPN/LVNs (although the cost for this insurance for the two latter groups is usually less than $100 a year).^[13] Of note, 9% of LPN/LVNs who work full-time report having no benefits at all.

With the passage of the Affordable Care Act (ACA) in 2010, expanding the role and number of nurses providing healthcare to a larger patient population became an important national objective.^[14] Nevertheless, so far, its impact on nurse compensation has been minimal. In the current survey, the majority of nurses, regardless of specialty, have experienced no effect on their income, whereas more than one quarter (27%) of LPN/LVNs, 20% of RNs, and 12% of APNs report a decrease. Only a very small percentage of each group said that the ACA had been responsible for an increase in salary. Many verbal comments from nurses in this survey indicated dissatisfaction with the impact of the ACA, however, particularly with regard to an increased workload with no commensurate increase in pay.

Three quarters of all nurses owe money for mortgages or home equity loans on either a primary or secondary residence. The other major debts (59%) are automobile loans. Twenty-eight percent still are in debt for college or nursing school. Of interest, according to this year's Medscape report on physician debt and net worth, this compares closely with the percentage of family physicians who still have outstanding loans for school (34%).^[15]

It makes sense that the more nurses make, the more likely they are to live below their means (ie, they can pay their bills, save money, and have little or no debt). About one third of APNs (34%) live below their means, which compares favorably with physicians (24%) who answered the same question in this year's Physician Debt and Net Worth Report.^[15] Only 15% of LPN/LVNs can make that claim, followed by RNs (29%). Most nurses live within their means, and only small percentages of all nurse specialties live above their means (ie, spend a lot and are in debt).

Only about one quarter (26%) of nurses identified their relationship with patients as the most rewarding aspect of their job, which is a lower percentage for this category than that reported by both male and female physicians (32% and 37%, respectively) in the 2015 Medscape Physician Compensation report.^[16] Only 22% reported being good at what they do as their highest professional reward, and just 18% cited "proud of being a nurse."

This word cloud reflects the verbal comments on the question regarding what nurses find more rewarding about their jobs. One nurse commented that her highest rewards were "relationships with my coworkers and the joy of caring for people, although it's not like it used to be, as patients are now customers and expect to be placated and not cared for." On the other hand, a happy 11 nurses who responded verbally wrote that they would choose "all of the above" options.

Only 60% of APNs, 56% of RNs, and 48% of LPNs/LVNs would choose nursing as a career again, percentages that are even lower than the 64% of physicians who reported in the Medscape 2015 Physician Compensation Report^[16] that they would make medicine their profession again. Nurses are even less satisfied with their practice settings: About one third (32%) of APNs, 22% of RNs, and 12% of LPNs would choose the same practice settings again.

About one half of nurses with a doctoral degree would choose the same educational preparation again, whereas one third would go for a master's degree again. Far fewer would choose the lower degrees. In the previous slide, 37% of APNs, 51% of RNs, and 60% of LPNs would seek additional educational opportunities. In 2014, the American Association of Colleges of Nursing recommended that the preparation necessary for becoming an APN be at the doctorate level by this year.^[8] One nurse who responded to the survey asked, "For those APNs who have their [doctoral] degrees, I would ask if they feel this degree has actually helped their career/income/status?"

Forty-three percent of nurses in non–hospital-based medical offices would choose that same setting again, which is far greater than the 25% overall percentage of all nurses who would choose the same practice setting in general. Less than one half of nurses (40%) who were faculty members would choose that setting again. The least favorite settings were nursing homes (21%) and working for the government, which included the military (23%).