In reading MODERN HEALTHCARE's recent article "IOM study shows jump in nurses' wages" (Feb. 12, p. 40), I was disappointed to find the story rife with misleading and biased conclusions about nurses' salaries.
After carefully reviewing my copy of the Institute of Medicine study (Nurse Staffing in Hospitals and Nursing Homes: Is It Adequate?), I was surprised to note that it contained barely a page on the issue of nurses' wages and their possible impact on the nursing job market, and included one paragraph containing salary data from the Bureau of Labor Statistics. This is hardly a comprehensive economic analysis of an extremely complex issue.
More perplexing, the article notes the growth in nursing jobs between 1983 and 1993, but fails to note that this growth occurred during a period of increased acuity of patients and intensity of inpatient services, and includes growth in both clinical and nonclinical roles as well as in all employment settings, not only in acute-care hospitals.
Why was Alta Bates Medical Center, a Berkeley, Calif., hospital where registered nurses' salaries are the highest in the nation (and the object of a lawsuit concerning its restructuring plan), selected to illustrate RN salaries?
First of all, there is nothing average about salaries of $60,072 to $92,822. The truth is that only 12% of nurses paid by the hour earn more than $50,000, and only 5% make more than $60,000 ("1995 Earnings Survey," RN, October 1995, p. 48). In fact, pay for RNs makes limited progress over a typical career, and the long-term financial rewards for nursing practice are much more restricted than in other occupations, where pay often doubles or triples over the span of a career.
Let's examine the trends in compensation for hospital staff nurses over the past 10 years to get a picture that's clearer than the distorted one painted by the article. In 1994 the median weekly salary for an RN was $682. Annualized, that is $35,464. In 1993, however, the median weekly salary was $5 more at $687, which annualized is $35,724, or $260 more than one year later.
With respect to nurse salaries 10 years earlier in 1983, the median weekly salary was $396, which annualized is $20,592. So, from 1983 to 1994 nurse salaries rose a total of $14,872, or, on average, $1,352 annually. I question whether "soared" is the appropriate way to describe this increase.
The modest salary gains made by nursing-a predominantly female and traditionally underpaid profession-should be viewed as important progress toward the goals of equity and fair pay for work of comparable value to that of other professions. It's disheartening to see that progress treated so derisively by MODERN HEALTHCARE.
Appropriate utilization of RNs is cost-effective. When you consider the range and scope of RN responsibilities, which include, but are certainly not limited to, continuously monitoring the status of patients, detecting critical changes in patient condition, providing life-saving care, providing education and counseling to patients and their families, preparing treatment plans for the chronically ill, and offering compassion and caring to patients and their families in an environment that is often cold and confusing, an average salary of $35,464 makes RNs the best value in healthcare.
Furthermore, a decade of research demonstrates that when there are more nurses, there will be lower mortality rates, shorter lengths of stay, fewer complications and even lower costs. A nurse's median weekly salary is just slightly more than the median cost of one day in the hospital. With nurses' positive impact on patient outcomes and a significant correlation between high RN staffing and shorter lengths of stay, hospitals save money by using highly skilled nurses in adequate numbers.
Any savvy payer or provider should be able to recognize the significant return on investment that RNs contribute by reducing lengths of stay and readmissions. The ill-conceived decision by providers to de-skill their work forces and replace RNs with unlicensed aides to save money and increase profits has proved to be a poor cost-saving strategy and a detriment to patient safety. Further, unlicensed aides are the most expensive workers in hospitals because 50% of their time is unproductive. The reason is they can't make nursing decisions and must receive instructions from a nurse.
Curiously, the largest growth in the history of RN employment and salary came shortly after the introduction of the Medicare prospective payment system in 1983. The shift from a cost reimbursement system had a significant impact on hospitals and was followed by a brief period of cutbacks in registered nurse staffing. However, hospitals found that attempts to economize by reducing use of RNs left their facilities ill-equipped to provide the more intensive care required by an increasingly acute patient population. Hospitals will find themselves faced with a similar dilemma as they continue to decrease their nursing work force to save dollars in the short term, resulting in significant loss in quality and value over time.
Although the IOM report predicts that RN job growth in the nonhospital sector will provide employment opportunities for RNs who are displaced from acute-care settings, the American Nurses Association's assessment of the environment finds that this growth has been slow because efforts to cheapen patient care haven't been limited to the inpatient sector.
As healthcare systems place greater emphasis on increasing revenues and maximizing profits, growing needs for nursing care go unmet. The ANA believes that any assessment of the need for nurses as well as their value in the changing healthcare system must be based first and foremost on the healthcare needs of the American people and not on market-driven or unsound arguments to justify decisions that adversely affect all of us.