Feb 23, 2024 NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two
NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two
NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two
When I chose my current job, I took whatever salary I was offered to me because I wanted the job so badly. It was the standard contract salary for all the new nurses fresh out of school. After seeing newer nurses with less experience come in making more than me, I am curious to how the hospital or nurse negotiated that. I always knew that Nurse Practitioners made more money, but I never researched salaries or considered the higher pay as part of my choice to go back to school. As a newer, inexperienced nurse that takes fewer patients, I would expect to make less. As I start to gain confidence and see more patients, I need the skills to negotiate a higher salary. Research has also shown that NPs make different wages based on specialty setting and other social factors (Greene, El-Banna, Briggs, & Park, 2017). A 2017 survey of Nurse Practitioners showed the average salary for a female NP was $96330 (Greene et al., 2017).
If I were seeing about 20 patients a day at a 90 percent collection rate, I would expect the average salary of the 15 patient and 24 patient NP. 103,000 sounds like a reasonable take-home salary for my patient load of 20 (Buppert, 2011). This salary is slightly higher than the average NP salary, but I could also show my boss salaries from the state and my specific specialty to back up my request. I would have realistic goals and expectations. There has been a shift in PCP pay based on performance and patient experiences (Gannon & Becker, 2013). As a future FNP, I have a role in transforming healthcare and giving my patients better care experiences. ACNPs have strong communication skills, improve work culture, and decrease Emergency Room visits (Gannon & Becker, 2013). Patients treated by NPs perceive better care and give higher scores on HCAHPS, leading to better Medicaid reimbursement (Gannon & Becker, 2013). With higher reimbursement rates, I deserve at the minimum the national average for pay, if not more for my patient load.
Greene, J., El-Banna, M. M., Briggs, L. A., & Park, J. (2017). Gender differences in nurse practitioner salaries. Journal of The American Association of Nurse Practitioners, 29(11), 667-672. doi:10.1002/2327-6924.12512
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Buppert, C. (2011). Nurse practitioner’s business practice & legal guide. (4)
Gannon, W. D., & Becker, D. (2013). The acute care nurse practitioner and the transition to pay for performance. Journal for Nurse Practitioners, 9(4), 249-251. doi:10.1016/j.nurpra.2013.01.014
As revenue generators, NPs must be aware of how their work contributes to the overall revenue of the clinical practice. You see 20 patients per day on average and take call every third weekend. According to Buppert (2011), an NP who sees 15 patients per day at $56 per patient visit, on average, brings in $840 per day. Allowing 1 week off for continuing education, 1 week off for illness, and 4 weeks off for vacation, this NP will bring in $193,200 a year, potentially. However, not all bills are paid. With a 90% collection rate—a reasonable collection rate for an efficient practice—this NP actually will bring in $173,880 per year. An NP who sees 24 patients per day will bring in $1344 per day, or $309,120 per year in accounts receivable. With a 90% collection rate, this NP will bring $278,208 to the practice (Buppert, 2011).
Establishing a salary can be a challenge for NPs. Deducting 40% of the NP’s gross generated income for overhead expenses (rent, benefits, continuing education, supplies, malpractice, lab expenses, and depreciation of equipment) leaves $104,280 for the 15-patient-per-day NP and $166,925 for the 24-patient-per-day NP. Further deducting 15% of that figure to pay a physician for consultation services leaves $88,638 in salary for the 15-patient-per-day NP and $141,887 in salary for the 24-patient-per-day NP. Deducting 10% for employer profit leaves $79,775 in salary for the 15-patient-per-day NP and $127,699 for the 24-patient-per-day NP (Buppert, 2011).
What salary would you propose for the contract renewal? How does your salary proposal fit in with the community standard for an NP in a similar practice? Use logical reasoning, and provide evidence based rationales for your decisions. Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP.
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After reading through the case study, there is definitely some figuring to think about. In all honesty, I would feel that the 24-patient-per-day salary is what I would propose for, because of many reasons. Where I currently work as a RN in the Emergency department, we occasionally float to the urgent care to work. This is a rural hospital, but it is a very busy facility. During the winter months, it is not uncommon to see upwards of 60 patients in a 12 hour period. This is definitely a large patient load for 2 nurses and one nurse practitioner. I have worked in that setting, and seen the struggle that it can be, but 24 patients in an 8 hour setting is 3 patients an hour, on average. The AANP suggests that the majority of nurse practitioners see 3 or more patients an hour (AANP, 2018).
To be honest, I would want to suggest a higher salary if I was applying for a position in an urgent care such as this one. If I was seeing 60 patients a day at $56 per patient visit, I would be bringing in a revenue of approximately $870,000. This is nearly 3 times as much as a 24-patient-per-day nurse practitioner. Granted, this is for 24 hour shifts, where the 24-patient-per-day is more than likely an 8 hour day. The nurse practitioner may treat four or more patients per hour throughout the entire work day in an urgent care setting (n.a., 2016). Working in the urgent care doesn’t have the luxury of having a schedule, so the amount of patients that you may see could be greater or lesser than 4-per-hour. On average, it will all even out. I think that when determining salary, it matters where they anticipate you to be working. I would like to work in an urgent care versus a primary practice, so I would want to have a higher salary than what the 24-patient-per-day nurse practitioner proposal states.
References
AANP, (2018). NP Fact Sheet. Retrieved from https://www.aanp.orgLinks to an external site.
n.a. (2016). How many patients should FNPs expect to treat per hour. [Web log post]. Retrieved from https://www.midlevelu.comLinks to an external site.
According to Brown and Dolan (2016), establishing a salary begins with understanding the terms and conditions of the contract. This is an essential element to avoiding conflict. After I have spent many years studying and practicing on a clinical level, the payoff is my salary (Brown and Dolan, 2016). Like many nurses, I feel competent enough to take the heavier patient load, which in summary equates to longer hours and more responsibility. The “community standard” for an NP changes according to which state I live in. Nurse Journal (2018) has released it most recent nurse practitioner salary by state. Nurse Journal (2018) states that my salary is also indicative of my specialty. For instance if I am a general FNP, I should expect to make a little less than an acute care NP or a geriatric NP. The more certifications I hold, the higher my salary is expected to grow. On a national level, salary.com lists a general FNP can command an annual salary of as much as $120,000. I would not ask for this much even though I am justified. Here’s why. The problem is that other job and recruitment sites post different salaries. For instance, ziprecruiter lists that an FNP makes on average $102, 000 per year. Glassdoor.com lists this salary under $100,000–depending on what state and area an NP practices in. Part of the issue with determining my salary is the fact the salaries vary so much state by state. After all that’s said and done, I would hope the owner knows and sees my worth and loyalty. I would hope the owner understands that not meeting my salary expectations could hurt his practice because patients feel more comfortable with clinicians they have established a relationship with. I will come to the table asking for the $102,000. I think this is fair being that I am an independent contractor who must pay many out-of-pocket insurance and licensing costs.
Reference
Brown, L. A., & Dolan, C. (2016). Employment contracting basics for the nurse practitioner. Journal for Nurse Practitioners, 12(2), e45-e51. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2015.11.026
Nurse Journal. (2018). Nurse practitioner salary by state. Retrieved from https://nursejournal.org/nurse-practitioner/nurse-practitioner-salary-statistics/
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