A great article from Nurse.com

Nurses speak out about gender pay gap

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By Nurse.com on August 10, 2015 National News Briefs

By Lisette Hilton
The Greek philosopher Heraclitus’ doctrine that everything changes and nothing stands still doesn’t seem the case when it comes to equal gender pay in nursing, a profession where men have steadily out-earned women since 1988. In fact, nurse researchers report in the March 24/31 Journal of the American Medical Association that there has been no narrowing of the gender pay gap across settings, specialties and job titles for about a quarter century.
This isn’t the first paper to document higher salaries for male RNs, but it does offer a previously unstudied view of the pay gap, according to lead author Ulrike Muench, PhD, RN, of the University of California, San Francisco. “There have only been a couple of studies that have looked at gender earning differences in nursing,” Muench said. “They were conducted over 10 years ago and didn’t examine data over time. Our study is the first to examine a trend over time, and our goal was to include more [updated]data.”
The study reflects data from nearly 88,000 RNs from the National Sample Survey of Registered Nurses from 1988 to 2008, as well as 205,825 RNs from the 2001-2013 American Community Surveys. Men represented 7% of both data sets. Both samples showed male RNs’ salaries were higher than female RNs’ salaries every year.
While researchers estimated the overall adjusted earnings difference was $5,148, they found larger and smaller gaps in different settings. The salary gap dropped to $3,873 for RNs working in hospitals, but rose to $7,678 in ambulatory care. Pay gaps varied among the seven specialties studied: cardiology, psychiatry, neurology, pediatrics, med/surg, orthopedics and chronic care. The gap was biggest in cardiology, at $6,034.
“It is important to remember that our study didn’t capture all clinical specialties that nurses work in, such as immunology, gynecology or infectious diseases,” Muench said. “This is for two reasons: The surveys didn’t include all specialties in every survey year …. Other specialties, such as gynecology, had too few men to be included as a separate specialty.”

Largest gap

Gender pay gaps also varied by position, with nurse anesthetists standing out with a gender pay gap of $17,290.
The fact that nurse anesthesia is the highest paid nursing specialty and attracts more men than any other area in nursing offers no explanation as to why there is such a significant pay gap between male and female CRNAs, according to Sharon Pearce, CRNA, MSN, president, American Association of Nurse Anesthetists.
“From a practice standpoint, all nurse anesthetists — male and female alike — receive the same education and training, and they all provide the same safe, high-quality patient care for every type of procedure requiring anesthesia,” Pearce said. “The AANA and the profession, as a whole, would like to see this gap eliminated, because there’s no acceptable reason for there to be such imbalance in the pay scales.”
The gender pay gap, while it’s making headlines in nursing, is relatively narrow compared with other professions. For example, women who are financial advisers make only 61% of what their male colleagues make, according to Ariane Hegewisch, a study director at the Institute for Women’s Policy Research, Washington, D.C.
Nurses, on the other hand make 90% of what their male counterparts make, according to IWPR’s calculations based on the U.S. Bureau of Labor Statistics Current Population Survey. IWPR published its fact sheet “The Gender Wage Gap by Occupation 2014 and by Race and Ethnicity” in April 2015. “But it is nevertheless quite shocking that [nursing]does have a gap, given that hospitals often are either in the public sector or are more likely to be unionized,” Hegewisch said. “Typically, there is greater transparency in the way people are appointed and the ways they are paid and promoted.”

What’s causing the gap?

So, why the lag in female nurses’ pay? “Practice pattern differences, career choices and educational differences explain most, if not all, of the gender gap in nursing,” said Linda H. Aiken, PhD, RN, FAAN, FRCN, professor in nursing and sociology and director of the Center for Health Outcomes and Policy Research, University of Pennsylvania in Philadelphia, who has studied the nursing workforce in the U.S. and other countries.
“Men work more hours, which is an important factor since a large share of nurses are paid on an hourly basis,” said Aiken, who was not involved in this study. “They are more likely to practice in geographic areas with higher compensation, including the two coasts and large cities. They are more likely to select highly compensated clinical specialties …. Men are more likely to have a bachelor’s degree or higher, and education is associated with compensation.” Research on male and female nurses suggests that male nurses tend to move up the career ladder faster than female nurses, according to Hegewisch. This phenomenon is referred to as the glass escalator, according to a May 21, 2012, article on Forbes.com. Women climb the ladder in a female-dominated profession, like nursing, while men glide to the top on an invisible escalator.
Caren Goldberg, PhD, an assistant professor of management at American University said in the Forbes article that part of that phenomenon occurs because women are more likely to experience career interruptions, including taking time off to care for children or elderly parents.

Closing the gap

Aiken said there are solutions that would help narrow any gender gap in nurse compensation, including realigning Medicare, Medicaid and private insurance payment policies to fairly compensate nursing care across settings and specialties. “Nurse practitioners still get only 85% of the payment that MDs receive for exactly the same services, and primary care providers are compensated less than in rapidly growing clinical specialties such as nurse anesthesia,” Aiken said. “Payment policies for long-term care including mental health services require nurses to sacrifice their incomes to provide much needed care.”
Hegewisch suggests nurses start a discussion about pay — that is, if they can talk about salaries. “Nationally, 60% of private sector workers say they are either prohibited by contract or strongly discouraged by their management from discussing salaries,” Hegewisch said.
Nurses can go to websites, such as Glassdoor.com or Monster.com, to share and compare salaries, according to Hegewisch. They also can talk among their peers; then, decide whether to approach management about any gaps in pay. “Be proactive,” she said.
Hegewisch said research has shown men are more likely than women to hustle for pay increases, and when women do negotiate, they may be perceived less positively than when men negotiate.
More research is needed to study possible explanations for gender pay gaps in nursing, Muench said. In the meantime, employers can introduce open-pay policies that increase transparency in compensation. For example, the U.S. Department of Labor offers “An Employer’s Guide to Equal Pay,” which includes useful tips on addressing questions about pay discrepancies.
Pearce said the AANA will be looking closely at the research from various sources and considering strategies for educating its members and their employers to ensure that all CRNAs are being compensated equitably.
“I am hoping that our study can raise awareness on this issue and that nurse employers will use our results to examine their pay data to see if differences in earnings exist in their organizations,” Muench said. “If not, then this is a great outcome; if yes, employers can assess if there are legitimate reasons for paying men more than women.”
Lisette Hilton is a freelance writer.

10 Ways for Nurses to Get Promoted

Are you stuck in a rut at work? If so, it might be time to consider a promotion. You may not have the authority to make that happen exactly, but you shouldn’t wait around expecting to be noticed either. You can—and should be—your strongest supporter. If you’re ready to take charge, here are 10 proactive ways to help you take that next step in your career.

1. Don’t Wait to Get Started
Don’t put off getting your career going, advises Beverly Malone, PhD, RN, CEO of the National League for Nursing (NLN) in New York City. “A lot of young people in particular will say, ‘I don’t know exactly what I want to do, so I’m going to wait before I make a move,’” she explains. “My advice is get started, even if you have to change directions later.”
For Malone, starting her career moves early made it possible to have a highly varied and distinguished career. The eldest of seven siblings, she was raised by her great-grandmother in rural Kentucky. As a young nurse, she worked in a psychiatric unit. Later, she served as dean and vice-chancellor of a historically black college. Then she became president of the American Nurses Association (ANA). And before taking the helm of the NLN, she lived in London, serving as general secretary of the Royal College of Nursing.
One of the hardest decisions for young nurses is choosing a field of study for a degree. “Don’t be too concerned about what kind of degree you get,” Malone advises. “There will always be something you can do with it later.” For example, she no longer works as a psychiatric nurse, but she says her experiences in the field still serve her well.

2. Be a Team Player
You can’t rise through the ranks without being a team player, argues Kanoe Allen, RN, MSN-CNS, PHN, ONC, executive director of nursing at Hoag Orthopedic Institute in Irvine, California. “Understand the staff you are working with,” she suggests. “The team can make or break you.” She also recommends volunteering for extra duties. “It allows other people to see you,” she says.
Raised in a family of Chinese, Japanese, and Hawaiian descent, Allen rose rapidly as a young nurse. Taking a job at a critical care ED, she was named charge nurse within a year and became interim administrator a year after that. A rapidly rising young nurse might have ruffled a lot of feathers among older nurses, but Allen thinks she “garnered some good will from the staff.”
Allen puts a lot of emphasis on social skills. “You need to understand the interplay between personalities and departments and work in a collaborative manner,” she advises. She still finds these skills invaluable as an administrator. “You have to really listen to your team,” she adds.

3. Find a Mentor
Finding a mentor is important to your career, because mentors know about “the back stairs,” Malone says, referring to the secrets of getting ahead in a large organization like a hospital. As a floor nurse, “you know there’s a door to go up, but you don’t know where the door is until a mentor shows you it.”
Sasha DuBois, RN, MSN, a 29-year-old floor nurse at Brigham and Women’s Hospital in Boston, relies on several mentors to show her the way. She acquired her first mentor in nursing school, when she heard her making a speech. “I walked up to her afterwards and struck up a friendship,” DuBois recalls. “She’s invested in seeing me grow.” They get together at least once a year.
Allen advises young nurses to cultivate people who are very accessible to them and can serve as career coaches. “A coach is someone who can be honest and tactful,” she says. “She can provide supportive feedback and help you with your own critical thinking.”

4. Follow Your Passion
You can’t have a successful career unless you are passionate about your work, argues Maria S. Gomez, RN, MPH, founder of Mary’s Center for Maternal & Child Care in Washington, DC. “If you want to achieve anything, you have to have a passion,” she says. “If you only care about your own job, it’s easy to get burnt out. You just go to work and come home.”
As an immigrant from Colombia at age 13, Gomez did not know any English except “thank you.” When she went to work in a large organization as a young nurse, she was unable to find a mentor. ‘The older nurses I worked with didn’t like their work,” she says. “I couldn’t wait to move on.”
She found her calling working at a public health department. “I saw a lot of injustices, and I wanted to make a difference,” she explains. In 1988, she founded Mary’s Center as a shelter for women immigrants from Latin America. Today, the organization has a budget of $39 million and provides care at six locations for low-income women, children, and men in the DC area.

5. Go Back to School
Going back to school to get a higher degree or certification is really about “creating opportunities for yourself,” says Kerry A. Major, MSN, RN, NE-BC, chief nursing officer for Cleveland Clinic Florida. “A degree can open multiple doors and help you find out what your passion is,” she says. “A lot of young nurses don’t realize all the choices that are out there.”
A degree makes you more competitive, Major says. At many hospitals, a master’s degree is a requirement for entry into management. But apart from spiffing up your resume, a degree is an opportunity to learn new skills. “The literature shows that a degree produces a more rounded nurse,” she explains.
Major notes that school is a great opportunity to mix with nurses from other walks of life who you might never have met within your own institution. “You can get an idea of all the opportunities that are out there,” she says. “You’ll meet someone who works in public health, and someone else is an operative nurse.”

6. Nurture Your Communications Skills
Speaking and communications skills become more important the further you move up the career ladder, says Glenda Totten, RN, MSN, CNS, PHN, director of nursing service at Kaiser Permanente Los Angeles Medical Center.
Totten is constantly honing her skills. She identified a senior manager with a great communication style and started paying attention to what he says and how he says it. “I listen intently,” she says. “He’s very precise. He doesn’t beat around the bush when answering questions. He’s able to give bad news in a realistic way, without sugarcoating it or kowtowing. And he’s open to feedback.”
Totten can practice her communication skills in many ways, including serving on a nursing quality improvement committee. She is also responsible for coming up with tools to quickly inform frontline nurses about changes in the hospital policies.

7. Read Voraciously
Don’t forget to read. It can help you improve your communications skills, find new role models, and get on-the-job training. “Reading increases your written and verbal comprehension, improves your vocabulary, and widens the topics you can talk about,” says Totten.
Through reading, Malone says she discovered a new mentor named Mary Seacole, a Jamaican-born nurse who worked in 19th century Britain. In a parallel career to that of Florence Nightingale, Seacole tended to troops in the Crimean War. “Sometimes having a mentor just means having that person in mind when you’re trying to accomplish something,” Malone explains.
Reading is also a good way to pick up new skills. Consider checking out The Nurse Manager’s Survival Guide: Practical Answers to Everyday Problems by Tina M. Marrelli, which is now in its third edition.
You can also take webinars. The “Nurse Manager Development Series” was designed by Lippincott’s Nursing Management journal and ANA to help new nurse managers develop their skills. Topics include retaining talent, managing disruptive behavior, conflict resolution, budgeting, and finance.

8. Volunteer for Assignments
Volunteering for assignments outside of your department helps broaden your skills and makes you a better candidate for promotion, says Juanita Hall, BSN, RN, a nurse manager for cardiology, outpatient treatment center, and dialysis at Providence Hospital in Washington, DC. “Get experience in different departments,” she advises. “Volunteer to be the float nurse.” For example, Hall volunteered to work in dialysis, where she didn’t have much background.
As a young nurse, Hall didn’t initially seek promotion, but she was always willing to learn new things. “I wanted to know what was going on,” she says, and because she was involved in many activities, “my name would come up to the nurse manager.” Even though Hall didn’t have a master’s degree, she got a job as an assistant nurse manager.
“It’s important for nurses to be willing to absorb,” Hall says. “Take in all you can from others. Ask questions [and] show yourself as very interested in what others have to say, so that people feed the information to you.”

9. Don’t Let Ambition Get Out of Control
Hard work and dedication are always welcome, but sometimes a person’s ambition ends up alienating others. “My position is that good things will come to you,” says Hall. “You don’t have to beat anyone up to get to them.” An associate minister in her church, Hall relies on her spirituality to center herself.
Nurses can also be susceptible to burnout if they take on too many assignments. The prime time for burnout comes when studying for an advanced degree while still holding down a full-time job. When DuBois was studying for her master’s degree, she was working 36 hours a week and taking three classes each semester. “I didn’t get burnt out, but I can see how it could happen,” she says. “Everyone has to figure out how much you can handle. It’s about balance.”
Even with her studies completed, DuBois still maintains a busy schedule, including a morning workout in the gym on off-days. “A lot of my friends look at my calendar and think I’m crazy,” she says. But she also reserves time for fun. “I like going out to a party or birthday. I feed off of that. That’s my time to let my hair down.”

10. Use Your Organization’s Career Ladder
Many organizations offer career-ladder programs, which offer higher pay or more responsibilities to nurses who demonstrate their skills, according to Shawana Burnette, OB-RNC, MSN, CLNC, a nurse manager on High Risk Post Partum and High Risk OB at Carolinas Medical Center in Charlotte, North Carolina.
Burnette’s hospital’s ladder process rates bedside nurses on engagement and certification and rewards them with a higher pay level. Nurses who achieve the next rung of the ladder, RN II, get a 10% raise. At higher levels, nurses may be asked to be a preceptor and orient new hires or a nursing student. “The focus is to encourage professional growth and to reward highly engaged nurses in your facility,” she explains.
The ladder process encourages earning certificates in various fields. Burnette is currently studying for a nurse leadership certificate. She says her hospital strongly encourages certification and even provides tuition reimbursement to take review classes to prepare for the certificate exam.
Enjoy the Journey
Nurses who continuously nurture their careers will reap great benefits as they advance up the ladder, argues Allen. “Your nursing career is a journey,” she says. “It’s an incredible journey. It will involve hard work and reaching something meaningful to you.”

Leigh Page is a Chicago-based freelance writer specializing in health care topics.

Leigh Page