Nurses speak out about gender pay gap




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.

To comment, email editor@nurse.com.


About the author
Sallie Jimenez

Sallie Jimenez 

Sallie Jimenez, who is Content Manager for Healthcare, develops and edits content for OnCourse Learning’s Nurse.com blog, which covers industry news and trends in the nursing profession and healthcare. She also develops content for the OnCourse Learning/Nurse.com Digital Resource Guides. She has more than 22 years of healthcare journalism, content marketing and editing experience.

16 responses to “Nurses speak out about gender pay gap”

  1. Time to table this beat old discussion, or to be honest about it.

    I have found that I consistently made more than my coworkers in nursing specifically because I’ve demanded the salaries I’ve made. I encourage my female coworkers to draw lines in the sand when it comes to pay negotiation, but they consistently say they are ‘too afraid’ to do anything other than take the offer they are given.

    That is not my fault.

    Additional issues that cause pay discrepancies is that women often leave the work force for periods of time to have children, truly a noble undertaking, but they then lose seniority when they return to the work force.

    Look, if women were so much cheaper to employ and did their work just as well, then it would not make any sense to ever hire a male in nursing or advanced practice nursing.

  2. I’m glad to see someone accurately sum up this “gender” pay discrepancy, thank you Dr Aiken! Being a male RN, or even a male, in this country, carries a negative stigma in so many facets. If Nurses can’t start looking at the individual, then no entity can. In my 30 plus years in medicine, I have never seen such a nation divided by gender, religion, sexual preference, or the color of ones skin. I was born in 1963, I never saw the prejudice of my parents generation till the last several years. As Nurses, we should be leading our Great Nation in love, compassion and mercy! It is in us, it is who we are, it is what makes us Nurses. The Government will never be able to regulate the giftings that make our profession the greatest calling on the planet. The Academic world doesn’t even recognize nursing as a profession, go figure. Let them spin the statistics however they want, I am proud to be a male nurse, it is an honor and privilege to love and serve people.

  3. SO what’s new!?? I started nursing in 1978 and my 2nd job (1980) at Seminole Memorial Hospital in Sanford, Fl paid me less than a male nurse hired a year later! I inquired as to why the discrepancy in a meeting with the powers that be, and was told it is because he was considered the breadwinner in the family (don’t know if he had a family or not).
    At the time I was a divorced mother of two nursery school aged children, with a non-paying ex! Hypocritical and excuses still prevail, I see!

  4. Interesting article. Can someone explain to me why I am making 80% of the lowest paid female RN as the only male RN doing the same work and having a CNOR cert that none of the female RN’s have?

  5. From my perspective I strongly disagree with this study. My wife and friends make the same pay as I do if not more in the private hospitals. In the VA where I work, I work with a female nurse who is paid twice as much as I do because she has a masters degree, but does not possess the skills, knowledge or experience I have. Then there are the female nurses who get pregnant and take off 6 to 12 weeks and some, because they are pregnant don’t, can’t, or chooses to use their pregnancy as an excuse not to do their job. Because I am a male, I have frequent request to “help” move a patient, or take patient who is aggressive or threatening. I have a very strong work ethic, I show up for work, ready to work and don’t call in sick. What I am saying is that if you wish to do a true study of comparing apples to apples, then I would do away with the male female definitions and comparisons and look at the expectations of what the nurse is expected to do, how well they do their job and how far beyond the bar they excel.

    Thank you
    Joe

  6. This article is just another ridiculous pack of lies. There’s no gender gap in pay. There’s no glass ceiling for women. There’s no glass escalator for men. We get paid by the hour. If I work 40 hours a week I get paid for 40 hours a week. If I work 80 hours I get paid for 80 hours. I have been an RN for 27 years. Every day I meet nurses who make more than me and some who make less. It has to do with our skills, our training, the work that we do and the years of experience.

  7. If I were the author I would take offense at the previous comment about a “pack of lies”. I have been an RN for 41 years. I have been told by hospital administration to hire a male nurse who was then paid more than I was because he “had a family”. (I also “had a family”) Longevity in nursing is not taken to account in most hospitals. They will count 7-8 years of experience and then eveyone is leveled out, so the longer you are a nurse, the more it is against you. The best advice I received over the years was from a female DON who told me to change jobs every five years and negotiate better pay each time because that was the only time one could negotiate.

    • I believe education and ambition is the reason. I was the only RN in my unit with a BS and volunteered for extra duties, such as research projects and the like, my female team members were not as ready to further their education and avoided extra offerings.JSM.

  8. In case you missed the “WHY” portion of this article please refer to this section:

    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,”

    and

    “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.”

    -Does the study actually compare HOURLY WAGE or just YEARLY SALARY. Of course, ANYONE would make more money if they work more hours in a week.

    As a male nurse i cant simply disagree enough and be even more astounded that the statement “Women climb the ladder in a female-dominated profession, like nursing, while men glide to the top on an invisible escalator.” would even be accepted!

    To summarize, this article suggests there is a pay gap simply based on gender. However, the article explains the difference in salary simply because males take higher paying jobs in cities and work more hours than their female counter-parts. That IS NOT A WAGE GAP. That is like saying there is a pay gap between nurses who work in washington compared to nurses working in california.

    i agree with some of the comments here: as a male i have been assigned the bariatric and violent patients simply because of my gender and “can take it as a man.” At times i have been the only oncology nurse on my ward because the women “are trying to get pregnant” and thus “refuse to be exposed to chemotherapy” products.

  9. I do not see the pay gap that this article claims exists. What I do see as a male RN working in a female dominated environment is a difference in the work ethic of the few men that I work with vs the women. The women call in sick every 3 to 4 weeks while the men show up for work regularly. The men also work more hours than the women. More hours worked equals more money earned. In my experience, this is what accounts for the difference in pay, not favoritism to male nurses.

    • No agreement or disagreement, but as a woman (who rarely if ever has called out), when you say every 3-4 weeks, I immediately noted a correlation with the timing of women’s menstrual cycles. Perhaps there is a link?

  10. As a male BSN, RN, I dont believe there is a real gender amongst nurses. I DO believe there is a significant pay gap between nursing, a female dominated field, and other professions requiring the same level of expertise, training, responsibility, and professionalism. As for me, forget it. I pay my crew leaders for my lawn service more than RN’s make here I Florida.

  11. The rate in pay is variable based on state and market. There are substantially more females in nursing so whenever a male enters the job force a discrepancy in male is going to be immediately noted. I do think that people should be paid based on productivity and performance rather than race or sex. As a black male nurse, I find that I am often paid substantially less then my cohorts.

  12. If they really want to study this, they should compare base hourly rates for the same education, area, experience, and hospital. The researcher admitted it was due to work habits such as hours worked. Why in the world you just ask yearly salaries? That is completely meaningless. I take every overtime shift that comes up, hence I make more than my female counterparts who work 36-40 hours. This doesn’t take expertise in statistical research to figure out how to compare apples to apples. Most hospitals have a straight scale aligned with experience, education ,and area, with no deviation, male or female.

    • Ken I totally agree. You cant look at yearly salaries.Compare hourly base pay. Historically more men work nights, weekends and do more overtime. They also gravitate to ER and ICU which often have higher sign on bonuses and departmental diffs. Most hospitals have pay scales. Once you top out on your pay scale then you are all same pay. I have been a nurse for 25 years. I make the same as a nurse of 12 years because we both topped out on our pay scale, not because he is a male nurse.

  13. Researching the pay gap across various professions, its repeatedly found that men have been willing to do more. From negotiation to relocation to education to overtime to specialization, along with risky and more demanding tasks, males generally contribute more to a given career overall.

    When female nurses do what males do, they experience similar success, as shown by one female interviewee that relocated from a hospitalist position in AZ to a care coordination position in MA for an increase of over $20/hr. This increase was related to geography, education, experience and specialization.

    Held back by societal roles such as familial care giver or female team member, female nurses feel a lack of opportunity that is actually created by their families, self image, female coworker group dynamic, and society at large.

    If you want to close a personal pay gap, you must negotiate, relocate, self educate, and motivate towards goals. Most complaints are from those unable or unwilling to make moves or take chances. Line up another job opportunity and ask your boss for a raise. Don’t blame others if you’re scared or reluctant to work a new job in order to get the money you want.

    If that’s not possible in your life, then help create a culture that makes it possible for a new bold generation of female employees. As females of your line or workplace choose to persue success, encourage them to step up, and also share your career story so they may feel less victimized by their workplace or less obligated to accept the traditional female roles.

    Blaming men negates your personal agency. It is the opposite of feminism, and the opposite of empowerment. It also makes the complainant appear to want more for doing less than others, which reduces the veritas of a legitimate topic.

    Talk of a “glass escalator” is cheap pander. When you do what successful people do, you will achieve success. Until that time, you have what you’ve earned, limited by your own circumstances and fears.

    If you want recognition from a current employer, let go of that. They’re going to miss you when you’re gone. That’s just how things work.

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