How Can ER Nurse Practitioners Expect to be Paid?

I’ve worked as an emergency nurse practitioner for nearly ten years now and am employed at three different hospitals. So, I’ve gotten a pretty well-rounded idea about what to expect as a nurse practitioner working in the emergency department. One big question I get about my job is in regards to salary – how much and in what manner can emergency nurse practitioners expect to be paid?

If you’re an NP interested in working in the emergency department, understanding how compensation is structured is critical to making sure your paycheck looks like you expect. In general, there are four ways nurse practitioners can expect compensation to be structured:

1. Productivity-based

Productivity is a common way hospitals structure provider compensation. Essentially, an employer measures the NP’s level of productivity taking into account the number of patients seen and the complexity of these visits. Each patient encounter is assigned a score, or number of Relative Value Units (RVUs), which are essentially productivity points. The employer pays the NP a certain dollar amount per productivity point in each pay period. If you aren’t familiar with the RVU system, you can learn more about it here and here.

Pros: If you’re a hard worker, comp based on productivity may be a way to earn significantly higher than average wages.

Cons: The RVU system is very complex. So, if you’re paid based on RVU metrics it can be difficult to determine exactly how much you’ll earn and if your paycheck is correct. An even more significant downside of productivity compensation structures is that factors outside of your control will directly affect your pocketbook. If the department is slow, for example, you won’t see as many patients and will earn less.

2. Hourly rate

Hourly pay is pretty straightforward. You’re paid for the time you’re present on the job. While being paid by the hour seems like an easy structure to wrap your head around, don’t forget to take into account other terms of employment like paid or unpaid vacation time and benefits when you calculate the value of your employment package. You’ll also want to look at these additional considerations if you’re signing on as a 1099 contractor rather than a W-2 employee.

Pros: Overall, hourly compensation leads to a predictable paycheck. You know how much you’ll earn and when you’ll be paid. Hourly comp can also lend itself to a more flexible schedule as it makes it easy to trade shifts with coworkers (depending on your employer’s policies about this).

Cons: Nurse practitioners working on an hourly basis must make sure their contracts are well written and understood. I have seen situations where NPs expect to work a certain number of hours but then their schedules are cut back as a result of low patient census, to name one scenario. If the NP is not guaranteed a minimum number of hours, this means a lower paycheck than expected.

3. Salary 

Salary is also a familiar pay structure for nurse practitioners. You agree to a certain annual compensation amount and receive equal compensation each pay period. As with hourly pay, nurse practitioners must also consider benefits in evaluating the total value of a compensation package.

Pros: Salaried nurse practitioners can count on a steady paycheck. Compensation does not vary depending on the whims of patient volume. 

Cons: Salaried positions may mean that emergency nurse practitioners may have less flexibility when it comes to which shifts they work. NPs compensated in this manner must also carefully pay attention to the job description outlined in their contracts. Employers may loop in responsibilities outside of patient care such as attending meetings or managerial tasks that fall under the umbrella of what is expected of the NP to earn the stated salary.

4. Combination of base + productivity 

Often, employers see benefits in more than one of these compensation structures so they create a more customized comp plan. Typically, this looks like a lower base salary or hourly rate coupled with additional payment based on productivity. For example, a nurse practitioner might earn a base rate of $40/hour plus an additional $3 per RVU generated.

Pros & Cons: Combination compensation structures have the benefits and drawbacks of each of the included structures. They can be a good option as they reward hard work but also ensure a predictable base income.

The emergency department is one of the highest paying specialties for nurse practitioners. Data from the Medical Group Management Association shows that NPs working in the ER can expect to earn about $124,126 annually. Included in this wage is an average of $6,291 in annual retirement benefits. So, however you’re compensated as an emergency nurse practitioner, you’re probably in a good place!

How is your compensation structured as an emergency nurse practitioner? What do you like or dislike about this structure?

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