American Academy of Nurse Entrepreneurs

Nursing & Salary Negotiation: A Mindset for Better Pay

There’s an interesting paradox between nurses – who give so much value – and how little they value themselves. Case in point. In our AANE FB Group, I posted this question “What are you making for overnight call (outpatient).” I asked because I was consulting for a telehealth startup who was wanting to properly compensate their nurse practitioners. I wanted to do my own research and get a feeling for how NPs are getting compensated. And as it turned out, they’re not.

Here are some of the responses I got:


By far, the vast majority of NPs were getting paid as little as $5/hr to $ZERO/hr for overnight calls. For many NPs, their only compensation is their salary. That’s it. And I have no doubts that the majority of those NPs are highly underpaid as is.

Now, you can look at this information and react in a few different ways.

It’s understandable if the knee-jerk reaction is frustration, anger, or disgust. We don’t get enough respect. Doctors don’t value us enough. The market isn’t paying us what we’re worth.

Certainly, there is truth in each of those statements. But staying in that frame of mind takes away your power. It closes you off from seeing possibilities and how you can improve circumstances for you and yours.

Setting the Stage for a Better Nursing Salary

In every other industry, it’s expected for the job seeker to negotiate their salary and compensation. Entire businesses are built around helping job seekers get better at this so they can earn a more than fair salary. And yet, what I see more often than not is nurses just taking what they can get. On top of that, many APNs are distraught when they realize they made more money as an RN! And I’ve been guilty of this, too!

After I graduated as an NP, I just wanted to be employed. My main criteria were that I wanted to work in the city and close to my house. That’s it.

So, when I found what I thought was a good fit, I jumped at the opportunity. Looking back, I realize that I didn’t properly prepare myself for the interview and negotiation process. When the doctor asked me about my salary needs, I just blurted out a number. My thought process for compensation was this: I was making $25/hr at the hospital and $35/hr as a medication assistant. So, for this job? I asked for $40/hr.

And I got it. No pushback whatsoever. She immediately said yes. (A sign that I asked for too little.) And so, I locked in at $40/hr as a contractor – no benefits, I paid my own DEA and malpractice, and was responsible for my taxes. After factoring in those expenses, I was making LESS than I was at the hospital!

Lo and behold, I became resentful.

But did I ever go to my boss and ask for the conversation to renegotiate compensation? Not even once. I just let the resentfulness linger and avoided the awkward conversation until I planned my exit strategy and left.

So, who’s to blame for my undercompensation? Sure, you could point a finger at the doctor and say, “Well, she should have done the right thing and offered you more.” And in a perfect world, that would be lovely. But we don’t live in a perfect world. And blaming the doctor isn’t empowering for me (or anyone) to make better moves in the future.

The truth is: I didn’t ask for my worth at the beginning. I wasn’t prepared. And so I settled with being resentful.

You’re never going to get what you don’t ask for 100% of the time.

Healthy & Successful Mindset

Setting your salary is about acknowledging your worth and taking personal responsibility for it. Yes, a negotiation is likely to happen, but you’ll get more than what you would if you just take what people give you.

It’s also helpful to explore what you’re afraid of and what you want to avoid by not asking for what you’re worth.

Do you fear a no or that they’ll rescind the offer? Of course you do. We all do. No one wants to get told no. But if someone doesn’t respect you enough at the beginning of your working relationship, what makes you think that they will later on? Sounds like a rocky path. What if a “no” helps you avoid a terrible fit?

Are you afraid they’ll get upset if you ask for “too much”? If so, that’s also a sign of a potentially bad working relationship. If they react with a negative emotional reaction to a business negotiation, then how else will they be unprofessional in the future?

What Stepping Up for Your Salary Can Look Like

One of my dreams is that more APNs can be practice owners so that we can better support and provide better paying jobs for one another. That’s why I started The American Academy of Nurse Entrepreneurs. One of my greatest joys is working with and employing nurses – and I know many APN owners feel the same way.

A few months ago, I needed to add a new NP to my team. I got connected with a wonderful woman with fabulous skills. When I asked her for her salary needs, I’m not going to lie, I was taken aback a little bit. Let’s just say, she slightly overshot her ask. But here’s what didn’t happen…

I didn’t shut her down. I didn’t get mad. I didn’t get offended. I didn’t rescind the offer.

Instead, I was actually proud of her for stepping into her worth and making the ask. I saw her bravery and determination. I was impressed. She sure seemed like someone I’d want to have on my team!

Here’s what did happen: a negotiation.

After just 2 conversations, we collaboratively found a win/win situation for both of us. Since then, she’s been fantastic to work with and I’m happy to have her part of the team.

Creating a better life for you and your family doesn’t come from fears and resentments. Explore what you feel your worth …and go after it. Whether it’s as an RN, NP, or APN Owner, you determine what you’re willing to ask for and accept.

AANE for Nurse Entrepreneurs

We help APNs start, grow & scale their practices with online resources, classes, community & mentorship.

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