Salary, Benefits Packages, and Negotiation Skills for Nurse

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Doctor of Nursing Practice Scholarly Project Irene Ransom Bradley School of Nursing

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Salary, Bene9ts Packages, and Negotiation Skills for Nurse Salary, Bene9ts Packages, and Negotiation Skills for Nurse

Practitioners Practitioners

Lea Ann Tyler

Pittsburg State University

, [email protected]

Laura A. Weiss

Pittsburg State University

, [email protected]

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COMPENSATION, BENEFITS PACKAGE AND NEGOTIATION SKILLS FOR

NURSE PRACTITIONERS

A Scholarly project submitted to the Graduate School

in partial fulfillment of the Requirements

for the Degree of Doctor of Nursing Practice

Lea Ann Tyler, ANP-C

Laura A. Weiss, FNP-C

Pittsburg State University

Pittsburg, Kansas

February 2020

COMPENSATION, BENEFITS PACKAGE AND NEGOTIATION SKILLS FOR

NURSE PRACTITIONERS

Lea Ann Tyler, MSN, ANP-C

Laura A. Weiss, MSN, FNP-C

APPROVED:

DNP Scholarly Project Co-Advisor___________________________________________

Dr. Karen Johnson, School of Nursing

DNP Scholarly Project Co-Advisor___________________________________________

Dr. Kristi Frisbee, School of Nursing

Committee Member_______________________________________________________

Dr. Stephen Horner, College of Business

Committee Member_______________________________________________________

Dr. Ashleigh Heter, School of Nursing

Committee Member_______________________________________________________

Dr. Sonja Albright, DNP, FNP-C

Director________________________________________________________________

Dr. Cheryl Giefer, School of Nursing

iii

COMPENSATION, BENEFITS PACKAGE AND NEGOTIATION SKILLS FOR

NURSE PRACTITIONERS

An Abstract of the Scholarly Project by

Lea Ann Tyler, ANP-C

Laura Weiss, FNP-C

Currently, there are nearly 250,000 practicing nurse practitioners providing care

in a broad variety of healthcare settings, and that number is growing by three to four

thousand every year. Historically, nurse practitioners have been paid a salary

commensurate with experience. As the healthcare market changes, so too is the way NPs

are being paid. It is imperative that nurse practitioner students are educated and

knowledgeable about nurse practitioner salary, benefits packages and negotiation

techniques. This information is necessary to make informed decisions on these matters,

and before signing any formal contract.

Through a substantial literature review, it was determined there was a paucity of

information detailing what new graduates can expect regarding compensation and

benefits packages; and negotiation techniques necessary to be successful during the

interview and hiring process. The purpose of this project was to determine if educating

nurse practitioner students on compensation, benefits packages and negotiation skills

allows them to feel an increased sense of confidence and understanding of this process so

they feel better equipped to fully evaluate and negotiate job offers. A 90-minute

presentation was given to NP students on these matters at a small, midwestern University.

A pre- and posttest format was used. The findings were significant, showing that prior to

the intervention students felt vastly unprepared to discuss and negotiate salary and

benefits packages with potential employers. The authors also found that the presentation

of information on these matters significantly increased their confidence and helped them

feel better prepared to participate in this process. For sustainability, the authors plan to

TABLE OF CONTENTS

Chapter I / Introduction……………………...…………………………………..……… 1

Description of the Clinical Problem ………………………………..………………….. 3

Significance………………..……………………………………………………………. 4

Specific Aims/Purpose…...…...………………………………………………………… 6

Theoretical Framework……………..…………………………………………………… 6

Project Questions……………..…………………………………………………………. 9

Definition of Key Terms….…………………………………………………………….. 11

Logic Model of the Proposed DNP Project…………………………………..………….14

Summary………....………………………………………………………………………16

Chapter II / Evidence/Integrated Review of Literature…………………………………..17

Literature Review...............................................................................................................17

Compensation Plans...........................................................................................................18

Salary.................................................................................................................................19

Productivity........................................................................................................................20

RVU.................................................................................................................................. 21

Salary vs. hourly ...............................................................................................................24

Job Satisfaction ………………………………………………………………………… 25

Pay for Performance ………..………….……………………………………………… 25

Gender Earnings Gap…...………………………………………………………………. 26

Contract Components…………………………………………………………………… 26

Status ………………………..………………………….………………………………. 27

Service …………………..………………………… ………………………………….. 27

Salary ……………………..……………………………………………………………. 28

Education ……………….……………………………………………………………… 28

Benefits ………….………………………………………………………………………28

Malpractice Insurance……………………..……………………………………………..28

Terms and Termination ……………….…………………………………………………29

Non-compete and Non-solicitation ……….……………………………………………..29

Negotiation of Contracts ……………….………………………………………………..29

Basic Principles of Negotiation …………………………………………………………31

Salary Negotiation …………………....…………………………………………………32

Quality of Care ………………………………………………………………………….33

Summary ……………………………………………………………………………….. 35

Chapter III / Methods and Plans....................................................................................... 38

Project Design....................................................................................................................38

Sample/Target Population ................................................................................................ 39

Protection of Human Subjects ..........................................................................................39

Instruments ……………………….…………………………………………………….. 40

Analysis Data……………………………………….……………………………………41

Procedure …………….………………………………………………………………… 41

Treatment of Data/Outcomes/Evaluation Plan……….………………………………… 42

Plan for Sustainability....................................................................................................... 43

Chapter IV Evaluation of Results..................................................................................... 45

Description of Population ................................................................................................ 45

Description of Key Terms/Variables................................................................................ 46

Analyses of Project Questions/Hypothesis....................................................................... 46

Results ……………………………………………...…………………………………... 48

Summary........................................................................................................................... 52

Chapter V / Relationship of Outcomes to Research......................................................... 53

Observations .................................................................................................................... 54

Evaluation of Theoretical Framework …………………………..……………………... 54

Evaluation of Logic Model …………………………………..………………………… 55

Limitations........................................................................................................................ 56

Implications for Future Projects/Research........................................................................ 56

Implications for Practice .................................................................................................. 57

Conclusion ....................................................................................................................... 58

References......................................................................................................................... 59

Appendix A....................................................................................................................... 66

Appendix B....................................................................................................................... 67

Appendix C ………………………………………………………………...……………68

vii

LIST OF TABLES

Table Page

2.1 Earnings Gap …………………………………………………………. 26

2.2 Negotiation Worksheet ………………………………………………... 31

4.1 Analysis of Individual Questions Pre-Posttest ………………………… 49

4.2 Analysis of Questions Mean Differences of Pre-Posttest and CI….…….50

4.3 Averages of Participants Pretest ………………………………………. 51

4.4 Averages of Participants Posttest ……………………………………… 51

viii

LIST OF FIGURES

Figure Page

1.1 Patterns of Knowing……………………………………………………. 7

1.2 Logic Model …………………………………………………………… 16

2.1 Factors included in RVU ………………………………………………. 22

Chapter I

Introduction

Nurse practitioners have been providing care to patients since 1965. Currently,

twenty-two states plus the District of Columbia allow NPs to practice independently,

without physician oversite. There are currently more than 248,000 nurse practitioners

licensed to practice in the United States, practicing in a broad range of settings. In 2016-

17 there were more than 26,000 new nurse practitioner graduates. This number continues

to increase by three to four thousand per year, over the prior year (American Association

of Nurse Practitioners, 2018a).

By the year 2020, the United States is projected to experience a shortfall of

approximately 45,000 primary care physicians (Kirch, 2012). As part of a plan to combat

this, the Institute of Medicine (IOM) has recommended that advanced practice registered

nurses (APRNs) should be allowed to practice to the full extent of their education and

training (Institute of Medicine of the National Academies, 2010). The care that nurse

practitioners provide has been proven to be as good or better than their physician

counterparts and more cost effective (Horrocks, Anderson, & Salisbury, 2002; Stanik-

Hutt, et al., 2013; Martin-Misener, et al, 2015). Nurse practitioners have repeatedly

demonstrated their value. With the need for primary care providers increasing and the

supply of primary care physicians decreasing, NPs are being educated and trained and are

ready to fill the projected shortfall.

In the past most compensation packages for NPs have been the pay similar to RNs

with either salary or hourly wages seen for compensation. As healthcare systems focus on

cost, quality, and access there are changes occurring in pay for NPs. These models vary

from institution to institution and consist of productivity bonus potential and/or valued

based incentives. Productivity is often calculated in the form of work relative value units

(wRVUs). The wRVUs are determined based on proper coding following the Centers for

Medicare and Medicaid Services (CMS) guidelines. These guidelines must be followed

for reimbursement purposes and to avoid any penalty from CMS. Once the wRVUs are

tabulated the institution will place a dollar limit per wRVU for distribution of pay. Many

compensation plans for the APRN have a lower base salary (guarantee salary) plus

productivity bonus. Some healthcare systems will also have an additional bonus based on

value-added services. These value-added services are services which are provided by the

NPs or physicians which do not generate specific wRVUs. These services can include a

variety of areas such as patient satisfaction scores, mandatory meeting attendance, and

other healthcare and quality metrics. Nurse practitioners need the appropriate information

to discuss any variation in plans and fully understand expectations before signing any

formal contract. For this scholarly project a presentation was developed with the purpose

of equipping the NP with the needed information to successfully negotiate any new plan

or changes in current plans.

Description of the Problem

Nurse practitioners are faced with many changes associated with transitioning

from RNs to NPs. It is imperative that they develop realistic expectations regarding

compensation plans and benefits packagers. Yet, there is a paucity of information

available on what to expect regarding compensation and compensation packages. Further,

there is little available to guide the nurse practitioner in how to successfully negotiate

with potential employers, once an offer is received. Empowering NPs with information

regarding these plans will increase confidence during contract negotiation phase.

Contracts are legally binding documents and considered to be a promise between

employer and employee. A thorough understanding of all items in a contract is essential.

Many NPs do not receive any information regarding compensation plans, wRVUs, value

added incentive during the formal education process. This requires NPs to complete the

learning process when the need arises. If NPs understand the basics involved during

contract discussions, then successful negotiations can occur. In addition, nurse

practitioners should not sign any contract without a complete understanding of all the

components. The results of this DNP scholarly project showed that education regarding

negotiating, compensation plans and benefits packages increased the confidence of NP

students regarding these matters.

It is difficult for an applicant for a NP position to determine if an offer of

employment is competitive due to a lack of available information and difficulty

compiling data. The nurse practitioner is then left trying to answer many questions, such

as what is a competitive salary? What is the average salary in my community? What are

the benefits or perils associated with accepting a salary based on productivity? How can

productivity be measured? It is important to be familiar with the answers to these

questions, and many more, before starting the interview process. What is learned from the

questions asked of a potential employer will help the NP decide to accept or decline an

offer of employment. It is important for the nurse practitioner to “take responsibility for

the disparity between experience and compensation and negotiate salaries and benefits

that are more in line with the degree of autonomy and skill that the job demands” (Kacel,

Miller, & Norris, 2005, p.31). As the healthcare industry is rapidly changing,

organizations are attempting to create compensation plans and productivity models that

reflect these changes. The parties involved range from human resource personnel to

financial officers with little input form clinical personnel. This adds to the confusion of

terminology and different expectations. In order for compensation plans or models to be

successful, all those involved must have a clear understanding of each other and related

expectations.

Significance

One’s profession is the single most significant activity that fulfills a lifetime of

education and training and a sense of achievement and personal satisfaction (Kacel,

Miller, & Norris, 2005). Steinke, Rogers, Lehwaldt, and Lamarche (2017) state “job

satisfaction influences employee retention, worker productivity, and performance, and is

directly related to NPs’ desire to work and to provide quality health care” (p. 31). In order

to recruit and retain nurse practitioners. it is important that employers look at factors that

improve job satisfaction; as well as those factors that contribute to job dissatisfaction.

The expense and time involved with NP turnover effect employers as well as the

employees.

A systematic review, published in 2018, found that one of the extrinsic factors

that most significantly contributes to job dissatisfaction is salary (Han, Carter, &

Champion). The final compensation and compensation packages are certainly important

to the individual as it provides them their livelihood. Any increase in salary will increase

the average pay of all NPs since compensation offers are often based on the market

average. This makes this issue important to the profession as a whole. As individual NPs

salaries increase, compensation as a whole will trend up.

With the increased focus on cost and quality, organizations are changing to

compensation plans based on productivity. Most productivity models include calculating

and tracking wRVUs. Calculation is based on coding and volume of patients seen.

Advanced practice registered nurses must have a clear understanding of coding not only

for the calculation of wRVUs but also to understanding all variables that can influence

their numbers. Some variables include global visits, shared visit, or “incident to” billing.

These variables involve the wRVU going to physician instead of the NP. Global visits are

a predetermined wRVU amount and usually assigned for a surgical procedure which

includes pre- and post-op care that is often provided by NPs. Shared visit and “incident

to” billing is when a service is provided by the NP however the billing is under physician;

therefore, the physician claims the wRVU. Another variable occurs if the NP is in

competition for wRVUs with physicians. (Picard, 2014). This will be important whether

novice or expert to comprehend all factors affecting compensation.

Studies suggest that nearly 80% of companies expect for individuals to negotiate

their salaries. In fact, many employers will initially offer less money, leaving room for

expected negotiations (Hartzell, n.d.). Unfortunately, nearly half of the general

population do not negotiate an offer (Sweeney, & Gossfield, 2013). Nurses fare worse. A

2018 nurse.com salary survey found that only 43% of the time do male nurses “most of

the time or always negotiate”, compared to slightly more than one-third of female nurses

(Mensik, Hess, Williamson, Cygan, Jimenez, Millineck, 2018). Employees who negotiate

their salary increase their annual earnings an average of $5000 (Sweeney, & Gossfield,

2013). This has important long-term ramifications as well as this initial increase in salary

translates to roughly $650,000 over a career (Marks, & Harold, 2011). Some other issues

that need to be addressed during contract negotiations include what type of services the

NP will be providing, compensation for continuing education, time off to complete

education, type of malpractice insurance, termination conditions, and noncompete clauses

(Brown, & Dolan, 2016). With enhanced knowledge on compensation and compensation

packages, as well as tools to assist in negotiations, nurse practitioners will be better

prepared and feel more comfortable embarking on their job search.

Purpose

The purpose of this project was to determine if educating nurse practitioner

students on compensation, benefits packages and negotiating allowed them to feel an

increased sense of confidence and understanding of this process so they feel better

equipped to fully evaluate and negotiate job offers.

Theoretical Framework

The theoretical framework for this DNP scholarly project is Barbara Carper’s

pattern of knowing (Carper, 1975). Carper’s theory was written 40 years ago with an

expansion by others, specifically Chinn and Kramer in 2008 (Chinn & Kramer, 2011).

The premise for this theory is that there are more ways to knowing besides empirical or

scientific knowledge for nurses. There needs to be an understanding of these patterns for

teaching as well as learning for nursing. The four patterns Carper recognized are (1)

empirics, (2) esthetic, (3) personal knowing, (4) ethics. Chinn and Kramer took this one

step further with the addition of emancipatory knowing.

Figure 1-1 Patterns of Knowing (Chinn and Kramer 2011)

Empirics or the science of nursing involves objective data such as the facts,

descriptions, models, and theories. Moran, Burson, and Conrad (2017) state the question

with empirical knowing is “what is this and how does it work?” (p. 103). All aspects need

to be understood for nurses to continue to grow. Mantzorou and Mastrogiannis (2011)

state Carper’s assumption was “the patterns and structure of nursing knowledge provide

the unique perspectives of the discipline” (p. 252). (See Fig. 1-1)

Personal

Esthetics

Ethical

Emancipatory

Empirical

Esthetics is the art of nursing based on direct feeling of experience. Esthetics is

subjective and includes such things as empathy, caring, and being in the moment. The

question one would ask is “what does this mean, how is this significant?” (Moran,

Burson, & Conrad, 2017 p. 103).

Personal knowing involves knowing oneself. Carper states “one does not know

about the self, one strives simply to know the self” (Mantzorou & Mastrogiannis, 2011 p.

254). There are 3 components to this learning “(1) experiential knowing such as

participating in the world; (2) interpersonal knowing through interactions with others;

and (3) intuitive knowing involving knowing something without reason “(Khuan, 2006

p.15). Moran, Burson, and Conrad, (2017) states the question one should ask is “do I

know what I do, do I do what I know?” (p. 104).

Ethical knowing involves doing what is morally right. Policies, codes, and

standards are expressed as ethical knowing. The question for ethical knowing “is this

right, is this responsible” (Moran, Burson, & Conrad, 2017 p. 104).

The final pattern of knowing was introduced by Chinn and Kramer. This is

emancipatory knowing which incorporates justice, equity, and transformational care and

encompasses all the previous patterns of knowing. There are multiple questions “what is

hidden?; what is invisible?; who is not heard?; who benefits?; what is wrong with this

picture? (Moran, Burson, & Conrad, 2017 p. 105). Emancipatory knowing considers the

social, cultural and political status quo and challenging things that are not right.

Incorporating these patterns of knowing into this project will assist the APRN during the

entire process.

Project Research Question

A project (practice) question is used when there is a lack of information on a

subject of interest to the researcher (Terry, 2018). The “sole intention of exploratory

research designs is to make the researcher more familiar with the phenomena being

investigated so additional, more precise research questions as well as hypotheses can be

generated” (Terry, 2018, p. 23). While information regarding compensation,

compensation packages and negotiation skills exist, it only exists in a piece meal fashion,

making it difficult for the nurse practitioner to obtain. An extensive literature search did

not find any resources that consolidate this information into a single resource. The

PICOT format is often used in developing the research question.

The PICOT question for this project is:

Do nurse practitioner students (P) who receive additional knowledge

regarding compensation, compensation packages and negotiation skills (I

&C) have an increased sense of confidence and understanding regarding

compensation, compensation plans and negotiations (O) after receiving an

educational program?

The question was broken down into specifics as follows:

1. Do nurse practitioner students have a clear understanding of compensation

packages available before education?

2. Do nurse practitioner students have a clear understanding of compensation

packages available after education?

3. Do nurse practitioner students understand the role wRVUs play on

compensation plans before education?

4. Do nurse practitioner students understand the role wRVUs play on

compensation plans after education?

5. Do nurse practitioner students understand the potential components of a bonus

before education?

6. Do nurse practitioner students understand the potential components of a bonus

after education?

7. Do nurse practitioner students have a clear understanding of benefits packages

available before education?

8. Do nurse practitioner students have a clear understanding of benefits packages

available after education?

9. Do nurse practitioner students have a clear understanding to complete

successful employment contract negotiations before education?

10. Do nurse practitioner students have a clear understanding to complete

successful employment contract negotiations after education?

11. Do nurse practitioner students have an understanding of the basic components

of a NP employment contract before education?

12. Do nurse practitioner students have an understanding of the basic components

of a NP employment contract after education?

13. Do nurse practitioner students have an understanding of the factors (intrinsic

and extrinsic) involved with job satisfaction before education?

14. Do nurse practitioner students have an understanding of the factors (intrinsic

and extrinsic) involved with job satisfaction after education?

15. Do nurse practitioner students have confidence negotiating contracts before

education?

16. Do nurse practitioner students have confidence negotiating contracts after

education?

Definition of Key Terms/Variables

There are key terms involved with this project. Nurse practitioners must have a

clear understanding of these terms to comprehend all components involved in

compensation plans and contract negotiation.

Advanced Practice Registered Nurse (APRN). An APRN includes nurse

practitioners, certified nurse specialists, nurse midwives and certified registered nurse

anesthetists. For the purposes of this project, the term nurse practitioner will be utilized

except when directly quoted in articles.

Center for Medicare & Medicaid Services (CMS). Part of the Department of

Health and Human Services. Oversees Medicare and Medicaid programs (Buppert,

2013).

Claims made malpractice insurance: the policy must be in place at the time the

act occurred and at the time the claim was made (Brown & Dolan, 2016).

Cost Center: a business unit or employee that generates a cost or expenditure

through work efforts: the opposite of a revenue center (Pickard, 2014).

CPT code: Standardized code assigned to every medical, surgical and diagnostic

services. Used by the Centers for Medicare and Medicaid Services (CMS) to determine

reimbursement. Every CPT code has an RVU attached to it (Pickard, 2014).

Gross billing: the total amount billed to payers for all of the work done by a

provider; the total amount billed prior to any deductions or discounts. (Pickard, 2014)

ICD-10: International Classifications of Disease – clinical cataloging system

which accounts for clinical treatment and medical devices (Brown & Dolan, 2016).

“Incident to” billing. Care provided by a nurse practitioner or other non-

physician provider (NPP) that is then billed by the physician. To qualify, a physician

must provide the initial service, remain actively involved in the treatment plan, and

continue to provide direct supervision to NPP. If the NPP changes anything in the plan of

care or addresses a new complaint, it cannot be billed “incident to”. Non-physician

providers are reimbursed at 85% of the physician fee schedule. “Incident to” billing is

reimbursed at 100% (Center for Medicare and Medicaid Services, 2016).

Institute of Medicine (IOM). Nonprofit organization providing leadership on

healthcare (Institute of Medicine, 2011).

Net Revenue: the final amount received from gross billing once deductions and

discounts are applied; the final amount received for a provider’s work (Pickard, 2014).

Occurrence malpractice insurance: effective if the coverage was in place when

the act occurred (Brown & Dolan, 2016).

Office of Inspector General (OIG). Works to “fight fraud, waste, and abuse;

promote quality, safety, and value; secure the future; and advance excellence and

innovation” (US Department of Health and Human Services, n.d.).

Patient Volume: the number of patients seen in any given unit of time by

individual providers. (Pickard, 2014)

Pay for Performance (P4P). Financial incentives given to providers for meeting

specific quality measures such as blood pressure goals, A1C control and cancer

screenings (Weirs 2010).

Productivity: measured in concepts of volume, cost, work effort, and revenue

(Pickard, 2014)

Relative Value Units (RVU). Created to monetize productivity in health care.

Created by combining three factors: work effort (time, skill, expertise, intensity) +

practice expense (rent, supplies, staff, equipment) + malpractice expense (professional

liability expense) (Pickard, 2014).

“Shared visits” billing. Care provided to established patients by both a non-

physician provider and physician in which both are actively involved in the visit. The

physician must document what they did. “Shared visits” are billed by the physician and

reimbursed at 100% (American Academy of Professional Coders, 2018).

Statute of limitations: the time allowed for a person to bring a claim (Brown &

Dolan, 2016).

Tail coverage. “A provision found within a claims-made policy that permits an

insured to report claims that are made against the insured after a policy has expired or

been canceled, if the wrongful act that gave rise to the claim took place during the

expired/canceled policy” (Internal Risk Management Institute, Inc, n.d.).

Value-added services: measured by the perceived or actual benefits gained

despite costs (Pickard, 2014).

Work Revenue Value Unit (wRVU). “Reflect(s) the relative time and intensity

associated with providing a service and equals approximately 50% of the total payment

(Rhodes, Bechtle & McNett, 2015, p. 125)

Logic Model

The development of a logic model for this DNP scholarly project began with the

review of literature, population to be studied, and continued education. The plan was then

coordinated with development, administration and calculation of the pretest to

participants. Prior to the classroom lecture (intervention), the students completed a pre-

test regarding the lecture content. After the intervention, the students were administered a

posttest, assessing their knowledge. The results were determined to be statistically

significantly. Based on student feedback, small changes were made to the program (See

Fig. 1-2). It is important for NPs to have this information for fair compensation packages

and any future contract negotiations. Nurse practitioners are the future of healthcare and

can influence changes for all others who will follow. The logic model represents the

processes to be taken during this scholarly project. Any variations determined will be

made during the process and documented accordingly.

Lecture, PowerPoint

slides

Figure 1.2 - Logic Mode

pretest

presentation

posttest

review results

and assimilate

new

information

amend

program as

needed

Develop Programs to

Educate Nurse

Practitioners

compensation

benefits packages

negotiation

Summary

Nurse practitioners have been providing exemplary, cost effective care for over 50

years. With the aging population, and the projected shortage of primary care physicians,

NPs will continue to fill this void. As nurse practitioners enter the job market, whether it

be for the first time or not, there are minimal resources available to help assess

compensation and benefits packages. The dynamics seen in healthcare requires NPs to

stay current with all data whether clinical or business related. Unfortunately, most

business aspects of healthcare are not adequately addressed during an NPs formal

education due to the volume of clinical information required. This leaves much of the

information needed for contract negotiations left to each individual NP. The healthcare

system is responsible for developing contracts that are often led by legal, human

resources and financial personnel who are familiar with the language and terminology

involved with compensation plan and contracts. Education targeted for NPs to improve

confidence with this process will be beneficial to all involved.

Chapter II

Evidence/Integrated Review of Literature

The literature available to nurse practitioners (NPs) regarding negotiating

contracts and understanding compensation plans is limited and incomplete at times.

While several articles tackled a single issue, or parts of an issue, a single resource

dedicated to educating nurse practitioners on information specifically pertaining to nurse

practitioner salaries, benefits packages and negotiation skills could not be located. As

healthcare continues to change with an emphasis on autonomy for NPs, it becomes

essential NPs understand all aspects of employment. A clear understanding of all aspects

related to employment leads to job satisfaction, quality of care, and less turnover.

Steinke, Rogers, Lehwaldt, and Lamarche (2017) state “job satisfaction influences

employee retention, worker productivity, and performance, and is directly related to nurse

practitioners’ (NPs’) desire to work and to provide quality health care” (p. 31). This

translates to improved access for those needing primary healthcare. Unfortunately, many

of these issues are not addressed in nursing schools, whether entry level nursing or

doctoral prepared nurses.

The review of literature was completed utilizing PubMed, CINAHL, Google

Scholar, Summons, Yahoo, and professional peer reviewed journals. The information

related to this project does not have any specific clinical practice guidelines with the

majority of the information obtained from review articles. Some of the results are from

surveys and qualitative research. The Pittsburg State University AXE library was utilized

with the following keywords: APRN salary and compensation packages, NP and salary,

APRN salaries and RVU, NP and RVUs. relative value units, pay for performance,

incentive pay, malpractice insurance, job satisfaction, gender differences in nurse

practitioner salaries, nurse practitioner’s salary, new NP and negotiating salaries, and NP

negotiation. Due to the limited data, articles 12 years or newer were accepted. The results

of the search produced 49 articles.

Nurse practitioners need to be aware of the various compensations plans to

successfully negotiation contracts. A clear understanding of productivity and relative

value units (RVUs) is essential for employment whether novice or expert. Negotiating

contracts requires knowledge of all components expected and questions to ask to

understand the systems future plans or any problems. The NP must also realize quality of

care provided by NPs in comparison to physicians and the importance of education of all

responsible parties.

This chapter will cover compensation plans, salary, productivity, relative value

unit’s, contract components, contract negotiations, and quality of care.

Compensation Plans

The literature review revealed several compensation plans for NPs. Registered

nurse pay consists of salary or hourly wages with some variations for experience,

specialty areas, and shift differentials. NP pay can vary with specialties and occasionally,

experience. However, there are other elements for NPs related to compensation plans.

Salary has been determined to significantly contribute to nurse practitioner job

dissatisfaction. It is therefore imperative for NPs to understand the basics of salary and

benefits packages and how best to negotiate for their interests. NP salary consists of three

possible components: base, bonus and productivity. Productivity includes revenue value

units (RVUs) and pay for performance (P4P). It is important that NPs are familiar with

how many RVUs they can expect to generate, as well as the pitfalls of productivity-based

pay. Multiple bonus plans are available as part of a salary. The potential components of a

benefits package include general as well as professional benefits; and malpractice

insurance. There are several important contract considerations as well, such as

noncompete clauses and termination clauses. There are several basic principles involved

in negotiations. Salary negotiations have their own set of principles and

recommendations.

Salary. A 2017 Nurse.com national survey lists the total average salary of

master’s prepared nurses is $90,286 (Mensik, et al., 2018). The American Academy of

Nurse Practitioners Fact Sheet (2018) reported the mean, full time salary for an NP was

$105,546. The Bureau of Labor Statistics (2017) website provides salary information for

NPs in multiple industries; by metropolitan area; mean and median hourly and annual

wages; as well as percentiles. The Bureau of Labor Statistics reports the mean annual

wage for NPs, nationwide is 107,480; in Joplin it is $92,320. The mean hourly wage

nationally is $51.68; in Joplin it is $44.39. The median annual wage nationwide is

$103,880; and in Joplin it is $93,260. The median hourly wage nationwide is $49.94; and

$44.84 in Joplin (Bureau of Labor Statistics, 2017).

One source (Kleinpell, & Perez 2006) described how to convert an offer that is

made at an hourly rate, to a yearly salary. This is done by multiplying the hourly wage

and the number of hours worked per week. Then, multiply that figure by 52, which is the

number of weeks in a year. For example, if offered $51.99/hour and this is a full-time

position, you would multiply $51.99 (hourly wage) x40 (number of hours worked in a

week) x 52 (weeks per year) = $108,139.20 (Kleinpell, & Perez, 2006). The reverse is

also true. If a yearly salary of $105,000 is offered, that translates to $105,000/40 (hours

per week)/52 (weeks per year) = $50.49/hour. Similarly, if offered $85,000 to work a 30-

hour week, that would be $55.49/hour (85,000/30/52).

Important salary considerations include number of hours worked per week;

administrative time; on-call time; and any overtime compensation or comp time. It is also

important to determine the number of hours in a workday that will be dedicated to seeing

patients and how much time will be allowed for administrative responsibilities, such as

refilling prescriptions, responding to emails and phone calls (Brown & Dolan, 2016;

Kleinpell & Perez, 2006). A nurse practitioner’s salary can be divided into three basic

components: fixed salary, productivity, or salary plus a productivity bonus (Satiani, Nair,

Starr, & Samson 2014). Incentives are frequently tied to a predetermined productivity.

Productivity. Productivity as stated by Pickard, (2014) focuses on “the amount of

work product created given a fixed number of resources and employees” (p. 1). When

relating this to healthcare it involves the amount of clinical services provided, the billing

activity of the designated providers, and the intensity of the work completed. As

healthcare continues to evolve with more focus on cost, productivity becomes an

important aspect to measure for all providers, including NPs. Rhoads, Ferguson, and

Langford, (2006) defines nursing productivity for nurse practitioners (NP) as “proof or

evidence of how effective the NP is in his/her labor, job setting, or how efficiently she/he

handles resources or equipment” (p.32). Since NPs are considered providers, the pay

structure is transitioning to productivity models, similar to physicians. Productivity is not

as simple as counting the number of patients seen. Rhoads, Ferguson, and Langford,

(2006) state productivity is typically based off of the total of gross charges, total net

medical revenue, total cost, patient panel size and growth, office hours, and procedural

volume (CPT codes). It is imperative NPs understand all these components when

accepting a new position. This is not an easy concept to measure and/or understand.

There are many external factors which can influence patient care to include

individual differences in patients’ symptoms and co-morbidities. With this variation there

are a number of ways productivity can be measured. Pickard, (2014) states simple

methods such as patient volume, gross billing, and net revenue can be used; however, this

method is limited and can provide an incomplete picture of care provided. The concept of

relative value unit (RVU) was created to provide an accurate, standardized method for

measurement of productivity.

RVU and wRVU. The main component of RVU is the assignment of Current

Procedural Terminology (CPT) codes. CPT codes describe medical, surgical, and

diagnostic procedures. CPT codes are important to understand as the Centers for

Medicare and Medicaid Services (CMS) use the codes for reimbursement. Pickard

(2014) defines RVU as the measure of three factors: work effort, practice expenses, and

malpractice expenses as illustrated in Figure 2.1

Work effort Practice Malpractice

Expenses Expense

-Time

-Skill -Rent -Professional RVU

-Experience -Supplies liability

-Intensity -Staff insurance

wRVU -Expense

Figure 2.1 – Factors included in RVU (Pickard, 2014)

Work effort or wRVU is the direct result of the providers use of codes for services

completed. A thorough comprehension of coding using CPT codes, billing for time, and

documentation determines an accurate calculation of wRVU.

Rhodes, Bechtle, and McNett, (2015) state RVUs “reflect the relative resources

required to furnish the physicians fee schedule service” (p. 125). CMS and other

insurance providers use the Medicare Physician Fee Schedule (MPFS) for reimbursement

of services. The three factors listed in figure 2.1 are used in the calculation of payment

using MPFS. The work wRVUs does equal approximately 50% of total expense. Most

models for NPs are structured similar to the

physician model. In states without full practice authority, there are limitations seen with a

productivity model.

RVUs are a standardized payment formula determined by the Medicare Centers

for Medicare and Medicaid Services (CMS) and are an attempt to quantify patient

complexity. RVUs are based on CPT codes and reflect the time it takes to perform a

given service, the necessary technical skill, the mental effort and judgement required of

the provider and the liability risk associated with providing that service (Pickard, 2014).

It equals approximately 50% of the total payment received for a service. CMS and private

insurance companies use RVUs to reimburse physician services.

How many RVUs can a nurse practitioner expect to generate? Buppert (2013)

noted that she is unaware of a good source for median annual RVUs for nurse

practitioners. She states that for physicians, the median annual RVUs for Family Practice

is 4,825; Internal Medicine is 4,795; Peds is 4,871 and OB/GYN is 6,714. A 2017 study

by the American Medical Group Association (AMGA) found that the median number of

RVUs a nurse practitioner in primary care generated was 3,273; Family Practice was

3,327; Hospitalist, 2,104; Internal Medicine, 2,982; and Pediatrics, 3,947 (American

Medical Group Association, 2017).

Pitfalls of productivity-based pay. RVUs do not take into account time spent in

non-revenue generating services. This would include services such as records review,

care coordination, phone calls, letter writing, documentation, medication refills and

preoperative teaching. A 2013 time and motion study (Ogunfiditimi, Takis, Paige,

Wyman, & Marlow, 2013) found that inpatient Advanced Practice Providers (APPS)

spent slightly more than 35% of their time on non-revenue generating activities. APPs

working in an outpatient environment spent slightly more than 38% of their time on non-

revenue generating activities.

Buppert (2013) notes for an RVU system to be meaningful, every visit and code

needs to be properly recorded. The provider needs to have a thorough understanding of

the use of modifiers, for instance, and which services can be billed separately. Wiers

(2010) states NPs tend to underbill and that it is imperative coding be done accurately for

an RVU system to work. She also notes that in an office that utilizes NPs in seeing

overflow patients once the physician schedules are full, productivity pay is unlikely to be

profitable. Further considerations include RVUs do not measure the quality of care a

patient receives; they do not reflect patient outcomes; nor do they figure in patient

satisfaction (Rhoades, Ferguson, Langford, 2006). A further consideration is the support

the practice provides for seeing the expected number of patients (Rhoads, Ferguson, &

Langford, 2009). If there is not adequate time and space, the NPs time may be spent in

non-revenue generating activities, such as rooming, drawing blood, etc. Kleinpell &

Perez (2006) recommends that new graduates not enter into productivity-based salaries

and bonus arrangements as they are developing their patient base, and do not have the

skills necessary to optimize their revenue generating potential.

Pitfalls in the use of RVUs specific to nurse practitioners include the fact that an

RVU system does not recognize the productivity of an NP if a practice utilizes “incident

to” billing. This type of billing allows a practice to bill for clinical services under the

physician, regardless of who actually provides the service. This maximizes the

reimbursement, but the NPs productivity is therefore hidden. One study found billing

under one’s own NPI number and having a one’s own patient panel was associated with

an increase of nearly $3500, in an average yearly salary (Greene, El-Banna, Briggs, &

Park, 2017). Another type of billing that results in hidden NP care is pre and postsurgical

care. Surgical services are billed as a global visit. Therefore, an NP who is providing pre

and postsurgical care to patients does not accrue RVUs, as this care is considered to be

included in the overall surgical care (Pickard, 2014).

Salary versus hourly wages plus bonus potential. Nurse practitioners can also

be compensated by hourly wages or base salary as seen with registered nurses. Bonuses

can be included using a variety of metrics. Bonuses can be based on value, exceeding

predetermined RVU limit, or other parameters. Some bonuses are distributed quarterly

while others may be yearly. NPs must understand requirements for all bonus structures.

Job satisfaction. For nurse practitioners to make informed decisions, and to

recruit and retain nurse practitioners, it is important that NPs and their employers are

familiar with factors that improve job satisfaction, as well as those that contribute to job

dissatisfaction. A systematic review on APRN job satisfaction (Han, Carter, &

Champion, 2018) found that intrinsic factors such as autonomy, favorable practice

environment and work meaningfulness were contributors to job satisfaction. The most

significant dissatisfiers were extrinsic factors, with monetary issues being the single

biggest contributor. Satisfied nurse practitioners are more likely to stay in their current

position, thereby reducing the costs associated with employee turnover.

Pay for Performance (P4P). Pay for performance programs remunerate

providers and hospital systems for achieving previously defined quality measures. These

measures are typically evidence-based measurements such as Physician Quality

Reporting Initiative (PQRI). This includes measurements such as hemoglobin A1C

control, blood pressure control in hypertensive patients, and screening for fall risks in

elderly patients (Mackey, Rooney, & Skinner, 2009). For P4P to be successful, goals and

benchmarks need to be clearly defined. Data collection must also be accurate, timely and

available to the NP (Mackey, Rooney, & Skinner, 2009).

Other ways to measure productivity. Employers may measure productivity in

other ways, include the number of patients seen per day/week/month/quarter; number of

new patients brought into the practice; gross billing; net revenue; patient panel size; and

CPT or procedural volume (Pickard, 2014).

The gender earnings gap. A study published in the Journal of the American

Association of Nurse Practitioners (2017) found that male NPs consistently out earned

female NPs, by $15,205 (Greene, El-Banna, Briggs, & Parks, 2017). When controlling

for work setting, demographics, number of years since graduation from an NP program

and clinical practice, the gender gap persisted, at $12,859. As table 2.1 below

demonstrates, the gender gap exists with nurse practitioners, regardless of when the NP

competed their degree.

Number of Years Since NP Graduation

Earnings Gap*

0-4 years

$7,405

5-9 years

$15,605

10-14 years

$10,095

15-19 years

$11,680

20+ years

$21,090

Table 2.1- NP earning gap between genders (Greene, El-Banna, Briggs, & Parks, 2017).

*with male NP pay exceeding yearly average of female NP pay

Contract components

Most NPs will sign a contract at the beginning of employment. There are several

components necessary in basic contracts. The NP must understand the basic components

in contracts to assure successful negotiation. According to Brown and Dolan, (2016) the

majority of NPs in the workforce will utilize employment contracts. An employment

contract is signed by all parties and considered a legally binding document. If the NP

signs the contract and does not understand all elements, it still may stand legally. The

employment contract cannot be confused with collaborative practice agreement. The

collaborative practice agreement is signed by the NP and collaborating physician in states

which NPs cannot practice independently. The components will be discussed below as

described by Brown and Dolan, (2016).

Status. This is to determine if the contract is employer-to-employee or

independent contractor. Taxes will be taken out for employer-to-employee and

independent contractors will be responsible for own taxes as well as malpractice

insurance. If there is a question regarding the type of contract, the courts will consider

such factors as the amount of control the NP has over

the type of work performed, workplace setting, hours, schedule, and benefits. The more

control the NP has, the more likely he/she is considered an independent contractor

(Brown, & Dolan, 2016).

Service. Brown and Dolan, (2016) define services as what services the NP will be

providing and how frequently patients will be seen. Aspects related to service include:

Will supervision be done by physicians? Will the physician perform the initial work-up

and NP complete follow-up visits and what is the extent of care? In order to reduce any

confusion having a complete job description will alleviate any concerns. Other areas to be

covered in service include an understanding of start date, expectations of number of

patients seen, time allowed to build practice, learn electronic health records (EHR), and

billing process. The number of hours per week, on-call time and responsibilities on-call,

and any overtime compensation are other areas the NP will need to understand.

Salary. As previously mentioned under compensation plans there are numerous

plans regarding salary and salary structure. The questions NPs should ask are: how, how

much, and when payments will be made? Brown and Dolan, (2016) state productivity-

based compensation is generally not recommended for new NPs because of the risk of

fluctuation in pay while building practice. An NP may receive a lower base salary with

bonus potential every quarter. The NP must understand all elements of salary and

bonuses. Additional information could include sign on bonus, merit programs, and ability

for profit sharing.

Continuing education/documentation/quality improvement. The NP must

know if and how much money is allowed for continuing education to include professional

journals, fees, licensing fees, and tuition reimbursement. Also, will time be allowed for

education, documentation, and Quality Assurance? The NP should determine if a laptop

will be provided, quality internet access, and literature access such as UpToDate (Brown

and Dolan, 2016).

Benefits. The benefits allowed for all employees should be given to the NP in an

employer-to-employee contract. In the employer-to-employee contract the employer will

deduct taxes. It is recommended to consult tax specialists for any concerns. The benefits

include vacation time, illness pay, medical and dental insurance, maternity leave,

daycare, life insurance, long-term care, and any pension plans (Brown and Dolan, 2016).

Malpractice. It is important to understand who will be responsible for the

payment of the NP’s malpractice insurance: the employer or employee? The NP must

also ask who will pay for malpractice insurance when volunteering. There are two basic

policy types of malpractice insurance. The first policy is occurrence-based and is

effective if the coverage was in place at the time the act occurred. The second policy is

claims-made and the policy must be in effect at the time the claim was made. If an NP

has claims-made insurance, then the NP must have a “tail” coverage upon leaving the

employer. The “tail” coverage extends the insurance through a specific time period,

which is usually the statute of limitations. The contract should stipulate who is

responsible to purchase “tail” insurance if needed (Brown and Dolan, 2016).

Terms and termination. Most contracts are good for one year and need updated

and signed annually. Contract termination details should be listed such as how many days

are needed to terminate the position. This can vary depending on area and specialty with

most ranging from 30 days to three months (Brown and Dolan, 2016).

Non-compete and non-solicitation. Some employers may attempt to prevent the

employee from practicing near the former practice area for a certain timeframe (Brown &

Dolan, 2016). Brown and Dolan, (2016) also state if the timeframe and distance seem

unreasonable, this may be a red flag in this contract.

Negotiation of Contracts

As NPs provide care, including primary care, an understanding of contracts and

negotiation is needed. An additional aspect NPs must understand is the fact that

healthcare industries are focusing on cost, quality, and increased access. These points are

necessary to ascertain when negotiation contracts. This will allow the NP to understand

expectations from the employer. DeCapua (2017) states one should never accept the first

offer and should ask for a raise without anxiety the employer will harbor resentment or be

offended at request for higher pay. DeCapua (2017) states 57% of men will negotiate

salaries which results in a 7.6% increase in the first offer. This is compared to 10% of

women who negotiate salaries (p.1). Salary research must be done by the NP prior to

beginning the process. The American Association of Nurse Practitioners conducts

national surveys of nurse practitioners by specialty.

Dillon and Hoyson, (2014) claim the employment experience will vary based on

if the employer has experience with NPs. When an NP is new to the practice, they may

assume a leadership role and can set standards for future NPs. If the employer does not

have experience, the NP must be knowledgeable in salary expectations for the area and

the number of patients expected to treat with adjustments to the numbers in six months

and one year. The NP must be aware of practice and malpractice expenses as this can

range from 20-50%. The expenses will need to be adjusted from the revenue generated.

One must ask if credentialing is required as this process can take up to three months in

some cases. An application for national provider identifier (NPI), Medicare provider

enrollment, and Medicaid application will need to be obtained in order for reimbursement

of services. Another question for the employer is how billing will occur? Will the billing

be completed under the NPs own Medicare number at 85% rate of the physician or will it

be billed “incident to”? “Incident to” billing can only occur in the outpatient setting.

When a bill is completed as “incident to” it is reimbursed at 100%, however there are

some requirements to this type of billing. The patient must be treated under direct

supervision of the physician. The physician does not need to see the patient or sign off on

all documents but must be directly available in the office to provide assistance. The

physician will need to see all

initial or new patients and the NP can treat follow-up visits. During the negotiation

process the NP must understand the collaborative agreement in states which require

collaboration.

Kleinpell and Perez, (2006) developed a negotiation assessment worksheet (see

Table 2.2).

Practice Assessment

Organizational

Analysis

Reimbursement

Structure

Contract Terms

-Type of clients most

often seen in practice

-Common diagnoses

that are managed

-Average number of

inpatients *

-Average number of

admissions*

-Average number of

patients seen per day

-Common procedures

performed for

patients

-Is practice affiliated

or owned by an

organization, practice

management plan, or

hospital

-What is the financial

status of the practice –

are any mergers or

acquisitions pending?

-Is there a business

plan for the practice?

-What is the

performance or the

practice on quality

indicators

-Type of payment

mechanisms used by

the practice

-Medicare, Medicaid,

insurance, managed

care contracts

-What reimbursable

services can be

provided by the NP?

-What is the proposed

length of the

employment contract?

-How can terms be

renegotiated?

-What is the required

advance notice for

termination?

-What is the timeframe

for contract review or

renewal?

Table 2.2 Negotiation worksheet. (Kleinpell, & Perez, 2006)

*if applicable for hospital coverage

It is recommended if the NP has any questions or concerns regarding the contract that

they obtain legal review by an attorney versed in contract law (Kleinpell, & Perez, 2006).

Nearly 50% of job candidates fail to negotiate an initial offer of employment

(Sweeney & Gosfield, 2013). Negotiating a higher salary can make a tremendous impact

on lifelong earnings. Even if a salary is non-negotiable, there are other benefits that may

be. It is imperative to know what you want and how to ask for it.

Basic principles. “Essentials of Negotiating for Employment in a Changing

Environment”, published in Journal of Vascular Surgery (Satiani, Nair, Starr, & Samson,

2014), discuss four basic assumptions of negotiating: be clear about your goals; be aware

of emotional goals; recognize outcomes consistent with these goals; and pay attention to

the relationship with the other party. Know that neither side should expect to get

everything it wants and be prepared for compromise.

Salary negotiations. The New York Times, in their article entitled, “Why You

Should Tell Your Co-Workers How Much Money you Make” (Herrera, 2018), noted that

since the National Labor Relations Act was passed in 1935, it is unlawful for private

sector employers to prohibit employees from discussing their wages. Discussions with

contemporaries regarding salaries can be a powerful tool to fight pay inequity. The article

recommends focusing on the salary and not the person. Another way to approach the

situation, is to ask an individual if they can provide the salary range for the position for

which you are applying.

Andrew Waite, in his article entitled, “Salary Negotiations” (2015) stated that

determining a salary range is more science than art. Most employers have a rubric that is

based on specific experience levels and is typically based on the going wage in that

geographic area. Within that range however, there is typically some leeway. When

discussing salary, employers are often willing to share the minimum and midpoint of a

position’s salary range (Waite, 2015).

When asked the salary expectation, it is appropriate for the NP to respond that

they expect to “receive a salary commensurate with my years of experience in the field”

(Anonymous, 2018). The same article reports if a potential employer persists with

questions about salary expectations, it would then be appropriate to provide a range. In

some states it is not legal to ask what an employee’s current salary is. It would be

important to know and reference this, as appropriate. In other situations, an appropriate

answer might be that the current salary is below market at X, and that based on

experience, qualifications and knowledge of the market, an adequate salary would be

between X and Y (Anonymous, 2018).

If a lower than expected offer is received, state the offer itself is exciting, but is

lower than expected. Then, ask if they have negotiated with candidates in the past. If the

salary is non-negotiable, it would be appropriate to discuss any other options that are

important to the NP, such as a four-day week, additional paid time off, etc. (Anonymous,

2018). Remember, it is the NPs responsibility to negotiate. Know what is wanted and

know what will be accepted.

It is recommended that pay is prioritized in job negotiations, as earning potential

compounds (Waite, 2015). Employees that negotiate their salary increase their annual

salary on average of $5,000 per year. “Assuming a 5% average annual pay increase over

a 40-year career, a 25-year-old who negotiated a starting salary of $55,000 will earn

$634,000 more that a non-negotiator who accepted an initial offer of $50,000” (Sweeney

& Gosfield, n.d.). Satiani et al (2014) recommends that an initial offer should never be

accepted. Rather, a time for further discussion should be determined.

Quality of Care

Patient access to primary healthcare continues to decline. There are several factors

to this decline to include the following: fewer physicians entering primary care, aging

population, and restriction on NPs as well as various compensation plans. The number of

NPs is increasing. According to the American Association of Nurse Practitioners (AANP)

NP Facts (2018a), there are “more the 248,000 nurse practitioners (NPs) licensed in the

United States” (p. 1). Enrollment in NP programs continue to rise. As registered nurses

(RNs) transition to NPs responsibilities, roles, scope of practice, and compensation plans

are changing. NPs must be aware of expectations to assure quality care and job

satisfaction.

Providing quality of care to all patients is paramount. It is essential quality

primary care is available for all patients. McCleery, Christensen, Peterson, Humphrey,

and Helfand, (2014) state there is no difference in health status, quality of life, mortality,

or hospitalizations favoring either advanced practice registered nurses (APRN) or

physician care in primary and urgent care settings. Stanik-Hutt et al., (2013) also stated

that there is a high level of evidence indicating better serum lipid levels in patients cared

for by NPs in primary care settings. They also indicated that patient outcomes on

satisfaction with care, health status, functional status, number of emergency department

visits and hospitalizations, blood glucose, blood pressure, and mortality are similar for

NPs and MDs.

The Doctor of Nursing Practice (DNP) graduate must understand how NPs can

provide primary quality care equivalent or better than physicians. The Institute of

Medicine (IOM) (2011) states APRNs must be allowed to practice at the highest level of

education. According to AANP (2018b) State Practice Environment map there are

currently 23 states (including the District of Columbia) with full practice authority.

Sixteen states have reduced practice and 12 states with restrictive practice. NPs with

reduced or restrictive practice are not able to practice at highest level of education which

can influence quality of care delivered. NPs must understand their individual state’s

scope of practice before signing any contract to assure they are practicing at the highest

level allowed by the state.

Shea (2015) stated “job satisfaction influences employee retention, worker

productivity, and performance, and is directly related to NP’s desire to work and to

provide quality healthcare” (p. 31). Shea (2015) completed a grounded theory approach

unlike others that relied on quantitative design. The findings identified NPs having job

satisfaction when able to provide holistic care and being valued as a professional. When

accepting a new position, the NP must have thorough knowledge regarding expectations.

Ryan and Ebbert, (2013) discuss perceived beliefs and barriers nurse practitioners

face. They continue with acknowledging NPs as critical players in primary care,

recruiting more nurses into advanced practice and identifying strengths and obstacles in

that environment become important. Ryan and Ebbert, (2013) discovered “having

information, support, resources, and opportunities to learn and grow increase self-

confidence and self-determination and impact performance outcomes” (p. 432). This

finding is consistent with the others regarding education or having the information to

improve satisfaction and quality of care.

Summary

The review of literature indicates a need for a single resource for nurse

practitioners to utilize when preparing for employment and negotiations. It is imperative

that nurse practitioners are prepared to fully discuss compensation plans and benefit

packages. They must also feel comfortable negotiating for any changes they desire in an

offer. Currently there is minimal information available for NPs to reference regarding

these matters, and what exists is not easily compiled.

When embarking on a career change, it is imperative that nurse practitioners have

a thorough understanding of the potential components of a salary and bonus plan. If a

salary offer includes a productivity component, it is critical to understand the benefits and

pitfalls. A familiarity in gender earnings gap, specific to NPs is important; as are the

types of bonus packages. In addition to compensation, a NP must be well versed in

potential components of a compensation package, including elements not likely

applicable to our work previously. This includes such things as malpractice insurance,

general and professional expenses. A nurse practitioner must have a basic comprehension

of components of a contract, as well. Finally, an NP must have a basic knowledge of

negotiations. The NP must keep abreast of changes that continue to occur in healthcare

related to compensation plans and contracts. This will be an evolving project requiring

constant review of new literature as it becomes available.

All the necessary components to start in a new position can become confusing and

frustrating. There is little education for NPs regarding this process in schools as there is

limited literature available. This DNP scholarly project is aimed at providing the

information needed for NPs whether currently enrolled in NP programs or an expert NP

to have the knowledge base necessary for understanding employment contracts resulting

in successful negotiations. This can help alleviate any additional stress during these

times. Assuring these expectations are understood can promote quality care and job

satisfaction.

As the information regarding education for NPs with the above-mentioned

process this project will try to provide more information to be available to all NPs

whether in the form of classroom education, webinars, or on-line sites to obtain the

necessary information.

Chapter III

Methods and Plans

Project Design

The PICOT question for this research project was “Do nurse practitioner students

who have additional knowledge regarding compensation, benefits packages and

negotiations have an increased sense of confidence and understanding regarding

compensation, benefits packages and negotiations after receiving provided education?”

As previously discussed, access to timely and accurate information regarding

compensation and compensation packages, specific to nurse practitioners, is imperative to

making a sound, educated decision regarding employment offers. NPs must enter the

interview process prepared to discuss all aspects of compensation plans and benefits

packages, as well as feel confident in their ability to negotiate vigorously for their

interests. It is the authors’ contention that at this time it is difficult to determine if an offer

of employment is competitive as available information is often outdated, too specific or

too generalized. The authors’ interest in this subject matter grew from frustrations

experienced in finding timely, reliable information pertaining to RVU salary packages.

The ultimate goal of this project was to develop a program that can be presented

to students to educate them on the particulars of nurse practitioner salary, benefit

packages and negotiations, so they are prepared for the interview process. To determine if

the program was successful in meeting these goals, students were given a pretest, to test

their comfort level surrounding these issues. Students then attended a ninety-minute live

presentation regarding these subjects. After the presentation, the same test was

administered, again measuring their comfort level.

Sample/Target Population

The population studied for this project were nurse practitioner students currently

enrolled in the Family Nurse Practitioner, BSN to DNP program at Pittsburg University

(PSU), in Pittsburg, Kansas. The educational program was conducted during the summer

semester, 2019. The population studied was a convenience sample. The faculty advisors

for this program facilitated the time and audience for the presentation of education

component. Students were excluded if they were enrolled in the MSN – DNP program, as

it was felt they likely had more experience in these areas due to their time in the work

force and were not actively seeking new employment.

Protection of human subjects. The Pittsburg State University Committee for the

Protection of Human Research Subjects (CPHRS) paperwork was submitted and approval

for the project obtained. The research presented no more than minimal risk of harm to

subjects and involves no procedures for which written consent is normally required

outside of the research context. The information obtained from the pre-posttest survey,

was evaluated and recorded such that the subjects cannot/will not be identified directly or

through identifiers. Full confidentiality and anonymity was maintained. All data collected

will be destroyed after publication and stored in a locked box until that time. The

potential benefits to the subjects was obtaining beneficial information pertinent to their

upcoming career search. No compensation was offered to the participants. No risks were

identified.

Instruments

The variables from the research question for this study were confidence and an

increase in knowledge regarding compensation plans and contract negotiations. The

expectation was there will be an increase in confidence and knowledge regarding

compensation plans and contract negotiations when additional education is provided. The

participants consisted of registered nurses (RN) enrolled in the BSN-DNP program at

PSU during the summer semester of 2019. The questions in the pre-posttest assessed the

students understanding and confidence in compensation plans, contract negotiations,

benefit packages, and job satisfaction. The data was analyzed for any statistical change.

The project employed a pretest-posttest design, with utilization of a 5-point Likert

Scale f (See Appendix A) for quantification of responses. Information from participants

regarding number of years’ experience, gender, and main area of practice as an RN was

also collected on the pre-posttests. A structured educational intervention to all

participants consisting of information obtained from research of the literature was

completed (See PowerPoint presentation, Appendix C). Both the pretest and posttest were

completed in approximately 10 minutes each. The time allotted for pre-posttest,

education, and questions was 90 minutes. A review of the pre-posttest was conducted by

the authors. The answers with higher numbers (4 and 5 or agree and strongly agree)

correspond with a sense of confidence and understanding of the information for each

question. The pretest was compared to posttest for significant changes.

Analysis of Data

The data collected was ordinal with both parametric and nonparametric statistical

analyses completed. The t-test was utilized for parametric statistical analysis with a

comparison of each question on pre-posttest for individual participants. From the research

question, two hypotheses were created for this project. The two hypotheses were research

and null hypothesis and are as follows:

• Research hypothesis: There will be increased confidence and

understanding regarding compensation plans and contract negotiations

with additional education.

• Null hypothesis: There will be no change in confidence or understanding

regarding compensation plans and contract negotiations with additional

education.

Regardless of the outcomes obtained during this project, dissemination of all

finding is essential. The development of future projects, education, and /or research can

be recommended once all data is assimilated.

Procedure

Once approval from the scholarly project committee members and IRB approval

from Pittsburg State University was obtained, the faculty in NURS 828 Primary Care III

was briefed on project details. The date scheduled for administration of pre-posttest and

education to the students is June 12, 2019. Due to the small number or participants (13

students) there was only one group analyzed. This was considered a focus group format.

The participants randomly received a packet containing a pretest and a posttest

with the same number on each test in order to compare tests individually. Once the

participants completed the pretest, it was collected and secured. The education

component took place with questions answered and completion of the posttest. These

tests have been secured by the authors until publication of information. A course

evaluation (See Appendix B) was completed at the end of the posttest. Anonymity was

maintained throughout the entire process.

Resources needed to complete the study were the cost of printing pre-posttest and

course evaluations, and time spent by authors analyzing the collected data. The audio-

visual equipment in the Pittsburg State University classroom for the presentation was

utilized.

Treatment of Data/Outcomes/Evaluation Plan

The education course and pre-posttest were designed from the data obtained

during review of literature and based on objectives for this scholarly project. The

objectives for the scholarly project are as follows:

• To provide nurse practitioners (novice or expert) the knowledge base regarding

various

compensation plans.

o Define compensation wRVU’s

o Define base salary

o Define bonus potential

• To provide the knowledge base regarding various benefits packages for NP

employment

• To provide information to nurse practitioners (novice or expert) to participate in

successful contract negotiations.

• To evaluate if formalized education improves understanding of compensations

plans, benefits packages, and contracts for nurse practitioners (novice or expert).

The evaluation of the education course was assessed by reviewing data obtained

from pre-posttest, completed course evaluations, discussion with participants during

question and answer session, and review with the scholarly committee members. The

tools used to link the objectives are the pre-posttest and the course evaluation. Once the

data was collected it was analyzed for any statistical significance utilizing the t-test for

individual comparison. Each question from both the pre-posttest was reviewed for

significance on an individual basis. The analysis of the group from pre-posttest utilized

the paired t-test for group comparison and any statistical significance (Burns & Grove,

2009; Sullivan & Artino, 2013).

Plan for sustainability

It is the fervent desire of these researchers to develop a program that can, once

perfected, be presented to all students entering their last semester(s) of their Nurse

Practitioner educational program. It is the desire of the authors to develop a similar

program that can be presented to Nurse Practitioner organizations. In addition, the

authors wish to develop published materials, both written and prerecorded, marketed

towards current NPs as well as students, to help prepare them for salary and benefit

package discussions, as well as employment negotiations. In American culture, an

individual’s education and their resultant professional responsibilities correlate with

increased compensation. This does not currently apply to the nursing profession as a

whole and most specifically to the NP role (Kacel et al, 2005). It is important as NPs, we

take responsibility for the disparity between experience and compensation and negotiate

salaries and benefits more in line with their education and responsibilities. The only way

to do this is to have access to timely and accurate information, which the researchers

hope to provide. In doing so, it is the authors’ hope that these programs will lead to

sustainable, profitable careers.

Chapter IV

Evaluation of Results

The purpose of this scholarly project was to determine if NP students have an

improvement in confidence level and understanding regarding compensation, benefit

packages, and negotiations after completing selected education. The main research

question (PICOT) was:

Do nurse practitioner students who have additional knowledge regarding

compensation, benefits packages, and negotiations have an increased sense

of confidence and understanding regarding compensation, benefits

packages, and negotiations after receiving provided education?

The hypothesis was: “There will be increased confidence and understanding

regarding compensation plans and contract negotiations with additional education”. Both

the research question and hypothesis will be discussed later in further detail.

Description of Sample/Population

The study population was comprised of BSN to DNP students at Pittsburg State

University (PSU) who graduate May 2020. The study was completed in June 2019, one-

year prior to graduation date. This was a sample of convenience. A total of 13 students,

11 female and two males, completed all components of the study. The years of

experience as a registered nurse ranged from four to 18 years with various practice areas

including ambulatory care, cardiac care and rehabilitation, emergency department, float

pool, infusion center, intensive care, medical-surgical, obstetrics, and pre-operative care.

The entire education process took a total of three hours to complete which included

introductions, pretest, education component, posttest, question and answer session, and

course evaluation.

Description of Key Terms/Variables

Burns and Grove (2009) state the independent variable is the variable to be

manipulated in an experiment. Melnyk and Fineout-Overholt (2014) state the

independent variable is the intervention or treatment. The scholarly project’s independent

variable was the education component or intervention involving compensation, benefit

packages, and negotiations provided to the study population.

Melnyk and Fineout-Overholt (2014) define a dependent variable as the variable

which is influenced or caused by the independent variable (p.604). The dependent

variable in this study was improvement in confidence level and understanding regarding

compensation, benefit packages, and negotiations as measured by pretest and posttest

results. In this project, the objective was to determine if the NP students’ level of

confidence and understanding were influenced by the education component.

Analyses of Project Questions/Hypotheses

Specific research questions were developed using the main research question

(PICOT) and the pre-posttest surveys. The pre-posttest surveys were comprised of a total

of eight questions, plus three questions addressing demographics. Sixteen research

questions were then designed utilizing the eight pre-posttest questions. The main

objective of the scholarly project was to determine if there was an increase in confidence

and understanding regarding compensation, benefit packages, and negotiations after

completion of the education component. The pre-posttests were approved by the

committee chairperson and members. The specific research questions are as follows:

1. Do nurse practitioner students have a clear understanding of compensation

packages available before education?

2. Do nurse practitioner students have a clear understanding of compensation

packages available after education?

3. Do nurse practitioner students understand the role wRVUs play on compensation

plans before education?

4. Do nurse practitioner students understand the role wRVUs play on compensation

plans after education?

5. Do nurse practitioner students understand the potential components of a bonus

before education?

6. Do nurse practitioner students understand the potential components of a bonus

after education?

7. Do nurse practitioner students have a clear understanding of benefits packages

available before education?

8. Do nurse practitioner students have a clear understanding of benefits packages

available after education?

9. Do nurse practitioner students have a clear understanding to complete successful

employment contract negotiations before education?

10. Do nurse practitioner students have a clear understanding to complete successful

employment contract negotiations after education?

11. Do nurse practitioner students have an understanding of the basic components

related to a NP employment contract before education?

12. Do nurse practitioner students have an understanding of the basic components

related to a NP employment contract after education?

13. Do nurse practitioner students have an understanding of the factors (intrinsic and

extrinsic) involved with job satisfaction before education?

14. Do nurse practitioner students have an understanding of the factors (intrinsic and

extrinsic) involved with job satisfaction after education?

15. Do nurse practitioner students have confidence negotiating contracts before

education?

16. Do nurse practitioner students have confidence negotiating contracts after

education?

Shier (2004) states the paired t-test should be used to compare two population means

where you have two samples in which observation in one sample can be paired with

observations in the other sample. An example is before-and-after observations such as

pre-posttest survey measurements with an intervention (education) between the surveys.

Results. The results were analyzed for statistical significance using paired t-test.

Table 4.1 displays the data for the individual questions on the pretest (before education),

the posttest (after education), and individual participants results. The rows in Table 4.1

represent individual participant scores for each question with the P-values included. The

columns represent an analysis of each question with all the participant’s scores on the

pretest and posttest as well as P-values. The findings of this scholarly project were

compelling for BSN-DNP students to have increased confidence and understanding

regarding compensation, benefit packages, and negotiations after receiving additional

education.

Participants

Question

Pre/Post*

Question

Pre/Post*

Question

Pre/Post*

Question

Pre/Post*

Question

Pre/Post*

Question

Pre/Post*

Question

Pre/Post*

Question

Pre/Post*

P-Value of

Individual

Participants

CI=95%

2/4

4/5

2/4

4/5

2/4

P<0.0001

2/5

1/5

2/5

4/5

2/5

4/5

3/5

P<0.0009

1/5

2/5

1/4

P<0.0001

1/5

2/5

1/3

3/5

1/5

1/4

P<0.0001

2/4

2/5

4/4

2/4

4/4

3/4

P<0.0054

2/4

3/4

2/4

P<0.0001

1/5

1/4

3/5

1/5

3/5

1/5

3/5

1/4

P<0.0001

1/4

2/4

3/4

2/4

4/4

2/3

P<0.0015

1/4

2/4

3/4

2/4

3/4

4/4

1/3

P<0.0025

#10

3/4

3/5

2/5

4/5

3/4

P<0.0004

#11

3/5

2/5

3/5

2/5

3/5

2/5

3/5

2/4

P<0.0001

#12

1/4

4/4

2/5

1/4

2/5

4/5

1/4

P<0.0052

#13

2/4

4/4

3/3

4/4

3/3

P<0.0052

P-Value

Individual

Questions #

1-8

CI-95%

P<0.0001

P<0.0005

P<0.0001

P=0.0019

P<0.001

Table 4.1 - Analysis of individual questions pretest and posttest of each participant.

1=Strongly Disagree, 2= Disagree, 3= Neutral, 4=Agree, 5=Strongly Agree.

CI=Confidence Interval

*See Appendix A for pretest and posttest questions.

A total of 13 BSN-DNP participants completed the pre-posttest surveys and

education component. The data from pre-posttest surveys were calculated for each

participant, each question, and the entire group using the paired t-test. The data showed

statistically significant differences between pretest and posttest surveys, thus supporting

the hypothesis and answering all the research questions (see table 4.1). The results were

statistically significant for increased confidence and understanding regarding

compensation, benefit packages, and negotiation in individual BSN-DNP participants as

well as the group.

Table 4.2 shows further analysis of the questions to include the differences

between the pretest and posttest mean (pretest mean minus posttest mean) for each

question and related confidence interval (CI).

Questions*

Pretest minus

Posttest

P-value

-2.69

CI 95% (-3.26 to -2.12)

<0.0001

-2.54

CI 95% (-3.26 to -1.81)

<0.0001

-1.77

CI 95% (-2.59 to -0.95)

<0.0005

-2.15

CI 95% (-2.89 to -1.42)

<0.0001

-2.23

CI 95% (-2.79 to -1.67)

<0.0001

-2.15

CI 95% (-2.89 to -1.42)

<0.0001

-1.38

CI 95% (-2.15 to -0.62)

= 0.0019

-1.92

CI 95% (-2.50 to -1.35)

<0.0001

Table 4.2 Analysis of question to include mean differences of pretest and posttest and

confidence intervals.

CI=Confidence Interval

*See Appendix A for pretest and posttest questions.

All the questions showed statistically significant results using the paired t-test.

Questions three and seven dealing with bonus potential and job satisfaction respectively

show the least change but remain statistically significant. These results may be influenced

by the similarities between registered nurses and nurse practitioners with bonuses and job

satisfaction. Questions one and two involving compensation plans for NPs and wRVUs

respectively had the highest change between pretest and posttest. The rationale for these

questions resulting in higher changes could be related to registered nurses not typically

dealing with compensation plans or wRVUs.

Additional Statistical Analyses

The entire group data were analyzed to determine significance. The group’s

answers for each question was recorded and multiplied by the number value of the

response (i.e. 1=strongly disagree…5=strongly agree) to obtain group data. The averages

were calculated by taking the sum of the group data for each question then dividing by 13

(number of participants). This provided the average (mean) for each question pretest and

posttest. The mean of each question pre- and posttest were analyzed using the paired t-

test. (See table 4.3 and 4.4).

Pre-Test

Questions

SD = 1

D = 2

N = 3

A = 4

SA = 5

AVERAGES

/ 13

participants

6x1= 6

5x2=10

2x3=6

1.69

4x1=4

5x2=10

2x3=6

2x4=8

2.15

2x1=2

4x2=8

4x3=12

3x4=12

2.61

2x1=2

5x2-10

3x3=9

3x4=12

2.54

3x1=3

7x2=14

2x3=6

1x4=4

2.08

2x1=2

6x2=12

2x3=6

3x4=12

2.46

1x1=1

3x2=6

2x3=6

7x4=28

3.15

6x1-6

4x2=8

3x3=9

1.77

Table 4.3 – Averages (means) of participants pretest.

1=Strongly Disagree (SD), 2= Disagree (D), 3= Neutral (N), 4=Agree (A), 5=Strongly Agree

(SA).

*See Appendix A for pretest and posttest questions.

Post-Test

Questions

SD = 1

D = 2

N = 3

A = 4

SA = 5

AVERAGES

/ 13

participants

9x4=36

4x5=20

4.31

6x4=24

7x5=35

4.54

6x4=24

7x5=35

4.54

1x3=3

6x4=24

6x5=30

4.38

1x3=3

8x4=32

4x5=20

4.23

5x4=20

8x5=40

4.62

6x4=24

7x5=35

4.54

3x3=9

9x4=36

1x5=5

3.85

Table 4.4 – Averages (means) of participants posttest.

1=Strongly Disagree (SD), 2= Disagree (D), 3= Neutral (N), 4=Agree (A), 5=Strongly Agree

(SA).

*See Appendix A for pretest and posttest questions.

The results of the group data using the paired t-test were statistically significant

with a P-value < 0.0001 with a CI 95% (-2.3787 to -1.7613). The mean of pretest minus

posttest equal -2.0700. These results are expected since the individual data was also

statistically significant.

Summary

The purpose of the study was to determine if there was an increase in confidence

and understanding with compensation, benefit packages, and negotiations after education

for BSN-DNP students. The data was remarkable as it exhibited statistically significant

improvements after education regarding compensation, benefit packages, and

negotiations. It is the experience of the authors that there is little in-class education

provided to NP students regarding this information. It is possible the same results would

be obtained for current NPs and not just NP students. It is imperative that one enters a

new career equipped with all information to be successful. A new job can be stressful and

knowing what is expected is needed regardless if the NP is novice or expert. Moving

forward, further research regarding this topic would be beneficial, whether the NP student

is completing an on-line or in-person curriculum. It is the hope of the authors to provide

web-based education regrading this information for NPs.

Chapter V

Relationship of Outcomes to Research

The purpose of this research project was to determine if educating nurse

practitioner students on compensation, benefits packages and negotiation skills helps

them feel an improved sense of confidence and understanding of this process so they

have the tools necessary to fully evaluate and negotiate a job offer. The data showed that

students feel vastly unprepared to discuss and negotiate salary and benefits packages with

potential employers. Data also showed that presentation of information on these matters

significantly increased their confidence and helped them feel better prepared to

participate in this process.

The paired t-test results for every item were significant at a 95% confidence

interval. This confirms the beliefs of the researchers that nurse practitioners have little to

no knowledge of matters relating to salary, compensation packages, the role wRVUs play

on compensation plans, benefits package, successful contract negotiations, basic

components of an NP contract, factors involved with job satisfaction, and negotiation

skills. It also confirms that education in these matters helps them to have a better

understanding and confidence of this subject matter. The authors also found that

information specifically relating to RVU expectations for nurse practitioners is difficult

to find and their research was unable to find any apparent industry standard.

As no similar previous studies were located by the authors, it is not possible to

compare the findings of this research to previous research. The lack of previous, similar

studies supports the need for future study in these areas. It is the authors’ contention that

as a result of this, nurse practitioner students are ill prepared to advocate on their behalf

during the hiring process. The results of this study bear this out.

Observations

It is the limited experience of the authors that classroom time is not dedicated to

educating nurse practitioner students on matters related to salary, benefits plans and

negotiation skills. So that NPs may better advocate for themselves and their profession, it

is imperative they have they knowledge to do so. If information were readily available

and contained in one easy to use format, it is the belief of the authors, NP students would

be better educated on compensation and benefits packages, and better able to negotiate on

their behalf. In addition, the fact that information on salaries and benefits packages for

nurse practitioners is difficult to find, educating oneself is at best, very difficult. The

instruments used to evaluate changes in knowledge before and after education were the

pretest and posttest. The findings were compelling, showing statistically significant

improvements in confidence and understanding of compensation and benefits packages;

and that comfort with negotiation improves with selected education. These findings do

correlate with the hypothesis designed prior to study. This was a small sample of

convenience and further research would be beneficial.

Evaluation of the Theoretical Framework

The theoretical framework for this DNP scholarly project was Barbara Carper’s

pattern of knowing (Carper, 1978). Carper’s theory was written 40 years ago with an

expansion by Chinn and Kramer, in 2008 (Chinn & Kramer, 2011). The premise for this

theory is that there are more ways to knowing besides empirical or scientific knowledge

for nurses. There needs to be an understanding of these patterns for teaching as well as

learning in nursing. The four patterns Carper recognized are (1) empirics, (2) esthetic, (3)

personal knowing, and (4) ethics. Chinn and Kramer took this one step further with the

addition of emancipatory knowing. All aspects need to be understood for nurses to

continue to grow. The study did show it is important to have empirical knowledge,

however personal knowing or experience does play a role in the NP advancing their

career. The components of job satisfaction would be part of esthetics as well as ethics.

The patterns of knowing framework works well for nurses caring for others as well as

themselves.

Evaluation of the Logic Model

A logic model represents visually the way changes will occur in a project. The

logic model proposed in this project functioned as it was hoped. Initially, the authors of

this study collected data regarding compensation, benefits packages and negotiations. In

doing so, they determined that minimal information on these subject matters was

available. Further, it was determined that no similar studies had been completed

previously. After extensive research, a program was developed and presented to nurse

practitioner students. Immediately prior to the presentation, NP students were given a

pretest to assess their knowledge. After the presentation, they were questioned about an

increased sense of confidence and understanding of these matters. The results were

overwhelmingly statistically significant, as detailed previously. One area student’s

continued to note confusion was regarding wRVUs. The authors are working to expand

yet simplify this information to present to future students so they may have a better

understanding of this concept. This was exactly as represented in the Logic Model, and

the way it was designed to work.

Limitations

Several limitations of this study were identified. First, the sample was a

convenience sample, and small. The participants of this study were all students of one

BSN to DNP program at a Midwestern state college. The authors acknowledge that

experiences of students in one school are not necessarily the experiences of many

students of multiple institutions. It is the authors’ contention, however, after completing

research on these matters that very little information regarding these matters are

available; and further, it is not easily accessible in a simple search. In addition, as this

was the first project of its kind, it was thought a small sample size for an initial study

would be best, giving the authors the opportunity to iron out any problems, if they should

occur, before a larger scale project was undertaken. A second limitation was the night

before the presentation, the slides for the presentation were inadvertently published and

available to the students. While it is unlikely that enough information was contained in

the slides to affect either the pretest or the posttest, it is possible. Given that all results

were statistically significant, comparing pretest and posttest results, it makes it even more

unlikely.

Implications for Future Projects and/or Research

The authors found that information relating to RVU expectations for nurse

practitioners is difficult to find and no apparent industry standard exists. What does exist

has been published by the American Medical Group Association (AMGA). For this

reason, the authors believe this presents an area for future investigation. It is the authors’

belief that these numbers should be determined by and for nurse practitioners. The

completion of this project on a larger scale, with students from other educational

institutions, in other geographical areas is another area for future work. A final potential

would include broadening the study and project to include currently practicing nurse

practitioners. Based on the reception of students as well as currently practicing NPs, there

appears to be a demand for this information.

The authors believe it is vital to disseminate the information from this study to

nursing faculty, practicing NPs, and nurse practitioner students entering the market for

the first time. To do this, they are preparing a poster presentation, to be presented at the

Advanced Practice Nurses of the Ozarks (APNO) and National Organization for Nurse

Practitioner Faculty (NONPF) yearly conference. They have also reached out to the

leaders of 4-State APN, to determine the feasibility of a podium presentation at their

yearly meeting; or a short presentation at their monthly meetings. Additionally, they are

actively submitting briefs for podium presentations at these as well as other conferences.

Finally, the authors have identified two peer-reviewed nursing education publications,

The Journal of Nurse Educators, as well as the Journal for Nurse Practitioners as

publications appropriate to their audiences. They are actively pursuing publication in

these periodicals as well.

Implications for Practice/Health Policy/Education

After completing their background research and this study, the authors feel

strongly that a significant knowledge deficit exists, regarding salary, benefits packages

and negotiation skills for NP students entering the workforce for the first time. So that NP

students are prepared for interviews, it is the belief of the authors that this information

should be included in NP curriculum. To promote the advancement of our field, and

prepare NP students for the work force, graduates need to be as prepared as possible. This

includes their ability to fully participate in the interview and hiring process.

Conclusion

The purpose of this project was to determine if educating nurse practitioner

students on compensation, benefits packages and negotiating allows them to feel an

increased sense of confidence and understanding of the process so they have the tools

necessary to fully evaluate and negotiate job offers. The results of this study support the

authors’ contention that students do not have a clear understanding of these matters; and

further, education regarding these matter provide this. As faculty members, we need to

graduate students that are fully engaged in their profession, including the interview and

hiring process. Anything less and we are failing our graduates.

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17.

APPENDIX

Appendix A

Pretest or Posttest

Circle which test

Compensation Plans and Contract Negotiation

Strongly Disagree (SD) = 1, Disagree (D) = 2, Neutral (N) = 3, Agree (A) = 4,

Strongly Agree (SA) = 5.

Please rate the following questions based on scale above.

1. I feel I have a clear understanding of compensation packages available to NPs.

SD D N A SA

2. I understand the role wRVUs play on compensation plans.

SD D N A SA

3. I understand the potential components of a bonus.

SD D N A SA

4. I feel I have a clear understanding of benefits packages available to NPs.

SD D N A SA

5. I feel I have a clear understanding to complete successful employment contract

negotiations.

SD D N A SA

6. I have an understanding of the basic components related to a NP employment

contract.

SD D N A SA

7. I have an understanding of the factors (intrinsic and extrinsic) involved with job

satisfaction.

SD D N A SA

8. I feel confident negotiating contracts.

SD D N A SA

How many years of experience do you have as a Registered Nurse (RN)? ___________

In which department do you currently work (ED, ICU, Home-Health, etc)? ___________

Gender (circle one): Female or Male

Appendix B

Course Evaluation Compensation Plans and Contract Negotiations

Lea Ann Tyler, ANP-C & Laura Weiss, FNP-C

Please complete the following course evaluation.

SD - Strongly disagree; D – Disagree; N – Neutral; A – Agree; SA – Strongly

Agree

1. The instructors clearly presented the information.

SD D N A SA

2. The instructors presented the content in an organized manner.

SD D N A SA

3. The information will help me understand the concepts introduced.

SD D N A SA

4. Were you satisfied with the content of the course presentation?

SD D N A SA

5. Please identify what you consider to be strengths of the presentation.

6. Please identify any weakness of the presentation.

7. Any suggestions for future presentations?

Appendix C

Education PowerPoint

Appendix C

Education PowerPoint