When Florence Nightingale’s Notes on Nursing was first published in 1859 nursing was transformed beyond local traditional care into a skilled profession with an evidence-based central tenet. In the intervening time the profession has grown in the United States from a single nurse who was trained by Ms. Nightingale in person to the nation’s largest healthcare profession. More than 2.7 million Registered Nurses work in the US today.
The nursing workforce has remained largely dominated by women in the United States. From 1970 to 2011 the percentage of male RNs has grown from 2.7% to 9.6%. Although the demographics of nurses have not changed substantially, both the scope and compensation of nursing has expanded greatly throughout its history. Today the median pay for nurses is almost twice that of the national median pay of all workers, and there are opportunities for advanced autonomous practice in many states.
Despite the current and historic female dominance in nursing, a gender pay gap persists. A recent article published in The Journal of American Medical Association, found that male RN salaries were higher than females during every year between 1988 and 2013, in all settings, positions, and most specialties, with no narrowing of this gap over time.
Contributing factors to this disparity are not addressed in the JAMA article. Information from the U.S. Census Bureau website may provide some clarity to this imbalance. Although male RNs only make up 9.6% of all RNs, approximately 41% of nurse anesthetists, the highest earning nursing specialty with an average salary of $96460 (the average RN salary is $65470), are men. Research shows that male nurse anesthetists out earn their female peers by an average of $17290. This disparity shows that male RNs do not only disproportionately pursue the highest paying nursing specialties, but they are paid more in those specialties than women. Similar disparities exist for female physicians even though men and women become physicians at close to equal rates today.
The physician and nurse workforces are both getting closer to representative of the country in gender distribution (physicians much faster than nurses). This change though has clearly has not led to equal pay. The gender pay gap issue has been discussed at length in public social discourse, as well as on this blog. I raise this issue in this forum with the hope that opening this conversation to include women across the spectrum of health care workers can help lead to comprehensive solutions to this shared experience.
As healthcare delivery becomes more integrated with the implementation of bundled payments for services the working relationship between physicians and nurses will become closer and more collaborative than ever. Physician and nurse fortunes will be tied to the success of our patient’s outcomes, as compensation will surely be impacted by the limited budget allocated to each patient per “episode of care”. We are invested in the same outcomes. Shouldn’t we be invested in each other as well? As this relationship changes my hope is that women healthcare workers will be able to fight together against biases that have plagued the perceptions of our value throughout the histories of our professions, to eliminate the gender pay gap, and be paid equally for the service we provide.