Running head: SALARY ISSUES IN NURSING 1

Salary Issues in Nursing

Ashley King

University of Saint Mary

Abstract

Nursing is a very common profession and viewed as a profession with a very positive income.

This may be true for a good percentage of nurses but there are issues involved that obstruct other

nurses to have the same opportunity in salary. The gender pay-gap and equality for women is

something that has been an issue for centuries and is also an issue in the female dominated

profession of nursing. Third world countries have a lot of struggles that Americans are aware of

but a lot of underlying problems Americans are not aware of. Nursing shortage, nursing salary

issues, lack of professional nurses, and lack of health care funds are just the beginning of

problems when it comes to health care in these third world countries. Gaining experience before

joining the registered nurse work force because experience makes more money is putting

pressure on potential nurses financially.

Keywords: nursing, salary, issues, third world countries, gender pay-gap, experience
SALARY ISSUES IN NURSING 3

Salary Issues in Nursing

When choosing a career, salary is usually an important part of that choice. Nursing

salaries vary from state to state and country to country. There are many positive factors relating

to registered nurses (RN) salaries, however there are also some issues involved. These issues

may include the gender pay gap, little to no salary for RNs in third world countries, and the

effect of prior healthcare employment on wages of RNs.

The gender pay gap is one of the most controversial topics in the country. It’s the notion

that men get paid more than women and nobody seems to have a logical reasoning as to why.

The gender pay gap even plays a role in nursing. Nursing is commonly perceived as a female

dominated career, initially developed by women like Florence Nightingale. Even considering all

of that male RNs still seems to have higher salaries than females with the same title. Every RN

takes the same oath and is expected to perform the same tasks and skills as their fellow RNs.

This issue has sparked interest and been the reason for several studies and hypothesis to be

conducted. Muench et al., (2016) conducted a study containing four different categories to help

break down the possible reasons for this gender pay gap: 1) career aspiration meaning the

motivational drive to do your job 2) work place experience meaning the amount of time in

nursing you already bring to the table 3) time taken out of the labor force for child rearing

meaning time taken off for child related responsibilities 4) physical strength. Hypotheses were

formed regarding these categories. The first hypotheses stated there are no systematic

motivational differences between male and female RNs. The second hypotheses stated that,

female earnings are lower than male earnings even when men and women have the same amount

of experience. The third hypotheses stated, female earnings are lower than male earnings even

for women who do not take time out for the labor force for childrearing. The final hypotheses
SALARY ISSUES IN NURSING 4

stated, female earnings are lower than male earnings in specialty areas and positions that are less

physically demanding, such as pediatrics, newborn care, education and research (Muench et al.,

2016). This study is evidence that there is no logical evidence behind the gender pay gap which

is why it is an issue in nursing salary. The Equal Rights Amendment (ERA) to the United States

constitution sought to obtain equal rights among both men and women. The ERA was passed by

congress in 1972 but failed to be ratified by the required quota of three-fourths (38) of the states

(Rudner Lugo, 2016). The states that failed to ratify this amendment within the 10-year window

are mainly made up of the southern states and Mormon based states such as Utah and Nevada.

The states that opposed the ERA were more likely to have unfair regulations for women, such as;

more likely to have unemployed women, women were not given the same opportunities as the

men, less likely to have policies to control domestic violence within the household, and less

likely to have welfare available for families with dependent children (Rudner Lugo, 2016). This

ERA vote mirrored cultural, religious, and other social values related to the narrow minded roles

of women. Even though times have changed over the years, the historical attitude towards

women is an ongoing gender dynamic effecting fairness and regulations in nursing practice.

Even though nursing is a female dominated career and even invented by women, according to

Rudner Lugo (2016) men still seem to bring in almost $9,000 more than the average salary of a

female nurse practitioner (NP).

Nursing in third world countries such as Pakistan can be a lot more difficult. These

hospitals are very understaffed and over populated with patients. According to Abbasi & Younas

(2016) the existing nurse patient ratio is 1:40 whereas, the nurse patient ratio recommended by

The Pakistan Nursing Council is 3:10 in the general ward. This ratio causes these RNs to be

overworked and patients to not get sufficient care. Salary in these third world countries such as
SALARY ISSUES IN NURSING 5

Pakistan are not sufficient enough for how overworked these RNs are. More developed countries

are attracting nurses in these third world countries by offering higher salaries and other

incentives (Abbasi & Younas, 2016). That is the reason these third world countries are so under

staffed. The salary issue is also causing a shortage of nurse educators. In these third world

countries there is also no moving up because lack of resources and money (Abbasi & Younas,

2016). Overall, this problem needs to be confronted and talked about more. Another third world

country facing difficulties in healthcare is Honduras. Just like Pakistan, most of the Honduran

population is living in poverty, sixty-six percent to be exact and forty-four percent are living in

extreme poverty (Tremethick & Smit, 2014). There are very limited financial resources available

for all healthcare systems and according to Tremethick & Smit (2014) and The World Health

Organization (WHO), for each person in Honduras the total spending was $134 while in the

United States it was $7,960 for each individual in the year 2009. That is a tremendous difference

and in healthcare $134 can barely even cover medication, let alone actual health care. Honduran

nurses also encounter types of diseases that are very rare and most of the time never seen in the

United States. With the limited health care funding this puts even more pressure on these over

worked nurses with health care money to make a difference for these patients with chronic

diseases. After hearing this statistic, it is hard to imagine these health care workers in Honduras

are even making a salary. There is a lack of professional nurses in Honduras due to the

requirement of four years of school and completing secondary schooling through grade 13. Most

of the nurses in Honduras are auxiliary nurses or technical nurses meaning they have completed

two years of studying nursing and only need three years of secondary schooling, meaning the

seventh grade through the ninth grade. Auxiliary nurses make up 78.8% of the Honduran nursing

work force due to lack of professional nurses (Tremethick & Smit, 2014). The nurse to
SALARY ISSUES IN NURSING 6

population ratio in Honduras compared to the United States is drastic. These nurses are

responsible for almost nine times the amount of patients as nurses in the United Sates are. Taking

the nurse to patient ratio and the amount of money each person has based on health care

expenses you can imagine the lack of salary these over worked nurses are receiving. This lack of

money for health care results in low pay for the average Latin American professional nurse

earning an equivalent to $400-$500 United States dollars per month (Tremethick & Smit, 2014).

Auxiliary nurses are making 30% less than professional nurses and these nurses are what makes

up most of the Honduran nursing population. The lack of health care funds and salary for these

nurses is causing most of them to migrate to more developed countries and begin careers that can

help them be more successful (Tremethick & Smith, 2014). These third world countries, such as

Pakistan and Honduras are being underserved and overworked resulting in their patients being

put in danger and the nursing community as a whole need to become more aware of these issues

and provide as much support and change as possible.

Experience is a key element in most work forces. Gaining experience in nursing before

you become an RN would include being a certified nursing aid (CNA) or a license practical

nurse (LPN). According to Byung-Kwang et al., (2016), the proportion of RNs with prior

employment in health-related positions before completing their initial RN education was 67.2 %

in 2008, having increased steadily from 28.8 % in 1992. This can be seen as an issue because not

everyone gets the chance to gain experience before they become an RN. Becoming a CNA or

LPN would require additional schooling before nursing school; which would require an

additional expense. This statistic could intimidate new RNs to feel as if they aren’t as ready to be

in the workforce as other RNs with prior healthcare experience. Also for many years RNs have

stated that time and cost are the two major issues holding them back to continuing their
SALARY ISSUES IN NURSING 7

education to the Bachelor of Science in Nursing (BSN). Barriers related to time are inflexible

schedules of BSN programs, especially with the demand of family if that applies to them. Cost

barriers, while the nurse is in school include loss of salary and loss of healthcare benefits during

the time the nurse is in school, on top of the cost of tuition (Zittel, Moss, O’Sullivan, & Siek,

2016). Potential nurses feel the pressure of continuing their education from and associates degree

to a bachelor degree because of the potential bills trying to be passed by certain state legislatures

that are requiring future RNs to obtain a BSN within 10 years of graduation from a diploma or

associates degree nursing program (Zittel et al., 2016). New York and and New Jersey currently

have this bill in place. This bill will cause potential nurses to change their mind on becoming

nurses because of the expense of schooling and the difference in salary for a nurse with an

associates degree vs. a nurse with a bachelor degree. An argument that has arose from this bill is

lack of evidence supporting why it is important to have a BSN and how the actual patients

benefit. The opposition of this bill has come from unions who believe that a BSN is not

necessary (Zittel et al., 2016). Nurses provide care, comfort, and compassion for patients in all

health care settings. Nurses’ concern for meeting their patient’s needs remains the same no

matter what the subject of care focuses on; from health promotion and illness prevention, disease

and symptom management, family support, or end of life care (Potter, Perry, Stockert, & Hall

2017). These unions that oppose this bill believe that this is possible whether you have an

associates degree or a bachelor degree.

When nursing is talked about as a career for the most part people say good things about

the pay and benefits. Bringing these issues to the surface should make people more aware of

some of the underlying problems that relate to salary in nursing. Although there are a ton of

upsides to becoming a nurse and the salary that comes along with it, it is helpful to understand
SALARY ISSUES IN NURSING 8

different aspects that could affect salary. Being a woman can bring the issue of equality into play

when you are going up against a man for the same career and expect to be paid and treated the

same. Third world countries evidently do not have the same resources and income as health care

in the United States and that needs to be made a bigger issue in today’s society. Experience does

not come free or cheap, so having the pressure to have experience before going into the

workforce could ultimately change the salary you desire. These issues that have been discussed

are issues that could potentially be solved and definitely need to be addressed more appropriately

to make nursing a more equal and successful career.

References

Abbasi, S., & Younas, M. (2016). Brain drain of nurses from Pakistan. I-Manager's Journal on

Nursing, 6(2), 7-11. Retrieved from Proquest.

Byung-Kwang, Y., Minchul, K., Tzu-Chun, L., Tomoko, S., Ward, D., & Spetz, J.

(2016). The effect of prior healthcare employment on the wages of registered nurses.

BMC Health Services Research, 161-12. doi:10.1186/s12913-016-1667-0

Muench, U., Busch, S.H., Sindelar, P.I. & Buerhaus, P.I. (2016). Exploring explanations for the

female-male earnings difference among registered nurses in the United States. Nursing

Economic$, 34(5), 214-223. Retrieved from CINAHL.

Potter, P.A., Perry, A.G, Stockert, P.A. & Hall, A.M. (2017). Fundamentals of nursing (9th ed).

St. Louis, MO: Mosby Elsevier. 2.

Rudner Lugo, N., (May 4, 2016) "Full practice authority for advanced practice registered nurses

is a gender issue" OJIN: The Online Journal of Issues in Nursing Vol. 21 No. 2. doi:

10.3912/OJIN.Vol21No02PPT54

Tremethick, M.J., Smit, E., (February 21, 2014) "Honduran nurses’ work-related rewards and

challenges: implications for international service learning and collaboration" OJIN: The

Online Journal of Issues in Nursing Vol. 19 No. 2. doi:10.3912/OJIN.Vol19No02PPT01

Zittel, B., Moss, E., O’Sullivan, A., Siek, T., (September 30, 2016) "Registered

nurses as professionals: accountability for education and practice" OJIN: The Online

Journal of Issues in Nursing Vol. 21, No. 3, Manuscript 1. doi:

10.3912/OJIN.Vol21No03Man01
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Appendix

I. Introduction

a. Some significant salary issues regarding registered nurses include:

i. The gender pay gap.

ii. Little to no salary for registered nurses in third world countries.

iii. The effect of prior healthcare employment on wages of registered nurses.

II. Gender pay gap

a. Female earnings are lower than male earnings.

b. The Equal Rights Amendment (ERA)

c. Studies show there is no logical reasoning behind the gender pay gap.

III. Third world country salary issues

a. Issues in Pakistan related to nursing and salary

b. Issues in Honduras related to nursing and salary

c. Compromised patient care

IV. Prior healthcare experience

a. Difference in wages when prior work experience as CNA or LPN

b. Difference in wages of RNs with an associates degree compared to RNs with a

bachelor’s degree

c. Expense of education

V. Conclusion