Editor’s note: This commentary is by Tristin Adie, who is a nurse practitioner at the University of Vermont Medical Center.
[I]n recent weeks, the University of Vermont Medical Center has distributed statements informing the public that their wage proposals for advanced practice registered nurses (APRNs) would lead to an average salary of $119,000 in three years. This sounds like a lot. Why on earth would we contemplate going on strike along with our colleagues in the Vermont Federation of Nurses and Health Professionals?
Unfortunately, this figure is quite misleading. We are paid according to a wage scale that moves our salaries up gradually over many years. Our pay thus varies considerable by years of experience. A few figures to consider:
- At present, 43 percent of APRNs at UVMMC are paid below the 2017 national median of $50/hour ($104,000 for a full-time position).
- Starting pay for an APRN at UVMMC currently ranks just above the lowest 10th percentile in the country.
- An APRN must work for 14 years at UVMMC to reach the national median salary.
- APRN pay in Vermont consistently ranks among the very lowest in the country.
In these negotiations, the hospital has made some significant movement on starting pay for APRNs, which is encouraging. Their latest offer would not bring new hires up to the national median, however, and would still not be competitive with what is offered by many hospitals and clinics in our region. In recent years we have seen positions in our clinics go unfilled for months, and even years, because the pay on offer is so low. This has made it very difficult for patients to access care, and it has led to burnout among our colleagues. The hospital’s latest proposal thus does not do enough to address this smoldering crisis.
There is an additional issue at play, and that is one of respect. Before the formation of the nurses’ union in 2006, it was common that RNs who became nurse practitioners and midwives, after completing master’s degrees and advanced training, received a cut in their salaries. Yes, you read that correctly: Despite taking on higher levels of risk and agreeing to work more hours, they received less pay than they did as registered nurses. That memory is carried by about a third of all nurse practitioners at UVMMC, those who have been here for 24 years or more.
The first union contract negotiated for APRNs included a significant raise, but our colleagues at the top of the pay scale have watched their wages stagnant since then. In lieu of an actual raise, they have received heavily taxed annual bonuses — not enough to keep up with the increased cost of living year to year.
UVMMC’s latest wage proposal would grant these APRNs a raise of about $1.20/hour per year. Held up against the raises we know have been granted to those at the top of our institution, such as the more than $500,000 increase granted to CEO John Brumsted in 2015, this is an insult. These are the APRNs who make up the most experienced, knowledgeable layer of our profession. They have been our preceptors and our mentors, and they are often the people we call on when we are at a loss for how to care for an especially complex patient. They have given their lives to this institution. Those of us with less seniority feel strongly that they deserve better. We have proposed yearly raises of 4 percent over the life of our contract, which would amount to an average raise of $2.50/hour per year for this group.
Finally, a few words about who we are: APRNs include nurse midwives and nurse practitioners in the hospital, primary care and specialty clinics. We are salaried employees, meaning we are not paid by the hour, and we do not receive overtime pay. The work we do is often indistinguishable from that done by our physician colleagues.
Most of us work very busy days attending to our patients. In addition to seeing patients in person, we are responsible for documenting visits; responding to patient phone calls and emails; following up on lab results, imaging and other tests; completing disability, FMLA, transportation, and myriad other types of paperwork; securing prior authorizations from insurance companies for medications and needed tests; and precepting students.
Much of this work is impossible to complete during a normal workday, so most of us try to complete these tasks during our lunch “breaks,” after dinner, before breakfast, and on weekends. For a full-time APRN, a 50- or 60-hour workweek is unfortunately not uncommon.
We love our work. The relationships we enjoy with our patients in optimizing their health are truly rewarding. But many of us also feel stretched to the breaking point. We have joined our nurse colleagues in calling for substantial raises and improved staffing because we see this as the only mean of safeguarding our patients’ health, as well as remaining in this profession. We are disappointed that the hospital will not prioritize patient safety and provider well-being over executive salaries and the acquisition of new properties. But we are determined to support our colleagues throughout all positions in the hospital by joining them on the picket lines this week if we must. We ask you to join us calling on UVMMC to do the right thing.
