Gender Pay Gap Persists in Nursing

Female RNs continue to earn less than their male counterparts across settings, specialties, and positions, data shows.

The gender pay gap in the United States may vary according to who's measuring it—the White House says women earn 77% of what men earn, while a Pew Research Center survey says women earn 84% of what men earn—but it's always there, even in the female-dominated nursing profession.

Men Still Woefully Underrepresented in Nursing

In fact, that gap is about $5,148 per year when adjusted for factors such as education and experience. And according to a study, nursing's gender pay gap hasn't narrowed in 25 years.

"We have been tracking these pay differences in the last few years, and so in some ways were not surprised to see the trend continue," lead author Ulrike Muench, PhD, RN, of the University of California, San Francisco, says via email. "But we didn't expect to see no improvement when looking over a period of 25 years."

Although the lack of men in nursing is often lamented, Muench's research, which was published in JAMA, in March, shows that men who are in nursing out-earn their female counterparts nearly across the board.

"Our study found that female RNs earned less than male RNs even when accounting for work settings, specialty areas, and job positions," she says. "We also adjusted for the number of hours worked, education, and many other factors." 

Muench and her team examined salary data from 1988–2013 using the now-discontinued quadrennial National Sample Survey of Registered Nurses (NSSRN) and the American Community Survey (ACS). The NSSRN sample included 87,903 RNs, and the ACS sample included 205,825 RNs. In both samples, 7% of the RNs were male.

"While numerous studies have examined pay differences for physicians, we know surprisingly little about pay differences in nursing, and no study has looked at RN earnings differences over time," Muench said.

The researchers found that the salary gap was $7,678 for ambulatory care and $3,873 for hospital settings. It was also present in all specialties except orthopedics, ranging from $3,792 for chronic care to $6,034 for cardiology. Salary differences also existed by position.

In addition, "No statistically significant changes in male vs female salary were found over time," the study says.

Male nurse leaders don't need to have experienced pay differences themselves to know that a salary gap exists across industries.

"I do think there are disparities in compensation between men and women in all different sectors," Dale Beatty, RN, MSN, RN, NEA-BC, CNO at University of Illinois Hospital and Health Sciences System in Chicago.

Although Beatty says he does not have any direct experience regarding pay differences between men and women, he has seen the literature about it.

"I'd like to say there isn't, but I think there's enough evidence out there to suggest that there is some work that we need to do. I think the bigger issue is if there are differences we should really look to try to understand what they are… It's not a healthy situation if that's occurring."

Muench's study didn't look at why the gender pay gap in nursing exists, and adds that it's "too early to speculate" without additional research. But she does offer a couple of theories of her own.

"It is possible that men gain more experience over time by working longer hours, or that men are more willing to take on additional shifts when the unit is short-staffed," she said. "Assuming all other factors stay the same, a worker with more experience or a more flexible worker earns more."

Muench says healthcare executives have a role to play in correcting the pay gap, and it's a role that starts in their own institutions.

"Healthcare executives are in a great position to examine in their organizations whether pay differences exist between men and women," Muench says.

If pay differences do exist, executives should next try to determine whether those differences are justified.

To get the ball rolling on equal pay, Muench points to the U.S. Department of Labor, "which suggests introducing open pay policies that help with transparency around compensation and has produced an employer's guide to equal pay that has some useful tips," she says.

For instance, a Department of Labor equal pay guide not only includes suggestions for employers such as implementing an open-pay policy, but also for regularly monitoring and evaluating pay policies and listening for red-flag statements from employees and managers, such as "It is not our fault if they are bad negotiators for their own salaries," and "I'm not exactly sure what was used to decide this salary."

Knowing that pay differences exist and acknowledging that they might not be justified are important first steps in correcting the gender pay gap. And perhaps this study will serve to alert any remaining skeptics that, even in the female-dominated world of nursing, the gender wage gap is real.

"If it's happening in other sectors," Beatty says, "Why would you believe it wasn't happening for nursing as well?"