Are nurses really overworked and underpaid?

The dissatisfaction among nurses was palpable in the avalanche of comments I received on my stories about nurses at Indiana University Health working to form a union and IU Health’s firing of one of nurses leading that effort.
 
One common theme was this: nurses are overworked and underpaid.
 
“No breaks, Skipped lunches, Few potty breaks; and inadequate compensation to Nurses who give their 110% and MORE,” wrote one commenter claiming to be an IU Health nurse.
 
Another wrote, “we have seen patient-ratio's increase, ancillary support staff reduced and morale at an all-time low. No we are not paid well at all for what we do. I know many professions blue and white collar that make much more than we do and no lives hang in the balance. DO you want your nurses, with your life in their hands, not having time to get to you, cleaning your floors and taking out trash since they reduced the staff that does that, being paid as low as possible and being unhappy?”

(If you want to read similar frustrations from some employees at St. Vincent Health, go here.)
 
Recent actions by IU Health show that it thought its nurse ranks were somewhat understaffed and underpaid at its downtown hospitals. The hospital system hired 452 new nurses at those facilities in the past six months. IU Health also gave a $2-per hour raise to most of its nurses as part of raises given to several groups of employees.
 
In a March 18 memo to IU Health employees, CEO Dan Evans wrote, “our IU Health Human Resources team regularly conducts research to ensure our pay and benefits are market-competitive. Their most recent research indicates that market increases to base pay are called for in several markets for certain jobs.  Therefore, many team members across the system will receive increases to bring their base pay up to market levels.”

While I don't have specific wage data for IU Health, it should be noted that its nurses in Indianapolis are likely some of the highest paid in the state, even if they were lagging their peers around the city. Hospital nurses nationally are paid a bit more than nurses that work in other settings, such as physician offices or nursing homes. Also, data compiled by ERI Economic Research Institute, a Washington-based compensation research firm, found that registered nurses in Indianapolis earn $34.18 an hour, on average, which is significantly higher than nurses earn in the rest of the state.
 
Even so, the idea that nurses are underpaid and overworked rings true on a gut level for me. After all, I work roughly 8-hour shifts, compared with the typical 12-hour shifts nurses at hospitals work. Also, I spend the majority of my time at a desk, not constantly walking from room to room, lifting patients, stocking supplies, cleaning up messes and all the other physical things hospital nurses do.
 
But I don’t engage much in gut feelings here at The Dose. Instead, I try to find good data to tell us what’s really going on.
 
So I pulled 2014 average hourly wage for registered nurses in all 50 states from the Bureau of Labor Statistics’ Occupational Employment Statistics Survey.
Then I compared those numbers to the average hourly wage for all occupations in each state.
 
Nurses earn above-average wages in all states. But I calculated the size of this nurse wage premium for each state, as well for the nation as a whole, to see where Indiana’s nurses stand.
 
With an average wage of $28.32 per hour, Hoosier nurses earn 42 percent more than the average of all occupations in the state.
 
That sounds good, but it’s actually worse than the rest of the nation, where nurses earn averages wages of $33.55 per hour, which is 48 percent higher than the average wages of all occupations nationwide. (You can see average wages for registered nurses compared with all workers in all 50 states in this spreadsheet.)
 
Indiana’s wage premium for registered nurses ranked No. 30 out of 50 states.
 
Hours were a tougher thing to capture. BLS captures average hours worked by surveying employers, not workers themselves.
 
It can tell me that private workers in Indiana average 35 hours per week, and that employees in the education and health care sectors average 32 hours per week. But it could not tell me average hours for nurses.
 
A 2013 national survey of registered nurses by California-based AMN Healthcare, a health care staffing company, found that nurses work 42 hours on average.
 
But by other measures, it appears that fewer nurses log more than 40 hours per week than is true among all workers. A 2014 Gallup survey found that half of U.S. workers in all industries are spending more than 40 hours a week on the job.
 
But in the AMN Healthcare survey, 30 percent of nurses said they worked more than 40 hours per week.
 
And a 2013 survey of 50,000 Indiana nurses found that only 22 percent were working more than 40 hours per week, with 55 percent working 33 to 40 hours per week.
 
Now a lot has changed since 2013, which is really why the IU Health nurses are trying to unionize. The number of nurses employed in Indiana ticked down in 2014 for the first time in years, according to BLS data, which likely means there’s more work to be done by fewer people.
 
IU Health’s nurses aren’t really complaining about their number of hours, but rather the amount of work they have to get done in the hours they work.
Lacie Little, the nurse fired by IU Health, eloquently described to me how that difference feels in practice.
 
“I want to do those extra things. When an ICU patient has been there 10 days, I want to give him a shave. I used to do those things all the time,” she said. But in the last three or four years, she added, “that doesn’t happen anymore.”
 
On top of that, she said, nurses (and nearly all medical staff) log more and more time to entering information on patients’ electronic medical records. (For more information on the "tragic" time-suck electronic medical records have become, go here.)
 
Blayne Miley, director of policy and advocacy at the Indiana State Nurses Association, said his group has heard more complaints about nurses’ workload in the past six months, but he can’t be sure that’s because the situation on the ground has changed or whether health care organizations, in general, are just not handling nurses’ concerns as often internally, prompting nurses to complain to their trade association.
 
“Nurse fatigue is a very real issue that not only creates the potential for high turnover in certain nurse settings, but can also lead to issues of patient safety,” Miley told me.
 
So it appears that nurses in Indiana are underpaid, relative to their peers nationally. They are not overworked from a sheer number of hours, but it sounds like the demands of their work have spiked recently so their margin for caring for patients with a human touch has been reduced.
 
For a business that competes on service and, increasingly, on price, those are big problems. Problems without easy answers.