Male Registered Nurses Make Thousands More in Salary Than Female Counterparts

UCSF-Led Study Finds No Improvement in Earnings Gap Since 1988

By Scott Maier

Male registered nurses (RNs) make more than $5,000 per year than their female counterparts across most settings, specialty areas and positions, according to a UC San Francisco-led study, and this earnings gap has not improved over the last three decades.

The analysis will be published as a “Research Letter” in the March 24/31 issue of the Journal of the American Medical Association.

“The roles of RNs are expanding with implementation of the Affordable Care Act and emphasis on team-based care delivery,” said lead author Ulrike Muench, PhD, assistant professor of social and behavioral sciences in the UCSF School of Nursing. “These results may motivate nurse employers, including physicians, to examine their pay structures and act to eliminate inequities.”

Salary Gap Has Closed in Other Fields

From the research letter background, while the male-female salary gap has narrowed in many occupations since the Equal Pay Act of 1963, it persists in fields such as medicine and nursing. Predominately female, nursing is the largest health care occupation, with salary differences by gender affecting about 2.5 million women, according to the researchers.

Ulrike Muench, PhD

Ulrike Muench, PhD

To better understand the current pay discrepancy between male and female nurses, researchers led by Muench used data from the last six quadrennial National Sample Survey of Registered Nurses (NSSRN) for 1988-2008. This mail, electronic and web survey selected a state-based probability sample of currently licensed RNs from data provided by state boards of nursing with a sample size of more than 30,000 RNs per year and response rate of approximately 60 percent.

The NSSRN is ideally suited for analyzing gender differences in the RN workplace because of the large amount of employment information available in this survey compared to other surveys that are typically used by social scientists to study pay differences by gender.

The American Community Survey, a household survey with a 90 percent response rate, also was used to extend the time trends to 2013 and establish that unadjusted salary differences by gender were not limited to the national sample survey.

Both surveys showed that unadjusted male salaries were higher than female salaries every year by an average of approximately $10,000. Male adjusted salaries were, on average, higher by $5,148.

Affecting Most Specialty Areas

Muench notes that the salary gap is affecting most specialty areas and positions and not improved since 1988, the earliest survey year used by the researchers. Specifically, the gap was $7,678 for ambulatory care and $3,873 for hospital settings. It occurred in all specialties except orthopedics, ranging from $3,792 for chronic care to $6,034 for cardiology. Salary differences also existed by position, ranging from $3,956 for middle management to $17,290 for nurse anesthetists.

By increasing transparency of gender differences in compensation, the hiring climate may become more conducive for female nurses to negotiate with their employer for wage parity, which also may help in the closing of the gap.

Ulrike Muench, PhD

Muench said over the course of a 30-year career, female RNs will have earned about $155,000 less than male RNs using the adjusted earnings gap, $300,000 less using the unadjusted gap.

“Given the large numbers of women employed in nursing, gender pay differences affect a sizable part of the population and their families,” Muench said. “We hope that our results will bring awareness to this important topic, which we believe might best be addressed through both private and public efforts.”

The researchers suggest that nurse employers can take important steps toward eliminating pay inequality by increasing transparency in compensation and determining if gender differences in pay exist in their organizations.

“If that is the case, employers should examine whether there are legitimate reasons for paying these men more than women and take action to correct existing inequities,” Muench said. “By increasing transparency of gender differences in compensation, the hiring climate may become more conducive for female nurses to negotiate with their employer for wage parity, which also may help in the closing of the gap.”

Other contributors to the JAMA research letter were senior author Peter Buerhaus, PhD, RN, Vanderbilt University Medical Center Department of Health Policy; and Jody Sindelar, PhD, and Susan Busch, PhD, Yale School of Public Health Department of Health Policy and Management. Funding was provided by a grant from Sigma Theta Tau, Delta Mu Chapter.

UCSF is the nation's leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospitals.