My first experience looking for a job as a nurse and attempting to understand compensation variability within the profession was both intimidating and stressful. After graduating from one of the best undergraduate nursing programs in the country, gaining clinical experience from top healthcare facilities and enduring the NCLEX and licensure, I assumed that finding a job would be a fairly straightforward process. Instead, I found myself scouring job boards, Googling for any new grad opportunity I could find, combing through Craigslist and blindly emailing the few contacts I had.
After a discouraging months-long search, I finally landed an inpatient opportunity as a pediatric nurse, but the experience was so painful that doing it again seemed unthinkable. So two years ago, when I had the opportunity to join the team at Trusted Health and to help other nurses avoid a similar ordeal, I jumped at the chance.
Today, along with a team of Nurse Advocates, I help nurses find new opportunities, maximize their income, and ultimately, build their careers. After helping hundreds of nurses navigate the job market, I’ve discovered a variety of strategies for any nurse looking to understand how they can grow their skills and increase their earning potential… all things I wish I’d had known at the outset of my career! Read on for three of my top tips.
Experiment with different income streams
One of the tactics I often recommend to the nurses who are looking to maximize their earning potential is to combine different types of opportunities, such as a per diem and a part-time role or travel nursing contract. While many nurses are familiar with this concept, most have questions about how to make it work on a practical level.
The key is to find a per diem role that offers maximum flexibility. If you’re restricted by a specific shift or weekend requirement, it’s likely going to be tricky to make both work. But, if you only need to work one to two days per month and are able to plan ahead, you can easily schedule around a part-time or travel position which may not be as flexible.
While combining two types of clinical opportunities, such as per diem and travel nursing, can be a great financial decision, it’s important not to overdo it. Be sure to consider the proximity of the two roles and how that will affect your ability to balance both and have downtime in-between shifts. I also encourage nurses to schedule time off or a vacation in between opportunities — particularly if they are working in two similar care settings — to avoid burnout.
Understand the salary landscape
The nursing industry suffers from a serious lack of transparency when it comes to compensation, especially for travel opportunities. Compensation information is often obscure and can vary by agency, plus most recruiters can only speak to the compensation trends across their open roles. Given how great the variances are geographically, by specialty, and care setting, it’s important to do your research. One great resource is a recent report from Trusted, which provides a comprehensive look at the salary landscape for travel nurses.
Some of the findings are what you might expect: cities like San Francisco, New York and Los Angeles lead in terms of pay, but there are nuances. While that big paycheck may not stretch very far in SF and NYC once you factor in cost of living, LA actually offers a pretty good bang for your buck. In fact, the average gross weekly pay for travel nurses in LA is 60% higher than the average for local residents.
St. Louis also emerged as a place where travel nurse salaries really stretch. While St. Louis might not top many nurses’ wish lists the same way that California or Hawaii often do, it has the advantage of its central location. So in addition to its low cost of living, it also may be a place you could potentially commute to for travel shifts while maintaining a per diem role elsewhere.
In general, I always encourage travel nurses to keep their minds open to locations that not be as obviously appealing. Rural or less-populated states often have a need for travel nurses that outstrips their supply, and as a result, are willing to pay top dollar. Alaska and South Dakota, for example, rank among the top five states in terms of pay, offering 9 and 6 percent above the national average respectively. It’s also worth noting that less obvious choices can sometimes make for surprisingly fun places to live. I frequently hear anecdotes from nurses who go to small towns with low expectations, only to find that they really enjoy the setting and lifestyle.
Embrace the art of negotiation
Broadly speaking, the characteristics that make a good nurse — selflessness, empathy and putting the needs of others first — are antithetical to negotiating savvy. It’s also not a skill taught in most nursing programs. As a result, it can feel taboo to nurses to have hard conversations about money. Fortunately, being informed can be just as effective as possessing those natural negotiating skills.
When you find a travel role you’re interested in, do your diligence to understand what compensation you should expect and whether it’s being offered by multiple agencies. Compensation and contract terms can often vary widely. To make an informed decision about the role, it’s important to understand the complete compensation package, which, in addition to salary, includes stipends and reimbursements.
While most of us don’t choose nursing for the money, that doesn’t mean you shouldn’t go after the pay you deserve. I know firsthand that travel nurses can be some of the hardest working and most experienced professionals in healthcare, and I hope these insights are helpful for anyone looking for ways to maximize their income!
Another important variable? Understanding how the length of your contract impacts your compensation. While longer contracts should generally mean higher compensation, it is important to find out if there is the possibility of an extension bonus. Even if you plan to stay for a longer period of time, it might benefit you to sign an initial contract first and later extend. And if an employer isn’t willing or able to budge on compensation, see if you can stipulate that your hours are guaranteed in your contract, thereby ensuring that your salary doesn’t vary if you’re called off shifts.
Sarah Gray is the Founding Clinician at Trusted Health, the career platform for the modern nurse. She is a graduate of the University of Pennsylvania’s Nursing School and began her nursing career at UCSF Benioff Children’s Hospital. Prior to moving away from the bedside, she was a Clinical Nurse III and an Evidence Based Practice Fellow, and served on multiple hospital-wide committee boards. At Trusted, she utilizes her clinical insight and passion for innovation to change how nurses manage their careers and solve for inefficiencies within healthcare staffing.
Have you noticed that nurse practitioners are becoming more
common in this country?
We are providing patients with essential medical services. We, as nurse practitioners, are able to offer diagnostic and treatment services for a wide range of illnesses. While many nurse practitioners might be happy at an office that is run by someone else, there are some who consider becoming an entrepreneur.
Starting your own nurse practitioner practice can be
lucrative and gives you an opportunity to help those patients in need, but you
should understand what you are getting into. I personally have been providing
patients with care at my clinic for many years and the knowledge I
have acquired is invaluable. If you are considering becoming a nurse
entrepreneur, be sure to learn more about the top characteristics that others
in the industry possess. This way, you can do a more thorough analysis of
1. The Ability To Be In Control
In one scientific publication, it was found that one of
the most important traits for a nurse entrepreneur is the ability to be and
remain in control over any type of situation. When you become an entrepreneur
and start your own nurse practice, you need to be in charge of various aspects
all at once. You need to be a leader and have the ability to recognize
situations that may spiral out of control quickly – and then take charge to
avoid such problems. For me, the ability to act fast and be in control at all
times is critical to the success of my practice.
2. The Ability To Analyze A
Situation And Know When It’s Okay To Take A Risk
Another critical characteristic lies in your ability to take
risks at the right times. There are many risks that have to be taken to succeed
in the business world. Understanding how these risks will play out and when it
is appropriate to take such a risk is critical. I often find myself taking
risks, but only when I am able to understand how my decisions might play out.
3. A Need For Achievement
You should have a desire for achievement. Once you have
established your new office, you need to recognize the fact that there is
always room to grow. You should know how to set goals – both short term and long-term
goals. You should also know how to continue striving toward those goals,
ultimately ensuring a consistency in achievements reached.
Innovation – the ability to adapt to new things – is a characteristic that is now more critical than ever before in a nurse practitioner. You should be able to adapt to the latest technological advancements that have been made. Plus, you need to be able to accept new changes in the industry and ensure you always have the latest treatments for patients.
5. Ambiguity Tolerance
Finally, ambiguity tolerance is another characteristic that
you definitely need. As a nurse practitioner, there will be times where the
result of something you strived for turns out as a disappointment. You should
be able to bounce back and avoid thinking negatively about such events.
As a nurse entrepreneur, I have a lot
of responsibilities. Understanding what it takes is important. I believe that
the characteristics outlined in this post are crucial to nurse practitioners
who are looking to take the entrepreneurial route.
This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a boxing coach.
By day, Cindy Bohmont, RN, SEN, Med, CCRN, CSD, works as
a staff nurse in the Cardiovascular Surgical Intensive Care Unit at Mercy Hospital
in Springfield, Missouri. She’s worked at Mercy for 48 years, and during that
time, she’s worked PRN in Coronary ICU, Pediatric ICU, Medical ICU, Neurotrauma
ICU, and Mercy Home Health Care. For five years, she even taught at St. John’s
School of Nursing.
In her free time, though, Bohmont does something that you
might never expect from a nurse: she officiates amateur boxing matches and is
moving into the professional field to work as an official for professional
About 25 years ago, Bohmont developed her interest in
boxing after two of her sons got into a fight on their ranch. When he was in
the Marines, her husband boxed, and he suggested that they find a gym for the
boys to learn boxing.
“We found a boxing program at the Boys and Girls Club in
Springfield, Missouri,” says Bohmont. “And I was hooked!”
Bohmont says that all five of her sons as well as her
youngest daughter became involved in boxing, although none of them ever went
While Bohmont began as a supportive mom, attending her kids’ matches, she soon learned enough to become an amateur official and began judging boxing tournaments all across the state. She also began coaching at the club. “I discovered that the sport of boxing is not just a legal fight. It’s a very complicated sport—[boxers are] trying to land scoring punches while at the same time protecting themselves,” explains Bohmont. “The most important things I taught were integrity, fair play, good nutrition, good sleeping habits, believing in yourself, generally taking care of your body and mind, and no drugs, smoking, or alcohol.”
Because, Bohmont says, boxing is an individual sport, whatever
athletes put into it—in terms of training and the like—that’s what they get out
Although some may think that it’s counteractive for a
nurse to coach a sport where athletes get injured, Bohmont says that “If you
listen to the news, you will rarely hear of a boxing injury. Everyone knows
someone with a tennis-elbow, football knee, etc. Most boxers are in tremendous
shape and are very skilled at defensive maneuvers.”
Over the years, Bohmont has won a number of awards,
including the Outstanding Official of the National Junior Golden Gloves
Tournament in Mesquite, Nevada as well as the Greater Kansas City Golden Gloves
Coach of the Year. “Those are major accomplishments when you consider this is
generally a male domain that I’ve jumped into,” Bohmont says.
Considering that coaching boxing can be tough on the
coach’s joints (Bohmont would hold practice pads and mitts for up to 30 kids to
hit each night for four nights a week over 20 years), she has decided to focus
on moving into the professional field of boxing and aspires to be an official
for pro fights.
That’s just one reason why Bohmont has begun working one
week a month in the ICU at St. Rose Hospital in Las Vegas, Nevada, as the area
holds tons of professional boxing matches.
“It has been difficult stepping back a little from coaching.
Then I get an email or see a Facebook posting from one of my former boxers with
a new aspect of their lives that I had a hand in guiding them toward,” says
Bohmont. “It’s so good for my soul to be able to work with healthy, thriving
young men and women after caring for the sickest of the sick in the intensive
care unit. It keeps me emotionally healthy and balanced.”
While working on
the job, have you ever been concerned that a mistake or an accident could cause
you to be sued? Even if that happened, you would be covered by your employer’s
malpractice insurance, right?
Well, maybe and
We interviewed David Griffiths, Senior Vice President for the Healthcare division of Aon Affinity. Griffiths has overall responsibility for the malpractice insurance program for the Nurses Service Organization. We asked him to explain how and when nurses are covered. (Note: because individual experiences are different, always seek professional advice regarding your own situation.)
Why should nurses considering having individual liability insurance?
Employer insurance is designed to protect the hospital or health care facility first and foremost. A hospital or health care facility’s coverage may extend to health care staff; however, there are key differences in how the coverage activates, and there could be gaps that would be detrimental to a nurse. Getting your own professional liability policy is a key way to make sure you are in control of the protection of your own career at all times.
What is the overall difference between the two types
- Employer Provided Malpractice Insurance:
A hospital or health care facility’s attorneys are
required to place the best interests of those organizations first. However,
this may or may not be in your best interests depending on the situation. Your
career is far too important to place in the hands of your employer, its
attorneys, and your employer’s insurance company. An individual professional
liability insurance policy ensures you have a team in your corner that has your
best interests in mind.
- Individual Professional Liability Insurance:
There are two key things an individual professional
liability insurance policy does that an employer’s policy may not:
- An individual professional liability insurance policy like those NSO provides covers you as a nurse 24/7–an employer’s policy only covers you when you’re on the clock.
- In addition to professional liability insurance, your individual policy provides license protection — most employer provided coverage does not offer defense of license to the board because it may be the employer who submits the complaint. Your license is your means of practicing as a nurse, and if it is threatened or taken away your livelihood is at stake.
Should only nurses in certain fields look into it? Why
or why not?
All nurses should
consider an individual professional liability insurance plan. There may be
differences in coverage for nurses in certain fields, but overall this type of
insurance is an effective source of protection for all nurses.
Are there any kind of specific experiences in nurses’
careers that should make them obtain professional liability insurance?
A board complaint can be made against your license for any
reason by anyone.
An analysis of license complaints from NSO insureds show
the location of most incidents are actually in the hospital.
The complaint could arise from a patient, family member,
the hospital, or even a colleague.
Most employer provided coverage does not offer defense of
license to the board because it may be the employer who submits the complaint.
Your license is your ability to practice as a nurse, it
represents a huge investment of your life, it defines who you are (as well as
helps pay the bills).
What other factors should be considered when to
purchase this kind of insurance?
Nurses help individuals when they are most at risk. Today, nurses are more at risk for legal action than ever before. An individual professional liability insurance policy helps them manage that risk and protect their careers and livelihoods. Many nurses may think an individual policy is complicated and expensive to get, and that’s simply not the case. In most cases, coverage can begin as soon as a completed application is approved and payment is received — online in a few minutes. Every nurse can afford malpractice insurance — the premium is in most cases about $100 a year, and the alternative is potential liability for upwards of millions of dollars on legal fees and payouts.
Is there anything else about the differences between
employer provided insurance versus individual professional liability insurance
that is important for readers to know?
Depending on the scenario, a lawsuit could be brought
forth years after the incident occurred. Many times, the nurse may have left
the facility. Depending on the type of insurance the employer carries, coverage
may end on the last day of employment. Nurses need to be aware of this very real
scenario. One of the values of having individual coverage is that it goes with
A fundamental tenet of culturally competent care for patients is providing clinically and personally pertinent information to patients in a language that they understand. As the diversity of non-English language speakers increases in the United States, nurses may find a new area of priority in advocating for their patients to overcome language barriers.
Fortunately, the Office for Civil Rights within
the U.S. Department of Health & Human Services (HHS), serves to protect
non-English speaking or limited English-speaking patients. Nurses,
however, can do this on a smaller scale in their daily work.
In accordance with Title VI of the Civil Rights Act of 1964, and the guidelines for developing a language access plan by HHS, health care institutions that receive federal funding must provide language assistance services suitable to the communities that they serve. This is assessed and implemented based on a stepwise approach appropriate for the patient population, qualified language service personnel, and interpretation devices and technology. Furthermore, health care personnel will be trained sufficiently and regularly to maintain an understanding of both the logistics and necessity of utilizing these services. This is especially true for nurses, who often have initial and ongoing close contact with patients.
Patients who speak limited or no English may be unwilling to admit that they do not understand the nature of their health care visit or its intended outcome. This is a detriment to both the provider and patient as the provider may proceed with a treatment plan with the belief that the patient is cooperating. It is easy to see how this can create increased stress and fear for the patient when actions are taken on behalf of their health that they did not corroborate and may not agree with. Regardless of the reasons for the patient’s decision to withhold their lack of understanding, health care professionals can take responsibility for establishing mutual understanding and help prevent these occurrences.
Utilize Available Technology
Fortunately, technology provides many resources today that allow for effective interpretation between providers and patients. Most hospitals have a team of on-site personnel that are credentialed interpreters in languages appropriate for the patient population of that site. For those languages that are less common, there are many devices, including phones and tablets, that provide immediate 24-hour access to remote medical translators in virtually every language. Many of the written documents that patients are exposed to are now offered in languages other than English as well.
Find a (Qualified) Translator
With a full understanding of the services offered, patients may decide that they prefer a family member to translate. Although it is not ideal because family members may lack health literacy, it is the patient’s prerogative to make that choice. If the patient requests that a bilingual nurse translate, he or she can only do so if the nurse has been credentialed in accordance with their facility’s policies related to medical interpreting. This is especially true regarding important documentation such as informed consent and does not include casual conversations or explanations.
It’s not a lack of resources, but a lack of understanding, that prevents non- or limited English speakers from getting what they need in health care today. Despite all of the services offered, providers may still try to take shortcuts for the sake of efficiency. As patient advocates, nurses can be mindful of patients and ensure that understanding is complete by utilizing interpreter services and reminding providers of the services available.
Pursuing jobs in the field of psychotherapy isn’t just for doctors; nurses can do it too. Benjamin Evans, DD, DNP, RN, APN, past president of the New Jersey State Nurses Association, has his own practice as a nurse psychotherapist in addition to consulting. He made the change in the 1980’s after he had completed his nurse practitioner training. Based on his work with people living with chronic and catastrophic illnesses, he decided to earn a master’s degree in counseling because it would be a good fit.
talked with us about what a nurse psychotherapist does and what nurses who are
thinking of entering this area of the field should keep in mind.
What exactly does a nurse psychotherapist do?
A nurse psychotherapist does the same work as any other educated psychotherapist — using psychological and counseling methods to assist in behavior and mental health changes. Usually the state board of nursing incorporates some form of health counseling within the definition of nursing practice. Psychotherapy can be done with individuals, families, and groups.
What should nurses keep in mind if they are thinking of becoming a nurse psychotherapist?
need to understand their reasons for wanting to become psychotherapists.
Psychotherapy is not about “fixing” others who have similar issues to the
is not solely health counseling for issues like nutrition, stress, or weight
control. It is not nurse coaching. Psychotherapy is undergirded with
theoretical frameworks that are used by the psychotherapist to help in the
who wish to become psychotherapists will be integrating nursing theories with
theoretical frameworks from psychology, psychiatry, social work, and other
Psychotherapy education is usually done at the graduate level. For this reason, the nurse wishing to do psychotherapy needs to determine if she or he will pursue psychotherapy education through a graduate nursing program like a psychiatric mental health nurse practitioner/clinical nurse specialist role or through another discipline like psychology, educational counseling, or social work.
kind of certification or other education would they need?
Certification can be obtained by credentialing organizations like the American Nurses Credentialing Center or through various certifying bodies outside of nursing. Some types of psychotherapy have non-degree supplemental experiential training and then “certify” the practitioner in a particular modality — for example, training in cognitive behavioral therapy.
else should they do?
nurse wishing to become a psychotherapist should meet with and shadow a nurse
psychotherapist to really learn all that the specialty initials. She or he
should become familiar with modalities of psychotherapy and vet programs for
What are the greatest challenges to being a nurse psychotherapist?
include training (time and cost), building a practice, obtaining referrals, and
ongoing maintenance of competency.
reimbursement issues play into the challenges of practice as many insurers do
not cover nurses for psychotherapy.
are the greatest rewards?
are many rewards to being a nurse psychotherapist, including watching as behavior
changes and mental health improvements are accomplished by the patients.
Is there anything else important for our nurse readers to know?
The practice of psychotherapy as a nurse is quite rewarding. The nurse who chooses to go into psychotherapy practice must want to help others to make behavioral or mental health changes. The nurse must have clear boundaries — being able to be empathic and not take on the issues of the client. Nurse psychotherapists must be mindful of self-care and to develop a sound network for referrals when the issues presented are outside of the psychotherapist’s area of expertise.