Between 2012 and 2023, registered nurses’ inflation-adjusted wages grew at a slower rate than other support and billed-for healthcare occupations, a review of Bureau of Labor Statistics data on millions of workers found.
The “fairly flat” 0.51% annual growth for RNs, the nation’s largest clinical workforce, across all employment settings came amid the industry’s broad demand for these types of admissions, researchers wrote in the study published this week.
At the same time, the increases were greater for lower-paid support positions like licensed practical nurses (LPNs; 0.79% growth per year) and nurse assistants (NAs; 1.41% growth per year).
That trend may suggest healthcare employers looking to check spending are prioritizing lower-paid roles, they wrote. By 2023, average annual wages for RNs were $94,480, compared to $60,790 for LPNs and $39,610 for NAs.
“Although hiring NAs and LPNs instead of RNs could cut costs initially, this could translate to worsening patient outcomes and higher overall expenses for health care organizations, as these workers may lack the training or scope of practice to manage more complex care needs,” researchers from the University of Michigan, Yale University and Johns Hopkins University wrote in Health Affairs.
RNs’ checked wage growth over the study period also lagged the annual inflation-adjusted increases of physicians (0.61%) nurse practitioners (0.62%) physician assistants (0.65%) and surgeons (1.41%), professional roles that each bill for their services.
The exception here came between 2021 and 2023, when physician assistant and nurse practitioner wages declined but RN wages rose. That trend “may reflect a post-pandemic shift in labor-market dynamics, and it warrants ongoing observation,” the researchers wrote.
That said, RNs’ slow overall wage growth amid the hiring and pay jumps among hospitals outlined in other studies is also cause for concern, as they “could be indicative of slow post-pandemic recovery in RN employment and wages across [all healthcare] settings,” they wrote.
Beyond employers’ potential interest in lower-cost support staff, the researchers said RNs’ shrinking wage gap with LPNs and NAs could reflect the ongoing demographic shift toward less experienced RNs—though this may be partially mitigated by RNs holding higher degrees than in the past.
More broadly, RNs’ limited wage increases could be a warning sign of some kinds of inefficiencies in the labor market, fueling the researchers’ call for more research and access to organizations’ operating practices.
“Healthcare organizations must increase transparency in cost and budget allocation among different types of nurses and other occupations,” they wrote. “These efforts can inform evidence-based strategies to create efficient wage structures and build a sustainable interprofessional healthcare workforce, ultimately enhancing health care delivery.”