In June 2012, AORN surveyed its members

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1 Results of the 2012 AORN Salary ad Compesatio Survey DONALD R. BACON, PhD ABSTRACT AORN coducted its 10th aual compesatio survey for perioperative urses i Jue A multiple regressio model was used to examie how a umber of variables, icludig job title, educatio level, certificatio, experiece, ad geographic regio, affect urse compesatio. Comparisos betwee the 2012 data ad previous years data are preseted. The effects of other forms of compesatio, such as o-call compesatio, overtime, bouses, ad shift differetials o base compesatio rates, also are examied. Additioal aalyses explore the effect of the curret ecoomic dowtur o the perioperative work eviromet. AORN J 96 (December 2012) Ó AORN, Ic, Key words: urse salaries, compesatio, ecoomy. I Jue 2012, AORN surveyed its members ad some omembers to examie the status of perioperative ursig compesatio i the Uited States. This market research study tracks compesatio chages o a yearly basis ad seeks to idetify factors that ifluece how much perioperative urses are presetly paid. The survey also addresses the perioperative ursig shortage, focusig o perceived chages i staffig-related aspects of the perioperative ursig workplace durig the past several years. Additioal questios were asked ad aalyses coducted to explore the effects of the ecoomic dowtur o the work eviromet of perioperative urses. RESPONDENT PROFILE For the ith cosecutive year, AORN coducted its survey olie. I late May, 50,531 potetial respodets, icludig 38,238 AORN members, were set a ivitatio to participate i the survey. This group of potetial respodets is larger tha last year s group (46,113), ad it cotais a higher percetage of AORN members. By late Jue, 4,186 uique resposes were received. Because the focus of this survey is perioperative ursig compesatio, respodets who did ot aswer ay compesatio-related questios were excluded. This criterio reduced the usable sample to 2,415 idividuals, for a 5.2% et respose rate. As show i Figure 1, approximately 41% of the respodets are staff urses, 25% are maagers (ie, urse maagers/supervisors/coordiators/team leaders/busiess maagers), 16% are high-level maagers (ie, vice presidets [VPs]/directors/ assistat directors, hospital/facility admiistrators), 8% are educators (ie, faculty members, staff developmet persoel), 3% are RN first assistats (RNFAs), ad 1% are cliical urse specialists. Less tha 1% are urse practitioers. Approximately 43% of the respodets are i their 50s, 23% are i their 40s, ad 14% are i their 30s; 5% are youger tha 30 years of age, ad 14% are at j AORN Joural December 2012 Vol 96 No 6 Ó AORN, Ic, 2012

2 2012 SALARY SURVEY Figure 1. Percetage of survey respodets by job title. least 60 years of age. Approximately 89% of the sample is female, ad 11% is male. Hourly paid employees comprise approximately 61% of the sample, ad approximately 39% are salaried employees. Most of the respodets work i acute care hospitals (77%), ad 23% work i a ambulatory surgery ceter (ASC), whether it be free-stadig (13%), hospital based (8%), or office based (2%). Geographically, the sample is well dispersed across the coutry. As show i Table 1, approximately 20% of the respodets live i the upper easter coastal area (ie, New Eglad ad the Mid- Atlatic), 16% reside i the South Atlatic area, ad 27% are located i the East ad West North Cetral regios. Approximately 16% reside i the East ad West South Cetral regios, ad 21% are located i the wester (ie, Moutai) ad Pacific states. Approximately 80% work i a urba or suburba area, ad 20% work i a rural locatio. Approximately 39% of the respodets have a bachelor s degree i ursig, ad 7% have a bachelor s degree i aother field. Approximately 32% of the respodets have a diploma or associate degree. Eleve percet of the respodets have a master s degree i ursig, ad 8% have a master s degree i aother field. Approximately 3% have a doctorate i ursig or i aother field or have some other type of degree (Table 2). TABLE 1. Geographic Locatio of Respodets Regio Frequecy Percet New Eglad (New Hampshire, Vermot, Maie, Coecticut, Rhode Islad, Massachusetts) Mid-Atlatic (New Jersey, Delaware, Marylad, Pesylvaia, New York, Washigto, DC) South Atlatic (West Virgiia, Virgiia, North Carolia, South Carolia, Georgia, Florida) East North Cetral (Wiscosi, Michiga, Illiois, Idiaa, Ohio) West North Cetral (North Dakota, South Dakota, Miesota, Nebraska, Iowa, Kasas, Missouri) East South Cetral (Ketucky, Teessee, Mississippi, Alabama) West South Cetral (Oklahoma, Arkasas, Texas, Louisiaa) Moutai (Motaa, Idaho, Wyomig, Nevada, Utah, Colorado, Arizoa, New Mexico) Pacific (Alaska, Washigto, Orego, Califoria, Hawaii) AORN Joural j 589

3 December 2012 Vol 96 No 6 BACON TABLE 2. Respodets Educatio Levels Educatio Frequecy Percet Diploma Associate degree Bachelor s degree i ursig Bachelor s degree i aother field Master s degree i ursig Master s degree i aother field Doctorate i ursig Doctorate i aother field Other Approximately 44% of the respodets have more tha 20 years of experiece as a perioperative urse, ad 31% have more tha 25 years of experiece. Approximately 25% of the respodets have from 11 to 20 years of experiece, ad 32% have 10 or fewer years of experiece. Overall, the respodets demographic profile is quite similar to the 2011 sample with oe small exceptio: the respodets have slightly fewer years of experiece (eg, a 3% decrease amog those with more tha 20 years of experiece, a 1% decrease i respodets with more tha 25 years of experiece, ad a 5% icrease amog those with 10 years of experiece or less compared with a 4% decrease i the 2011 sample). Figure 2 represets some of the demographic iformatio from the sample. BASE COMPENSATION I performed statistical aalyses to idetify which factors have the most ifluece o perioperative ursig compesatio. It should be oted that the sample is ot perfectly radom, because the et respose rate was modest (5.2%). Still, the sample is sufficietly represetative of the perioperative urse populatio that statistical tests ca provide isight. A summary of the salary fidigs, categorized by job title ad size of facility, is show i Table 3. This aalysis ad the salary aalyses that follow iclude oly urses who were employed full time Figure 2. Profile of survey respodets. 590 j AORN Joural

4 2012 SALARY SURVEY TABLE 3. Estimate of Average Base Compesatio by Job Title ad Facility Size Job title Average percetage time i direct patiet care Small facility (10 ORs) Large facility (>10 ORs) Staff urse 87.6 $65,100 $67,800 Hospital/facility admiistrator 23.1 $99,000 * Vice presidet/director/assistat director of ursig 13.7 $99,100 $128,900 Nurse maager/supervisor/coordiator/team leader/busiess 35.3 $79,800 $87,000 maager Educator/staff developmet 18.4 $75,700 $79,400 Cliical urse specialist (master s degree or higher) 87.2 $77,400 $78,300 RN first assistat 36.4 $82,800 $83,300 Other 54.4 $78,400 $81,800 Total 87.6 $65,100 $67,800 Note: The small et subsample sizes for educator/faculty member ad urse practitioer resulted i their exclusio from the regressio aalysis. Other samples with fewer tha 30 observatios are oted with a asterisk. Dollar amouts are rouded to the earest hudred. i the Uited States. Facilities are categorized as small or large based o a media split of the umber of ORs reported. These fidigs show the calculated average salary for urses who sped a average amout of time o direct patiet care for their title. As ca be see, urses geerally receive more compesatio i larger facilities. O closer examiatio, the relatioship betwee facility size ad compesatio may also be iflueced by facility type. Table 4 shows how the average umber of ORs varies by facility type ad how the umber of ORs is related to staff urse compesatio. Takig facility size ito accout, the uiversity or academic facilities ted to be larger tha other facility types. As was the case i the 2011 sample, the uiversity/academic ASCs paid more tha ay other facility type; however, the small sample sizes for both groups call the validity of these results ito questio. The challege i uderstadig perioperative ursig compesatio is i estimatig the simultaeous ifluece of the may differet variables that ca affect compesatio. I used multiple regressio as the primary aalytical tool i this study because so may variables are ivolved. The multiple regressio model makes it possible to estimate the effects of oe variable o compesatio while statistically holdig the other variables costat. The ifluece of each variable ca the be idetified, idepedet of the others. For the aalysis, I used hierarchical regressio by eterig the variables expected to explai the most variace ito the model first ad the eterig the less importat variables. I etered several variables with related TABLE 4. Size ad Compesatio by Facility Type Facility type Size (average umber of ORs) Average staff urse base compesatio Cout Acute care hospital, geeral/commuity 15 $64, Acute care hospital, specialty 18 $72, Acute care hospital, uiversity/academic 30 $69, Ambulatory surgery ceter, geeral/commuity 12 $59, Ambulatory surgery ceter, uiversity/academic 20 $82, AORN Joural j 591

5 December 2012 Vol 96 No 6 BACON effects iitially ad simultaeously. These variables are job title, facility size, facility type, populatio settig (ie, urba, suburba, rural), regio, ad percetage of time spet i direct patiet care. I the etered other variables oe at a time. These secodary variables are years of work experiece, compesatio basis, certificatio, educatio level, participatio i a collective bargaiig uit, household status, ad geder. To obtai the most reliable results, I limited the sample for the regressio aalyses to respodets who are full-time employees ad who work i the Uited States. I elimiated statistical outliers (eg, uusually high or low pay reported by a very small umber of urses) to avoid skewig the results. I coducted checks to esure that the statistical assumptios behid the regressio model were met (eg, liear relatioships ad ormally distributed errors). The fial model explais 64% of the variatio i base compesatio. What follows is a overview of the results cocerig each variable icluded i the regressio aalysis that was foud to be sigificatly related to base compesatio level. All variables were sigificat at the P.05 level. Readers ca obtai the estimates of compesatio for ay particular ursig positio by usig the compesatio calculator o the AORN web site at (accessed September 6, 2012). Job Title More tha ay other variable, differeces i job title are liked to differeces i compesatio. The average staff urse, for example, ears $66,800 ($1,000 less tha i 2011), ad the average VP/director/assistat director of ursig ears $111,900 ($4,300 more tha i 2011). Part of the differece i salary across titles is explaied by the differece i the percetage of time spet o direct patiet care versus the percetage of time spet o other tasks, such as maagemet or admiistratio. To explore the treds i salary for urses ad urse maagers over time, I combied data from 10 years of AORN salary surveys. Figure 3 shows that staff urses ad VPs/directors/assistat directors of ursig have see icreases i average compesatio durig this 10-year period. Over 10 years, the overall rate of growth has bee the same for staff urses ad for VPs/directors/assistat directors of ursig (averagig 3.1% a year). Durig the past five years, however, staff urse compesatio has rise at a rate of 2.0%, while compesatio for VPs/ directors/assistat directors of ursig has rise at a rate of 3.6%. For compariso, the average aual iflatio rate is 1.6% over the past five years ad 2.5% over the past 10 years. O average, staff urses sped 88% of their time providig direct patiet care, ad urse maagers sped 35% of their time providig direct patiet care. As expected, high-level maagers sped a smaller percetage of time o direct patiet care (23% for facility/hospital admiistrators, a 4% icrease sice 2011, ad 14% for VPs/directors/assistat directors of ursig). The percetage of time spet i direct patiet care varies amog urses with the same title. For example, some urse maagers sped as much time o direct patiet care as the average staff urse, whereas some other urse maagers sped as little time o patiet care as the typical director or VP. Facility Type The regressio model idicates several differeces i compesatio related to facility type. Hospitalbased urses ofte see more compesatio, especially i a acute care hospital, whereas urses i ASCs see less compesatio. This year, urses i 592 j AORN Joural

6 2012 SALARY SURVEY Figure 3. Treds i base compesatio. acute care hospitals received $10,600 more tha urses i office-based ASCs. Nurses i hospitalbased ASCs received $6,300 more tha those i office-based ASCs, ad urses i geeral/commuity hospitals received $4,100 less tha urses i other types of hospitals (ie, specialty hospitals or uiversity/academic medical ceters). Facility Size The size of the facility is a importat differetiator i ursig compesatio. This differece is particularly proouced for those who work i higherlevel maagemet positios. After cotrollig for facility type, hospital/facility admiistrators ad VPs/directors/assistat directors of ursig ear o average $1,400 more per OR i the facility (up $100 from 2011). This differece may the result of the greater umber ad rage of resposibilities that these higher-level positios etail. No statistically sigificat relatioship was foud betwee staff urse compesatio ad facility size. Differet types of facilities (eg, acute care hospitals compared with ambulatory care facilities) also differ i size, ad so for urses, after facility type is cosidered, the size of the facility makes little differece. Facility Owership Approximately 58% of the respodets are employed by ogovermet, oprofit orgaizatios. The fidigs idicate that urses i these facilities ear $1,700 more tha urses i facilities with differet owership structures (eg, private, for profit). Those few respodets (4% of the sample) who work i govermet or federally owed facilities (eg, Veteras Admiistratio hospitals) ear $6,800 more, o average, tha do other urses. Populatio Settig The locatio of the facility, i a urba, suburba, or rural area, substatially iflueces compesatio. Nurses i rural settigs ear a estimated $9,600 less per year ($9,300 less i 2011 ad $8,900 less i 2010) tha they would if employed i a suburba or urba settig. Geographic Regio Cotrollig for all variables previously discussed, geographic regio explais sigificat differeces i compesatio levels across the Uited States. While urses i the West South Cetral ad East North Cetral regios ear approximately average AORN Joural j 593

7 December 2012 Vol 96 No 6 BACON icome for urses, urses workig i the Pacific regio receive $24,500 more tha the average staff urse compesatio. The other regios with higher icomes are New Eglad ($15,900 more), Mid- Atlatic ($6,700 more), ad Moutai ($5,400 more). Regios with below average compesatio are the East South Cetral ($5,700 less), West North Cetral ($3,900 less), ad South Atlatic ($3,200 less). Time Spet o Direct Patiet Care Nurses i a particular positio who sped more or less time tha the average for direct patiet care i that positio should expect to receive differet compesatio tha the estimated average compesatio. O average, staff urses ear approximately $400 more per year tha the average staff urse compesatio for each 10% decrease i time spet o direct patiet care per week ad, correspodigly, for each 10% icrease i time spet doig maagerial tasks. This relatioship is the same for urse maagers, educators, RNFAs, urse practitioers, private scrub urses, ad other urses. This year, exactly the same icrease i compesatio with more time spet o maagerial tasks was also foud for hospital/facility admiistrators ad VPs/ directors/assistat directors of ursig. Work Experiece The polyomial regressio model suggests that urses geerally see large icreases related to experiece early i their careers but much smaller icreases later. For example, the icrease i compesatio from the first to the secod year is close to $1,400, but the jump from the 25th to the 26th year is oly about $200. I this sample, the average urse has 18 years of experiece (compared with 19 years i 2011 ad 18 years i 2010). Nurses with more or fewer years of experiece should add or subtract some amout per year of experiece to estimate their base compesatio. Of iterest is that hospital/facility admiistrators ad VPs/directors/ assistat directors of ursig ear approximately $550 per year of experiece, ad this relatioship cotiues through 30 years of experiece. O average, these idividuals report 23 years of work experiece (the average was 22 i the 2011 sample). Compesatio Basis Whether a urse is paid o a hourly basis or is salaried is related to base compesatio level, eve after all of the factors metioed previously are cotrolled for i the regressio model. Salaried employees ear $3,200 more per year tha do hourly employees. This amout is approximately the same as the $3,000 additioal compesatio reported i the 2011 survey. Certificatio Te types of certificatio were examied: BC (board certified), CNOR (certified OR urse), CRNFA (certified RNFA), CPAN (certified periaesthesia urse) ad/or CAPA (certified ambulatory periaesthesia urse), CPSN (certified plastic surgical urse), CNA (certified i ursig admiistratio), CNAA (certified i ursig admiistratio advaced), ONC (certified orthopedic urse), CNS (cliical urse specialist), ad NP (certified urse practitioer). For 2012, oe of these certificatios were associated with sigificatly higher pay. Of particular ote, these fidigs are qualified by the small umber of urses i the sample who hold certificatios other tha CNOR. Although 57% of respodets are CNOR certified, oly a small percetage hold BC, CPAN or CAPA, CPSN, CNA, CNAA, ONC, CNS, or NP certificatios. Oly CRNFA is held by more tha 1% of respodets (3% of the sample). Thus, the umber of some certificatios was too small to reder a statistically sigificat effect i regressio aalysis. However, 38% of the respodets said that their facility pays more for holdig a ursig certificatio (approximately the same percetage as i 2011). I respose to a follow-up questio, of those who said their hospital offers more compesatio for some certificatios, 92% of the respodets said they receive extra compesatio for CNOR, 27% said their facility offers more for CRNFA or CPAN 594 j AORN Joural

8 2012 SALARY SURVEY ad/or CAPA, 14% metioed ONC, 13% metioed CNS or NP, 12% metioed CPSN, ad 8% metioed BC, CNAA, or CNA. Most of these percetages are slightly higher tha the 2011 report, which were higher tha the 2010 report, idicatig that facilities may be gaiig iterest i certificatios. Thus, while the regressio model did ot show large differeces i pay related to certificatio, may urses report that their facility does pay for certificatio. To gai more isight, we asked urses whether they received the pay as a additio to base pay or as a oe-time bous. More tha half (58%) of the urses i our sample reported that the pay was a additio to their base pay, ad 24% reported that the pay was a oe-time bous. The remaider of our sample (18%) reported a variety of resposes, icludig o additioal pay, a aual bous, or better opportuities for promotio. Although it appears that some urses receive extra compesatio for a variety of certificatios, this compesatio may vary by hospital. Also, urses with some certificatios, such as CNOR, may fid work i facilities that offer more compesatio, or they may sped more time o maagemet tasks. After cotrollig for facility type ad time spet o direct patiet care, the effect of certificatio o base pay by itself is less proouced. Educatio Level Nurses with a master s degree i ursig add a additioal $3,400 i aual base compesatio, while urses holdig a master s degree i aother field receive $3,300 more. Whe asked directly, oly 27% of the respodets said that their facility pays more for havig a degree i ursig (compared with 26% i 2011). Nurses with oly a diploma receive $2,100 less i aual base compesatio. It may seem surprisig that educatio has so little effect o compesatio i this aalysis, but it should be oted that I have already cotrolled for job title, ad a urse s educatio level may well affect the level of resposibility to which he or she may rise. Table 5 provides a aalysis of educatio by selected job titles, icludig staff urses, urse maagers, ad higher-level directors ad hospital admiistrators. The urses i higher-payig positios, especially the directors ad admiistrators, are less likely to have oly a diploma or associate degree ad are more likely tha others to have a master s degree i ursig or aother field. Thus, although level of educatio does ot always have a strog direct effect o compesatio for urses with the same title, educatio may well affect the title each urse holds. Collective Bargaiig Uit Approximately 10% of respodets reported workig i a eviromet with a uio or collective bargaiig uit (the same as i 2011). Nurses workig i a uioized settig ear a average $6,100 more i aual base compesatio tha do urses employed i a ouio workplace (compared with $7,300 i 2011 ad $8,700 i 2010). Workig i a uioized eviromet does ot appear to affect the compesatio of maagers. TABLE 5. Educatio by Selected Job Titles Educatio Staff urse ( ¼ 1,001) Nurse maager ( ¼ 611) Director/admiistrator ( ¼ 328) Diploma 10% 10% 6% Associate degree 30% 22% 12% Bachelor s degree i ursig 42% 40% 27% Bachelor s degree i aother field 9% 7% 7% Master s degree i ursig 4% 10% 20% Master s degree i aother field 4% 7% 26% AORN Joural j 595

9 December 2012 Vol 96 No 6 BACON Household Status ad Geder This year, a sigificat differece i compesatio was foud related to the presece of childre i the home. After I cotrolled for all of the aforemetioed variables, I foud that urses with childre uder the age of 18 years livig with them received $2,400 less per year tha other urses. I also explored the associatio betwee marital status ad icome at this poit but foud o sigificat relatioship this year. I 2011, I foud that sigle urses received more icome tha married, partered, divorced, or widowed urses. I 2010, marital status was ot related to icome, but beig married with childre at home was associated with lower icome. From the fidigs over the years, it could be that urses with fewer commitmets outside of work geerally receive a higher base wage. This year, as i may previous years, I foud geder to be sigificat after cotrollig for all of the variables metioed previously. Me eared a average $2,800 more tha wome (compared with $3,300 more i 2011 ad $2,700 more i 2010). The varyig results across the past several years of studies suggest that there may be a geder effect, but the effect is icosistet ad small relative to all of the other factors that ifluece perioperative ursig compesatio. Other Variables As a cautioary ote, the results from the regressio aalysis represet geeral patters ad do ot address several variables that ca affect compesatio, such as the uique eeds of facilities, iterpersoal skills, ad leadership ability. The results are geerally accurate eough that two-thirds of urses or maagers who fit a particular profile will see a aual base compesatio withi $15,500 of base compesatio estimated by the model. I questios urelated to the base compesatio model, 69% of the respodets reported receivig a raise this year, approximately the same as i 2011 (70%). For those receivig raises, the mea pay raise for staff urses is 2.4% (compared with 2.6% i 2011 ad 2.7% i 2010). As show i Table 6, raises are slightly higher for those with greater maagemet resposibilities. Hospital/facility admiistrators received a average 3.6% pay raise (3.9% i 2011 ad 3.7% i 2010); VPs/directors/ assistat directors of ursig averaged a 3.4% raise (3.3% i both 2011 ad 2010). Nurse maagers averaged a 2.8% pay raise (compared with 2.9% i 2011 ad 3.0% i 2010). Notably, ulike for the other groups, the pay raises for staff urses ad TABLE 6. Mea Pay Raises by Job Title Job title Percetage of pay raise 2008 Percetage of pay raise 2009 Percetage of pay raise 2010 Percetage of pay raise 2011 Percetage of pay raise 2012 Staff urse Hospital/facility admiistrator Vice presidet/director/assistat director of ursig Nurse maager/supervisor/coordiator/ team leader/busiess maager Educator/staff developmet Cliical urse specialist (master s degree or higher) RN first assistat Other Note: The small et subsample sizes for educator/faculty member ad urse practitioer resulted i their exclusio from the regressio aalysis. 596 j AORN Joural

10 2012 SALARY SURVEY urse maagers have declied every year from 2008 to OTHER FORMS OF COMPENSATION The regressio aalysis previously described applies to base compesatio. I the preset sample, 62% of the respodets receive additioal compesatio from a variety of sources, icludig overtime, shift differetial, o-call compesatio, ad bouses (the percetage was 65% i both 2011 ad 2010). The amout of additioal pay differs substatially by title. The average percetage of additioal compesatio, by title, is show i Figure 4. As show, RNFAs ad cliical urse specialists received the largest additioal compesatio relative to base pay (15.8%), followed by staff urses (10.9% compared with 10.5% i 2011). VPs/directors/assistat directors of ursig received the smallest additioal compesatio relative to base pay (3.6% compared with 4.2% i 2011). O-call Compesatio More tha half of the respodets (57%) report that they take call (54% i 2011). The media umber of hours per week o call is 16 (the same umber of hours as reported i the previous seve surveys). Amog the o-call respodets, 68% receive a dollar-per-hour amout for beig o call (67% i 2011), 6% receive a percetage of their base pay (same as the past three years), ad 26% receive o compesatio (20% for the previous three years). Amog those who receive dollar-per-hour pay, the media pay is $2.75 per hour ($3 i 2009, 2010, ad 2011). If called i, 55% receive time-ad-a-half pay (61% i 2011), 23% receive o additioal pay (16% i 2011), ad 5% get straight-time pay (same as i 2011). Istead of pay, 4% of the o-call Figure 4. Mea percetage of additioal compesatio by job title. AORN Joural j 597

11 December 2012 Vol 96 No 6 BACON respodets receive comp time (5% i 2011). Overall, fidigs o the methods of o-call compesatio are quite similar for the past five years. Overtime Compesatio A large majority of respodets work overtime (84% i 2012 ad 77% i 2011), totalig a average of 5.5 hours each week (4.9 hours i 2011). Approximately 61% of those who work overtime receive time-ad-a-half pay (60% i 2011), but 30% receive o additioal compesatio (same i 2011 ad 29% i 2010). Almost all of those ot compesated for overtime are salaried (98% compared with 97% i 2011 ad 2010). As show i Table 7, hospital/facility admiistrators average the most overtime at 8.3 hours (5.3 hours i 2011), followed by VPs/directors/assistat directors of ursig (7.8 hours compared with 5.9 hours last year) ad RNFAs (7.1 hours compared with 6.6 hours i 2011). Staff urses work the least amout of overtime (4.5 hours a week compared with 4.3 hours i 2011). Notably, the two groups with the highest percetage of salaried employeesdhighlevel maagers ad admiistratorsdexperieced the largest icreases i weekly overtime hours sice 2011, ad staff ursesdthe least likely to be salarieddexperieced the lowest umber of weekly overtime hours i 2011 ad oly a 12-miute icrease i weekly overtime sice Hirig Bouses Relatively few of the respodets received a hirig bous whe they were hired (11% this year compared with 12% i 2011 ad 13% i 2010), ad oly 8% are certai that their employer ow offers a hirig bous for their positio (9% i 2011). Of these bouses, 19% were i the $1,000 to $2,499 rage, 17% were i the $2,500 to $4,999 rage, ad 13% were i the $5,000 to $7,499 rage. The employees who are most likely to receive a hirig bous are staff urses, RNFAs, urse educators, ad cliical urse specialists (approximately 8% of employees i each category). Although hospital/facility admiistrators are least likely to receive the bous (2% this year ad 1% i 2011), 8% of VPs/directors/assistat directors of ursig reported that their facility is ow offerig a hirig bous for their positios. Shift ad Other Differetials Amog the respodets, 91% work the day shift, ad 4% work afteroos/eveigs. Very few respodets work ights, weeked days, or weeked ights (less tha 3% for the three categories combied). For those workig the afteroo/eveig shift, the media differetial is $2/hour or 10% of base pay (compared with $3 ad 10% of base pay i 2011). Note that the dollar amouts differ across years, but the percetages do ot differ; the TABLE 7. Average Overtime Hours per Week ad Percetage of Respodets Who Are Salaried Job title Average umber of overtime hours per week Percet salaried Staff urse Hospital/facility admiistrator Vice presidet/director/assistat director of ursig Nurse maager/supervisor/coordiator/team leader/ busiess maager Educator/staff developmet Cliical urse specialist (master s degree or higher) RN first assistat Other Note: The small et subsample sizes for educator/faculty member ad urse practitioer resulted i their exclusio from the regressio aalysis. 598 j AORN Joural

12 2012 SALARY SURVEY dollar differeces may be the result of a samplig error. Beefits Almost all of the respodets receive beefits as part of their compesatio. As show i Table 8, the most frequetly received beefit i 2012 is health isurace (93%), followed by eared time or paid time off (90%), detal isurace (86%), life isurace (82%), ad bereavemet leave (76%). This year, the percetage of recipiets declied i seve of 24 beefit categories (compared with 12 decliig categories i 2011) ad the declies were small (from 1% to 2%). However, over the past five years (2008 to 2012), fewer respodets received beefits i 23 of the 24 categories, ad four types of beefits experieced double-digit reductios (employee referral bous had a 19% declie, paid coferece travel had a 14% declie, tuitio reimbursemet had a 11% declie, ad tax sheltered auity plas had a 10% declie). Notably, pesio plas declied i each of the past five years, ad the percetage of respodets receivig 401(k) cotributios has flatteed durig this five-year period (Figure 5). THE EFFECT OF THE ECONOMIC DOWNTURN ON THE PERIOPERATIVE NURSING WORK ENVIRONMENT The ecoomic dowtur that started i the fall of 2008 has had widespread effects o the perioperative ursig eviromet, but the egative TABLE 8. Percetage of Respodets Receivig Beefits Beefit type Percetage receivig beefit i 2008 Percetage receivig beefit i 2009 Percetage receivig beefit i 2010 Percetage receivig beefit i 2011 Percetage receivig beefit i 2012 Health isurace Eared time or paid time off Detal isurace Life isurace Bereavemet leave (k) cotributios Jury duty compesatio Log-term disability Short-term disability Free/discouted parkig Tuitio reimbursemet Pesio pla Paid certificatio exams Paid coferece travel Pharmacy discouts Tax sheltered auity pla Employee referral bous Flexible schedulig Icetive bouses Malpractice isurace Relocatio assistace Retetio bouses Subsidized child/elder care Life quality service (eg, dry cleaig) AORN Joural j 599

13 December 2012 Vol 96 No 6 BACON Figure 5. Chages i retiremet beefits. effects cotiue to lesse accordig to the latest survey. For each of the past four years, we asked respodets whether they had see ay chage i activity at their facilities. Although more tha half (53%) of respodets i 2009 reported that activity had declied, the percetage reportig reduced activity has cotiued to declie i each of the subsequet years, to 31% i Cocurretly, the percetage of respodets reportig a icrease i facility activity has grow from 14% i 2009 to 51% i To further explore chages i perioperative ursig activity, this year we asked urses if they have see a shift i ambulatory/itervetioal/ hybrid treatmets relative to ipatiet treatmets. More tha half (52%) reported a icrease i these treatmets relative to ipatiet treatmets, up slightly from 48% i A small percetage, 11% (15% i 2011), reported a decrease i ambulatory treatmets relative to ipatiet treatmets, ad 37% (this year ad i 2011) reported o chage. We asked the respodets what steps, if ay, their employers have take to deal with the curret ecoomic situatio. As show i Figure 6, reduced/ elimiated reimbursemets for coferece travel ad a hirig freeze were the steps most frequetly take (reported by 35% ad 32% of respodets, respectively). Hirig freezes have steadily declied durig the past four years (50% i 2009, 43% i 2010, ad 35% i 2011). UPDATE ON THE PERIOPERATIVE NURSING SHORTAGE I the latest survey, the media percetage of vacat full-time ursig positios was low, at 3.4%, but the rate is otably higher tha i 2011 ad 2010 (at 0.4% ad 0.9%, respectively). Adequate staffig remais a priority for urses. This year, 38% of high-level maagers reported that the shortage has had a moderate-to-crisis level effect o their workig eviromet (compared with 31% i 2011, 32% i 2010, ad 46% i 2009). Amog urses i this year s sample, 53% share this view, which cotiues a geerally decliig fiveyear tred (72% i 2007, 66% i 2008, 56% i 2009, 53% i 2010, ad 54% i 2011). As expected, the effect of the shortage o patiet care teds to be rated more severely by those with the most patiet cotact. Approximately 58% of staff urses rate the shortage as havig a moderate-to-crisis level impact 600 j AORN Joural

14 2012 SALARY SURVEY Figure 6. Chages made by employer to deal with the ecoomic dowtur. compared with 47% of urse maagers, 39% of VPs/ directors/assistat directors of ursig, ad 25% of facility/hospital admiistrators. Respodets rated their agreemet with several statemets about their work eviromet. Several of these statemets were phrased as satisfactio measures. The results, divided by urses ad maagers, are show i Figure 7. Overall, maagers are more satisfied with their jobs tha are urses (a 0.3- poit differece). However, maager satisfactio has declied i all but oe aspect of the work eviromet, with declies mostly ragig from 0.3 to 0.4 poits. Coversely, urse satisfactio declied i approximately half of the workplace aspects ad the reductios were smaller (0.1-poit reductios i all but oe of the aspects). The largest gaps i satisfactio betwee the two groups cocer support from hospital maagemet (a 0.9-poit differece betwee maagers ad staff members) ad a adequate umber of staff members (0.7-poit differece). Nurses are most satisfied overall with their jobs, ad they are least satisfied with hospital maagemet support, staffig, ad pay. Maagers are most satisfied overall with their jobs ad least satisfied with the pressure they feel to work more hours tha they prefer to work. The respodets also were asked to idetify their top three priorities for improvig the workplace. Nurses who are ot i maagemet rate their top priorities as more pay (46% rated this as oe of three top priorities), more support from maagemet (33%), ad a adequate umber of staff (25%). These were the same top three priorities as i 2011 ad Maagers rate their top priorities as more pay (36%), more educatio ad traiig for coworkers (31%), ad more available equipmet (29%). These were also maagers top three priorities for the past two years. OPEN-ENDED COMMENTS ABOUT PERIOPERATIVE NURSE COMPENSATION Respodets were asked to provide ay commets about compesatio or other workplace aspects that they would like to express. More tha 300 urses offered their views (approximately 13% of the etire sample). Amog those who provided a opiio o AORN Joural j 601

15 December 2012 Vol 96 No 6 BACON Figure 7. Nurses ad maagers satisfactio with aspects of the work eviromet. ay subject, 57% expressed dissatisfactio with compesatio, ad amog the 158 respodets who commeted specifically about their compesatio, 93% were dissatisfied with their pay. Cocerig the reasos for this dissatisfactio, may respodets said that their pay does ot reflect the amout of resposibility, physical work, stress, icreasig kowledge requiremets, ad specialty ature of their jobs. Oe urse commeted, As a specialty urse, we should be compesated differetly tha floor urses. We have more traiig, we must keep up our certificatios, ad keep up with techological chages. 602 j AORN Joural

16 2012 SALARY SURVEY Aother wrote, This field is highly specialized. We should be paid the same as urses i [itesive care uits] ad other critical care uits. Several complaits cetered o iadequate compesatio for certificatios ad advaced degrees. Oe urse wrote, Certified urses should be recogized ad paid for the certificatios especially i our area, but too may hospitals do t. This year, a larger umber of admiistrators, maagers, ad salaried urses expressed cocers about their pay ad workload tha has bee the case i past surveys. These commets coicide with the declie i maager satisfactio with several aspects of the ursig eviromet. If you figure the umber of hours we work ad compute a hourly rate, we most likely are oly makig miimum wage, wrote oe maager. Aother wrote, It is extremely difficult to be a admiistrator. They ask more ad more of us ad the compesatio does ot match the immese demads. Executives get large bouses, ad they are quite discoected from the issues we are facig. Very disappoitig. Very scary. Cocer about iadequate call pay was expressed by several urses. Oe wrote, O call compesatio is way too low for the amout of call that I have to take. Sometimes I do t see my kids for a couple of daysdi ca watch them sleep though! It s a big impact o my family that does t get compesated. Call pay should be icreased, wrote aother urse. I ve bee gettig the same amout to be o call for the last 25 years. Related to compesatio issues, urses expressed cocers about reductios i beefits, especially health isurace. Oe urse wrote, Hospital cotributios to our health isurace are shrikig, ad our cotributios ad the deductibles we pay are higher. This is ot fair whe we have spet years takig care of the health of our patiets. Some urses expressed frustratio with the do more with less pressures of their workplace. Oe urse wrote, Educatio is ot as importat as it used to be. Now, it is how may cases you ca get doe faster with less staff. Turover, turoverddo it quicker is the rule. Cocers about a agig workforce were expressed by may respodets, particularly about the availability of qualified perioperative urses to replace retirees. We eed to trai more OR urses to lesse the burdes placed o older urses, wrote oe ursig maager. We curretly will retire four urses i the ext six moths, ad I have o idea where we will get traied OR staff to replace them. Aother wrote, There are o experieced OR urses applyig for positios, ad workplace costraits do ot allow sufficiet opportuity to educate ew perioperative applicats. Cocerig traiig, several urses were troubled by the quality of traiig of ew urses. Oe wrote, There is a severe lack of traiig for perioperative urses. We are hirig RNs with o experiece ad puttig them ito CVOR [the cardiovascular OR] with oly [o-the-job traiig] by urses who were traied the same way, with very icosistet results. It seems that the ursig shortage has produced schools that crak out miimally traied urses who have o idepedet critical thikig skills, who oly follow orders without problem solvig o their ow, ad there is at most i their traiig, a day of observatio i the OR. How ca we get good OR ad CVOR urses this way? Aother wrote, We trai the ew OR urses ad the they leave for surgery ceters. Oe urse uderstood this turover: Let s face it e if you ca go somewhere ad ot take call, ot work past your shift, ad do less difficult cases ad get paid the same, why ot? Agai this year, there were positive commets about the effects of uios o compesatio ad AORN Joural j 603

17 December 2012 Vol 96 No 6 BACON beefits. A urse wrote, I am well compesated dollar-wise thaks to my uio represetatio. Aother urse commeted, Private sector coditios for OR urses are ot good i Texas. The Califoria Nurses Associatio is actively orgaizig here ad they re havig good success eve i this rightto-work state. Uios are the future for RNs. Oly collective bargaiig at the facility level gives RNs the power to chage workplace, wages, ad workload issues. However, despite the challeges i compesatio ad i the workplace, a few urses report that they are simply thakful to have a job i these difficult ecoomic times. Oe urse wrote, Pay could be better, but I am grateful to be employed. Although the large majority of commeters stated their cocers about compesatio, beefits, ad the preset ursig eviromet, a umber of urses expressed satisfactio with their pay ad jobs. Oe urse wrote, This hospital pays very well, ad that is the mai reaso I am here ad why I staydfor ow. Aother urse commeted, OR urses at my hospital are compesated well. We have a very cohesive group of urses with a strog voice. Our maagemet listes ad uderstads. Aother wrote, Give that I started at $3.10 a hour may years ago, we ve come a log way. As with previous years results, commeters expressed thaks to AORN for the compesatio survey ad for AORN s work for the beefit of OR ursig. Thak you for doig this survey, wrote oe urse. I use the results. Aother said, I thak you for cotiuig to be such a strog orgaizatio i support of perioperative urses. Doald R. Baco, PhD, is a professor of marketig at the Uiversity of Dever, CO, ad a research associate at Rocky Moutai Market Research, Dever. Dr Baco has o declared affiliatio that could be perceived as posig a potetial coflict of iterest i the publicatio of this article. AORN thaks Baxter Healthcare Corporatio, exclusive sposor of the 2012 Salary Survey ad olie AORN Compesatio Calculator. 604 j AORN Joural

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