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LEGAL SCENARIOS
Nurse pay not equal across genders
Addressing inequities in salaries between female and male nurses
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By Nancy J. Brent
MS, JD, RN
EDITOR'S NOTE:
Nancy J. Brent, MS, JD, RN, brings more than 30 years of experience to her role as Nurse.com’s legal information columnist. Brent’s posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. 
In 1938, Congress passed the Fair Labor Standards Act, which established minimum wage and overtime pay for employees. In 1963, Congress amended Section 6 of the Fair Labor Standards Act and called the amendment the Equal Pay Act. The act prohibited employers from discriminating in the payment of wages on the basis of gender/sex when equal work of equal skill, equal effort and equal responsibility was done under similar conditions. The only exceptions to this prohibition
were a “bona fide” merit system
, an incentive pay system or a difference in wages based on a factor other than gender/sex. By 1993, this goal had not yet been achieved. Women made up more than 45% of the workforce, and their wages were 68% those of male workers.
Fast forward to today and the nursing profession. Although predominately a female profession,
a recent study
of 87,903 RNs, of whom 6,093 were men, revealed that unadjusted male salaries were higher than female salaries from 1998 to 2008. The higher rate of pay occurred across settings, specialties and position with no narrowing of the pay gap over time.
Data from the study indicated the pay gap was about “$5,000 even after adjusting for factors such as experience, education, work hours, clinical specialty, and marital and parental status,” according to the Scientific American article
“Even in Nursing, No Equal Pay for Women”
.
Explanations for the existence of unequal pay for equal or similar work include that men are better negotiators than women and therefore can achieve a higher level of salary. Many women work part time as opposed to full time in order to care for children or ill family members. Women’s work is seen as less valuable then the work that men do.
These rationalizations may work in male-dominated workplaces, but they simply do not fly in nursing, which is predominately female. Moreover, with such laws as the Family Medical Leave Act, in which a male or female worker can take an unpaid leave to care for a child (birthed or adopted) or other family member, these excuses are hollow.

Published research identifying men as better negotiators than women have to be carefully analyzed before applying the findings to each and every male and female who negotiate salaries.
Linda Aiken, PhD, RN, professor of nursing at the University of Pennsylvania School of Nursing and a renowned researcher, author, leader and teacher has an interesting viewpoint on pay equity. She believes it involves more than gender. In the Scientific American article, she cites the fact Medicare pays nurse practitioners working in primary care 85% of the rate that physicians are paid for the same services. She also points out that primary care providers are paid less than clinicians in subspecialties such as anesthesia.
In the article, Aiken also points out that if female nurses’ incomes are due to their choice of specialties that are needed, such as primary care and long-term care, it would not be in the public’s interest to encourage them to follow their male counterparts and select specialties that pay more.
These rationalizations may work in male-dominated workplaces, but they simply do not fly in nursing, which is predominately female."
-
Nancy J. Brent, RN

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Explanations for unequal pay
Be assertive
Clearly, the Equal Pay Act’s overall objective has not yet been fully realized. However, female nurses have ways to avoid becoming an unknowing target of unequal pay for equal or similar work.
Some considerations include:
Sharpen your negotiation skills before applying for a job, seeking a raise or asking for a promotion.
If possible, increase your hours of work in order to have “hours equity” with your male colleagues.
If possible, request to work a different shift if it results in more pay that is equal to male nurses who work that shift.
Raise questions with human resources about any of your employment benefits (e.g., bonuses, pay raises) if you believe your male nurse counterparts are receiving enhanced or better benefits.
Fight for equalization of Medicare reimbursement for APRNs.
If you are a CNO, help develop and initiate salaries that eliminate pay disparities.
Voice your concerns when administration or other staff downplay unequal pay issues.
Be certain to share your clinical experience and expertise whenever an increase in salary is involved.
Be appropriately assertive and self-assured when practice and pay issues arise.
If you believe you are being paid less due to your gender, seek a consultation with a nurse attorney or attorney who can provide guidance and representation if needed.
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