John Lavery, formerly a nurse recruiter with Temple Health based in Philadelphia who recently retired, said salaries and benefits vary more by location. “I think it’s more of a regional difference than by size,” he noted. “The Midwest and more remote locations will be different [in compensation] compared to the region from Boston to Washington, D.C.” The regional difference for nurse compensation is backed up by data from the U.S. Bureau of Labor Statistics for 2016, which reported RN salaries varied noticeably between states, as well as by data gathered by the Nurse.com's salary survey. Lavery, who has decades of recruitment expertise, said benefits and compensation for RNs is market driven. “In the Philadelphia area, there are two different markets — the inner city and the outlying hospitals and organizations,” he said. “They [the outlying sites] are still within the city zip code, but those are more neighborhood facilities.” Lavery explained inner-city health systems, as a market group, conduct market surveys, so they can better compete with other systems in the same market. He pointed out that inner-city hospitals, at least in Philadelphia, pay slightly higher than those not considered inner city. “Part of that [pay difference] is driven by how much it costs to work in the inner city,” he said. “For instance, at every hospital in inner-city Philadelphia, staff has to pay to park. That’s an added expense.” Nurses at city-based hospitals also may have to pay city wage taxes, another consideration in compensation comparison. Otherwise, Lavery sees that health and benefits packages and retirement plans are generally competitive from one system to the next in the same region.

“The trend is for hospitals that are spread out over a large area to become part of one system,” Lavery said. “Smaller community hospitals are joining a system and will gradually align their benefits.” Cultural issues also can come into play when talking about working within a health system versus a stand-alone hospital, Lavery said. Nurses can choose to work within a specialty, such as cancer care or acute care. Also, the more people employed in a large system, the more leverage employees have to negotiate benefits. Lavery suggested RNs look for healthcare plans that provide care within their own system, since it could be a better financial deal. Patton pointed out that healthcare systems are savvy to the reality that nurses will stay within a system if the organizational culture works for them. “Staff nurses often are attracted by salary first; the culture then either keeps them or drives them away,” he said. Clinical ladders are one element of organizational culture that afford both advancement and higher earnings. Lavery agreed that the culture matters. “At some hospitals, there is very little turnover,” he said. “It’s pretty much related to the way nurses can move within the facility and still advance.” He said health systems that encourage nurses to grow by moving to another job in the system might see turnover of less than 5%.

Market drives pay

Culture plays a role

Trend toward larger systems

Scope out the full benefit package

Benefits such as tuition reimbursement and retirement packages matter in the long run. Patton observed many organizations are beginning to scale back retirement plans, sometimes in an effort to counter the increase in healthcare costs. Nurses should check into the matching amount the organization offers. A healthy retirement plan, he said, is an attraction that keeps nurses in the system. Besides hard cash, other benefits can enhance work satisfaction. For example, working at a Magnet hospital where staff buy-in is high and shared governance is the norm can be a plus. Loan repayment programs, payment for staff to attend work-related conferences, or bonuses for attaining specialty certification are perks that nurses find favorable, according to a June 15, 2016, article in the American Journal of Nursing. There are no bad places to work, Lavery concluded. It all depends on what you’re looking for.