RNs say pay not enough for job’s demands
They press hospitals to bill separately for services
Alan Lessig / The Detroit News
Prudence Burns Burrell, 84, started her career during World War II in the Army Nurse Corps. Retiring after 40 years, she has a small pension and no medical benefits.
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By Sarah A. Webster / The Detroit News
DETROIT — After 40 years of dedicating her life to the care of others, retired nurse Prudence Burns Burrell finds herself with a small $467 monthly pension and no health benefits, other than Medicare.
It is a sharp irony for Burrell, 84. One of the few black nurses admitted to the Army Nurse Corps, she tended to soldiers wounded in World War II. She later supervised federal research on tuberculosis and taught at several colleges before ending her career treating mental patients for the state of Michigan.
“I think it’s unfair,” said Burrell, who loved nursing.
Yet her situation is common.
“Most pension plans for nurses are poor,” said John Karebian, chief labor office for the Michigan Nurses Association. “They traditionally don’t get health-care coverage.”
Experts say nursing compensation packages must increase substantially if the health care industry is to attract students into a field that is emotionally and physically demanding.
But Ed Murphy, a Detroit-based health care consultant with William M. Mercer, a global human resources consulting organization, said only about 30 percent of employers offer some form of retirement medical coverage and the benefit is eroding as health care costs rise. Retirement health coverage, he noted, tends to be lower among health care workers.
Five of the seven major health systems serving the competitive Detroit market said they offer some form of retirement health benefits to their registered nurses. But the vast majority of RNs, including those at major health systems and community hospitals in Michigan, still do not get that benefit. That includes prominent facilities such as St. John Health System in Detroit and Mt. Clemens General Hospital.
Real wages
Hospitals note that RN salaries have risen significantly in recent years because of the shortage. Indeed, the average RN salary has risen from $43,698 in 1999 to $48,972 in 2000, an increase of 11 percent, according to Martin Fletcher’s 2001 Nursing & Allied Healthcare Annual Compensation and Benefits Report.
But nurses say their current pay levels — comparable to the pay of automobile production workers — are insufficient based on their educational prerequisites, the stress level of their jobs and their life-and-death responsibilities.
Unlike auto workers, nurses must have a college degree. They are at increased risk for contracting diseases, some of which are deadly. They routinely bend and lift while handling heavy machines, supplies and patients, increasing chances of injury.
Moreover, labor experts say, nurse pay levels have barely kept up with inflation. A 2000 report by the U.S. Department of Health and Human Services concluded nurses salaries have “remained flat since 1992” when adjusted for inflation. Another study says they declined.
“RNs experienced relative wage declines of 2.2 percent per year compared to college-educated women and 1.9 percent per year compared to other workers in the health care industry,” according to a recent study published in Industrial & Labor Relations Review.
Less than 10 years into their career, nurses also find that they hit a pay ceiling of about $58,000. If they want better pay, they have to move into management, said Ada Sue Hinshaw, dean of the University of Michigan School of Nursing. The pay increase for nurse managers was 21 percent between 1999 and 2000, when average salaries rose to $71,240.
But the move to management removes experienced nurses from direct patient care, and many times, the part of the job they like best.
“You should be able to get nice pay increments over your career, just like any other profession,” argued Barbara K. Redman, dean of the Wayne State University College of Nursing.
Sexism persists
Compensation issues also rub nurses the wrong way for sensitive reasons other than the pay itself.
Sexism, for example, is viewed by many nurses as an underlying cause for the status quo. Historically, Karebian said, health facilities assumed nurses were women, that they would be married and that their husbands would be the main source of income and retirement benefits.
But today, nursing salaries and benefits are the primary compensation for many single and divorced women and men who may be raising families.
“A lot of them aren’t married or their husbands aren’t going to have health insurance either,” said Roxann Louden, a St. Clair Shores nurse. “People are starting to realize that.”
Even those nurses who may be married say they resent being paid less based on lingering sexism. Yet disparities seem to persist. In a profession that is more than 90 percent female, male nurses made about $5,616 more annually than female nurses in 2000, according to the U.S. Bureau of Labor Statistics.
Many nurses also perceive that more resources are being spent on hospital executives and the appearance and marketing of their facilities than on quality nursing care.
The nurses union at Mt. Clemens General questioned how the hospital could afford 10 new buildings during the past decade but not retirement health benefits for nurses.
“We are not asking for cars, free gas cards or other perks,” the bargaining committee for Local 40 of the Office and Professional Employees International Union wrote in a letter to the hospital. “Is our earnest need for retirement health care to be sacrificed to a budget that can accommodate yet another building project?”
Doug Czajkowski, a Mt. Clemens General spokesman, said construction is necessary to stay competitive and remains a small part of the overall budget. He said the hospital simply cannot afford retirement health benefits for its nurses.
“Every day the reimbursement shrinks, the payment plans are getting slower, and you know the people are getting sicker,“ he said. “We’re doing everything we can to keep our heads above water.”
Bed rates
Nurses say they would have a much better sense of how much they should be paid, if they knew what hospitals charged for their services.
Hospitals bill separately for most “professional services” like doctor’s fees and X-rays. But with a few exceptions, nursing care is lumped in with janitorial, dietary, equipment and other costs under a billing category called “bed rate.”
“It’s the most degrading thing,” said Kathleen Vollman, a clinical nurse specialist at Henry Ford Hospital.
Some nurses allege that under this “bed rate” billing system, hospitals can easily keep RN salaries low and nurse staffing thin and then make a profit on high bed rates.
For example, the bed rate for Warren resident Joyce Shields’ stay at St. John Macomb Hospital, where she claims she received inadequate nursing care, was $1,540 a day. Her radiology tests, respiratory services and emergency room fees were all billed separately.
Based on the average $20 an hour paid to nurses, it would cost $480 to hire one nurse to care for a single patient for 24 hours. RNs are usually assigned to four or more patients at a time, which would drop that cost to less than $120 a day — just eight percent of Shields’ bed rate.
Nurses know that most insurers pay only a fraction of the actual charges. Still, nursing care is the primary service of hospitals, and they question whether all those bed rate funds are being spent properly.
Don Potter, president of the Southeast Michigan Health & Hospital Council, said hospitals bill the way insurers and the government requires them to and denied ulterior motives.
“I don’t think there’s anything shadowy involved here,” he said.
But nurses like Sandra Sulflow, who has worked at Mt. Clemens General for 21 years, questioned the accountability in the current system.
“There isn’t a nurse walking that can tell you what is billed for his or her services,” she said.
You can reach Sarah A.
Webster at (313)222-1463 or swebster@detnews.com.
