Essential Tactics for Nursing Contract Negotiation

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: A nurse looks at documents on a clipboard while sitting at a table.

Starting a nursing career or changing employers can be an exciting, although stressful, time. Even for the most experienced nurse practitioner (NP), walking into a job interview can cause anxiety. However, nurse practitioners who are prepared for their interviews can manage this stress and skillfully discuss the terms of their contract. Nurse practitioners armed with the essential tactics for nursing contract negotiation can be prepared to negotiate better terms for their future employment contracts.

Which Contractual Terms Are Typically Negotiable?

Negotiating the terms of a nursing contract is a common practice between employers and job applicants. This discussion helps an employer identify your value as a prospective hire and whether you’ll be a good fit for their organization.

While contract terms will vary by healthcare employer, the following conditions are typically discussed during the nursing contract negotiation meeting.

Salary — Of course, the most pressing term in any contract is how much a new hire will be paid. Based on the scope of practice, an NP (NP) may have a yearly, hourly, daily, or per-patient salary contract, according to the American Association of Nurse Practitioners (AANP). Additional pay structures may be used, such as a base salary with a percentage of income generated above a certain amount or only a portion the net income made.

As a job applicant, you should prepare for your interview with an estimate of the value of the service you’ll provide to the healthcare facility. NPs can find this value by researching salaries similar to their position or, if they have the correct information, follow an equation to build a longer-term estimate. NPs should estimate their expected patient load per day and build patient-load projections for six months and one year. Using the employer’s average charge per patient, applicants can multiply this cost by their expected patient-loads and subtract the overhead costs, which typically range between 48-52%, according to the AANP. If the value outcome is significantly over the usually expected profit margin of 15-20% for a private practice, as outlined by AANP, the employer may not be able to pay the applicant’s expected salary.

Benefits — If an employer has limited flexibility to negotiate salary due to government funding restrictions, job applicants may be able to discuss additional benefits as part of their total salary package. Nurse practitioners may be allocated non-salary benefits, such as personal health insurance, vacation time, allowances for continuing education, and paid professional membership fees. Typically, benefits packages are offered to salaried professionals and may not be available for hourly or per-patient contract work.

Malpractice Insurance — Malpractice insurance is a type of insurance coverage purchased by healthcare professionals to protect them against legal action from litigants who claim they were harmed, either through negligence or intentional treatment, during their care. Malpractice insurance may be included in the salary or benefits negotiations. However, if you are working part-time or occasionally, you may have to purchase insurance separately.

Hospital Credentialing — According to the American Academy of Family Physicians (AAFP), “credentialing is the process of verifying qualifications to ensure current competence to grant privileges.” This process verifies that the job applicant meets the experience, education, and licensing requirements. In some instances, nurses may be required to complete credentialing before starting work with the employer, and the credentialing process can take up to three months to complete. NP applicants who are still finalizing their certifications may be able to negotiate the start date of their credentialing process to speed up the hiring process.

Becoming a Member of a Nursing Union

A labor union is an organization of working professionals who have formed a group to advance the interest of its members with employers regarding pay, working conditions, and other employee benefits. In 2017, the BLS reported that all nonunion workers only earned 80% of the median weekly earnings received by workers who were union members.

Nurse practitioners who belong to a union, like National Nurses United, may have further leverage with potential employers on issues such as overtime limits, continuing education, health and safety requirements, and stipulations for discipline and termination.

Nursing Contract Negotiation Tactics

To help both member and non-member nurse practitioners work with their potential employers to secure the best contract, below are the top tactics to use in nursing contract negotiations.
● NPs should thoroughly research the facility before attending interviews to gain an idea of the range of total patients seen as well as any on-call responsibilities. Applicants should also examine state and local regulations to discover whether a facility meet legal requirements. While much of this information can be found online or through professional organizations, you may need to request information from the employer’s recruitment officer. Applicants can also ask other local NPs to have informational interviews about the position.

● To prepare for the salary conversation, review similar jobs online through platforms such as LinkedIn, PayScale, and Glassdoor. You can also reach out to other nursing professionals in your area or association network to request salary-range data. The AANP completes an annual survey of wage and benefits information, which can be a helpful tool for benchmarking salaries.

● NPs should also identify other work qualifications that can be leveraged to attract a more favorable deal. If you participate in nursing associations, write for publication, or have additional references, you can use these assets to negotiate with employers.

● NPs should establish a final number that they are comfortable settling for before walking into an interview. If the interviewer does not provide the salary range first, applicants should propose an estimated salary that is slightly higher than their bottom line, without being too aggressive. Federal or state-funded facilities may not have flexibility in their salary offerings, so prospective employers may not be able to match a high salary proposal. If the wage itself is inflexible, job applicants can negotiate non-salary benefits to create a desirable package. However, if the employer cannot provide the bottom line package, nurses should reevaluate whether the position is right for them.

Finding the right job can be a challenging step for new nursing graduates and veteran nurses alike. However, nurses who know the essential tactics for negotiating their nursing contracts can be well-prepared to create an agreement that suits their needs.

American Academy of Family Physicians, “Hospital Credentialing and Privileging FAQs”
American Association of Nurse Practitioners, 2017 National Nurse Practitioner Sample Survey Results
American Association of Nurse Practitioners, Employment Negotiations
American Nurses Association
American Nurse Today, “6 Tips to Salary Negotiations”
Forbes, “Key Strategies for Overcoming Job Search Stress”
Investopedia, “Malpractice Insurance”
Merriam-Webster, “Labor Union”
National Nurses United, About
The Journal For Nurse Practitioners, “Beginning Employment: A Guide for the New Nurse Practitioner”
The Online Journal for Issues in Nursing, “Traditional and Non-traditional Collective Bargaining: Strategies to Improve the Patient Care Environment”
U.S. Bureau of Labor Statistics, “Table 3. Union affiliation of employed wage and salary workers by occupation and industry”
U.S. Bureau of Labor Statistics, “Union Members Summary”