How a Critical Care Nurse Does Money

Linda is a 33-year-old ICU nurse who works at one of the nation’s top 10 children’s hospitals in Denver.

Mike: How much do you earn as an ICU nurse?

Linda: That depends. I have a base hourly rate in the mid $30s, plus my shift differentials. I work 36 hours a week, without a set schedule, so my actual hourly rate changes depending on the day (we get a weekend differential), the time (night shift differential for me), and the fact that I float between ICUs (float differential). Plus there’s almost always overtime available, which is time and a half.

Mike: Can you explain the differentials to me? Does this mean you get paid differently for those shifts?

Linda: Yep. We get an increase to our hourly rate for any or all of those reasons. So working a weekend night shift as a float increases my base rate by about $15/hr. And there’s even more considerations — I’ve worked nights for long enough that I get the top night differential, whereas nurses who rotate between days and nights get a lower night differential when they’re on nights. All that to say that while I have a reasonable base hourly rate for my specialization and experience, a nurse’s actual paycheck can vary greatly based on shift choice/requirements.

Mike: What does this come out to be for you annually?

Linda: I’m making slightly under $100K.

Mike: Is this is higher than the average of what registered nurses typically earn?

Linda: I’m not sure, actually. I mean, it’s higher than a nurse working a straight day shift at my hospital, or nurses that don’t float between units. I’m actually on the low end for my hourly rate (based on my experience and clinical ladder status), but I know that my hospital pays pretty well comparatively speaking. Also, the fact that I’m a bachelor’s-prepared nurse at an urban magnet hospital (meaning specifically certified) makes a huge difference, so it’s very difficult to talk about average nursing salary more broadly. Registered nurses do not all have the same education at the entry level, so the salary can vary wildly. Also, being in a larger city and at a larger hospital changes pay dramatically as compared to a smaller, more rural situation.

Mike: What did you study in college?

Linda: Nursing. I have a bachelor’s degree in nursing, a BSN. I also have a B.A. in writing and philosophy, which was my first degree.

Mike: When did you know you wanted to go into nursing?

Linda: Well, I’d always planned to go to medical school — like, from the fifth grade on. So I got my writing degree while also doing all my med school pre reqs, and at the same time I became an EMT and started working as a tech in a hospital. After graduating, I could not bring myself to actually take the MCAT or do anything to pursue medical school. It just didn’t feel right. So I took some time to figure it out, since I had a decent job as a tech, and ended up teaching EMT students. My boss there, who was in nursing school, asked me why I wasn’t considering that as an option and it just sort of clicked. Within a year, I was in an accelerated, one-year bachelor’s program for nursing.

Mike: Did you know you were going to work in a pediatric ICU setting?

Linda: Yes. I’ve never even considered working in adult medicine. I also always knew I wanted to do critical care. I should say that I had wonderful experiences with adult care in nursing school but my heart belongs to pediatrics. 🙂

Mike: How did the job hunt go for you? Nursing is in demand?

Linda: I graduated in spring 2008 and had already accepted a job. I think when I graduated, four months before the stock market crash, represents a very different experience as a new grad nurse than new nurses have now. I applied for two jobs in the very specific area of critical care that I was interested in, interviewed for both, was offered both, and picked one. Had I graduated later, I probably would have had to broaden my search. Nursing is always in high demand, but that demand is often for experienced nurses. There are absolutely jobs available for new nurses, but it can be competitive to get into more specialized areas at top hospitals. If you don’t have a pretty strong stomach and wickedly sick sense of humor, nursing probably won’t be a good fit.

Mike: Was any of this communicated to you before you started working as a nurse, or was this a learning experience?

Linda: There was a lot of discussion in nursing school about compassion fatigue, self care, and resiliency, for sure. And I had already worked in hospital settings, doing patient care, for five years by the time I went to nursing school, so my perspective as a new nurse was perhaps different. But I think truly understanding what a nurse does is something that’s learned through experience. My patients and their families teach me so much about being human every day and my colleagues are the most incredible teachers and mentors I’ve ever known.

Mike: What kind of benefits does your job offer you in terms of things like health care, retirement, and time off?

Linda: I have pretty excellent health care coverage, including vision and dental. There’s a good retirement plan that is matched to a certain amount. I accrue paid time off based on my years of service and hours worked, so I have lots of PTO in my bank. We use PTO for everything, so we don’t have specified vacation days, sick days, personal days. It’s all just PTO and it rolls over every year. As a nurse in the ICU setting, I work a certain number of weekends and holidays since we’re a 24/7 kind of place.

Mike: Have you been able to take any big vacations?

Linda: Yup, my husband and I were in Europe for two weeks last year and I was able to take three weeks off for our wedding the year before. As long as I plan, I can take pretty significant amounts of time off. For example, I can request 36 hours of PTO, so a whole week off, but schedule myself for Sunday-Tuesday the week before and Thursday-Saturday the week after my vacation and end up with 15 days off. We do have to request vacations upwards of a year in advance, but since I work for a small team, it’s usually not too difficult to get time off, especially if I’m flexible about dates.

Mike: What does your husband do for a living? How do your schedules match up?

Linda: He’s a graphic designer. Our schedules do not match up at all, actually! For example, I just worked Monday-Wednesday nights and haven’t seen him since Monday morning since he leaves for work before I get home and vice versa. But I’ve worked nights as long as we’ve been together, so we’ve come to appreciate the alone time our schedules allow for us. Plus it makes us really happy to see each other all the time. 🙂

Mike: I’d imagine so!

Linda: We’re buying a house right now which has really driven home how challenging our differing schedules can be!

Mike: Have you set any financial goals together?

Linda: Oh yeah, we have all sorts of financial goals together, first and foremost has been paying off student loans. Now we’re buying a house and then it’s time to address the retirement planning issue that we’ve been avoiding. We’re not done with the loans, but we’re in a good place, making headway every month.

Mike: How much student loan debt did you take on while you were in school?

Linda: $63K for my one year of nursing school, plus $30K from my first degree (I sort of took my time and took advantage of a broad liberal arts education with my first degree). My husband also has some debt from his BFA and MFA. I took a really big gamble with nursing school and chose to attend a rather pricey private school as opposed to the state school that I also was accepted to. The private school’s program started sooner, which given the stock market crash, was well timed although I certainly wasn’t concerned about that possibility when I chose. I then managed to qualify for a government loan repayment program that gave me $30K over three years to go towards my nursing school loans in exchange for continuing to do my job at the bedside at a hospital with a large percentage of medicare/medicaid patients.

Mike: Oh interesting, so the government program is going to help you tackle half of nursing school.

Linda: It did. I finished my third year of payments last year. So I’m almost six years out of nursing school and I’m on track to pay off my loans in the next few years.

Mike: How do you feel about your savings and retirement — do you have any credit card debt?

Linda: We have almost no credit card debt, but we really haven’t started saving towards retirement. That’s definitely a priority for this year. And our savings could use more prioritization, especially now that we’re going to have this house and it will no doubt decide to break at inopportune times. One of the pluses of nursing is that things like a new roof or a vacation can be thought of in terms of extra shifts, i.e. if I just work four extra shifts in the next two months, our vacation is paid for. But I think that’s a negative sometimes, too, since I tend to not think in terms of a broader savings strategy. It drives my husband slightly crazy since he’s always had salaried positions, which I can’t quite get my head around. I’ve always worked in a world where overtime is readily available. I’m also used to be paid for every minute that I work, including all the meetings and education that I go into work for outside of my normal hours.

Mike: What kinds of opportunities for advancement do you have?

Linda: All sorts! There’s a clinical ladder for nurses at my hospital, so as you become more involved in projects and increase your expertise, you can apply for advancement that way. There’s always management, too, which is in no way appealing to me but it’s nice to know it’s there. There’s also just the fact that I can always try a new type of nursing if I want, at any time. If I’m done with the ICU, there’s the OR or the cath lab. If I want a day position with no holidays or weekends, there are clinics. If I want to go back to school to be an advanced practice nurse (get a master’s or doctorate), my schedule is flexible enough to allow that and there’s tuition reimbursement. I think it’s important to note that a lot of these opportunities are based on having a bachelor’s degree in nursing at minimum. Nurses who have an associate’s degree in nursing do not have the same opportunities. Magnet certified hospitals only hire nurses with at least a BSN and many of the opportunities for specialization and advancement are at these hospitals. That’s not to say that an associate’s in nursing does not allow for advancement, by any means, but it does limit the job opportunities to some extent, especially if working at a renowned teaching hospital is something that you prioritize.

Mike: What do you think of television shows that feature nurses on them? I’m sure they’re not too accurate, but perhaps you can tell me what’s up.

Linda: I maintain that “Scrubs” was the most accurate representation of hospital dynamics that I’ve ever seen. I’ve never seen a nurse portrayed in a particularly accurate way — most medical shows seem to ignore nursing as a way to focus on doctors which is…not surprising? I haven’t watched any shows about nurses, though. Maybe I should? Once Netflix started streaming Buffy, I sort of checked out from current TV. 🙂

Mike: You did say nurses need a wicked sense of humor.

Linda: It is imperative. Because if we can’t laugh, we’d probably be too sad to do our jobs. You just have to find the humor in the situation.

Mike: Final thoughts?

Linda:I love my job. Being a nurse is enormously challenging, but also incredibly rewarding. I just want people to know that while the money and benefits are great, there’s also a huge amount of personal satisfaction that I get from my job. And I know how lucky I am to be well compensated for doing a job that I love.

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