 Nurse salary negotiation includes counteroffering to achieve your absolute best deal.
We will all have different targets in our salary negotiations and it’s during the counteroffer that you’ll bring more of these in. It’s perfectly ok to ask for the things that are important to you in order to create your preferred work-life balance. Dollars are not the only thing that matter. What I’m saying here is that there’s no right or wrong. There’s only what works best for you. In Goal 1 you set your dollar amount, but here in Goal 5, it’s time to think about what you are willing to exchange in lieu of money. So before you make any serious counteroffer, let’s give this some thought so you will have some notes jotted out and ready to reference when the time comes. Depending on your type of job, your counteroffer requests will vary widely. Some examples of things that will be important to you might include a guarantee of day shift, 4 weeks uninterrupted paid time off each year, scheduling flexibility, company car, travel expense reimbursement, work from home opportunities, or the ability to come in late or leave early to work around your children’s school schedules. Depending on what type of job you have you will know what kinds of requests make sense and might be possible. You will have to decide how much you are willing to flex on salary to receive those. But be very careful: whatever salary you eventually agree to, you will be tied to it in perpetuity because all future pay increases will be based on your agreed upon starting rate. But be very careful to not give too much away in your counteroffer. Whatever salary you eventually agree to, you will be tied to it in perpetuity because all future pay increases will be based on your agreed upon starting rate. For me personally, I know that for a job to be a good fit I require scheduling flexibility, and uninterrupted paid time off that I can take when it suits my schedule. I am willing to sacrifice a lot in dollar amount for those two things. However, I still have a minimum that I’m willing to exchange my time for, and that’s an amount that permits me to pay my bills, of course, and save enough to bring my adventure dreams to life. Now that I’m in my 40s, and not feeling the desperation of accepting any old job for money, I’ve grown in my negotiation confidence. If you aren’t yet feeling the flexibility that financial security brings, I have good news for you. As a nurse, there are soooooo many jobs available to you. Don’t get stuck in something that’s making you miserable or that’s not paying you what you think your time is worth. Make a change and do it now. As a nurse, there are soooooo many jobs available to you. Don’t get stuck in something that’s making you miserable or that’s not paying you what you think your time is worth. Make a change and do it now. These 5 Goals of Nurse Salary Negotiation work. My hope for you is that you will use this in your next salary negotiation to get the most compensation possible out of your employment financial or otherwise. Get additional support by joining our supportive, private NIFW group on Facebook. Here you will meet nurses who are maximizing their wealth and ready to give you a cheer along your negotiating journey. In this series, we're working on 5 goals:
 Angel Mathis, MN, MPH, ARNP, FNP-BC Hi! I'm Angel. I am the founder of Nurses Investing For Wealth. I teach nurses simple money tactics that turn them into millionaires. This is where you learn how to use your nursing knowledge to invest your money better than an expert.
If you want to end money confusion, be unstuck from nursing, and create financial freedom, come join my Tiny Training Nurse Investing Series.
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 Nurses must negotiate their salary emotionlessly. Photo by Francisco Venâncio on Unsplash
When asked if I would consider less (as shared in Goal 3, go back to read it here), here’s what I said: “No, I don’t think so. That would be very difficult for me because I wouldn’t be able to meet my own expenses at that amount.” Ok, so this may not be 100% accurate, but it is 100% true. It’s not 100% accurate because as a Pacific Crest Trail thru-hiker emeritus who has spent 5 months of my life walking across the USA and living outside carrying only life’s necessities with me in my backpack, I feel even more confident in my ability to live on practically nothing than I do in my salary negotiation skills.  Negotiate emotionlessly for your nursing salary making sure that you are asking for an amount that at a minimum covers your expenses. It’s 100% true to say I can’t meet my expenses because the other thing thru-hiking ingrained in my is that my most precious resource is my time. I had already worked through Goal 1 and was pretty clear about the minimum I was willing to trade my time for. This offer had not hit it, and this is why I could respond earnestly, “No, I don’t think so. That would be very difficult for me because I wouldn’t be able to meet my own expenses at that amount.” Guess what happened next? The interviewer squirmed. They tried to explain why they needed to provide less - blah blah blah. Always consider this white noise. I listened patiently and emotionlessly to the justification of the lower pay offer. Then I didn’t budge and emotionlessly repeated, “I can’t cover my expenses on that amount.”  A nurse's ability to negotiate their salary is a key component for nurse's investing for wealth. The 4th goal of nurse salary negotiation is to do it emotionlessly. I can’t cover my expenses on that amount. Now would’ve been a fine time to briefly review comparable market rates and all the value I was bringing - my years of nursing experience, my track record of being results driven, a self starter, excellent with technology, my exceptional performance reviews. However, those are all things we’d reviewed in the interview already. I’ve gone down that road in the past, and when I did, I have led myself into the squirming position. It’s difficult and it doesn’t feel good when trying to convince someone else that your personal worth is tied up in a specific dollar amount. Remember when I told you about the time I was negotiating for an internal salary increase with the president of my organization, and he dismissed me with a wave of the hand? That was a very devaluing moment in my career that I never care to repeat. It’s difficult and it doesn’t feel good when trying to convince someone else that your personal worth is tied up in a specific dollar amount. It’s my belief that once you’ve reached this part of the interview, now is not the time to make your case and attempt to attach your worth to a dollar amount. You’ve already demonstrated your worth in your interview, through your resume, and maybe through direct observation of your work. You will potentially have opportunity to do that again during your reference checks. So when you find yourself at this part of the process, do yourself a favor and stick to something that the interviewer can objectively understand, your ability to cover your expenses. It’s an easy concept for leaders to grasp - if the amount they are offering you will not cover your expenses, then you can’t in good faith accept the position and support yourself. It signals to them that it’s up to them to do the right thing and pay you what you need to exist. You’ll both be seriously considering if this job will be a good fit and if one of you needs to leave this negotiation at this moment. So after the interviewer made their case for lower pay, and I repeated emotionlessly, or perhaps with a tinge of regret, “I’m very sorry. I can’t cover my expenses on that amount,” the interviewer came to their conclusion, “I cannot make this decision on my own so I will have to review this with my leadership team and get back to you.” Whether I got the job or not, I felt a success in this moment. A day later, I received a request to check references getting me one step closer to the fifth and final goal in nurse salary negotiation: counteroffering. In this series, we're working on 5 goals of nurse salary negotiation:
 Angel Mathis, MN, MPH, ARNP, FNP-BC Hi! I'm Angel. I am the founder of Nurses Investing For Wealth. I teach nurses simple money tactics that turn them into millionaires. This is where you learn how to use your nursing knowledge to invest your money better than an expert.
If you want to end money confusion, be unstuck from nursing, and create financial freedom, come join my Tiny Training Nurse Investing Series. Follow on Instagram  The third goal of nurse salary negotiation is to show up prepared to ask for a salary that is higher than an organization will willingly offer. Photo by Thought Catalog on Unsplash
I was interviewing for a job where my background experience and skills fit the business needs perfectly. Prior to the interview the business had disclosed to me their starting hourly rate. The rate was only one number, not a range. Any nurse who’s been around the block knows that union position's hourly rates will range very widely depending on number of years of experience. The rate quoted to me was very, very low, and I approached this with the mindset that it was likely a rate for a new grad nurse. I was prepared to make a salary request that was well beyond the shared amount and that was also fully worthy of my time and skills (Goal 1) and on par with market rates (Goal 2). It was to my benefit that the company had willingly offered me this number without me even asking. However if they had not, I would've asked them what their budget was for this position. A golden rule of negotiating is to always get the business to share their budgeted amount for the position with you before ever offering a salary suggestion of your own. A golden rule of negotiating is to always get the business to share their budgeted amount for the position with you before ever offering a salary suggestion of your own. On this occasion, I was aware of their minimum budget, but had no knowledge about what their upper pay step was. So when the topic of salary inevitably came up, the default for the interviewer was to say our starting rate is $30 per hour, are you ok with that? We reviewed briefly my years of experience, my awareness of market rates, and I said, “The absolute minimum I can accept is $40 per hour” and let the pregnant pause ensue. After a moment, they responded, "There’s no way we can offer you the amount you’ve requested. Will you consider less?” Will You Consider Less? Always be prepared for this question by working through Goal 1 and Goal 2 so you can know with great confidence how much 1) you are willing to do this work for and 2) how much colleagues are being compensated. Remember, a business exists to make money, so it makes sense that they will like to save money on the work you’re doing by paying you less if you willingly agree to it. It’s part of the negotiation game. Expect it but don’t capitulate. And I know you won’t even be tempted if you’ve already done the work in Goal 1 and Goal 2. So back to my interview - I responded, “Well what are you thinking? What are you capable of within your budget.” “We start all new staff on this step, and we will be able to advance your pay as you grow in experience. It’s very expensive for us to bring new staff onboard and we can’t justify paying you more when you’re just starting out and needing so much training.”  Nurses in salary negotiations should ask for a salary higher than an organization will willingly offer We bring everyone in at a lower pay since they will need expensive training and over time you will become eligible for merit raises.Do not ever be fooled by this age-old tactic used by human resource departments where they justify lower pay in the name of onboarding and provide false reassurance that your salary will be advanced to meet your needs based on merit. First of all, the salary you agree on now is going to be the salary that all your future pay increases is dependent on. You will be in training for a short time, not for a lifetime. Never ever fall for this rationale. Second of all, companies and organizations have very stringent merit recognition, and for companies that allow this, you will likely find that a merit raise is going to take you years to achieve your minimum ask unless the offer is very close. It’s very unlikely it will be worth it. I worked for a company once that required a painstaking amount of documentation in order to be seriously considered for a merit raise. A very small portion of our team would be selected for the merit increase, and even then, the increase was equal to 3% of gross pay. This isn’t bad if you know you will realistically be eligible for this merit increase every year, but you won’t be. Don’t be fooled. Every year, managers felt an obligation to pass this merit based award around to other excellent members on our team too. And so they should because that is the ethical thing to do. I share this story to demonstrate only that a discussion during an interview process of a merit based salary enhancement is nothing more than an HR strategy that gets you to agree to a lower starting rate that will effectively lock you into years of lower pay. Don’t fall for it. Set your salary number high and then set your focus on the fourth goal to get your best nursing salary: emotionless negotiation. In this series, we're working on 5 goals of nurse salary negotiation:
 Angel Mathis, MN, MPH, ARNP, FNP-BC Hi! I'm Angel. I am the founder of Nurses Investing For Wealth. I teach nurses simple money tactics that turn them into millionaires. This is where you learn how to use your nursing knowledge to invest your money better than an expert.
If you want to end money confusion, be unstuck from nursing, and create financial freedom, come join my Tiny Training Nurse Investing Series. Follow on Instagram.  Nurses negotiating their salaries effectively will ask colleagues and research going rates. Photo by Christina @ wocintechchat.com on Unsplash Before walking into any negotiation or interview, you must know what the going rate for your position is. Be familiar with the salary range of your nursing role and that of colleagues. Not sure? Ask them! That's the very best way to know and will have the strongest social proof when you bring it up with your boss or interviewer. You should also do some more general research. When you visit the the Vitals Kit you will find excellent resources that I recommend you use to help you with your research. In the Financial Vitals Kit you’ll find transparent information that’s reported by your colleagues around the world so that you know exactly what similarly experienced nurses in your specialty area and geographic location are getting paid.
If this is a unionized nurse position, look up the salary steps/wage structure. Find these on the organization’s bargaining agreement – that’s usually publicly available through the union website or by a quick internet search. For example, put into an internet search engine “[the organization’s name], state, bargaining agreement, nurses.” Pull up the bargaining agreement and browse to the wage structure then analyze the steps. Think about how you might fit into this structure. Can you justify a higher step? How might you include your nurse aid or other professional experience to move up in steps. Highlight your certification status and degree level. Now’s a very good time to highlight all your experience because once you get assigned a step, your salary advancement as long as you stay in this job is always going to be based on this initial agreement you make. Know whether your organization hires a lot of travel nurses, locums, or temporary health care providers. If so, this means they are chronically short staffed and your value as a permanent employee will be higher to them. Use this as a negotiation point if you’re applying to a permanent position. And remember, you can always be a travel nurse yourself. Never forget your powers. Be cautious when looking at base rates since they do not ever take into account what the benefits or perks of a position are. They also don’t factor in hidden costs. Get all the data including expense reimbursements, information about benefits like health insurance, and retirement plan perks. If you’re driving an hour to work each day, that’s an hour of your time that’s unpaid and you will have associated gas and car maintenance costs. These things can really add up! Make sure to factor all of them in! I once was in negotiations for a nurse practitioner locums position that was offering me a $65 base rate along with a rental car, and free accommodation since the position was away from my hometown. I wouldn’t receive a retirement plan or any health insurance which in the USA is easily $500 a month when purchasing out of pocket. I was required to drive 3 hours to the clinic location which meant 6 hours of unpaid commute time each week so long as there was no traffic and fuel costs were my responsibility. Sound good? I already had a car of my own, and I’ve never been one of those people who enjoys driving. I had a primary home where I enjoyed living, so accommodation wasn’t a draw either and especially not this accommodation: it was in an assisted living - yes, an old folks home where they offered to have me stay! I passed on the offer. I ended up taking a similarly paying position with health insurance (valued at $700+ per month), and a retirement plan. Commute time was minimal, but my car and accommodation weren’t covered. In a 2.5 year period, I socked away $25,000 of my own pre-tax income from my paychecks into my retirement plan. My employer matched 50% of up to 4% of my elective contribution in addition to funding a defined contribution account equal to 6.3% of my gross earnings. Would you believe that my $25,000 pre-tax investment turned into $137,000? I had invested it effectively and I will show you how in this book in a later chapter, but my employer contributions helped me along. For me and my life goals, this second option was the better option and paid me more than any accommodation or car benefit on offer. I know this in retrospect, but when making the decision, it wasn't made with great certainty. So take some time and really consider what's important to you and what you hope to achieve from your pay and benefits. It’s hard to make direct comparisons in these scenarios, but it’s important to review your Goal 1 so you’re clear on how you value your skills and your time. Does one position fit your values better? Will one make you richer? How will you choose? Whatever thoughts you have about this, just make sure you take into account the various ways you will receive pay beyond your base rate and use those to help you make a decision that’s best for you. Word to the wise: I know you would never do this, but do not ever make an argument against your own best interests to help an organization justify bringing you onboard at a lower rate of pay or pay step. For example, you’ve been a nurse for 5 years, took a year off, and are offering to come onboard at the 4th year pay step. NEVER EVER do this! This is the time to conflate (not lie) your experience and do it proudly! All life experience matters. Include all your information in your CV and don’t cover anything up when interviewing. If your organization wants to pay attention to this, let them take the initiative and use that in your negotiations which we’re getting to soon in Goal 4. Do not ever volunteer a lower step.  Nurse Salary Negotiation Goal 2: Know what the going rate is. In this series, we're working on 5 goals:
 Angel Mathis, MN, MPH, ARNP, FNP-BC Hi! I'm Angel. I am the founder of Nurses Investing For Wealth. I teach nurses simple money tactics that turn them into millionaires. This is where you learn how to use your nursing knowledge to invest your money better than an expert.
If you want to end money confusion, be unstuck from nursing, and create financial freedom, come join my Tiny Training Nurse Investing Series. Follow on Instagram.  NHS nurses strike: Heroes shouldn't have to use food banks. Photo by Ehimetalor Akhere Unuabona on Unsplash When it comes to salary negotiations, you have to know two equally important things:
In your interview, the subject of salary is going to come up. With any luck, you will already know the budgeted salary range from the job posting or the pre-interview information you will have received. But ask again in the interview. Be prepared to lead this conversation by directly asking, “What is the business’s budgeted salary range for this position?”
Listen carefully for a salary range and to learn if union directed pay scales affect the position. If you are only quoted a single starting salary number, you can assume this is the very lowest budgeted amount. Whatever is put on the table, don’t be discouraged. Take the information in and carry on. How much money do you need to willingly exchange your time to do this work?  Nurse Salary Negotiation Goal 1: Ask for financial compensation that is worthy of your time and skills. Let’s back up to before you ever step foot into the interview though. When you are preparing, please, promise me, that you will do a little soul searching. I know, ugh. But it doesn’t have to be ‘ugh.’ All I mean by this is for you to really think about how much money you need to willingly exchange your time to do this work? This is for your personal benefit only, so ask yourself honestly. Every single one of us is going to have a different answer to this and our answers are going to change throughout our lifetimes too. When I was a new grad, I had very different goals from now. As a new grad, I was excited to use my new skills and get experience. I was thrilled that I could get a job and that it happened so quickly after university graduation. I was ready to receive my steady and stable paycheck every 2 weeks! I was 22 years old and had been living in near poverty conditions prior to this in a $200 per month shared apartment in Louisville Kentucky, donating plasma a couple times a week for $20 a pop, and eating meal worm infested oatmeal with butter and jam mixed in for flavor and calories because I was so food insecure. My present self wants to tell my past self that this really isn’t necessary - go to a foodbank! My point is that I felt like I hit the jackpot when I graduated nursing school and took my first job as a nurse at the lowest salary I’ve ever received as a nurse: I believe my hourly pay was around $18. That first year was tough, but not due to the pay. It was mentally, physically and emotionally exhausting. I know I’m not alone either in how rude of a wake up call the first year of nursing can be as the responsibility and accountability sits crushing down on your shoulders. Through this first year I stayed up all night to work my 7 p.m- 7 a.m. shifts, and I learned first-handed what it was like to de-escalate violent situations, get groped by nasty old men, watch people die while crushing into their chest doing CPR, be sprayed in my face with sputum propelling from trach tubes, spilling urine down my legs when catheters disconnected, wiping people’s butts that were so big my entire arm would get lost in the crack and when it came out to be found again, it was soiled with poop. If anyone dared me to do any one of these things for $18 a pop, I would tell them to fuck off. Yet here I was doing it in a professional capacity multiple times an hour and staying up all night to do it.  Nurse salary negotiation is key to maximizing your income. My present self thinks about my current job prospects, and can say ‘Sure, there are still jobs that I will do for $18 per hour,’ but I’ll be damned if those jobs are nursing on a hospital floor. Hell, no. Starting my own adventure storytelling business and podcast and living below poverty level for a few years, sign me up! But not floor nursing for a liveable wage - it was liveable back then in Louisville, Kentucky. I can say with 100% certainty that I’m simply no longer willing to give my personal safety, and all of my emotional and physical energy for a job caring for sick and dying people listening to their worst problems all day long in exchange for a salary that I could make with a simple career shift that doesn’t include shift work, schedule inflexibility, and denial of paid time off. But hey, I’ve been a nurse for 20 years, and I’ve done a lot of jobs in that time and there was a time in my past that I was willing to do all of those things! When I was 22 years old, doing this work for $18 an hour was worthy of my time and skills. Now that I’m 42, and I know what this gig is all about, it’s not. But never, ever do I regret my earlier decisions. My present self is thankful to my past self, because I bravely did that work, got valuable experience, and I don’t have to do any of those things anymore. We’re all different here. We all have different goals and different experience levels. So ask yourself, ‘For what price am I willing to sell my time given the work duties I will be fulfilling?’ How does this compare to the business’s budgeted salary? Will the budgeted salary meet your expenses? If not, can you in good conscience accept less, and if you answer, ‘Maybe, yes, if…’ then know that you can give it a go with your counter offers which we’ll get to later in this series in Goal 5. If you answered with a resounding, “Hell no!” and if you find that your time is never going to be compensated in a way that adequately suits your needs, then you’ve recognized that the toll of this specific job is too much for you. The world is not over and neither is your nursing career. Now is the time for you to think about side-hustles and alternate career paths - remember, there’s a nursing pathway out there for everyone! What about research? Tech? School nursing? Teletriage? No matter how you just answered this question, you will want to get a solid cash savings to cover a good portion of your year’s earnings and you’ll want to do it ASAP, because this my friend, is your negotiating super power. We will work on this in depth in future articles, but first we have 4 more goals of nurse salary negotiation to visit. In this series, we're working on 5 goals:
 Angel Mathis, MN, MPH, ARNP, FNP, BC Hi! I'm Angel. I am the founder of Nurses Investing For Wealth. I teach nurses simple money tactics that turn them into millionaires. This is where you learn how to use your nursing knowledge to invest your money better than an expert.
If you want to end money confusion, be unstuck from nursing, and create financial freedom, come join my Tiny Training Nurse Investing Series.  Salary Negotiation for Nurses Photo by S O C I A L . C U T on Unsplash No matter if you’re an hourly or salaried, non-union or union nurse, you will ALWAYS be able to negotiate your salary. This is especially true if you have a year or more experience with any advanced certification or qualification. In this series you will learn how to prevent years of missing out on higher wages by setting five goals to get you ready to negotiate your nurse salary. Before we get to these goals, let's establish our foundation.  Before your start your next salary negotiation for your new job, set some goals. Yay! A new nurse job!Don’t do what I did. I once interviewed for a non-union nursing position not long after finishing grad school. I was an experienced nurse in a new role with a new certification and eager to start using my new skills. When the interviewer asked me what salary I would accept, I said something like, ‘Well, I currently make $35 an hour so I need to match that.’ The person interviewing me practically jumped with excitement, while screeching, “Done!” and promptly ended our meeting. I low-balled myself so much that the interviewer responded to my offer like an eager traveler who had just found an error sale on a flight to Greece. I knew immediately that I had made a mistake, but I didn’t know how to renege my low-ball offer for a job that I genuinely found interesting. I was offered the position by the end of the day and gratefully accepted it - with a lot of excitement too, I might add. Even though I was tickled with my ability to rapidly secure a good job that I was interested in, I look back on this and realize this was an extremely rookie move. It affected me for the entirety of my work life in that position. How? Because when you agree on a starting salary, you have pre-determined your ability for financial advancement for your entire life within an organization because your new salary is the base of all future raises. So as you’re preparing for your next interview, remember 3 things:
Your negotiation goals should be almost scandalous! They should raise the eyebrows of the interviewer and they shouldn't result in an an immediate deal. You will know your goals have brought you success if the person you're negotiating with asks for time to seriously consider if they can meet your request.  Internally negotiating nurse salaries: go armed with data, be prepared for frustration. Photo by Adeolu Eletu on Unsplash I’m already employed as a nurse and want to negotiate my current salary. What about me?Oh dear, don’t you know I’ve been here too. The absolute easiest time to lock in your highest possible salary and benefit package is when you are interviewing for a new role or a new position. But if you’re like me and you low-ball offered yourself and gratefully accepted a role that you were more than happy to fill, now that you’ve become your future self, you have to ask yourself 2 things.
Even armed with all the data in the world, significant internal salary adjustments are next to impossible to come by. I once had a job where it was blatantly obvious my salary was well below the market rate. More specifically, I was working as a nurse practitioner but my pay had fallen below what I would’ve been making as a nurse on my union pay scale. I had data, spreadsheets and tables including how my salary increase across the years hadn’t kept up with the market minimums. I also had data showing that executives had prioritized their own 10% pay raise by the board of directors over the 2% raise granted to our provider team in the same years. I brought all of this information to the president - yes, the one who was enjoying their 10% pay increase. The president asked me, “How much money do you make?” and when I told him, his response was simply, “That’s more than enough” and waived his hand dismissively in my direction. That was the end of that conversation with that organizational power-holder. Later I took the issue up with the executive director. She did listen and was interested to see the data I had collected. She agreed that salaries needed to be raised (win!) but cautioned me that it wouldn’t happen for years since she would need to raise the issue and get approval from the president (you know where he stood on the issue) and the board of directors. I stuck around for another year or two after that meeting. Another cost of living adjustment came that just covered the cost of our new insurance premium, but didn’t really help cover the sky-rocketing costs that came with living in the center of Seattle within walking distance of my work. I finally gave up waiting, and I put in my notice. Oh, that was tough. I poured a lot of emotional energy into that negotiation that lasted years. After I leaving, I rapidly secured a new job and nearly doubled my salary using the same negotiation tactics that I'm preparing to share with you. I tell you this story not to discourage you. I am sharing it with you to be realistic. If you are attempting to negotiate your salary while you are already doing the work for an organization, you are starting from a point of disadvantage. This kind of negotiation will take patience and determination. It will very likely include many failures and at times feel humiliating as you absorb notions from leadership that the work you put in isn’t worthy of a raise. Internal negotiations will test your patience since they will likely take years of work before you see success, if you ever see success at all. So if you’re gearing up for an internal negotiation, ask yourself, and be brutally honest, ‘How hard am I ready to work for this? How long am I willing to wait? How will this impact my future self?’ Are you ok with your real answers to these questions? If so, good luck!  Nurse super power for salary negotiation: financial security. Photo by Rafał Szczawiński on Unsplash Your nurse super power for fearless salary negotiationThe very best way to bravely enter a salary negotiation is by being financially independent or having plenty of cash savings. Why? Because when you feel financially secure and don’t feel a need to urgently make money, you don’t show up to an interview out of desperation or with any personal financial pressure. Going to an interview with financial security on your side means that you show up because you have decided the work you will do is of interest to you and worthy of your time. You show up with the belief that you are offering a company something of high value. Out of mutual respect, you expect that a company will show up in a way that shows they value you too. And if they don’t, you emotionlessly walk away from the opportunity and continue looking for something worthy of your time and talents. I understand that many of you who are reading this book won’t yet have achieved financial independence or have your emergency funds fully funded, and that’ s okay. I know by reading this series you are actively working on this. I have great confidence this security is in your future!! Until then, I am loaning you my financially secure confidence to take with you to your next negotiation. Take this confidence and work on these five goals:
 Angel Mathis, MN, MPH, ARNP, RN, FNP-BC Hi! I'm Angel. I am the founder of Nurses Investing For Wealth. I teach nurses simple money tactics that turn them into millionaires. This is where you learn how to use your nursing knowledge to invest your money better than an expert.
If you want to end money confusion, be unstuck from nursing, and create financial freedom, come join my Tiny Training Nurse Investing Series. Before nurses can maximize their career and earning potential, we must first fully embrace what power we have. And it's almost all the power. The Nurses Investing for Wealth blog starts here.  Nurse with all the power. Photo by Luke Jones on Unsplash It’s easy. As a nurse, you can just quit whatever job you currently have and immediately find a new one. Any organization not recognizing this or your value doesn’t deserve you and you probably don’t want to associate with them either since it will only invite you a great deal more pain than necessary. Whether or not leaving your current position is a thing you do doesn’t matter. To get the most out of this career, you have to recognize your worth. Do you know the powers you already have? To fully maximize your potential as nurse, and get on your path to complete independence, financial or otherwise, let’s explore your powers Power 1: You are licensed & certified You are a highly skilled, licensed, possibly certified health care professional with unique skills to care for a certain population. Having a license to touch other humans is very unique. And being unique means it’s not easy to replace you. A person can’t come straight in from off the street and legally do the job you are doing. Power 2: You are tolerant of danger & risk Nurses are tolerant of danger and risk. Photo by Ömer Yıldız on Unsplash Nursing and health care work is dangerous and when you step into your work each day, you are accepting the risks that come with it. I have personally worked on a unit that was held up by gunpoint and my nursing colleague de-escalated that situation – not the police and not hospital security, a nurse! I’ve been hit, pinched, and sexually assaulted by patients on more occasions than I can count. My spouse who is a psychiatric nurse once came home with a black eye because he had his face smashed into a door by a patient. Physical and mental abuse is just one risk we face though. Another looming danger, especially currently, is contracting infectious diseases. It saddens me to write here that occupational COVID-19 infections have killed more than 3000 nurses around the world. This risk of death from occupational exposures is not new though. I have nursing colleagues who put themselves in grave danger by willingly caring for patients with Ebola, a disease without any treatment that carries up to a 90% death risk if infected. COVID and ebola are just 2 recent examples of infectious disease risk from our work environments. I have personally experienced needlestick injuries that thankfully didn’t turn into anything but could have put me at risk for contracting a bloodborne disease, particularly HIV and hepatitis C. These are some of my personal experiences across multiple workplaces and if you’re a nurse, no doubt you have your own stories. For nurses, occupational danger is an expectation and mitigating it is part of our role. Your ability to tolerate danger and risk, although stressful, is a power and if you’re not clear about why, then let’s take a look at your third power. Power 3: You relieve a critical shortage area in exodus times  Nurses relieve a critical shortage area in exodus times. Photo by Vladimir Fedotov on Unsplash You have a unique and difficult to replace skill set, you’re tolerant of danger and risk, and there’s a worldwide nursing shortage that’s getting compounded by an exodus of nurses from the field. The International Council of Nurses estimates the current nursing shortage to be about 13 million worldwide and current events (go away COVID!) are only making these numbers climb! So when you leave the profession, there’s no one to replace you. It’s probably not news to you that the nursing shortage is intensifying as our population ages, but the new player here, COVID-19, has really driven nurses to the brink. It’s being widely reported that nurses are leaving en masse to spend their time in ways that they most value, which, surprise (!), isn’t caring for strangers in a high risk environment risking their personal wellbeing and sometimes their lives. Even the best educational efforts to increase the numbers of new nurses entering the profession will not stop the exodus of experienced nurses who are leaving. This guarantees you infinite job security and an ability to demand what you need from your job. But let me tell you, this doesn’t mean that employers aren’t going to try to bully you into submission along the way. Power up! Power 4: You have lifestyle choices Nurses have lifestyle choices that provide more freedom than many other professions. Photo by Christine Roy on Unsplash Anyone who has ever worked shift work knows the unique challenges that come from covering a 24/7 schedule. If you have a partner that does shift work too, you know that it’s possible for you to go many days without seeing each other. Shift work causes a loss of connection with loved ones that seriously erodes a nurse’s wellbeing if not carefully checked. I once had an employer who tried to write a scheduling guideline stating that nurses would not be permitted to adjust their schedules based on “lifestyle choices.” This was an indirect response to my request asking for help with switching some of my shifts so I could align my own shift-working schedule with my shift-working partner’s schedule. I picked up shifts to fill open gaps in the schedule and requested that other less critical shifts be removed from my schedule that didn’t suit my schedule. Rather than approving this, my manager met this request with the forbidden lifestyle choice email to my entire team. I felt like a chihuahua dog with blood shot eyes that were half bulging out of its head that had just heard a knock on the door. I brought my concern directly to my manager, who was willing to meet with me only during her working hours of 9 a.m. - 5 p.m., not during my shift hours. She refused to let me drop any of the shifts – the ones I had asked to be dropped, or the new one’s I had picked up. As we talked it through she responded, ‘If I allow you to adjust your schedule, then I will have to adjust other people’s schedules to what suits them too. Then I will have an obligation to adjust schedules all day.’ The result was that I was required to work 36 extra hours in addition to my normal hours. I can say with great confidence that her ability to make the change would not have come close to 36 hours. It was clear to me that her primary motivation was to protect her own time only. In addition to the unilateral ‘lifestyle choice’ rule communicated in her email, she also issued several other restrictive scheduling changes without any collaborative effort with the ARNP team. This was particularly stinging given we all felt the effects of compassion fatigue taking hold as we were regularly trying our best to cover the 24/7 schedule and accepting overtime. This was disappointing, but unfortunately this is my common experience working with large healthcare organizations, particularly in the USA. You’d better believe I was prepared to leverage my nurse powers and I did. I applied for a different but similar job on the evening of the day that I had received the new rules. I received a phone call back on my application the following morning to set up a job interview 1 business day later. At the same time, I negotiated for my needs with my current manager, met with the union and our ARNP team and was unrelenting in my lifestyle choice requests. This is what my power in action looks like. This is the power available to you. Do not underestimate it. Ever. When, not if, the time next comes that your employer attempts to take ownership of your life by attempting to micromanage your schedule, threatening you with a lack of work, declining your request for paid time off, or refusing a need to reduce the number of hours you’re working, I’m here to tell you that you don’t have to go along with it. You should not go along with it. Remember the nurse exodus, remember you’re relieving a critical shortage area, then negotiate (I originally wrote laugh in their face but negotiate seems more professional for the nurses that we are) for your best interests and use your power to become more resolute on your demands for better working conditions that meet your needs. And of course, always keep your eyes on the job market. There’s always going to be a job waiting for you. Power 5: You are an Organizational AssetHealth care everywhere, but especially true in the USA, is a business focused on customer service. As nurses, we don’t like to believe this. In our fantasies we are helping the population be healthier and live their most fulfilled and abundant lives. As nurses focused on health outcomes, we commonly confuse our fantasy with our work, meaning we commonly think that health is the same as healthcare. It’s not. When you separate these things, you will be able to see clearly the role you are playing in this system and that’s what I hope to help you with here. I do not intend to reinvent the wheel here, so let’s just agree that we can define health loosely as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. I took that directly from the leading authority on the matter, the World Health Organization. (Constitution of the World Health Organization. In: World Health Organization: Basic documents. 45th ed. Geneva: World Health Organization; 2005.) Healthcare is not health. Healthcare is a service that maybe strives to help people toward health through delivery of medical and nursing services and products, however never equate your nursing service to someone else’s health. To shed light on this, let’s look at an example. I get occasional headaches. When I have an active headache, I am not at full health. I can achieve my full health through different treatment pathways. The non-healthcare related pathway I will usually try is to relax, drink fluids, and focus on self-care. Sometimes this is all I need for my headache to melt away to get me back to full health. The healthcare related pathway I sometimes opt for requires me to purchase goods - a pain reliever, other times requires me to purchase services, like massage or acupuncture. I severe instances it might require me to seek emergency nursing and medical care along with specialty imaging and treatment. Those goods and services are what make up healthcare. And my health only comes from my own body. See the difference? The goal of healthcare may be an effort toward health, but it is not and should not be confused with health. We sell healthcare, but we cannot sell health. And this is important for nurses to understand because it means your service is an organization asset because it is being sold to earn money for large healthcare organizations. When you start thinking of healthcare in this way, it makes sense that healthcare organizations are brands and their sole purpose is to try to get customers (patients) to choose them to buy from. This is why hospitals spend so much money on branding, advertisements, sponsoring major events, and remodeling their facilities with fountains, and fancy birthing suites while at the same time saying there is absolutely no budget to support their critical nursing workforce. It might not feel good, but it’s important for you to see yourself as a money-making and reputation building tool for the healthcare organization you have chosen to give your time to in exchange for a paycheck. In business, quality and customer service is paramount. If your patient has an excellent experience, feels well cared for and like their needs are met (whether or not they are health related to their actual diagnosis) they are going to think more favorably on your organization. And this is the overarching goal of your employer so that more people will choose to do business with them. This then makes nurses huge assets for healthcare organizations because
When I first moved to Seattle, I worked in a large medical center in a high rise building on the 16th floor. All the patient rooms had large picture windows and the rooms on the south side of the building had splendid views of Tahoma ( Mt. Rainier). On Level 16 I regularly cared for folks who were recovering from major head and neck surgeries for serious invasive cancer treatments. The surgeries were severe, removing large parts of the face, tongue, and face bones. On one such occasion, I was helping a pleasant gentleman recover from such a surgery. As per usual, his face was so swollen that he had a tracheostomy tube in his throat to breathe through. For his case, he had part of his chest muscle cut out and grafted into his face to decrease his disfigurement so he had staples crisscrossing his chest and face to hold all of his wounds together. He was unable to swallow his saliva so it would run out of his mouth, but he didn’t notice because he didn’t have feeling in his new face that only a short time before had resided in his chest. We regularly dabbed at his face to wipe it off. Having a surgery like this is a testament to the miracles of modern medicine, but when people are in the early days of recovery, it’s hard going. I was tasked with making sure he was receiving the right amount of tube feedings that consisted of a brown milky liquid that smelled like canned dog food that I kept pumping through the tube that had been inserted through the wall of his stomach. I regularly checked the muscle flap by poking him in the new and old areas of his face and tongue with a cotton swab to make sure blood flow was getting to the area as expected. We were dealing with lots of head and neck fluids that were constantly threatening to block his airway, obviously there’s a risk for death when that happens, so to avoid that I regularly stuck a soft clear plastic tube into his throat through his tracheostomy to suck those phlegmy fluids out. With a new tracheostomy, talking was mostly impossible since the air that would normally get forced from the chest during the contraction of the diaphragm up the throat and past the vocal cords before coming out of the mouth in the audible shape of words would now simply bypass and blow straight out the hole in his neck. If I was close enough, I could feel the damp chest breath on my cheeks and nose that smelled weakly like morning breath. When that happened, I would try to focus intently on his lips which would inevitably move to talk, a habit his body had normalized throughout the 60 years of his life, and I would try to read his lips, sometimes with success, but often with failure. After too many failed guesses, he might capitulate and write it on a handheld size dry erase board that we provided to aid in communication. So reading handwriting became the next challenge. This gentleman and I had worked together for a few days, and I had helped him move into this private more spacious room on the south side of our building that evening. I was aware that he hadn’t yet looked in the mirror and that he wa nervous to do that. On this crystal clear Seattle evening, as the sky was turning pink, I angled his bed so that it was facing out the picture window and as the sun was setting in the west, Tahoma loomed in the distance and glowed pink. It was in this moment of beauty on a summer evening that all the hospital noise had become drowned out and it was just he and I. I handed him a mirror and there in the room, the pink light flooded in onto his scarred face as he took a look in the mirror he saw his face on the backdrop of the glorious pink Tahoma and he winced. Then he stared and eventually he turned to me and lipped words to me that he looked horrible. I had nothing to say. We took this moment together. I stood quietly in support by his bed, looking at Tahoma and the city that skirted the hospital just below and it struck me as bizarre that people out there were just going on with their lives like any other day. Your power as a nurse is your presence. Your presence and your body is an organizational asset in and of itself. Understanding this, you can understand why a nurse’s happiness and wellbeing is an organization’s responsibility if they want to maintain their reputation. The very last thing an attuned healthcare organization should want is for a nurse to leave. When that happens, they are losing their most highly valued customer service agents who can provide experiences that no one else is prepared to deliver. Power 6: You are union eligible Nurses have power in their unions by having a collective voice. Photo by Ehimetalor Akhere Unuabona on Unsplash If you aren’t in a union, you are cheating yourself. If you are a nurse like me, you may have heard messaging in university along the lines, ‘because nurses are professionals, they should not be part of a union.’ For this message alone, I think I deserve at least a 50% refund on my tuition because this is plain wrong. I have held unionized and non-unionized nursing positions. My personal experience screams that my pay, working conditions and rights protections are far better when I have union backing compared to when I don’t. I wasn’t always a true believer in unions. Aside from my university’s inculcation, I didn’t much appreciate the fees I was paying from my paycheck each month to a nebulous organization that I rarely had any interaction with. When I moved to New Zealand in 2002 to live and work, I discovered that nearly every worker in the healthcare industry, regardless of their professional status, was unionized. In addition to the nurses’ union, which more than 90% of nurses belonged (compare that to 20% in the USA), there was the doctors’ union, the hospital administrators’ union, the midwives’ union, and so on. Yes, I was surprised to learn that poor little physician interns were unionized, and, no, it wasn’t legal for them to work 36 hours straight because it was considered a serious safety issue for the physician and also the patients they were serving. Duh, but 36 hour shifts are a standard in the USA where physicians are largely non-unionized. I came away from my time in New Zealand a much more enlightened nurse on the affect of good social policy on general social welfare. Not only had I experienced excellent working conditions and culture, I was relieved of stress of having to deal with management who was constantly changing and morphing my job description, work expectations, and demands on my unpaid time. There were clear boundaries and everyone knew what they were and the union was leading the way to define them. Unions are very much for any professional group but corporate America has been highly successful in convincing laborers that this isn’t the case. Here’s my best personal example. I took a nurse practitioner job with a corporate healthcare organization in Washington State. Washington does have one of the highest unionized nursing workforces in the USA, but this job was not a unionized position. At my interview my soon to be manager said, “This isn’t a unionized position.” “Okay.” “It’s not a union eligible position.” "Okay." “That’s not ever going to change.” Getting skeptical now, “Umm… okaaaay?” What I didn’t know, was this was a salaried position within an organization where a subsegment of the organizational nursing and nurse practitioner workforce were already unionized with an collective bargaining agreement. The job really interested me, and I took it. I was very lucky that I worked with an excellent team with an extraordinarily ethical manager who I always felt (mostly) had my best interests at heart. However, some of the things I experienced working for this billion dollar company included my hours being cut back with minimal notice and very low pay that didn’t come close to matching the nurse practitioner bargaining agreement. It would be years before I fully realized how low the pay was and it took leaving and returning to the organization years later in a fully unionized position. Can you believe that my pay in my unionized position with the exact same organization was more than double my pay in my non-unionized position?! In this scenario, I fell into the non-union trap. ‘Take this non-union job that you really want! You will like it. We will raise your pay when we can through merit. You will have the ability to negotiate on your own behalf. You will not have to have a union negotiate for you which will negatively impact your ability to rise above.’ Corporations have been very successful at convincing workers and even nursing educators that negotiating individually on behalf of their own best interests is the best way to get a step up. However, let’s get out of that fantasy! Think about it, you with your one small voice may be successful at negotiating a pittance of a pay raise, but do you really think you’re going to double it? Do you think your request for PPE can be honored? And if not, what option do you have? What if you get COVID or any workplace injury that leads you to take time off work or, worse, lose your job? Who will ensure you get covered for sick leave and protect your rights? If you’re on your own, you have the option of buying your own PPE, hiring your own lawyer, and fighting your own fights with your one voice. But with a union, you will have the option of having all your nursing colleagues be informed of the situation, learning that they have the same frustrations, and accessing a paid advocate and lawyer to promote and advance your concerns while legally holding your organization accountable. As nurses, our responsibility is to our patients. Our time spent on work should be prioritized on caring for our patients, not feeling miserable from our working conditions. And when misery arises, we cannot individually hold multi-million and billion dollar organizations accountable. And this, my fellow colleague, is why your power is in your union. If you are in a position that’s not unionized, time to do that or weaponize your other powers and look across the street. As a nurse, you have many powers, but there are weaknesses all nurses have that repeatedly take us out at the knees, and I need to be frank with you about it. We'll talk about those in a future post.
Do you have any other powers as a nurse? I'd like to hear them. Share your comments with me about your powers and how you leverage them down below, or with other nurses investing for wealth in our Facebook group, or on Instagram @nursesinvestingforwealth. |
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