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Wage Inequity

Within-Market Comparative Analysis of Salary for Public Health Nurses and Hospital Nurses

Issel, L. Michele PhD, RN; Lurie, Christine Fitzpatrick MSN, RN; Bekemeier, Betty PhD, MPH, RN

Journal of Public Health Management and Practice: November/December 2016 - Volume 22 - Issue 6 - p 550–558
doi: 10.1097/PHH.0000000000000390
Original Articles

The labor market perspective focuses on supply and demand for registered nurses (RNs) as employees. This perspective contrasts with beliefs in the public health sector that RNs working in local health departments (LHD) as public health nurses (PHNs) accept lower wages because of factors other than market demand. This study sought to describe the extent to which hourly wages of RNs working in LHDs are competitive with hospital RN wages within the same county market. A repeated measures survey design was used in collecting 2010 and 2014 data. The unit of analysis was the county, as an RN labor market for LHDs and hospitals. Survey questions captured factors common in human resources benefits and wage packages, such as differential pay, hourly rate pay based on years of experience, components of benefit packages (eg, sick and vacation leave), and reimbursement for education. Within each county, the LHD and all hospitals constituted a “market,” yielding a potential 12 markets in our study sample. Human resources representatives from each of the 12 LHDs and from all hospitals within those 12 counties were invited to participate. We conducted comparisons with survey data using t test of mean differences on mean RN wages across years of experience. On average, LHDs paid significantly less than hospitals in their markets, at all levels of RN experience, and this gap increased with RN experience in the sample markets. Salary compression was evident in 2010 and worsened for PHNs in 2014, when compared with hospital RNs. In 2014, 100% of the sample LHDs offered reimbursements for continuing education for PHNs compared with 89% of hospitals providing this benefit. This study contributes to our understanding of the human resources challenges faced by LHDs and provides evidence elucidating resources issues that need to be addressed in order to improve recruitment and retention of PHNs.

This study describes the extent to which hourly wages of registered nurses working in local health departments are competitive with hospital registered nurse wages within the same county market.

Department of Public Health Sciences, University of North Carolina at Charlotte (Dr Issel), Charlotte, North Carolina; College of Nursing, University of Illinois at Chicago (Ms Lurie), Chicago, Illinois; and School of Nursing, University of Washington, Seattle, Washington (Dr Bekemeier).

Correspondence: L. Michele Issel, PhD, RN, Department of Public Health Sciences, The University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223 (

Funded in part by HRSA Bureau of Health Profession, Division of Nursing, under the Nurse Education, Practice and Retention Program, grant number D11HP14605. A special note of appreciation to Jillian Edwards, Jennifer Wattoff, and Hilary Kirk for their assistance in data collection.

The authors declare no conflicts of interest.

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