Wage Gaps Equality

Equality is a concept familiar to most Americans; from slavery, and women's suffrage to ongoing civil rights movements. The face of the topic changes and evolves with the passing of time, yet the theme remains the same: Egalitarianism. Equal rights, equal opportunity, and equal pay for all, regardless of race, ethnicity or gender. The gender wage gap is not new, in fact it has been an ongoing issue for decades. In 1963, Congress and President Kennedy passed the Equal Pay Act attempting to equalize wages among the genders and abolish wage discrepancy. However, more than fifty years later, that gap remains in every state in the union, across occupations. Nursing is no exception.

Prior to the Second World War, women weren't as prevalent in the work force as they are today. However, to assist in the allied war effort, they entered the workforce in droves, providing the vital labor required in factories and other strategic industries and occupations. After the war, many women went back to the traditional "stay at home mom" roles as the men returned from overseas. Although, many women remained in the workforce, and have even continued to expand into less traditional occupations. With nursing being a predominantly female profession, some may think that no such wage gap would exist between genders, but astonishingly, that is not the case.

Currently a wage gap exists in every state in the United States, and is particularly high among the rural Southern and Midwest states. It is lowest in New York (89%), and highest in Wyoming (64%). In a 2015 study, women working full-time were reported to have made approximately 80% of what males did in that same year. The traditional argument against the statistics has been that women and men go into professions with vastly different rates of pay, and while that is true, even with adjustments for these discrepancies, the wage gap still exists by single percentage points. One study conducted in the United States over a fifty year period demonstrated that an influx of women in professions previously dominated by males would actually result in wages falling for that profession. Additionally, women still experience wage discrepancies even when working in the same occupation as men; nursing is no different.

The Equal Pay Act of 1963 was passed by Congress and signed into law by then President John F. Kennedy in an attempt to prohibit any discrimination of employment based on sex, and race, as well as any discrimination of wages between jobs that require the same skill and responsibility level. Since that time, wages have slowly continued to trend towards becoming equal, however, it is estimated that it will not be until the year 2152 that wages will become truly equal given the current trends in the United States.

A recent study compared wage inequities of genders among registered nurses and teachers, another predominantly female profession. While there isn't as large of a discrepancy between percentage of male teachers to female teachers (23% male teachers as compared to 8% male nurses), the study still demonstrated that males make more over the course of the year, even accounting for differences in hours worked. The authors of the study came to the conclusion that male nurses made on average 27.9% more without controlling for hours worked per week, and male teachers around 19.6%. When controlling for hours worked per week the study concluded that male nurses make 10% more, and male teachers make about 15% more than females in the same profession, aproximately the same age, with the same education, and in the same local region (Wilson et al, 2017).

The general consensus among the variety of research papers and articles have demonstrated the unadjusted wage gap among nurses to be anywhere from $2.00 an hour, to $5,000-$11,000 over the course of the year. Muench (2016) conducted several regressions and analyses regarding the theories and myths concerning why males make more than females, including males go after the higher paying jobs within the field, women take more leave for children, men get paid more for their natural strength, and the differences among each genders willingness to relocate to receive a higher wage.

Several conclusions were drawn regarding the above theories and statements. Males move far more frequently than females do for work, and the same theory holds true for nurses. The study concluded that males are far more likely to move to a different state for a pay increase than females. At the same time, constantly moving and changing jobs can negatively impact wages.

Another theory put forward in the study is that males are more likely to work extra hours, thus gaining more experience steadily over time, increasing their productivity while at work, consequently explaining their alleged greater worth monetarily than female nurses. Indeed, males are shown to work approximately one to two more hours per week on average than females. However, Muench (2016) stated that clinical experience going into and the first few years of nursing is similar for both male and female nurses, yet the earning discrepancy was some $5,000 between the two genders, which traditionally only widens as years and decades progress.

Interestingly, Jones and Gates (2004) stated that males and females start their careers at similar wages, with women actually earning more initially, yet men passing women by the fifth year of their respective careers. Jones and Gates (2004) conclude that males see an increase of approximately 2.5% in their wages each year they work, with women receiving an increase of approximately 2%. Both genders see their wages peak at around the two-decade mark of their careers, with men earning an estimated 32% higher than their initial starting wage, and women earning an estimated 26% of their initial starting wage.

Yet another theory of the wage gap is that women take extended time off to have and raise children. While in theory this is true as men cannot physiologically have children, it still doesn't explain the fact that women who don't have children and are single continue to make less than men who are also single and without any kids. Muench (2016) found that female nurses aged 40-45 without any kids at home earned some $6,207 less than their male colleagues of the same age and status.

Jones (2004) suggested that women may incur a "wage penalty" for expected departures from work, perhaps such as childbirth, and have less opportunities for on the job training as a result of time lost due to child birth. This might explain the above data concerning men and women of the same age with no children also having a significant gap in their yearly salary. This theory, however, would be difficult to prove with any statistical evidence.

Finally, the last theory put forth by Muench (2016) asked if men perhaps made more due to their muscles being more in need and desired, especially on medical surgical floors, and other more physically demanding positions within the hospital. However, they quickly realized this wasn't the case, as their study results showed men drastically out earned women in almost every specialty, save for orthopedics and middle management, where the difference was "only" around $4,000.

Two separate studies found a significant salary gap between male and female nurses in almost every single specialty, except orthopedics. One study that didn't adjust for any differences regarding time worked, found the gap in ambulatory to be around $7,500, $4,000 for chronic care, $4,000-8,000 for cardiology, and nearly $4,000 for middle management. Muench (2016) went a little more in depth with their separation of specialties within the hospital, yet still found very similar content regarding the wage gap. Their study found that men earned nearly $7,000 more on medical-surgical units, $5,500 in neurology, $3,500 in pediatrics, $4,900 in chronic care, $5,400 in psychiatry, $6,600 in cardiology, and $4,400 in what it labels as "other specialties." The gap also applies to nurses with advanced degrees or masters in education, which well be discussed more in depth later on.

The gender wage gap is a huge issue in the United States and has been discussed at length for several decades. However, it isn't just an issue in the United States; it is an issue in countries within the European Union as well. Muench (2016) conducted another study within the European Union, specifically in Germany, to attempt to find out if men receive increased pay in a country with a nationalized health care system where the wages are, for the most part fixed, leaving little room for negotiations in salary between the individual nurses and their employer. He thought this would reduce the discrepancy between motivation, and skill set between male and female nurses.

Muench (2016) found that the unadjusted monthly earnings for men in Germany was much higher than that of women, with an average of men earning 2,951 euros compared to 2,264 euros that women earned. The study found that on average, women's contracts averaged approximately six hours less a month than men's. Interestingly, those women typically had about four more years of nursing experience because they were more likely to choose nursing as a first career profession than their male coworkers. Furthermore, the authors concluded that men earned about 10% more than women monthly in Germany, which they found interesting because there is much less opportunity for vertical growth within nursing, like the United States and United Kingdom, due to the heavy regulations on the industry. Additionally, there isn't a whole lot of opportunity to go back to school and move into advanced practitioner degrees or programs like the aforementioned countries, so that doesn't explain the wage gap. The conclusion drawn is that the only two explanations for the wage gap in Germany are better opportunities for male nurses, and gender discrimination.

Economic disparity in nursing doesn't just exist between male and female nurses; it also exists between Caucasian and minority nurses. A recent study conducted in New York City by Moore (2016) found that on average, white nurses earned more than minority nurses, even when adjusted for factors such as hours worked. Another study by Moore (2016) concluded that nonunionized minority registered nurses earned about 8% less than nonunionized white nurses. The unionized nurses displayed no difference in wage gap regardless of race or ethnicity.

Moore (2016) conducted her own study regarding the average hourly wage between white, black, Hispanic, and Asian registered nurses nationally, and came away with some surprising conclusions. First she found that Asian registered nurses actually earned more per hour than white registered nurses, followed by black and Hispanic registered nurses. Asian nurses educated in the Philippines were more likely to have a higher wage than any nurses because they were more likely to hold bachelor's degrees, which is commonly associated with higher wages. Asian nurses not educated in the Philippines were less likely to earn more than white nurses. The data came out to white nurses earning $33.05 an hour, black nurses earning $32.07, Hispanic nurses earning $30.76, and Asian nurses earning $34.19, and Asian nurses not educated in the Philippines earning $33.16. Compared to white nurses, back nurses earned less across a number of variables ranging from working for the same employer, overtime, and having a job other than staff nurse. The same can be said for Hispanic nurses, although the study concluded that holding a bachelor's degree was more beneficial to Hispanic nurses than white nurses. The study concluded that some of the differences in pay could be attributed to minority nurses living in and working in poorer communities and hospitals that were public, whereas white nurses live in and work in more affluent communities with private hospitals that can pay more.

The gender wage gap isn't just applicable to registered nurses; it also applies to advanced practitioners and masters educated nurses that go into management and teaching. Greene (2017) stated that a 2009 study found that male Nurse Practitioners (NPs) earned around $13,370 more than female NPs, but that study didn't adjust for any variables including job types or hours worked, and stated that males are more likely to work in higher paying NP roles than females. Greene's goal was to conduct a study to attempt to control for the differences work settings and demographic differences.

In her study, Greene (2017) found that a wage gap did exist among male and female NPs, even starting out at graduation. Newly graduated male NPs earned on average $7,405 more than female NPs, and that gap only continued to widen as the years progressed in their respective careers. Male NPs earned $15.605 more with 5-9 years of experience, $10,095 for 10-14 years of experience, $11,680 for 15-19 years of experience, and finally $21,090 for those with more than 20 years of experience. The study found the largest gap exists in surgical specialties where it was some $24,285, and lowest in primary care subspecialties where it was $8,919. Interestingly enough, the study also found that Hispanic NPs earned more than white NPs.

One of the fastest growing and highest paying careers for advanced nursing practitioners is the certified registered nurse anesthetist or CRNA. There has been speculation that this job could account for a large portion of the difference of salary between male and females in nursing. Jones and Gates et al (2004) state that male CRNAs earn 4% more than female CRNAs, and this accounts for approximately 61% of the wage discrepancy between men and women in nursing. Muench (2016) found that male CRNAs make around $17,694 more than female CRNAs, and found it to be around $17,290 in 2015.

Some other advanced practitioner degrees in nursing include middle and upper management, nurse educator, and nurse researcher, all of which males make more on average than females. Muench (2015) states that males in middle management make on average $3,956 more, and in 2016 found that number to be closer to $4,000. Muench (2016) found that males in upper management make a little over $7,000 more than females, and in education and research, males make a little over $5,000 more.

Over fifty years after the passage of the Equal Pay Act, women and minorities are still facing economic disparities in the work force everywhere in the United States in almost every profession, and a profession dominated predominantly by women is no different. The American Association of University Women found that women earn 82% of what men do after one year of graduation, and while that isn't true initially for registered nurses, it is true for nurse practitioners as Greene (2017) demonstrated, and multiple studies have demonstrated that whether it be registered nurses, or advanced practitioners, males tend to make more per year after the first few years, and the salary difference only goes up from there, especially as time passes. Wage equality isn't just a national issue, as the study conducted in Germany demonstrates, all over the globe women face issues with wage equality in almost every profession, even those predominantly populated with women.

References:

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5. Bland-Jones, C., & Gates, M. (2004). Gender-based wage differentials in a predominantly female profession: Observations from nursing. Economics of Education Review. 23, pp. 615-631. 10.1016/j.econedurev.2004.06.001. https://www-sciencedirect.com.ezp.lib.rochester.edu/science/article/pii/S0272775704000664?_rdoc=1&_fmt=high&_origin=gateway&_docanchor=&md5=b8429449ccfc9c30159a5f9aeaa92ffb&ccp=y
6. Muench, U., Busch, S. H., Sindelar, J., & Buerhaus, P. I. (2016, September-October). Exploring explanations for the female-male earnings difference among registered nurses in the United States. Nursing Economics, 34(5), pp. 214+. Retrieved from http://link.galegroup.com.ezp.lib.rochester.edu/apps/doc/A469502594/AONE?u=nysl_ro_rochstru&sid=AONE&xid=85ddf2d2 http://go.galegroup.com.ezp.lib.rochester.edu/ps/i.do?p=AONE&u=nysl_ro_rochstru&id=GALE|A469502594&v=2.1&it=r&sid=summon&authCount=1
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