How to Negotiate Your Nurse Practitioner Contract

✅Finish NP school!
✅Pass boards!
✅Find a job!
✅Sign your contract! (wait, what?)

We hope that everyone finds their dream NP job, but when you get that job offer with the contract to sign, it can be scary and intimidating! What is a non-compete clause? Will your employer cover malpractice insurance? Should you carry your own malpractice insurance? And what things are negotiable? We will go through all the important things to consider when reviewing (and negotiating!) your NP contract. 

Prefer to listen? Put on your headphones and tune into this podcast episode about nurse practitioner contract negotiation with Sarah Michelle and Anna!

Negotiation #1: Compensation

Let’s start out with probably the most important part of your nurse practitioner contract negotiation: how you’re going to get paid! And that may seem like a pretty easy answer, but there are actually quite a few different ways that nurse practitioners can be compensated.

The two most common compensation methods are through salary or hourly rates. Now, NP salaries can vary a lot between states due to different costs of living, and salaries can vary quite a bit between specialties and types of clinics.

What about other pay structures?

There are other pay structures (particularly with part-time roles) that pay a flat fee for a day or even a flat rate per patient the NP sees. When it comes to a flat rate per day, you want it to average out to a decent per hourly rate and take into consideration the complexity of patients you are seeing. You would want a higher rate if you are prescribing medications and managing care than maybe a position where you are mostly doing chart reviews or insurance evaluations.

The fee per visit structure should also take into consideration the complexity and amount of patients you are seeing. I had an NP job where I received a flat reimbursement of $30 per patient working per diem in long-term care. Those visits could range from a quick follow-up on labs, to an hour long admission and chart review, or an in-depth management of chronic illness exacerbation.

It’s really important to think about what your needs are and make sure you are being compensated fairly. As a new nurse practitioner, you should not expect to make the top range of NP salaries in your state, but you also shouldn’t be low-balled either.

What about compensation or bonuses based on RVUs?

RVU stands for relative value unit. This is a system used by the Centers for Medicare and Medicaid Services (CMS) and some private insurers as a method of compensating clinicians. For example, let’s say that a level 3 E&M coded outpatient visit is worth 3 RVUs, a level 4 visit is worth 6 RVUs, and a level 5 visit is worth 10 RVUs. Those are all completely hypothetical reimbursements, but it illustrates how an RVU changes based on the complexity of the visit.

Then, the RVUs are multiplied by a conversion factor. For example, maybe you earned 20 RVUs last week at a conversion rate of $30 per RVU, meaning your reimbursement was $600. So, your overall salary might be based on the average number of RVUs a clinician bills for in a year, but if you are seeing more patients, or more complex patients, you might receive additional compensation or a bonus based on those RVUs.

Negotiation #2: Schedule

Hopefully during your interview, you gained a good understanding of what the clinic schedule is like and how many patients you are expected to see in a day, but make sure you read the fine print. Will you slowly be ramped up over a few months to the patient per day goal, or will you be expected to start right off seeing that number of patients? Will you be given any orientation or mentoring? Will you be required to stay late for any reason? Will you have administrative time during the day or the week to catch up on patient calls, results, and documentation?

Those might be things you didn’t know to ask during your interview, or your employer didn’t thoroughly explain them. We can’t stress enough how important orientation and mentoring is, and you should definitely negotiate for it in your contract! You want to make sure that you will be supported in your role transition and set up for success, especially as a new NP!

Will you be making patient rounds?

Another part of your schedule might be making patient rounds. In primary care, for example, that could be seeing patients in a long-term care setting or group home. Be sure to ask how you will be compensated for that. Home visits are also becoming more popular. Will you be compensated for travel? Will you have a designated day for home visits, or is it expected that you will fit them in with your regular in-office patient schedule?

Will you be on-call?

Lastly, you may be asked to participate in the on-call schedule. That’s usually phone coverage after hours for patient questions and concerns. Things to ask about are the frequency of on-call coverage, who else participates in the on-call coverage, how will you have access to patient information, and how you will be compensated. Typically, on-call coverage is a flat reimbursement per day, although some organizations may reimburse per hour or per call answered. 

Negotiation #3: Benefits

Besides salary and compensation, what are some other benefits to consider when reviewing your contract? Here are just a few:

How much vacation time do you get?

A big thing to ask about and negotiate for is time off. Most new NPs start with around 3-4 weeks per year of vacation time, but that might be more depending on the organization or any prior employment with the organization.

What are your insurance benefits?

Next, look at insurance benefits. What is the insurance coverage you would be eligible for to receive for health, vision, and dental? Do benefits start on day one, or do you need to be employed for a certain amount of time? Other insurance benefits might include short term disability or life insurance—so depending on your personal situation, those may be important to you as well.

What kind of professional development support do you receive?

Be sure to ask about professional development or continuing education funds. As NPs, you are required to have a certain amount of continuing education credits to maintain licensure and certification and most employers will provide some degree of reimbursement for those activities.

Do you receive reimbursement for licensing fees or malpractice insurance?

Also, make sure to ask about reimbursement of fees for licensure and nurse practitioner malpractice insurance. State licensure and national certification fees can become expensive, and if you will be prescribing any controlled substance medications, a DEA license costs over $800 every three years.

Many employers will help with the cost of those fees. Regarding malpractice, make sure you understand how you are covered. Larger organizations will typically add you on to their malpractice coverage policy, but if not, you will need to purchase your own malpractice coverage. 

Other Considerations

Let’s review some final considerations for nurse practitioner contract negotiation:

Are there any restrictions on your future positions?

First, look to see if there is a non-compete clause or a restrictive covenant. That means that if you leave your current position or employer, you may be restricted to a geographical area that you can practice in for a certain period of time.

Non-complete clauses are illegal in some states, so be sure to understand what the employment regulations are near you. The main point of non-compete clauses is to prevent a clinician from taking patients with them if they leave. Some organizations worry that if you leave, your patients will follow you to your new practice, reducing their revenue.

So, while you might like to think that you’ll never leave your new job, you never know what will happen or change in your life and you don’t want to significantly reduce your future employment opportunities. (True story: I once agreed to a 60-mile, 2-year non-compete clause 😬 I have since learned my lesson…)

Are your duties within your scope of practice?

Lastly, make sure that your contract includes duties that are within your scope of practice. That probably sounds like a no-brainer, but not all organizations or employers may understand the scope of your NP role. For example, you might be the first NP in the practice, and while they may be super excited to have you on board, they might not know your exact scope of practice based on specialty certification and state of practice.

So double check that your contract doesn’t list any activities that you aren’t licensed or certified to do, while also making sure that you are supported to work to the fullest extent of your license!

Final Thoughts on Nurse Practitioner Contract Negotiation

Although it might seem complicated and intimidating, reviewing your NP contract is crucial to be on the path to success and satisfaction in your new position!

Take your time and go over each section of the contract. Make sure that your new position is meeting your needs and goals. It’s not all about salary, and you will also want to have work-life balance and be supported in your new position, especially starting out.

🩺 If you’re still on the hunt for an NP job, we’ve got you covered! Join our Job Hunt Course for help building your resume, practicing interviews, negotiating contracts, and more!

Best of luck on your nurse practitioner contract negotiation—you got this! 💜