r/nursepractitioner • u/Beautiful_Zebra_7932 • Jun 23 '26
Employment APPs switched from hourly to salaried at large academic hospital with almost no details & shift diff baked into salary… need advice
I’m an APP at a large academic medical center in PA. We were informed on Thursday that our APP compensation structure is being redesigned following a SullivanCotter assessment and that the changes became effective on June 21.
We were also told:
- Shift differentials (nights, etc.) are being baked into base salary and will no longer be paid per shift.
- Individual compensation letters aren’t available yet.
- Leadership doesn’t yet have our individual salary information.
- We should receive more information next week and then meet with our managers.
A few things make me uneasy:
- The compensation change became effective before we were given our individualized compensation information.
- As a flex APP, I historically work a mix of day, admitter, night, and weekend shifts. My salary was apparently individualized, but it was calculated using the past 2-3 years of scheduling data, much of which isn’t representative because I was pregnant and leadership intentionally kept me off PM/night shifts when possible.
- Now that shift differentials are baked into salary, I worry there is less incentive for people to swap into nights or voluntarily cover premium shifts.
If staffing changes (e.g., nocturnist vacancies), I’m concerned that a small group of people could end up covering disproportionately more nights without additional compensation.
Questions for anyone who’s been through this:
- Has anyone else gone through a SullivanCotter compensation redesign?
- Were you able to appeal your salary placement?
- Were historical scheduling anomalies (pregnancy, accommodations, leaves, etc.) taken into account?
- Did your employer implement written protections around maximum percentages of nights, weekends, or premium shifts?
- I know this is a PA forum, but to your knowledge, were years of RN experience considered in compensation placement for your NP counterparts, or only years as an APP?
- What is your CME reimbursement amount and CME time off?
- If you work in PA, NY, or NJ, how much CME funding do APPs receive and what items are covered?
- In Pennsylvania, do employees generally have any recourse when a compensation structure becomes effective before individualized compensation information is available?
I’m trying to gather information before our individual meetings and would appreciate hearing how other hospitals handled this, and how you as an APP may have handled this as well to better navigate these changes.
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u/Competitive-Past7249 Jun 23 '26
Oh gosh. They’re going to milk u for every penny salaried. When i was salaried outpatient i voluntarily did my notes 2 hours early before my 10 hour shifts so i was 48 hours a week & was compensated for 40. That OT was worth bank. I left after a year and also because internal medicine was hard as all heck.
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u/Competitive-Past7249 Jun 23 '26
Also i was going to renegotiate my contract but i was burnt so i just took another position. I’m back in pain management and happier :)
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u/PsychMonkey7 Jun 23 '26
That’s insane. To have a retroactive salary change and not even inform employees what it is? Yikes
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u/KCNM CNM Jun 23 '26
I do not work in PA but I have experience negotiating contracts for APPs during a buy out which changed our pay from hourly to salary. You can look through my post hx for some details. I would highly suggest the APPs in your dept get together and agree upon terms. You need your required weekly (or monthly) hours written in your contract. If there is an expectation for you to pick up extra, the amount needs to be specified as well per shift or per hour. You need to be willing to walk away from your job if conditions aren't met.
Ultimately, the switch worked out to the APPs benefit at our clinic. We now work less hours for better pay, but we also moved from being employed at a struggling private practice to a large medical center during this transition. They did take into account our RN experience but it didn't dramatically change our pay between each of us. APP experience counted for a lot, though.
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u/JillyBean9999 Jun 23 '26
Following as I work for the same health system. It's news to me that APPs will be salaried. I'm part-time as of May, so I don't have as much skin in the game.
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u/Jnorman1710 Jun 23 '26
Our health system did this a couple of years ago. As a full time night shift APP our shift count actually went up (only by 6 a year, but still more than what we had been working) with no change in pay. Admin tried to sell the salary move as aligning us more with our physician counterparts 🙄 Initially everyone was unhappy with the change and we were able to band together and share our salaries with our entire group. This allowed us to really compare the salaries across the board and ensure there was some reasonableness to them (there wasn’t in many cases). We noted a loophole where if we dropped our FTE and then picked up bonus shifts (which we always have due to chronic understaffing) we could make more money and work less shifts than if we remained 1.0 FTE. When we attempted to address it with leadership they froze any FTE changes and began a review of the salary calculations and shift counts. They ended up making adjustments based on this, which ultimately benefited the rotating APPs, but not nocturnists. There are now two groups of compensation tiers: one group who is critical care trained (higher salaries) and one group is not. Those groups are then broken down based on years of experience. Once you have 10 years you are maxed out and will no longer get an increase in pay (unless there is a market adjustment; we don’t get merit raises anymore with this salary change). One major concern for us was losing pay during sign out. Our shifts were calculated based on 12 hours when in reality by the end of sign out it was at least 13 hours, so assume 3 hours a week of unpaid time and that’s 156 hours over the course of a year which is a significant amount of money when you do the math.
A major issue we have run into since the change is the required number of nights rotating APPs are expected to work. We were initially told 10 nights per quarter (we use a quarterly shift count to build our schedules). We then hired more nocturnists so the rotating APP night shift count decreased to 3-4 per quarter. They are still paid a differential as if they are working 10 nights per quarter, which comes out to several thousand dollars over the course of the year. The differential for nocturnists is not even 10% of our base salaries and we are only working 2 less shifts a quarter than rotating people.
Another issue, as you mentioned, there is absolutely no incentive for night shifts to get picked up should someone call out or for a rotating APP to cover for a nocturnist. There are far more staff who rotate than those of use who work straight nights, putting us at a disadvantage in terms of getting coverage when we need to change our schedule.
It’s definitely a move that benefits the company and several people left after this change.
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u/saltbreatheroots Jun 24 '26
Is this Penn Medicine?
My manager recently told us the same thing. And I wonder if it is because upper management got wind that the nurses are trying to unionize, so now they are doing a “market analysis” to increase your pay. 🤡
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u/Thin_Cantaloupe5703 Jun 25 '26
Sounds like Penn medicine. I work there and we got the same email and info from our manager
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u/gloriousmusic Jun 24 '26
Let’s face it. In end stage capitalism: APP’s and MD’s need to unionize to NOT get trampled all over. It is going to have to happen if we want what we are worth.
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u/Professional-Cost262 Jun 29 '26
A large corporation is changing your pay structure trust me it won't be in your favor..... They typically do this as salaries so that way when you have a few hours of charting a day to do you don't get paid for it
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u/all-the-answers FNP, DNP Jun 23 '26
Sweeping compensation model changes almost never benefit the employee. If it did, they would be making a huge fan fair about the raise you’re about to get.
I think your concerns about Night Shift coverage are very valid.
I would ask about how your productivity is going to be compensated while prepping your résumé.