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HIC's 1999 salary survey: Wage increases stay ahead of inflation

Note: The following salary survey refers to various charts and graphs that are not included in this HTML document. We apologize for any inconvenience.

HIC's 1999 salary survey: Wage increases stay ahead of inflation, but future growth is iffy

Infection control professionals are generally drawing wages in the mid-five-figures — with most raises over the last year outstripping inflation — and program directors are garnering the top compensation by title, according to the 1999 salary survey by Hospital Infection Control. However, troubling undercurrents are being seen in the health care economy as a whole, as the nation faces a shortage of qualified nurses that will worsen over the next few years, nursing officials report.

In the 1999 HIC salary survey, the median overall salary range for all respondents was $45,000 to $49,999. In median salary ranges by title in the survey, respondents listing their title as director of infection control reported annual incomes in the $55,000 to $59,999 range; those who had the title of epidemiologist had a median salary range of $50,000 to $54,999. Infection control coordinators reported annual salaries in the $45,000 to $49,999 range, and those who listed their title as infection control practitioner fell into a median salary range of $40,000 to $44,999.

Asked to report their salary increase in the last 12 months, 55.5% of the 346 survey respondents to that question listed raises in the 1% to 3% range. Another 18.8% reported wage hikes of 4% to 6%, but 20.8% of respondents reported no raises during the period.

Looking at some comparative figures regarding raises, the American Compensation Association (ACA) in Scottsdale, AZ, reports average annual raises of just over 4% in its 1999 survey of 2,800 companies in the United States and Canada. The average raise for salaried employees in health care in 1999 was 3.5%, the ACA reported. In a breakdown of wage hikes in 39 industries, the high was 5.6% (for information service employees) and the low was 3.1% (for employees in the mining, oil, and gas industries).

The salary increases primarily reflect cost-of-living and merit increases and exclude promotions, reports the ACA, a nonprofit organization of some 24,000 members who manage employee compensation and benefit programs. Noting that fiscal policy decisions by the U.S. Federal Reserve Board are keeping a lid on inflation, the ACA reports that the average salary gains are more than double the rate of inflation. According to the U.S. Bureau of Labor Statistics, the rate of inflation was 1.6% from June 1998 through June 1999.

The most recently available comparative salary data from the American Nurses Associa tion in Washington, DC, shows that RNs who are employed in nursing on a full-time basis in 1996 were making slightly more than $42,000. While typical merit increases in most fields would place that figure in the mid-$40,000 range now, the ANA points to a trend of "salary compression" that has beset the nursing profession in general.

The spread of managed care, with its pressure for efficiency and lower costs, dampened job growth for nurses and contributed to a drop in their real wages, reports Michael Stewart, ANA spokesman in Washington, DC. Between 1994 and 1997, employment growth for RNs was just under 2% a year, while wages dropped an average of 1.5% each year after adjusting for inflation, he reports.

Cutting costs by cutting salaries

"Probably the biggest contributor was the tendency on the part of many managed care organizations to focus on salaries as a way of cutting health care costs, cutting the nursing work force, and in some cases substituting unlicensed personnel for nurses," he says. "We have a host of problems with that. The ANA doesn't oppose the use of unlicensed people in hospitals, but we don't think they should be doing nursing duties — things that require a health care knowledge base or assessment skills."

As a result, many of the displaced nurses moved on to other fields or non-hospital settings, creating the looming shortage of qualified nurses, he notes. The shortage has broad implications for the delivery of cost-effective, quality care, including nosocomial outbreaks linked to the use of aides and "pool" nurses. (See HIC, June 1999, pp. 79-80.) Now, many hospitals are taking a variety of measures to entice nurses back, including employee referral bonuses, relocation allowances, signing bonuses, and continuing education allowances, Stewart says. But as the economic trends took shape, nursing schools began scaling back their student populations, further exacerbating the situation, he notes. As a result, the shortage is emerging in certain geographic areas — particularly California and Florida — and also in certain nursing specialties, such as critical care and gerontological nursing.

"The traditional fixes for a nursing shortage aren't going to work this time around," Stewart says. "[You cannot] solve a complete shortage by offering sign-on bonuses or relocation bonuses. Yes, that will work to an extent to attract some nurses, but you run into two problems. One problem is that if there's an emerging shortage, pulling a nurse from one place to another helps the one facility but hurts the other. The other situation is that those sort of traditional fixes for a shortage like sign-on bonuses worked better 20 years ago, when the nursing work force was younger and they could pick up and move more easily."

Amid such dramatic and continuing shifts in the health care economy, ICPs may well draw comfort from the accreditation and compliance aspects of their job that give them a clear role in their institutions. Indeed, an ICP found in a survey that hospital administrators ranked the role of ensuring regulatory and accrediting compliance as the most important aspect of the infection control department. Moreover, even ICPs ranked compliance duties as primary, and that may be a troubling sign, notes Virginia Kennedy, RN, MS, CIC, a consultant with Infection Prevention and Management Associates in Houston. She ascertained the perceptions of both administrators and ICPs of their infection control programs in a survey of 108 facilities in Texas. In general, administrators and ICPs perceived compliance with regulations and accreditation preparedness as most important.

"Administrators and ICPs are in alignment on compliance and accreditation, and maybe one could say that's really good," Kennedy says. "Yet part of me says [that view] is too narrowly focused. There are other areas that are going to be of potentially greater impact in terms of patient outcomes and financial issues for institutions."

Indeed, a linkage between compliance and job security and compensation is somewhat double-edged, as perceived value could wane with regulatory changes, she notes. "Should those standards change, should licensing changes occur, then, in fact, [ICPs] would in essence be perceived as having no value," Kennedy notes. "To me, that speaks to the issue that we really have not addressed — how we as individuals and as a profession positively affect patient outcomes."

In that regard, ICPs in the current health care economy must "internally market" themselves to their administrators, as have other successful outcomes management groups, she notes. The financial benefits — even in the "soft dollar" terms of cost avoidance — must be emphasized to show that, for example, lowered nosocomial pneumonia rates translate to reduced lengths of stay and decreased expenditures of non-reimbursable dollars.

"In the future, people might have a background in outcomes management, infection control, or performance improvement, but what they'll truly be good at being is 'interventional epidemiologists,'" says Kennedy, envisioning a role that would blend clinical and financial knowledge into a single goal of improved outcomes.

"I'm quite concerned that we are missing opportunities both for education of ourselves and as a profession in terms of some of these other issues — finances as well as increasing epidemiological skills and statistical analysis," she says. "Compliance with regulations and accreditation is important, but it should not be the focus. I think if [ICPs] increase their skill sets — and we all will need to do that — we as a group will have greater job security. Definitely, we will have potential for greater remuneration because we will be perceived as more valuable."