New geographic pay eases some pain of no career ladder for NPs, PAs
LET’S TALK — Nurse practitioners Christine Pettit and Carl Ankrah meet with state legislator Peter Abbate Jr., who chairs the Assembly Governmental Employees Committee, to discuss the need for a civil service career ladder for their profession.
By SHERRY HALBROOK
After years of advocacy by PEF and its members, the state Department of Civil Service has boosted pay for most state nurse practitioners and physician assistants, setting new annual geographic pay differentials of $20,000 upstate and $30,000 downstate.
State law does not allow PEF to negotiate geographic pay. Instead, it is a tool the state can use to raise pay for specific job titles in specific areas when the regular pay level is too low to compete in a local labor market and state agencies suffer chronic recruitment and retention problems in those titles.
In this case, the new geographic pay levels affect nurse practitioners including all “parenthetics” and physician assistants at the following state agencies:
• Department of Corrections and Community Supervision;
• Department of Health, Helen Hayes Hospital, and the veterans homes;
• Office for Alcohol and Substance Abuse Services and treatment centers;
• Office for People with Developmental Disabilities
• Office of Children and Family Services; and
• Office of Mental Health.
The $30,000 differential is payable to NPs and PAs who work in the counties of New York, Kings, Queens, Richmond, Nassau, Suffolk, Rockland, Westchester, Putnam, Orange, Sullivan, Ulster and Dutchess. The $20,000 differential applies in all counties north of there. These new geographic differentials were effective April 6 for employees on the state’s administrative payroll and April 13 for those on the institutional payroll.
“This is definitely a step in the right direction,” said PEF member Carl Ankrah, a nurse practitioner (psychiatric) at Rockland Psychiatric Center. He and another nurse practitioner at Rockland PC, Christine Pettit, have been leading PEF’s efforts for more than two years to get the state Department of Civil Service to finally create a career ladder for nurse practitioners.
And while the new, higher level of geographic differential pay (As NPs in Rockland County they have been receiving a geographic differential of more than $12,000. (The new rate will replace that for a net benefit of a bit less than $18,000.) While it should help improve recruitment and retention, they do not see it as addressing the core issue.
“If you are a nurse practitioner and you go to work for New York state, you will be a grade 24 until you die or retire,” Ankrah said. In other words, with no career ladder the job is a dead end for NPs who want to stay in their clinical career track. “When nurse practitioners apply to work for the state and then they find out about the pay and lack of promotion opportunities, they don’t even pick up the phone when an agency calls to offer them a job.”
He, Pettit and other state NPs have created the “Coalition of NYS Civil Service Nurse Practitioners” to advocate for establishment of an accurate job description and a career ladder for their profession.
Pettit said she believes some agency managers and the state Division of Classification and Compensation do not fully understand what nurse practitioners do.
“Initially, when I brought this to their attention more than two years ago at an Office of Mental Health labor-management meeting, managers asked if I wrote prescriptions (a key part of an NP’s duties). They truly had little understanding of our education, training, board certification, and role within their facilities. NPs are working autonomously and independently, and sometimes they are the only prescribers (of medication and treatment) at various clinics across the state,” Pettit said.
NP requires a separate license and degree, and involves a different role, duties, and scope of practice from nursing. Also, it requires a DEA (U.S. Drug Enforcement Administration certification).
“State agency officials truly lack understanding of what we are doing. So, I asked civil service to shadow the NP item to understand the breadth of duties, but they declined,” Pettit added.
In a letter they sent to a state legislator in November 2015, the NPs asked him to contact the state director of classification and compensation and ask him to reclassify NPs “to adequately reflect the complexity of the duties we undertake.” And to propose creation of a career ladder that would start with NP 1 at grade 28 for NPs with no board certification, advance to NP 2 at grade 30 for board certified NPs, and top at NP 3, grade 32 for certified NPs in a supervisory role. Salary grade is not just based on education, but also on the responsibilities of the job.
“We are the only licensed independent providers without such a career ladder in NYS service, and having career opportunities would put the NP profession on the same footing as other professions such as doctors, pharmacists, psychologists and social workers, all of whom have career ladders based on certification,” Ankrah said.
What DCS wants before acting to create an NP career ladder is to receive support for it from the major affected agencies. While most do support it, the state Office of Mental Health has withheld its support and it is the agency that employs the most NPs.
Undaunted, the coalition members have gone to their state legislators for help and succeeded in getting state Sen. Kemp Hannon to introduce a bill, S3567. State Assemblywoman Aileen Gunther introduced the companion bill, A834, in the Assembly.
The nurse practitioners said they feel the public will benefit from better health care if the state creates the career ladder and pay grades that recognize the education, professional certification and experience needed to perform these duties.
“New Yorkers in rural areas of the state are driving many miles for their health care, especially mental health care. It discourages them from getting care and the longer they wait, the harder it is to treat them effectively,” Ankrah said. Sometimes the state pays contract psychiatrists to help, but they only work for a few months and patients end up being bounced from one doctor to another, he said. However, if the state started to pay and promote nurse practitioners appropriately, it would be able to staff services that provide high quality, consistent care to more people and closer to their communities.
“We have nurse practitioners with 20 years of service and experience, but they can’t move up in pay grade. So they are leaving or retiring from the state. This must stop,” Ankrah said. “We can save the state a great deal of money by treating patients before they need to be institutionalized. Inpatient care is the most expensive kind. The state should put its resources at the front end.”