You nailed the interview, the offer has been made, you’re staring at numbers and trying to make sense of them. Is this a competitive offer, can I ask for more, what will happen if I make them mad? The thoughts and indecision can get real heavy for some. They certainly did for me. Maybe it’s because I’m female, maybe it’s because I despise burdening others, maybe it’s because I’m used to nursing offers which are straight forward. Either way, I royally suck at asking for the things I want. I find that many new nurse practitioners have similar struggles. Even more struggle with the unknown of negotiation, they know they want to ask but don’t know how and when to ask, push, or just stand their ground. This blog post will discuss how I learned to approach contract negotiation as a nurse practitioner.

Have you ever bought a house? If so you probably recall spending time with your agent discussing a negotiation strategy. It typically is a multi-faceted offer with layers of options which can be easily shed to allow for some back and forth. For example, we wanted to get the face value down but instead of just offering a low-ball and hoping to land in the middle at our desired price we asked for many other add-ins. We asked for seller paid closing costs, TV’s left in place, some furniture (that we didn’t necessarily want), and an extension on the closing date. They countered, to which we counter-countered and eventually came to a mutually acceptable agreement. Including some nice to have extras that you can painlessly “sacrifice” allow the seller to retain a sense of control.

In this manner, negotiating your nurse practitioner contract is the same. Most medical groups have different categories (also referred to as budgets, buckets) of funding and the budgets for each are separate. This allows you leeway to ask for more. Then when they counter you can offer good graces and eliminate one of your requests while still asking for more from a separate bucket.

Here are the buckets of money you can and should negotiate:

• Base Salary.

• Performance based bonus aka work relative value unit. RVU’s pay at a rate compatible to the work you are performing. For example a patient evaluation/note pays differently than a procedure. Procedures pay at different rates based on complexity. A tracheostomy will offer many more RVU’s than a daily progress note than an in office follow up. Some, but not all groups offer an additional pay out for RVU’s and some further qualify as a pay out for anything generated over a set amount of RVU’s.

• Quarterly or annual quality metrics based bonus. In my experience these are group based. So how the team performs as a whole dictates what your pay out will be.

• Sign on bonus.

• Retention bonus.

• Shift differential. Weekends/nights/holidays.

• Incentive/Extra shift differential.

• Call pay.

• PTO.

• CME. Don’t underestimate the value of a great medical conference which typically involves a fun trip.

• If this is a leadership position that should be accounted for as well either by pay or protected administrative time.

• Paid administrative time. Particularly important for my outpatient friends. The amount of time you will spend on busy work will astound you. Fight for paid time to accomplish these tasks that are protected outside of face to face patient time.

Even if the employer has notified you that the position is non-negotiable I would still advocate for making one request. People are always scared to do so, I hear this a lot. My reply is this, what’s the worst that can happen? The worst is they will say no. If the worse than worst is that they say no, and are so offended that they rescind the offer, alarm bells should be going off in your head. This is a major red flag for a future employer. If they are so butt hurt that they no longer want you then they really never wanted or valued you. You just saved yourself lots of future hardships. I have never heard feedback that this happened. In all scenarios I have ever been a part of, the reply is simply no. In that case you decide if the terms are acceptable to you as is or if you need to move on. Simple. The hardest part is putting on your big girl/boy pants and asking. To that I advise, KNOW YOUR WORTH. You bring high quality, affordable, income for this group. Yes, there is a lot of competition out there, but you are the one they want.