How to Negotiate a Raise for Nurse Practitioners with Amanda Guarniere
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Show notes:
There’s a lot of information about negotiating a salary when you’re just starting a job and how to find a new job if you’re underpaid— but what if you love your work? Maybe you want to stay there, and just want to know how to negotiate a raise.
Many people feel like asking for a raise is intimidating, and haven’t actually asked for one before. The good news is that it doesn’t have to be rushed, pressured, and happen in a day like the salary negotiations of an initial job offer with a quick turnaround. It actually is better to do when you make a plan over time and have a runway leading up to the conversation.
The first place to start? Listen to that voice that’s bringing up the idea of a raise. What is giving you that nudge? What is the disconnect between the work you’re doing and the amount your being paid that feels off? In other words, the difference between what you bring to the company versus what you’re bringing home.
In this interview with my guest Amanda Guarniere of The Resume Rx, we start with this first step and walk you through the step-by-step process of how to negotiate for a raise, starting with what information to gather through having the conversation with your employer, addressing common questions along the way.
We cover:
Building your case and taking the pressure out of the conversation
Understanding what matters to the employer and using their language and metrics to avoid the knee-jerk “no, there’s no money”
The specific data to gather to make your case, and where to find it
How to have the conversation, and how to address non-committal answers from employers
Understanding the various alternative compensation options if there really isn’t cash as an option for a raise
I’m so grateful for Amanda’s experience, wisdom, and scripts to use when having these types of intimidating conversations.
Resources mentioned in this episode:
The NP Salary Report: https://www.theresumerx.com/salary
The Resume Rx Podcast: https://www.theresumerx.com/podcast
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Amanda Guarniere (she/her) (00:00)
you have to support your request and you need to support your request with things that matter to the other party. And it's not because, well, I'm having trouble paying for this daycare bill or there's not enough money for me to save for retirement at the end of the month. Those are not things that your employer cares about, sorry to say. So there's an element of data collection that is important on your end as the NP who's asking for a raise. And there's a few different data collection points. You want to collect data about yourself in your job in metrics and language that
are important to the employer, i .e. money.
Liz Rohr (they/she) (01:01)
Hello, hello. This episode is with my dear friend, Amanda Garnieri. If you've been around here for a bit, you've probably come across her work. She introduces herself in this interview, so I'll let her say more, but in this episode, we're talking about how to negotiate a raise. This is something that can feel very intimidating and overwhelming. And what I love about it, which I say at the end of the episode is how matter of fact,
and simple and step -by -step and strategic Amanda is about this process and makes it feel so accessible and so easy. Well, simple, maybe not easy, but simple, because I know it can be intimidating for people. But it's definitely a question that has come up a bit in the real world MP community. And I trust Amanda Garnieri as the career navigation expert with the resume RX as her company.
to help guide us through this process. So I really hope that you enjoy this interview.
Liz Rohr (they/she) (02:02)
Well, thanks for being here. It's wonderful to have you back on. So I feel like you don't need introducing, but I know that there's new people all the time coming into this world of ours. So can you introduce yourself for the people who don't already know you?
Amanda Guarniere (she/her) (02:06)
Yes.
Sure. So my name is Amanda Gournery. I am a nurse practitioner for the past 13 years now and founder of the Resume RX, which is an educational platform and content site for nurses and NPs to really learn the topics we didn't learn in school about how to find a dream job, how to interview and negotiate and prepare for career advancement and kind of all the things that go along with that.
Liz Rohr (they/she) (02:46)
So yeah, so the question came in, and it comes in a bunch, but I just the other day someone was like, how do you negotiate a raise? And I was looking through your stuff and I was like, I don't know if Amanda's talked about, I'm sure Amanda's talked about that, but it would be really fun for us to talk about. Yeah, just like have a conversation about that topic. I know it's really stressful for people. And I think that there's like maybe an added layer with nurse practitioners. I don't know, maybe this is all just my anecdotal experience, but.
Even talking with a friend who's not in as a nurse practitioner was talking about asking for a raise today or in the last couple of days. And she's stressed out, but like there's something I think extra with medicine, especially for like maybe people on the newer side. We're not talking specifically about new grads right now. We're talking about people who have a nurse practitioner job and want to advocate for a raise or ask for one. It can still feel a little tricky. And I think that there's a little bit of this like culture of medicine that's like a little bit.
know, paternalistic or something. And people don't necessarily want to rock the boat, stuff like that. So if somebody is thinking about that, they've been in their practice for a bit and they're like, I'd really love a raise. Like, where would somebody start if they have that thought? Where would you recommend that they start?
Amanda Guarniere (she/her) (04:00)
Yeah, I think this is a great question. And just to kind of frame it a little bit more, I feel like there's a lot of content and information about how to negotiate a salary when you're starting a job, right? And a lot of information about, all right, if you're underpaid, here's how to find a new job. But maybe the gap in conversation is, all right, I like where I work. I would like to stay here. I'd like to be more fairly compensated. Or there are some things that I want to change. But to your point, there's
Liz Rohr (they/she) (04:10)
Yeah.
Yes.
Amanda Guarniere (she/her) (04:29)
there's more to lose almost, right? Because what if they say, no, I still have to show up here every day, right? So I think that's really, it can feel a bit more emotional, whereas you might feel emboldened to try to negotiate for more money in a job where you're comfortable walking away if you're in the job search, right? So I think that's part of where, and also the kind of paternalistic issues in medicine, I definitely think kind of compound on each other, but.
Liz Rohr (they/she) (04:30)
Yeah.
Yeah.
Yes.
Amanda Guarniere (she/her) (04:57)
I think the first place to start is if you feel deep down inside that you want to ask for a raise, listen to that. Listen to that voice. Ask yourself, all right, what is giving me this nudge? There's some sort of disconnect here between what I feel I'm bringing to the job and what I'm taking home financially from the job.
realizing that it's not going to be, like it's not something that you just do one day, right? You can thoughtfully plan out asking for a raise and that's really how I recommend doing it. You know, as opposed to when you're negotiating a salary during a first, during a job interview or a job hire situation where you kind of have to come back quick with, no, actually that's not what I was looking for, can you do this?
Liz Rohr (they/she) (05:35)
Mmm.
Yeah.
Amanda Guarniere (she/her) (05:52)
You know, this is more something that you can have a bit of a runway for and the better that you execute that runway, the more likelihood you are to succeed with your original intent of getting what you asked for.
Liz Rohr (they/she) (06:05)
I love that. I love that. I've actually, it's occurring to me. I don't know if I've ever asked for a raise. I don't think I ever have in any of my jobs. Actually, maybe I did as a collective with our nurse practitioners, we had a conversation about we'd like to adjust compensation for all of us across the board. So yeah, so having I love that piece of like a runway, it doesn't have to be high pressure, it doesn't have to be high stress. That's like, like, take the air out of the balloon a little bit.
Amanda Guarniere (she/her) (06:12)
Hahaha!
Liz Rohr (they/she) (06:34)
planning a runway. So what does that look like for people? Let me rewind. What are some of the factors? I think that maybe some of the factors that go in from maybe an employer side would be helpful for people to understand. What are some of the factors that go into that conversation from the employer's perspective? I think that some people go in and they're just like, well, they're just going to say no because there's no money. But what are?
I don't know, can you speak to either of those pieces? I think they're kind of interrelated. Like what is that kind of runway that leads up to it? But I think it's really influenced by what actually matters to the employer in that conversation. So wherever you want to take it.
Amanda Guarniere (she/her) (07:13)
100%, that's a great point and that's really a perspective that's important to keep as you're going into these conversations because the kind of knee -jerk reaction to the question, can I have a raise, is why? They're not necessarily gonna say why, right? But you have to support your request and you need to support your request with things that matter to the other party. And it's not because, well, I'm having trouble.
paying for this daycare bill or there's not enough money for me to save for retirement at the end of the month. Those are not things that your employer cares about, sorry to say. So there's an element of data collection that is important on your end as the NP who's asking for a raise. And there's a few different data collection points. You want to collect data about yourself in your job in metrics and language that
are important to the employer, i .e. money. Ultimately, at the end of the day, you need to find the money. Exactly, exactly. So if I'm asking for a raise, I'm planning ahead and I'm pulling my productivity reports. I'm pulling RVUs generated. I'm pulling how many patients I'm seeing. I'm pulling my no -show rate.
Liz Rohr (they/she) (08:17)
Yeah, yeah, different ways of talking about money, yeah.
Amanda Guarniere (she/her) (08:40)
all types of stats that indicate that I am making this practice or this facility a lot of money. And hopefully you're privy to that type of information or at least privy to enough of it that you can come up with data to support your request. So you may or may not know exactly what you're getting reimbursed from Blue Cross for a 99214.
Liz Rohr (they/she) (09:01)
Yeah.
Amanda Guarniere (she/her) (09:09)
But if you do, then you can do some back of the napkin math. Look at what you've coded over the past two, three months. Assume those collection figures and be able to have at least a back of the napkin number of, all right, here's the revenue I've generated for the practice now compared to maybe when I started, right? Because you want to show the difference. You wanna show why you're asking now.
Liz Rohr (they/she) (09:34)
Mm -hmm.
Amanda Guarniere (she/her) (09:38)
and why the practice should theoretically have more money now than they did before, right? So that's definitely part of the data that you wanna collect about yourself. You can also put in things that are more qualitative things. So are you taking on certain responsibilities? Are there other things that you touch inside of the organization that are helping
Liz Rohr (they/she) (09:42)
Yes. Yes.
Amanda Guarniere (she/her) (10:07)
with efficiency, with generating revenue, with all the things that matter to the employer? And should there be a monetary value for that work? So those are kind of the things that you want to collect data about over the past, I don't know, whatever look back period you decide you're going to look at. I think usually three to six months is a good look back period.
And then you also want to look for data, not necessarily about yourself, but about things out in the world. So what are MPs making in similar roles in similar geographies? What has the inflation rate been year over year for the past few years? And looking at all of that and being prepared, having it written somewhere so that you can eventually take it into the conversation. And we can kind of.
Liz Rohr (they/she) (10:41)
Mm -hmm. Yeah.
Amanda Guarniere (she/her) (11:04)
go down that path a little bit further after we chat about what I just talked about.
Liz Rohr (they/she) (11:08)
Totally, totally. Yeah, I'd love to keep going with that. I think I want to pause for a sec, because I think that there are people who are new and who are experienced who might not be as familiar with some of the pieces that we've introduced. So yeah, so I guess just to recap, the thing that you want to be prepared for is like you're almost building a case of like why you need a raise.
and hopefully your employer has already considered cost of living, inflation increases just at baseline. Cause I think that people kind of expect like, why am I not getting a salary increase every year? And that's usually where that comes from is like that, at least from my perspective. So correct me if I'm, if I'm, if there's other things that I'm not thinking of, but typically if, if an employer is giving you raises, it's because of that reason. But the other reasons that you can collect data on are how many patients you see, how many patients you, you're no show, right? So the percentage of patients.
week over week that don't come to their scheduled appointment. So if you're booked for 20 a day, are you seeing 16 patients? And what is that average over time? Your no show rate is that's the terminology that people in clinics use. And then you have your, so that's like the, that's like productivity quote unquote is like how many patients you're seeing versus not seeing. And then how much revenue does that bring in? And the way that you see that is when you're looking at your billing codes, whether you bill 99212,
three, four, four, things like that. Every single one of those billing codes brings in a different amount of money. And so did I get that? Do you think that I explained that all clearly for those pieces? Just I'm thinking of like the new grads or I'm thinking of people like in my clinic, like I worked in a federally qualified health center for actually all of my jobs. And we didn't really have that data readily accessible. And we also used Medicaid and Medicare and.
Amanda Guarniere (she/her) (12:46)
Yeah.
Liz Rohr (they/she) (13:00)
the reimbursement rates were not the same as like a private insurance. And so it was almost like a flat rate. Like it made a tiny difference if you saw a four versus a three, but it wasn't huge. And then we also didn't necessarily have easy access to that data. So that's my other follow -up question is like, how do people, like have you worked in a clinic or heard of people in clinics where they have ready access to that? And also can you speak to RVUs? Like what that, I think that there's a lot of misconceptions about what RVU means.
Amanda Guarniere (she/her) (13:03)
Mm -hmm.
Sure. So I think that some practitioners have access to that data, particularly if they are working in a private practice setting where they may already have some sort of productivity -based pay or bonus incentive. So typically, there is some sort of feedback loop where you are getting information of the number of patients or the value of the patients that you saw, which is then translating to some additional.
Liz Rohr (they/she) (13:43)
Mm -hmm.
Amanda Guarniere (she/her) (13:57)
bonus or compensation. So I think that category of people probably has the most precise data about productivity, right? But to your point, right, for those who don't get access to any sort of financials of the clinic, then we're kind of doing what I call back of the napkin math, where you're kind of reverse engineering, looking at your averages, looking at, you know, what
Liz Rohr (they/she) (14:03)
Yes.
Amanda Guarniere (she/her) (14:23)
maybe the lowest payers are paying you per visit to kind of figure out the lowest possible revenue that you're generating for the practice. In terms of RVU, it stands for Relative Value Unit. And it's kind of like a standardized value, a standardized number or unit that CMS, which is the Centers for Medicare and Medicaid have assigned for particular procedure codes.
And we say procedure codes, it might not be an actual bedside procedure, but we're talking about all the things that we do that are codable. So an outpatient visit, different levels of outpatient visits will have a different RVU allotment to them. And so the way to standardize that across all sorts of settings and practices is with this RVU number so that you can kind of
Liz Rohr (they/she) (15:00)
Mm -hmm.
Amanda Guarniere (she/her) (15:21)
compare apples to apples, so to speak, because if I'm working in the emergency department, I'm not doing nine, nine, two, one, three, or four outpatient visits, right? I'm doing emergency level visits, and I'm doing suturing and incision and drainage, right? And so RVU assigns a value that really speaks to the time it takes and the funds generated by that activity.
Liz Rohr (they/she) (15:49)
Mm -hmm.
Amanda Guarniere (she/her) (15:50)
So there are a lot of practice settings that will have either RVU -based expectations for their providers or RVU -based compensation for their providers. So typically if someone has productivity -based pay, it's based on the RVU expectation that they have in a given quarter. Usually these are looked at quarterly.
Liz Rohr (they/she) (16:21)
Cool. Yeah, that's really helpful to hear. And I've definitely have had colleagues that work in a private practice or a hospital -based clinic. And they had monthly check -ins. And it was kind of stressful, actually. It sounded really stressful. But it was almost like you'd post your stats. And it was like, I don't know. I don't know if I believe in that practice of doing it in front of other people, because that's like, my god. But it also is occurring to me that maybe patient reviews
I have a lot of feelings about like the Prescaini stuff. I'm not a fan, but maybe if that's something that your clinic really believes in, like I think that for this particular person, they also included patient feedback as part of like the data picture. So yeah, I think that's really helpful to hear. And I think that if, and this is what I would do if I was in that setting again and I was looking for my data and I wasn't provided it, like,
Amanda Guarniere (she/her) (17:05)
definitely.
Liz Rohr (they/she) (17:19)
I can't imagine going back through my EHR and just looking at my visits. So I would probably go to my office manager because they do have this information somewhere. Somebody is looking at this information, even if it's not readily available. You can ask your office manager, for example, of, hey, I'm really looking to get an understanding of the patients that I'm seeing, the number I'm seeing, the no show rate, just listing those things. And I imagine that they would readily help you out with that. Because if I was an employer,
of my team member, I'd probably be like, they're gonna ask for a raise in a second. But I would be like, okay, so the person I'm supervising, I would be happy to know that they cared about their data because we all wanna give healthcare, we all wanna do a good job, we wanna keep the doors of the clinic open. And so even if they are gonna ask for a raise, number one, I wanna give it to them if I have money for it, but then also it's nice to know that they are caring about it.
Amanda Guarniere (she/her) (18:10)
Yeah, for sure.
Liz Rohr (they/she) (18:11)
Yeah, but so it sounds like, OK, so data collection, you're looking over the past three to six months. And then are you comparing it to when you first started? I guess I'm wondering about when people, I think, I imagine this question would come up of when do I even ask for a raise? Is it like annually? Is it, you know what I mean, like any sort of thoughts on that? Because I mean, sometimes people get annual reviews, but I don't know if everybody gets them. I don't know if that's the time, because that's kind of a pressured situation, you know?
Amanda Guarniere (she/her) (18:38)
I think.
Yeah. Yeah, I think annually is a nice cadence. Or at least thinking about whether you've had some sort of period where there's been an increased expectation. So let's say you've been asked to take on more in some capacity. Or let's say your clinic is understaffed or something like that. So waiting, I think, you know,
Liz Rohr (they/she) (18:56)
Mm -hmm.
yeah.
Amanda Guarniere (she/her) (19:09)
three months from a major change. That way you have that look back period to say like, hey, three months ago, I was a team player and increased my capacity for visits by 20 % because we have been understaffed. And here's the data I've collected and I'm happy to continue working at this capacity. And with that, because of my increased productivity, I'd like to kindly ask
for x, y, z. And we can kind of, the next step to give some foreshadowing is to decide what you're asking for. So, but to, yeah, to answer your question, I'd like to see people getting at least an annual raise or at a shorter increment if there's been some other significant change.
Liz Rohr (they/she) (19:44)
Yeah. Yes, I love that.
I love that. I love that. Yeah, so where do people go from there deciding how much how much or what to ask for? And you and I have talked in the past about compensation is not necessarily all about dollars, right? There's many ways to get compensated in a full kind of package, whether it's your initial thing or negotiating. So so yeah, I guess if that's the next step of like, how how how should people work on deciding what they're going to ask for?
Amanda Guarniere (she/her) (20:13)
Yes.
Liz Rohr (they/she) (20:24)
And then maybe after that, we can talk about the actual asking, because it's just so nice to hear you speak so matter of factly and plainly and that energy. I'm like, okay, I'm just going to copy that script, play it back over and over again. I'm just going to use that tone. Go ahead.
Amanda Guarniere (she/her) (20:32)
Ha ha ha.
Liz Rohr (they/she) (20:38)
question is, how do they decide what they want to ask for considering that it's not just about dollars, that there's a full compensation package?
Amanda Guarniere (she/her) (20:44)
Right. Yes, yes. So yes, you're totally right. I like to talk about this all the time, that compensation, there are so many different factors to it than just the actual top line salary amount on your offer letter, right? So what I really recommend is doing a little bit of an audit of your current total compensation package. So this could be as simple as taking a piece of paper
piece of lined paper, folding it in half, and say on the left side of that paper, writing current or now or whatever it is, and listing down kind of piece by piece what's included in your compensation.
So your salary amount, of course, and then any productivity or bonus structure that you might have. And then going deep into all the different benefits that are included. How much PTO do you get? What's your CME allowance financially and time -wise? And list everything that you know that you get that some sort of benefit, including as granular as what's your expected schedule, the times that you are expected to work.
How much administration time do you get? Do you have any helpers? Do you have a medical assistant? Do you have a scribe? All those types of things. So write down everything that you have. And then think about what prompted you to think, I should ask for a raise. Is it something that there's a struggle in your household with the actual amount of dollars that's coming into your?
Liz Rohr (they/she) (22:05)
That's a great one.
Amanda Guarniere (she/her) (22:32)
bank account, if that's a big pain point of yours, then you're probably going to be asking for more money. If you are feeling totally burnt out and all you do is work, work, work, then maybe you're asking for more PTO or maybe you're asking for a schedule modification. Whatever it is, you can decide whatever you want that ask to be. And aim high, right?
ask for something in every category if you want. That may not be what you get and we can kind of in the next phase decide what you're willing to accept. But at least when you're starting this process and you're ideating and you're dreaming of, all right, best case scenario, what does this raise look like? That's how I would approach it.
Liz Rohr (they/she) (23:02)
Yeah.
I love that. I'm getting like a little bit of nervous system activation, just thinking about asking myself. I'm like trying to put myself in there. I'm like, So it is scary. I just want to normalize that. And I think the other thing that kind of came up for me was like, shoot, I just lost it.
Amanda Guarniere (she/her) (23:30)
You
Liz Rohr (they/she) (23:48)
Hmm. I guess, have you ever heard of, I think that there's a worry that people have. I think the thing that's kind of coming up for me is like, it just feels, I guess two things. So one, it feels scary to think about making this dream list and like kind of coming in and being like, I want all of these things. And then they're just like, no. Number one is like, are they, have you, you might not be able to speak to this, but is there a risk for people getting let go?
because they asked for a raise. I don't know. I don't know if you can even speak to that. And I don't know what the laws are and maybe it's state to state or whatever. but I think kind of like on the tail end of that is like, the thing that's kind of coming in to support that for me is like, you believe in the justification of it, right? Like, I mean, first of all, we all deserve to have as much money and time off as we want and wellness and like, we all deserve that at baseline. So like embedding that in there and
further believing in the story that you're telling based on all that information. But yeah, I don't know. Do you have any thoughts about that? Like I've, like, I guess like as we're approaching how to have that conversation, if we've decided, you know, I think I can, I think I can see people being like, well, I want the moon, but like, how do I go about and ask for that without like totally getting, you know, worried about him getting fired or like clamming up or how do I even say that with a straight face and I'm not like running away.
Amanda Guarniere (she/her) (25:03)
Yeah.
Yeah, yeah, I think you have to decide on an amount or an ask that feels good to you. It needs to feel good in your body. And if it doesn't feel good in your body, it's going to be hard for you to communicate it. I think also you want to leave yourself some room for growth. So maybe part of the ask is, here's where I'd like to be two years from now. How can we get there? So I like that.
Liz Rohr (they/she) (25:10)
You
Yeah.
Mm. I love that.
Amanda Guarniere (she/her) (25:39)
I like that type of approach when asking for a raise because it shows it's disarming, right? It shows that you are thinking about the future. You want to be with this organization long term. You also have goals for yourself and you want to decide together how to make that happen. So that's my favorite way to go into the conversation. But to back up, you need to have
an ask that you feel good about that leaves you some room for growth. And yeah, something that like has to be a reasonable request, right? And that's where your data comes in, you know, the data of the supporting data that's not yours. So the supporting data of what other NPs are making and the normalizing data, right? Like this is what's customary.
other people in our area are making for the same amount like the normalizing data. So, and you know, the other piece too is you could have all sorts of different motivations for asking for a raise. You could love your organization and you wanna stay there long -term, you wanna lead the team, you know, you wanna be a director level someday or whatever it is. Your approach is gonna be different than...
you've actually got another offer, and you would stay for the right amount in this job. So that's going to have you approaching the conversation differently, making asks in a different way. And so you might be coming up with an offer that matches what another company is offering you in an effort to stay because it's less friction to stay or because you like it.
Liz Rohr (they/she) (27:05)
Mm -hmm. Yeah.
Amanda Guarniere (she/her) (27:29)
in your current job better, that type of thing. So there's so many factors in determining. But it's your choice what you get to ask for. And just kind of keeping in mind how it's going to be received. Is it going to be received in a way that's a realistic ask? And how are you going to present it in a way that keeps you in a favorable light and not as someone who's
Liz Rohr (they/she) (27:31)
Mm.
Yeah.
Amanda Guarniere (she/her) (27:58)
trying to rock the boat or whatever. And you asked, is there a risk of being let go? It depends. If you're like, this is what I want, and if you don't give it to me, then I'm going to walk. Then if they can't do it, they can't do it. You have to keep in mind that.
Liz Rohr (they/she) (28:14)
Yeah.
Amanda Guarniere (she/her) (28:19)
Healthcare is a business. Everyone has to balance their books at the end of the day. Not every business is run really well. So even if you know how much money you're generating for a practice, that doesn't mean it's all sitting in a pile somewhere waiting for you to get it. It's being spent elsewhere, and that's not your fault. But just kind of keeping that in mind that they sometimes can't make it come out of nowhere if it's tied up elsewhere.
Liz Rohr (they/she) (28:27)
Yeah.
Yeah. Yeah.
Amanda Guarniere (she/her) (28:48)
So a lot of directions to go in from here.
Liz Rohr (they/she) (28:52)
Yeah, I think it's really helpful to, even if there's multiple directions, I think that the framing of partnership is helpful, because I think a lot of people come in, whether it's just the overarching conception of what negotiations are supposed to be, that's this confrontational thing of, I want this thing, and they're going to say no, and how do I argue for it? And it has to be this really intense thing versus what you said is like, you know, like,
I think that, I don't know, maybe this is my own anecdotal experience, but it seems like the people who employ us want, like, they want the best for the company, for the mission. They want to support us. And so, yeah, so if we can approach it from that perspective of like, this is the story, here's what I need. How can we make this happen? And then just having a conversation going back and forth.
So yeah, I guess do you have any thoughts about that? Like in terms of what are the typical, or what are some options in terms of preparing ahead of time? Because I think that for me, if I'm thinking about doing this myself, it's nice to know like different options, right? I think the worst case scenario I'm envisioning is like, no, you're fired for asking. It's like, I don't think that's real, right? But it's like, what are the potential things that you see for people? It's like, well, excuse me. Like one of the things I've heard from people is like, they're just like, not right now. You know, or they're...
Amanda Guarniere (she/her) (30:06)
Hehehehehe
Liz Rohr (they/she) (30:20)
Be like, okay. Like, what are some of the things that people might say back? Just in terms of preparation of next steps, because I think that sometimes people are so new to this that they might just freeze and be like,
Amanda Guarniere (she/her) (30:30)
Yeah. So I think one thing that I want to say before I forget is there's a really wonderful book called Never Split the Difference by Christopher Voss, who is a well -known hostage negotiator. And really interesting book, and it's all about negotiation and the dynamics of negotiation. And I think to go back to the point of, you know,
Liz Rohr (they/she) (30:38)
Yes.
Amanda Guarniere (she/her) (30:57)
so many people get kind of hyped up that it has to be this intense exchange. You know, really your job in this scenario is to disarm the other person, right? To really, to take away that energy of it being a confrontation. So I would like, that word disarm is what I would...
Liz Rohr (they/she) (31:10)
Mm -hmm.
Amanda Guarniere (she/her) (31:27)
kind of keep in mind as you're thinking about this. The other thing is along the lines of preparing, right? Like we said from the top of the episode, preparing in advance is really smart. You want to know, before you ask for the meeting, which we'll talk about in a minute, you want to determine what is your BATNA, B -A -T -N -A, which stands for your best alternative to the negotiated ask.
So that's a common acronym that's used in negotiation. And basically, what you're determining is, what are you going to accept? You know what you're going to ask for. Like, here's the moon, all the things that you want. But at the end of the day, after the conversation happens, what is what you're willing to accept and settle for if you don't get everything that you ask for, which is entirely possible? So know what that is. And then,
you're going to ask for a meeting and you're not going to say what it's about. So you're going to ask for a meeting, hey, boss, are you free next Tuesday at 3 o 'clock for a quick meeting? If they ask what it's about, you can say, I prefer to discuss it in person. Leave a little bit of mystery. Have them feeling a little bit uncomfortable.
I'm not, I don't mean to say be very misleading, but just thinking from their perspective, if you are a super valuable employee and you've asked for a meeting and haven't told them what it's about, what are they worried about? They're worried you're going to quit. They're worried that you're going to quit and they're going to be up a creek, right? So they may be pleasantly surprised to hear that you love working there.
Liz Rohr (they/she) (33:08)
Yes.
I'm sorry.
Mm -hmm.
Amanda Guarniere (she/her) (33:19)
there's a bit of an ask to keep you happy, right? So being strategic about asking for the meeting, not disclosing what it's about, not giving them time to come up with a case to say no. And then in that meeting, you present your case. And it's positive. It's collegial. I love working here. Here's all the things that I contribute to. Here's why I'm happy. Here's...
some of the data of why I'm so valuable. Here are some of the data of what else is going on in the real world. And I have a goal of increasing my salary to x, y, z, and would love to discuss an additional week of PTO. How can we get there? And you could get a no right away. And my response to that would be,
I really would love for you to take some time to think about this without there being an immediate response. So can we meet again next week or can we set up a time to discuss in a certain time period from now? And that would be, if there's a non -committal answer, I would ask, when can we reconvene?
to discuss this further, when can I expect a decision, that type of thing. So not being pushy, but just asking to close the loop. And.
Liz Rohr (they/she) (34:57)
Yeah. Like a non -answer is not really an option. I mean, people might try to do it, but like that's what you're trying to avoid in that situation is a non -answer. It's like either a clear yes or no. But I love what you said about taking some time to consider, because if I'm putting myself in the employer position, if somebody asked for that meeting, I'd expect that they were leaving or that they were going to ask for a raise and I'd probably prepare for both scenarios. But I know for me in the moment the way that I process and I think, and I'm just like,
I'm not gonna have an answer for that. And I'm not gonna know what they're, like, I have no idea what they're gonna ask for. And so maybe I haven't prepared for their ask, but I just need to sit with it and process it. And it's not that I don't want to, it's just like, I have to look at my budget. Me as a business owner, I'm thinking, I'm like, I have to look at my budget. I have to look at the upcoming plans, like where to allocate funds. Like that's where I'm coming from. In a healthcare organization, maybe you're a clinic director. There's just a lot of moving parts. I haven't been a clinical director, but it sounds like, you know, it's not just,
the CMO or the chief medical person, it's like, you know, operations gets involved, finances is involved, like HR is involved. There's a lot of pieces. So I think that's a really, really important point is that you might not get an answer that day or probably likely you won't get an answer.
Amanda Guarniere (she/her) (36:08)
Yeah, and right, and expecting that you won't, and kind of going into the conversation respectful of the process. You know, it's one thing if they're like, yes, we were actually planning to give you a raise tomorrow. Great. That's like the best case scenario. We can all go home and end this episode, right? But if they're kind of like, I don't know. Hey, I fully understand and respect that this is.
Liz Rohr (they/she) (36:24)
Perfect!
Amanda Guarniere (she/her) (36:36)
an operation, this is part of a bigger process, I'm sure there are things on your end that you would want to review in response to my request. So does it make sense for us to set another meeting a week from now after you've done what you needed to do? And you can kind of say like, have your weekly whatever meeting with, you know, if you know that there's some sort of clinical leadership team meeting that happens weekly, whatever, you know, reflect that back. I'm sure you want to talk this over. So does it make sense for us to?
set another time to continue the conversation or whatever that looks like. Because to kind of draw not a parallel, but the opposite of parallel from negotiating in a job hire situation, this isn't like a, well, we can do this. Well, we can do this. It's not like a back and forth because.
Liz Rohr (they/she) (37:28)
Mm -hmm.
Amanda Guarniere (she/her) (37:31)
because it's just different, right? There needs to be some analysis involved to make that decision. They weren't exactly, exactly, exactly. It's not like, yes, 100%.
Liz Rohr (they/she) (37:35)
They weren't like prepared in that situation. Yeah. Versus in a hiring, they know what they have to offer.
And I guess I have a question about, like, if you have, I mean, there's different structures, but I'm thinking about when we talked about raises, it was a longer conversation and it was like, hey, you know, boss, the other NPs and I were talking about like, you know, compensation packages, because everybody was the same, depending on your level of experience. And so it wasn't about individual people asking for their own raise. It was kind of the expectation was that there was like a tier system.
And I know that there's some places that are like unionized and maybe that's a little bit different, but can you speak to anything in terms of that process if you, if it's not individualized in that same way, if it's really like a tier system or it's like a cohort type of system or something like that?
Amanda Guarniere (she/her) (38:23)
Yeah, sure. Sure, it definitely depends on where you fall in that cohort, right? Like, are you a member of the group? Are you the lead NP in the group? But I think, you know, if you're a member of the group, it's tricky. You want to do things in a way that doesn't create an us versus them type of situation, right? That can be very threatening to leadership.
Liz Rohr (they/she) (38:47)
Mm -hmm.
Amanda Guarniere (she/her) (38:51)
leadership doesn't typically respond favorably to like, we all talked and we think that this is unfair. And, you know, you know, that's, that's not a dynamic that's favorable, right? It can be an effective one, but we want to avoid going there. Because it can just create some irreparable relationships and a divide between leadership and staff. And really, we want to keep that divide to a minimum if we can.
Liz Rohr (they/she) (38:59)
Yeah.
Amanda Guarniere (she/her) (39:20)
So asking for a meeting with the other NPs or bringing it up, really what I would do is bring it up individually to whoever your lead NP is saying, hey, have you thought about this? Is there an opportunity for us to discuss, you know, have you thought about bringing this to leadership and requesting a fair market adjustment, that type of thing. So it can be trickier when you're kind of
part of a group, but really advocating for yourself and try not to be someone who stirs the pot, but rather someone who advocates for yourself and your peers going through the proper chain of command, right? Because they're not going to give a raise to someone who they think is insubordinate, right? Which is unfortunately just the reality of dynamics in a workplace.
Liz Rohr (they/she) (40:07)
Mm -hmm.
Amanda Guarniere (she/her) (40:18)
So I'm a mediator and a peacemaker by nature. So on the spectrum of conflict averse, I'm like very conflict averse. So someone who's not as conflict averse as me may have a difference of opinion. But I think that there's a way to be strong and assertive and get what you want without it being a huge power play.
Liz Rohr (they/she) (40:43)
Yeah, and I loved how you phrase it. I mean, words, I think, make a big, words mean things. And I think it makes a big difference in terms of the conversation and relational approach, because it's like, what did you say? Have you thought about blah, blah, blah, or would you consider blah, blah, right? Because I think that we come out with this assumption of like, again, maybe I'm just revealing my own stuff, but I feel like this is, I feel this almost like, zeitgeist I don't know if that's the right word, but it's almost like I,
Amanda Guarniere (she/her) (41:06)
Yeah.
Liz Rohr (they/she) (41:12)
I want to raise and they're going to say no, and they don't want to do this. Right. I think that's like the leading thing versus like, you don't actually know if your leadership has talking about this constantly and they've been working on something and they just haven't announced it yet because it's not ready. Right. And so it's not like, it's like, we need a race. It's like, like, have you thought about, and it's just like a conversation to get it started because ultimately we want to like assume, I don't know, not everybody has positive intent, but we want to assume positive intent. Right. And so if you have your lead NP, it's like, these are the things we're thinking about because of X, Y, and Z.
have you been talking about that or have you considered that, right? It's just a little bit more of a conversation. And it's not that we have to be people pleasing or we have to, not ask for what we want and what we need, but it's like, we can, we can kind of do so in a collaborative way.
Amanda Guarniere (she/her) (41:58)
Yeah, yeah, I really like the, you know, whenever you can use we, I think goes over really well. So how can we get there is a phrase that I like to use. I think that I said earlier, you know, if you're saying this is a goal of mine to make whatever amount by the end of the year or whatever it looks like that you're asking for, how can we get there? Or can we discuss a plan of how
Liz Rohr (they/she) (42:04)
Mm -hmm.
Amanda Guarniere (she/her) (42:27)
we can get me there, that type of thing. And don't forget, maybe your requests are also requests for growth, right? So I'd really love to see a pathway for me to become the lead NP with our group. How can we get there? And that goes back to deciding what it is you want because
Liz Rohr (they/she) (42:36)
Mm -hmm.
Totally.
Mm -hmm.
Amanda Guarniere (she/her) (42:55)
You might be someone who's motivated by money. You might be someone who's motivated by time. You might be someone who's motivated by recognition, right? So having that good awareness of what motivates you and what makes you feel valued is certainly like way at the beginning of the process so that you can then have your asks reflect what you know is going to keep you happy and fulfilled and motivated to continue in the job.
Liz Rohr (they/she) (43:22)
I love that. And I guess maybe to wrap up, are there any things, after you have this conversation, what are the next things maybe to expect or to keep in mind or follow up with? I don't know, any things you want to add with that?
Amanda Guarniere (she/her) (43:38)
Yeah, I think it really depends on your leadership, but there could be kind of a due diligence period where they're like, we've heard your request. We'd really like to look into it. Can you provide us with this data that you gave to us? Because you might have said, NP's in this metro area are averaging X. They may want to see that source.
Liz Rohr (they/she) (44:04)
Yeah.
Amanda Guarniere (she/her) (44:05)
Or if you say, well, I've increased my collections 10 % in the last quarter, they may want to follow that trail to make sure that you're backing up what you're asking for. So I would say be prepared for there to be a request. And that's not a power play. That's a business doing their due diligence to make sure that they can justify your request. And if anything,
Liz Rohr (they/she) (44:15)
Mm -hmm.
Amanda Guarniere (she/her) (44:35)
questions like that should be seen as favorable. And I don't want to say almost a done deal, but you will get something because if they didn't like you or didn't think that you were deserving of that or truly did not have any funds to spare, then you would have gotten a hard no right then and there. And so hopefully that's not the case.
Liz Rohr (they/she) (44:39)
Yeah.
Mm -hmm.
Yeah, awesome.
Amanda Guarniere (she/her) (45:04)
And if that is the case, you know, feel free to push back a little bit and say, you know, I really want to know what it looks like to get promoted or to earn more or to make myself more marketable in this profession. And I love it here. And if I'm going to stay here, what does that look like for me? Is there a pathway where I will be earning more because, you know, if not, then... And that's like...
Liz Rohr (they/she) (45:31)
Yeah.
Amanda Guarniere (she/her) (45:33)
That's tough to go down, right? You need that. It comes with some element of privilege to be able to say like, like, if you can't do this for me, that I'm going to be leaving, right? Because it's something you would have to be able to back up potentially. So we'll save that option for another day.
Liz Rohr (they/she) (45:35)
Mm -hmm.
Mm -hmm.
Yeah.
just one other scenario I think comes to mind is like, like at the end of this quarter or at the mid -year review or something like that. So I guess if there's any thoughts that you have about this of like, hey, like if it's a non -committal answer, but it's like committed enough where it's like at the end, right? So like a non -committal answer is like, I don't really know. It's like, well, when can we meet next week to talk about it? But if they're like,
not right now, but when we get to the end of this quarter, we'll be able to see our finances. And that's like, you know, every quarter is three months. I don't know, I guess, I guess the thing that's popping in is like being strung along. And maybe that's not a thing, but I feel like I can see that happening too, where somebody is like, is non -committal, but almost in like a denial way, or like, I don't actually want to confrontationally say no to my employee. I don't know, do you have any thoughts about that?
Amanda Guarniere (she/her) (46:31)
Mm -hmm.
Yeah.
Yeah, I do. I would say, if that conversation happens and it's in person or over the phone, I would put it in writing. I would thank them for the meeting, thank them for their time, looking forward to discussing again next quarter, like you mentioned, after the financials are in, whatever. And then I'm setting a reminder in my calendar for end of quarter and asking for a meeting again. And my strategy might be different then. You may need to have different leverage.
Liz Rohr (they/she) (46:45)
Mm -hmm.
Mm -hmm.
Amanda Guarniere (she/her) (47:05)
If you have someone who's kind of kicking the can down the road, so to speak, maybe you're applying to other jobs and using another offer as leverage. And if that's not enough for the employer to say, yes, we're going to keep you, then maybe the writing's on the wall for you in that role. And maybe you're honoring your worth and finding a place that can better value you.
Liz Rohr (they/she) (47:34)
Yeah.
Amanda Guarniere (she/her) (47:35)
because they should be able to give you something even if it's not monetary. So maybe they're like, we recognize all that you've been doing, we recognize your tenure. While we can't give you a salary increase right now, we'd like to give you a title increase, like a consolation prize title increase. And then we hope that later we'll be able to, like that's a sign of someone who wants you there.
who's not kicking the can down the road. So just kind of reading those cues and figuring out if and when it's time to be looking elsewhere, which I'm sure we've covered in another episode.
Liz Rohr (they/she) (48:06)
Mm -hmm.
Yeah.
Definitely, definitely. And we can always do more if you want. I love what you said about in terms of the hard no, the question of what can I, what could, what would it look like for me to do X, Y or Z, whether whatever the thing you're asking for, like, what would it take for me to get to an extra $5 ,000 or something like that? Because then I think it's like, hopefully they can answer a clear yes or no. And if they can't, then we know, but it's like, nice to know that helps inform the reason why they're saying no and what concretely could actually help them say yes.
or they're just kicking the can down the road, in which case you're like, okay, enough of this. But I love that. And I love how matter of fact you are because it does feel really unnerving even for me as somebody who's had many, many a confrontational conversation, not necessarily in this context, but it still feels confrontational quote unquote. So, I really appreciate you modeling that for people and having a systematic kind of process just really breaks it down and makes it feel a lot more accessible and easier. Even if it's, it's that like simple, but not easy thing.
Amanda Guarniere (she/her) (49:15)
Yeah.
Liz Rohr (they/she) (49:16)
so it can still feel scary, but it's, it's a really, especially if you're thinking of leaving, it's a super worth, I would feel like it would be a really worthwhile practice to do. Even if you're already like, I'm getting out of here. It might just be nice to practice a negotiation thing and see, and then if they say no, great. And then if they say yes, maybe you do want to stay. I don't know. Like you don't want to like mess with people's, you know, emotions and stuff, but you know, if they're going to say no anyway, then might as well practice. And then it's like, it's not that scary.
Amanda Guarniere (she/her) (49:25)
Yeah.
Totally.
Totally.
Yeah.
Yeah, and just to normalize, you can feel totally frazzled on the inside and with practice, be calm, cool, collected, confident on the outside. Right? So that's, yeah. Right? Yes, and that's something that comes with practice. Even as we're on this interview right now, I'm fidgeting. I've got like,
Liz Rohr (they/she) (49:53)
Yes.
Yes, I want to second that. I want to 17 that because that's like every day for me.
Amanda Guarniere (she/her) (50:08)
I don't know, the cover to my water bottle in my hand. And it's like, because I know that there's always a buzz of energy that I need to get out elsewhere so that I can keep my tone nice and slow and think about my thoughts. And that comes with practice, right? So just want to normalize that you can feel a frenzy inside and learn to present more
Liz Rohr (they/she) (50:21)
Ha ha ha!
Totally.
Amanda Guarniere (she/her) (50:38)
cool -ly, if you will, on the outside.
Liz Rohr (they/she) (50:39)
Yeah, I love that. Well, thank you so much. Any other parting thoughts you want to share with people? you know what I want to share is I don't know if you still have this, but it's it was a salary list where people it was like a you it's your hostage, people submit their salaries, right?
Amanda Guarniere (she/her) (50:49)
yeah. Yep.
Yeah, there's almost 5 ,000 entries on there now.
Liz Rohr (they/she) (50:57)
Amazing. So what is it? So just tell people if they don't know what it is.
Amanda Guarniere (she/her) (51:01)
Yeah, so it's called the NP salary report. And basically what it is is it's first a survey where if you are practicing NP, you submit your salary data anonymously, of course. I collect your email so that I can give you access to the salary report. And then on the back end, when you have access to it, you can sort and filter by all sorts of parameters. So it's not just a simple spreadsheet. You can filter only people in your state or only people in your specialty. It's really quite advanced so that you can extract the information that you want to support your ask of what are NPs making. So it's free to access. And if you are not yet a practicing NP, there's a question on there that says, are you an NP student? And just click Yes there, and you get to bypass the salary entry. So it's at https://www.theresumerx.com/salary/ And I hope you check it out.
Liz Rohr (they/she) (51:33)
I love that.
Mm -hmm.
I love that. Yes, I think that'll help contribute to just that pay clarity. Some states have that. I think Massachusetts just passed, or not just, a couple years ago passed something about, there was, yeah, salary transparency. So I don't know if that's the only mass, but yeah. But there was something about like you weren't allowed to talk about, you're not allowed to ask people to keep their salaries confidential anymore or something. I think that's a Massachusetts thing, but I remember that when that passed, I was like,
Amanda Guarniere (she/her) (52:03)
Totally.
salary transparency on job postings. Yeah, New York City has it as well.
Yes. Yes.
Mm -hmm. Yeah, yeah.
Liz Rohr (they/she) (52:24)
I'm super nosy and I want to talk about stuff with people. And that's what helps transparency with each other is what helps us grow. Right. So I love that. Well, any other parting thoughts or words of wisdom or things you want to share? I mean, you're at https://www.theresumerx.com/. It's obviously going to be in the show notes, but yeah.
Amanda Guarniere (she/her) (52:31)
Yes, totally.
Yes, yep, go visit me on my website or on my Instagram, and then I don't put out new podcast episodes anymore. However, there are 150 something episodes that are still quite relevant on the Nurse Becoming podcast at https://www.theresumerx.com/podcast. Thank you, always a pleasure.
Liz Rohr (they/she) (52:47)
Mm -hmm.
I love it. Thank you so much.
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