Benefits and Bonuses

If you’re like most students, job benefits are a completely foreign concept. Yes, your job as chief burger-flipper may have offered free “food,” and your stint at Mall-Mart may have offered a generous employee discount in exchange for making you work on every major holiday, but those mall job benefits barely scratch the surface of what real employers offer their workers.

Now that you’re preparing for a better future—one that hopefully won’t involve super-sizing anything—you need to understand what benefits employers will dangle under your nose, which employers offer the best deals and how to bargain your way to a more inviting work environment.

Benefit Basics

When interviewing prospective employees at job fairs or during campus recruitment drives, human resource personnel often refer to a “standard benefits package” while painting their place of employment as a worker’s utopia. Unfortunately, no benefits package is ever standard, as you’ll quickly discover once you start comparing one company’s offerings against another’s.

Here’s an explanation of benefits that employers might use to entice you, starting with those most likely to be offered and ending with ones you might have to bring up on your own:


As you might expect, health insurance coverage is offered by almost all employers. Not all health care coverage is created equal, however. And note that we didn’t say “free health insurance coverage.” In many cases, the employee will have to pay for at least of portion of the premium through payroll deduction, at least during the first year or so of employment. Premiums have been jumping by double-digit percentages each year, which makes it imperative for employees to become increasingly savvy about what’s covered.

“Most people have become pretty intelligent in terms of retirement packages, but the big difference now will be what your co-pay is, what your deductible is, what your out-of-pocket maximum is and so forth,” says Alex Ogburn, vice president of recruiting for Allied Consulting, Inc. in Irving, Texas. “[Health insurance] can be a tremendous part of any benefits package.”

If you have a spouse and/or dependents that need health insurance from your employer, be sure to find out how much you’ll have to pay out of your own pocket. Medical coverage for a family of four might cost you $600 a month through one employer and less than half that through another. It could be the deciding factor in choosing between job offers.

Liability insurance, which covers legal costs in case you are sued for mistakes on the job, also ranks high among benefits offered. Dental, vision, disability and life insurance are less common.

Vacation, holiday and sick leave

Every company offers some number of vacation days and paid sick leave, but specific figures vary widely, as does a company’s willingness to offer unpaid leave to employees who want to take long summer vacations.

Relocation funds

If you’re moving more than 100 miles for your new job, your employer may pick up the tab, sometimes on moving day itself. “In the past, you had to out-of-pocket that expense and wait to get repaid,” says Trevor Williams, vice president of recruiting for Martin, Fletcher, a retained recruiting firm in Irving, Texas. “Now, 30-40% of the hospitals use direct billing to pay moving expenses for you. You’re taxed on that relocation bonus, but you don’t have to wait to get reimbursed.”

Tuition or loan reimbursement

To get students right out of school, more and more employers are willing to cough up a few thousand dollars per year, generally for two to three years, towards repayment of student loans. “This benefit used to be only for pharmacists,” says Williams, “but now allied health candidates should ask for it every time.” Again, you’re taxed on this benefit, but it’s still better than laying out the funds yourself.


Having the freedom to choose your own hours is a given with many health care-related employers. Perhaps you want to work 6:00 a.m. to 3:00 p.m. daily so you can spend the evenings with your children, or you’d rather work 10 hours daily for four days so that you can enjoy three-day weekends. Ogburn says that some students placed by Allied Consulting have such diverse skills that they work three 12-hour shifts at one full-time job, then pick up two eight-hour shifts as a part-time position. “They still work five days a week, but for 50+ hours,” he says. “For someone right out of school with no attachments, they often think, ‘Why not work more?’”

Savings plans

The standard 401(k) option can be found with many employers, however, the dollar value or percentage of your contribution that the company will match can make a huge difference decades down the road.

Free housing

Some employers are so short-staffed that they want you to start as soon as possible—and they’ll prove it by paying rent on an apartment or placing you in staff housing for 60 to 90 days until you find a place of your own.

Commuting pay

If you live outside a certain radius from the employer, or you’re a CT tech, for example, who’s paged in the middle of the night, your employer might reimburse you for the commute, either directly or by adding hours to your paycheck. Says Ogburn, “That’s not really mainstream yet, but it’s something to look out for.”

Employee support and mentoring

Some facilities offer new employees the chance to work one-on-one with more experienced employees.

Certification bonuses

With each exam you pass, you’re a more valuable asset, both to your current employer and to the market at large. Some companies will reward you with a higher hourly rate (up to $1/hr) to keep you on their team.

Child care/dependent care coverage

Most parents will have to cover child-care expenses on their own because hospitals prefer to avoid the high liability costs associated with on-site child care. A flexible schedule can make it possible for you and your significant other to avoid day-care costs—just get used to communicating with your partner through notes.

Immediate benefits

Not a separate benefit so much as an acceleration of existing ones, Williams says that a number of facilities are forgoing the 90-day wait period before benefits kick in and offering them from the first day of employment.

Not-So-Basic Benefit Plans

Other benefits plans that you might encounter include the “cafeteria” benefit plan and the flexible benefit plan.

The cafeteria plan works as if you were choosing benefit options from a menu: Each employee has a certain amount of money to spend on the benefits that he or she deems most desirable, so one person can choose a pediatric dental plan to cover her four kids while a childless employee might opt for more vacation days and no dental plan at all.

A flexible plan grants an employee even more leeway about how his or her benefit dollars are spent. As in a cafeteria plan, the employer determines an upper limit for each employee, but the employee also has the option of receiving part of the funds in cash. However, cash benefits are taxable, whereas life and health insurance are not, so the “take home” value of these options isn’t always equal.

How Employers Stack Up

Nearly every position in the health care industries is in huge demand, in part because the economic boom of the 1990s drew students away from medical schools and into MBA programs. In a tight labor market, conditions have never been better for medical students entering the work force.


“Hospitals are a very good environment,” says Donna Broderick, director of the medical laboratory technician program at Harcum College in Bryn Mawr, Pa. “My husband works for Quest Labs, and his benefits aren’t any better or worse [than those available at hospitals].”

As might be expected, for-profit hospitals tend to be the most aggressive with their salary and benefit offers. In addition to including many of the largest health care systems nationwide, for-profit hospitals often have more leeway than non-profit facilities with their budget. As Ogburn points out, to fill vacancies on a temporary basis, a hospital typically must pay twice the normal hourly rate for that worker; an ultrasound temp, for example, might earn $50 per hour, whereas a staff member would earn $25. For-profits can count on the increased funds a permanent worker would bring in to offset the salary expense, but non-profits typically operate on a set annual budget and don’t have such freedom.

Trevor Williams says that a more important consideration than whether a hospital is for-profit or non-profit is where it’s located. “There’s a massive shortage of allied and nursing personnel in the Midwest,” he says. Richard Doolittle, head of the department of medical sciences at Rochester Institute of Technology, says that many students stay with the clinics and hospitals at which they intern during college, which means that those willing to travel cross-country to a more needy environment might receive juicier offers.

Clinics fall next in terms of aggressive benefits packages, says Williams, “largely because of the quality of life they offer a candidate versus call schedules and different types of shifts available elsewhere.”

Government hospitals fall at the bottom of the scale, offering little more than a strong retirement package and, as Tyler Wilkerson, director of research of Allied Consulting, puts it, “every holiday you can think of.” The government retirement package is strong enough, though, that Williams says many people come out of the service and head straight for VA hospitals.

Sounds Good, But…

Just like buying a new car, don’t feel compelled to sign on the dotted line after the first offer. “It’s very rare when an employer makes an offer that it’s a ‘take it or leave it’ offer,” says Steven Rothberg, founder and president of Minneapolis-based “There’s little to no harm, and often great gain, in asking for an increase in salary or better benefits.”

Despite how it might feel when you’re sweating in the interviewee’s chair, you have almost as much power as the HR manager doing the grilling. Once he makes an offer, you’ve been given the green light to start negotiating. He wants you to work there as badly as you do, and now it’s up to the two of you to decide how valuable you really are.

Ideally, you’ve done research ahead of time—either by asking other students about their paychecks, calling other companies in the field, or reviewing sites such as—so that you know what kind of salary to expect for this position. Before you blurt out a number, however, make sure you understand exactly what this position entails. You don’t want to accept an offer, and then discover you’re also responsible for driving tissue samples back and forth from lab to hospital. Oh, and picking up the lab coats at the dry cleaners. And….

Even if a salary offer falls in the range you expect, you lose nothing by asking for a bit more. Says Rothberg, “Many employers have more respect for employees who aren’t afraid to ask for what they feel they’re worth.”

If more salary is out of the question—and “hard” benefits such as health care insurance and pension plans are non-negotiable, as they often are—it’s time to switch gears and start pushing for “soft” benefits, which include flex-time, shorter review periods, a better workspace, paid or unpaid leave, sign-on bonuses and even fancy titles. “In many organizations, the managers have discretion over soft benefits,” says Rothberg.

Again, whether your proposals are accepted or brushed aside, you gain from having been bold enough to ask. “They understand that you’re not a pushover, that you have value and won’t blindly accept whatever they offer you,” says Rothberg. “Six to 12 months down the line, when it’s time for a formal review, you’ll enter negotiations with the manager knowing you’re not afraid to ask for more.”

Whatever salary and benefits package you finally agree on, don’t seal the deal with a handshake. Get the offer in writing to avoid arguments months later over whether you can take a week’s leave without pay or race lab carts down the hallway.

Finally, don’t be afraid to turn down an offer and go elsewhere. “Anyone in imaging—X-ray, CT, MRI, ultrasound—needs to understand the value they bring to a facility,” says Williams. “Facilities don’t really see the direct benefits of a nurse, but imaging brings revenue into the hospital.” Even if you’re not in imaging, your work will contribute to the value of any organization. Make sure to keep that in mind when you negotiate an offer, and your employer-to-be will have no choice but to do the same.

Forgotten Heroes

As the nation and the world witnessed in the wake of the September 11 terrorist attacks, police officers and firefighters who get hurt in the line of duty are treated like heroes—and deservedly so. When one of their own is injured or becomes disabled, these professionals rally together to help their fallen comrade, providing both emotional and financial support.

Unfortunately, this is often not the case in the nursing profession. Based on my own experience as well as those of other RNs in the same situation, nurses who become disabled due to on-the-job injuries are far more likely to be cast aside by their employers and colleagues than to receive their solidarity and support.

With the nation’s nursing shortage now at crisis levels, more RNs are becoming injured and permanently disabled because of unsafe working conditions. Today’s understaffed health care workplace, where severely overworked nurses are staggering under the burden of unprecedentedly long hours and increased patient-to-nurse ratios, is an injury time bomb waiting to explode. Consider this scenario:

You arrive at work just like you have done for years. Your patient assignment is already a heavy one when three more admissions come your way. You go into Mr. Jones’s room to help him change position. Even though this patient is a large man, asking one of the other floor nurses to help you lift him is not an option, because their workloads are just as frantic as yours.

So you do it yourself—and then you feel an incredible pain in your back. The pain shoots up your neck, causing an unbearable headache. Just as quickly, you experience numbness in your arms and legs, and you fall to the floor. Obviously, you need immediate medical attention. But if you leave the unit, who will take care of your patients?

Because you are not an indestructible Supernurse, however, you have no choice but to go to employee health. Meanwhile, your colleagues are feeling resentment at having to take on your patients and responsibilities in addition to their own. They project their frustrations onto you–and now your coworkers and friends are upset with you because of an unforeseeable accident that was not your fault.

Employee health tells you that you can go back to work if it is light duty–is there any such animal as “light duty” in nursing?–or else you will have to take the next 10 days off. So you stay home for the next week and try to recover. But after a few days, your condition worsens. Now the nightmare begins.

Your medical insurance will not cover you for the accident because it was work-related. The workers’ compensation insurance company insists that you be seen by one of their doctors. After three hours of sitting in a waiting room, the doctor finally enters, pushes you in a couple of places and tells you, “You’re fine, go back to work”—even though your pain is so severe you can barely walk or stand.

Your coworkers can’t understand why you are not coming back to work if the doctor said you are fine. You must be malingering, they conclude. And what if you are unable to return to work for weeks or months? What will you and your family do after the paychecks and disability-leave benefits run out—while your medical expenses continue to mount?

Money Talks

While what I’ve described may sound unbelievable, several employment-law attorneys I consulted after my accident, including the lawyer who is currently handling my case, report that my experience is not unique. And, they add, the reason why this situation keeps occurring can be summed up in one word: money.

Employers pay the premiums for workers’ compensation insurance with the understanding that they want their employees back to work as soon as possible. The insurance company, in turn, wants to keep its costs down by paying out as few claims as possible. Since money talks, the party that is paying the premiums is the one whose interests are honored. As the injured nurse, you quickly learn that you are not a priority with the insurance company.

As for the question of how workers’ comp doctors can get away with telling severely injured nurses they are well enough to return to work despite obvious evidence to the contrary, who is going to go after them? Disabled nurses who have no money to take them to court because they now have no income, medical coverage or workers’ comp benefits?

In New Jersey and some other states, an injured employee is denied by law the right to sue their employer for negligence or even force them to have the worker’s compensation insurer pay for their lost wages or medical care. To make matters worse, another reality I learned the hard way is that work-injured nurses must endure the humiliation of having people from the insurance company follow you and photograph your movements in the attempt to prove that you are a fraud. As a result, you must obtain a lawyer to protect your rights, incurring even more expense.
Depending on the severity of your injuries, this nightmare can drag on for years, leaving many disabled nurses unable to pay their bills or receive appropriate medical care. Some may even lose their homes and their marriages. Many of the work-injured nurses who have shared their stories me have had their cases in litigation for anywhere from eight to 15 years before they were settled. And even though these nurses’ experiences seem to indicate that such cases are usually settled in favor of the disabled worker, why are we forced to wait so long to receive justice?

Some workers compensation companies have tried to argue in court that the nurses are faking their injuries by using their medical knowledge. This is simply absurd. Are police officers who are wounded in the line of duty accused of shooting themselves because they carry guns? Are firefighters who suffer from smoke inhalation accused of starting the fire because they have knowledge of fires? Why does this seem to happen only in the nursing profession—a field whose very reason for existence is to help the sick and injured?

An Unequal Commitment

In England, a government agency, NHS Direct, has been looking into solutions for assisting nurses who have become disabled due to workplace injuries. As reported in the September 2000 issue of Nursing Times, a “work-based assessment is done and ergonomically designed equipment is provided to meet their needs.” Here in the U.S., the federal Department of Vocational Rehabilitation provides resources—such as assessments, educational funding, hearing aids and computers—to help work-injured persons resume their careers or transition into new ones.

But the nursing profession, whether in the clinical setting or in academia, has yet to demonstrate this same level of commitment to helping nurses who have fallen in the line of duty regain their professional lives.

Some work-injured nurses do manage to continue their careers by returning to school and earning advanced degrees. But this, too, is a long process with its own challenges, barriers and prejudice caused by preconceived images of people with disabilities. According to a recently published Minority Nurse article on nurses with disabilities, “because of a long-standing myth that health care providers must be physically perfect…many [disabled nurses] are told that they have no business pursuing or continuing a career in health care altogether.”

The passing of the Americans with Disabilities Act (ADA) more than a decade ago has done much to help level the playing field for disabled nurses. But still, change is slow. A February 2001 Nursing Spectrum article noted that “career transitioning is hard work for disabled nurses…new grads and experienced [nondisabled] nurses are also in competition for the same positions. It’s a buyer’s job market.”

As nurses, we devote our lives to caring for our patients—but when we are the ones who are hurt and need help, we don’t receive the same level of care. When injured nurses are in danger of losing their livelihood, the nursing profession should be part of the solution, not part of the problem. Disabled nurses have a right to expect their employers, educators and colleagues to step up to the plate for them and show the same professional support that police and firefighters do. We deserve more than to be cast aside like forgotten heroes.

Author’s Note: Thanks to Carolyn Zagury, RN, PhD, for her sincere help and support.