Throughout the COVID-19 pandemic, health care workers who were working long hours with few resources were framed as heroes on the front lines helping defend the world against a deadly virus.
In South Dakota, some health care heroes — nurses — aren’t paid a hero’s wage. Nursing wages in South Dakota are the second-lowest in the nation, trailed only by Alabama.
The hourly mean wage for a registered nurse in the state is $29.31, and the annual mean is $60,960, according to a report from the U.S. Bureau of Labor and Statistics. For Rapid City, the annual mean wage is $61,540, but that still pales in comparison to the national mean annual salary, which is $80,010, and the national mean hourly wage of $38.47.
South Dakota trails behind neighboring states in a regional comparison of nursing salaries as well — North Dakota’s mean hourly salary is $33.47 and mean annual salary is $69,630; Minnesota’s mean hourly is $38.92 and mean annual is $80,960; Nebraska’s mean hourly is $33.41 and mean annual is $69,480; Wyoming’s mean hourly is $34.90 and mean annual is $72,600; Iowa’s mean hourly is $30.08 and mean annual is $62,570; and Montana’s mean hourly is $33.91 and mean annual is $70,530.
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Low wages and other factors affect types of nurses and regions of the state differently, however.
In Rapid City and Sioux Falls, the state’s two urban areas, the average nurse’s salary is a little higher than the state average. The highest concentrations of nursing jobs in the state also exist in Rapid City and Sioux Falls, and more specialty nursing jobs are available in those areas. Sioux Falls has one of the highest concentrations of nursing jobs in the country, according to the Labor and Statistics report.
Toni Miller, a home health nurse with Avera@Home, said that she is satisfied with her current job and that she is fairly compensated for the work she does, but that is not the case for some of her nurse friends who work in clinics and long-term care facilities. Some of the struggles in those areas include high turnover and long hours in addition to below-average pay.
Miller, who lives in Sioux Falls, has been a nurse in several different settings. Her current position is a “night-and-day” difference from when she worked in a clinic.
“The busiest work was in the clinics. You are literally rooming patients every 15 minutes and going all the time,” she told the Journal. “I was not fairly compensated in the clinic … looking back, I can’t believe they pay people in clinics [so little]. The work is very, very busy, and I don’t feel anyone was compensated fairly. The work is not so much physically hard as it is mentally hard.”
In rural areas, hospitals and clinics have a harder time recruiting and retaining nurses and rural positions often do not pay as much as those in urban areas.
The executive director of the South Dakota Board of Nursing, Linda Young, told the Journal that the most successful strategy for rural recruitment is “growing your own,” referring to locals who come back to work in their hometowns.
For Miller at least, that holds true. She was born and raised in South Dakota and her entire family lives in the state as well. She started working as a nurse in the Sioux Falls area right out of college, bought a house, and never left.
Young also said due to the pandemic, the state has been bringing in a larger number of travel nurses to help keep up with the demand, and hopefully some will be inspired to stay in the state.
“Wage is a big impetus in that decision,” she said. “Hopefully, we can see the number go up and we can be a little more competitive in this country.”
Nursing wages also differ by health care system. There are a number of nurses who work for the state whose salaries can be accessed at open.sd.gov. The state has three different categories of nurses — I, II, and III — who get paid anywhere from $25.66 to $35.83 per hour. All of the state’s nursing jobs fall well below the national average for nursing salaries.
State nursing facilities include the State Veterans Home, the Department of Social Services, and Department of Corrections infirmaries, and they require a medical staff to treat various conditions of individuals receiving care. The Department of Health also employs nurses who work in community health offices statewide, according to Jesse Merkel, a spokesperson for the State Bureau of Human Resources.
“Nursing professionals employed by the state are dedicated to fulfilling the medical needs of their patients. They have been on the front line of defense during the past year, and their hard work is greatly appreciated by all South Dakotans,” Merkel said.
At Avera, Vice President of Talent and Rewards Kimberly Enebo said she feels the health care system has a competitive pay rate for its nurses. Avera has a market-based compensation program that looks at national, regional and local nursing salaries to determine a competitive salary. Enebo said over the last few years, Avera has invested in structured pay increases for their nurses.
Additionally, Avera offers a student loan repayment program to incentivize their nurses to stay, which gives them up to $10,000 over the course of five years to help them repay their student loans. Enebo said more than 400 nurses are participating and there has been no turnover from participants in the program.
“We have to have a competitive rate to attract new graduates. They’ve got student loans and they want to get their life started, get married, buy a house and have children,” Enebo told the Journal. “I feel we have a competitive salary — we have to, or we wouldn’t be able to continue to fulfill the ministry of Avera.”
Monument Health in Rapid City also said it provides satisfactory compensation to its workers. Trina Allen, Monument’s vice president of human resources, said “no matter how you slice it,” the average salary for a Monument nurse is several dollars higher than the state average.
“I take pride in our competitive wages. We do a market analysis and look at what others are paying. And when we see those reports [from the Bureau of Labor and Statistics], we are proud that we are significantly higher than the wages they keep showing for South Dakota nurses,” Allen told the Journal. “We don’t want this reputation that South Dakota pays low wages; we feel that’s not true.”
While Monument’s wages are competitive, Vice President of Foundation and Brand Strategy Robin Zebroski said the housing market in Rapid City makes it difficult for potential new nurses to find an affordable place to live.
Allen said occasionally Monument loses nurses who are in search of better pay, but mostly people leave because they are leaving the state or pursuing a new opportunity. Frequently, nurses leave for jobs elsewhere or to go back to school. Over the last year, Zebroski said the top reason nurses leave is scheduling issues; many nurses have families to take care of.
South Dakota ranks toward the bottom for most salaries, not just nursing, according to South Dakota State Federation of Labor, AFL-CIO President Kooper Caraway. Low wages can create multiple problems for workers, as issues of workplace safety also relate to pay grade. Low wages can force a worker to pick up extra hours that may not be healthy for them, and more accidents happen when people are overworked.
Unionizing can help with this, he said, because workers can collectively bargain for better pay and conditions. For health care workers specifically, the appetite for unionization is generally high, according to Caraway.
There are a few health care unions in South Dakota, but only a “real small handful,” Caraway said. Potential unions have to struggle against misinformation campaigns that claim South Dakotans can’t unionize because it is a Right to Work state.
“Our position is all health care workers deserve the right to unionize. They should form unions and the AFL-CIO would be willing to give time, resources and manpower to achieve that,” Caraway told the Journal.