NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Sample Answer for NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two Included After Question

As revenue generators, NPs must be aware of how their work contributes to the overall revenue of the clinical practice. You see 20 patients per day on average and take call every third weekend. According to Buppert (2011), an NP who sees 15 patients per day at $56 per patient visit, on average, brings in $840 per day. Allowing 1 week off for continuing education, 1 week off for illness, and 4 weeks off for vacation, this NP will bring in $193,200 a year, potentially. However, not all bills are paid. With a 90% collection rate—a reasonable collection rate for an efficient practice—this NP actually will bring in $173,880 per year. An NP who sees 24 patients per day will bring in $1344 per day, or $309,120 per year in accounts receivable. With a 90% collection rate, this NP will bring $278,208 to the practice (Buppert, 2011).

Establishing a salary can be a challenge for NPs. Deducting 40% of the NP’s gross generated income for overhead expenses (rent, benefits, continuing education, supplies, malpractice, lab expenses, and depreciation of equipment) leaves $104,280 for the 15-patient-per-day NP and $166,925 for the 24-patient-per-day NP. Further deducting 15% of that figure to pay a physician for consultation services leaves $88,638 in salary for the 15-patient-per-day NP and $141,887 in salary for the 24-patient-per-day NP. Deducting 10% for employer profit leaves $79,775 in salary for the 15-patient-per-day NP and $127,699 for the 24-patient-per-day NP (Buppert, 2011).

What salary would you propose for the contract renewal? How does your salary proposal fit in with the community standard for an NP in a similar practice? Use logical reasoning, and provide evidence based rationales for your decisions. Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP.

A Sample Answer For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

According to salary.com the average US NP makes approximately $116,000 per year. The same site states that the average salary in my area is between $108,000 and $126,000 per year. Danielsen, Potenza, and Onieal (2016) suggest that you should not think that the salary of the position you are pursuing has a predetermined rate. Considering a previous rate of approximately 20 patients a day and a projected rate of 24 patients a day, a salary of $117,000 would be appropriate. Using Buppert’s equation, seeing 20 patients a day would produce an approximate salary of $106,000 and seeing 24 patients would produce an approximate salary of $128,000.

If you take both salaries and average them it is approximately $117,000, a fair rate in the current market of NPs. This also leaves room for negotiation for the next contract when goals are met. Considering this position is a contract position, I would not hesitate to ask for a bonus based on performance, collection rates, and revenues. Independent contractors typically provide for their own medical insurance, malpractice insurance, and continuing education costs, this is a substantial savings to the practice. In New Jersey the cost of a family health care plan can cost an employer more than $20,00 yearly, while malpractice insurance costs approximately $2000 a year for a family practitioner (NSO.com).

Resources:

Danielsen, R., Potenza, A. & Onieal, M. (2016). Negotiating the professional contract. Clinician Reviews, 28-33.

Decapua, M. (2016). How much revenue does a primary care nurse practitioner generate? Retrieved from https://www.bartonassociates.com/blog/how-much-revenue-does-a-primary-care-nurse-practitioner-generate/

Nurses Services Organization. (2018). Quick Quote for Individual Professional Liability Insurance. Retrieved from https://forms.nso.com/mustela/site?productName=HCI#/QuickQuoteDetails.

Salary.com. Nurse practitioner salaries in Toms River, NJ. Retrieved from https://www1.salary.com/NJ/Toms-River/Nurse-Practitioner-salary.html

A Sample Answer 2 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

I had an experience to try to negotiate my salary as an RN when laterally moving from a per diem position to a full-time position at my current job. I was per diem and circumstances at the hospital meant that I may not be able to work as much as I would like. I took a position with a differential then before my transfer a full-time position opened on the unit I was working on. I wanted to stay on the unit, but I did not want to lose the differential of the other position since I was taking a cut in pay from the per diem position. I had a meeting with my manager and told her that I needed a little higher of a salary to take the position on my unit. Unfortunately, one of the hospitals in our system is union and there is a set protocol for pay.

However, since my manager really wanted me to stay on the unit I was given the salary of an RN with 5 years-experience even though I was several months from that anniversary. I would have stayed even if I didn’t get more money. That was the job that I really wanted. Happiness in your position is sometimes more important than salary. Gillet, Fouquereau, Coillot, Cougot, Moret, Dupont, Bonnetain, and Colombat (2018) in their study of job satisfaction and quality of care found “the present results revealed that job satisfaction related positively to quality of care and negatively to turnover intentions” (p. 1215).

Resource:

Gillet, N., Fouquereau, E., Coillot, H., Cougot, B., Moret, L., Dupont, S., Bonnetain, F., & Colombat, P. (2018). The effects of work factors on nurses’ job satisfaction, quality of care and turnover intentions in oncology. Journal of Advanced Nursing, 74, 1208-1219.

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A Sample Answer 3 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

I would propose a salary starting with the base of the 20 patients per day I would see and calculate from there similar to Buppert (2011), including costs, consults, sick time, vacation, and continuing education which would be around $105,000. This base rate varies by state and specialty, taking for instance the 2012 survey in Arizona depending on the nurse practitioners specialty the salaries range from 24,000 to 103,000 dollars (Widemark,2012). According to this scale the range would not be correct therefore it is important to know the state salary and living expenses in which you are in.  

Another driver of the wages one will make as an nurse practitioner is the demand for nurse practitioners in that area, as the need for mid level providers increases the wages will increase until the void is fulfilled. According to the bureau of labor the number of nurse practitioners in some states is minimal yet they are being paid some of the highest in the country to keep up with the competitive salaries of those states with more demand for nurse practitioners (Bls.org,2017)

Bureau of Labor Statistics,2017, Bls.org

Widemark,2012. Nurse practitioner salary survey. Nurse practitioner world news

A Sample Answer 4 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Since I am a family nurse practitioner nursing student I could only make a guesstimate on what should be the proper salary for a practicing nurse practitioner.  Actually the only research I have looked into when it comes to nurse practitioner salaries is the common median salary for a nurse practitioner in the state of Texas.  From the various websites and from talking to actual nurse practitioners the median in Texas seems to be over $100,000.  I would have to learn more and actually become a nurse practitioner to figure out the true salary that I believe I deserve and would work towards obtaining in the future.  

Apparently according to other nurse practitioners at the organization that I work at, the amount of patients that you see will contribute to salary.  I would strive to see a good amount of patients ranging from 20 to 24 patients based on the salary breakdown on the question above.  I would propose for $110,000 to $120,000 salary based median.  I believe that fits with the common median of what a nurse practitioner who makes.  One also has to understand where the nurse practitioner is working because based on where the nurse practitioner is working it will affect and contribute to how much the NP will make in a year.  

For example a nurse can work at a private practice office, a clinic, or even go a step further and work in the hospital setting as an advanced nurse practitioner.  It is important that a nurse practitioner keeps up with the current salaries because it is important that he or she gets paid the correct amount that he or she deserves. Nurse practitioners do  have more advocacy and independence then a bedside nurse however there comes more responsibility.  

I do believe that as a nurse practitioner games more responsibility I believe that the salary needs to be revised and examined.  Patients are becoming more complex and critical and there is a shortage of actual practicing physicians .  This is  One of the reasons that nurse practitioners are gaining more responsibility and I believe as nurse practitioners gain more task and responsibilities that the salary should be increased. (Levine, 2015)

NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two
NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Referances:  Levine, J. (2015). Nurse practitioner practice characteristics, salary, and benefits survey, 2003. Clinical Excellence For Nurse Practitioners, 9(1), 49-58.

A Sample Answer 5 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

NPs salaries is an important discussion because it directly ties in with our work ethic. The connection between pay and the NPs work attitude is a subject that is typically swept under the rug. When pay is brought up, physicians argue they charge less for NP services. Yet, physicians want to collect the most money they can from NP fees. While nurse practitioners continue to draw lower salaries because doctors charge lower fees for NP services, NPs are doing more and more work.

Our duties and scope of practice has expanded due to legislation that has been passed. True, NPs want full practice and prescriptive authority, but we also want an increase in pay. As the medical field relies more on NPs to fill the primary care physician void reimbursement and salary issues must be addressed to avoid a backlash from NPs (Ulrich et al., 2014). Salary transparency is a positive factor; however, salary transparency combined with pay fairness and pay raises eliminates employee turnovers and employee dissatisfaction.

Research conducted by the Society for Human Resource Management shows a fair and transparent pay process boosts employee engagement more than providing additional pay (Miller, 2017). I am a proponent of both: fair and transparent pay and additional pay. Just having an open dialogue about pay is not enough for me. I appreciate the accolades about my contributions to the practice and patients’ health welfare, but ultimately, I want to be compensated for my work.

References:

Miller, S. (2017). Pay fairness perception beats higher pay for improving employee engagement. Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/compensation/pages/pay-fairness-beats-higher-pay-for-engagement.aspx

Ulrich, C. M., Zhou, Q. (Pearl), Hanlon, A., Danis, M., & Grady, C. (2014). The impact of ethics and work-related factors on nurse practitioners’ and physician assistants’ views on quality of primary healthcare in the United States. Applied Nursing Research : ANR27(3), 152–156. http://doi.org/10.1016/j.apnr.2014.01.001

A Sample Answer 6 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

After reading through the case study, there is definitely some figuring to think about. In all honesty, I would feel that the 24-patient-per-day salary is what I would propose for, because of many reasons. Where I currently work as a RN in the Emergency department, we occasionally float to the urgent care to work. This is a rural hospital, but it is a very busy facility. During the winter months, it is not uncommon to see upwards of 60 patients in a 12 hour period. This is definitely a large patient load for 2 nurses and one nurse practitioner. I have worked in that setting, and seen the struggle that it can be, but 24 patients in an 8 hour setting is 3 patients an hour, on average. The AANP suggests that the majority of nurse practitioners see 3 or more patients an hour (AANP, 2018).

To be honest, I would want to suggest a higher salary if I was applying for a position in an urgent care such as this one. If I was seeing 60 patients a day at $56 per patient visit, I would be bringing in a revenue of approximately $870,000. This is nearly 3 times as much as a 24-patient-per-day nurse practitioner. Granted, this is for 24 hour shifts, where the 24-patient-per-day is more than likely an 8 hour day. The nurse practitioner may treat four or more patients per hour throughout the entire work day in an urgent care setting (n.a., 2016). Working in the urgent care doesn’t have the luxury of having a schedule, so the amount of patients that you may see could be greater or lesser than 4-per-hour. On average, it will all even out. I think that when determining salary, it matters where they anticipate you to be working. I would like to work in an urgent care versus a primary practice, so I would want to have a higher salary than what the 24-patient-per-day nurse practitioner proposal states.

AANP, (2018). NP Fact Sheet. Retrieved from https://www.aanp.orgLinks to an external site. n.a. (2016). How many patients should FNPs expect to treat per hour. [Web log post]. Retrieved from https://www.midlevelu.comLinks to an external site.

A Sample Answer 7 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Wow, the information Buppert (2011) presented in the above discussion, regarding the income an NP bring home after all bills are paid was eye opening! I can see how establishing a salary for a NP can be challenging.  Even with the information Buppert (2011) present, when I determine the salary I desire to earn I would consider the National Salary Survey of Nurse Practitioner conducted by ADVANCE, the geographic area, and the average APN FNP during that time.  I also think it would be a great ideal to network and speak with other ANPs within my areas to get a better understanding and ideal for what is common when negotiating. 

I’m sure with any job or career salary is a sensitive topic for the employee and employer but it is a topic that has to be clear and address.  According to Danielsen, Potenza, and Onieal (2016), regarding salary and bonus compensation can be either objective (production based), subjective (entirely up to the discretion of the employer based on internal criteria) or both.  Regardless of the system that is used it is critical that NPs have a clear understanding on what is expected and what the rewards are for meeting those performance expectation and goals. 

Because this will be a contract renewal I would propose a higher salary than the previous two years of service but a salary that is within expectation/limits for the practice. I do believe that what is most important is that the expectation and desired salary is reasonably and realistic.  

Reference

Danielsen, R. D., Potenza Ll, A. D., & Onieal, M. (2016). Negotiating The Professional Contract. Clinician Reviews26(12), 28-33.

A Sample Answer 8 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

According to the Bureau of Labor Statistics (BLS), the average NP salary is $107, 460. As of April 2018, Salary.com has listed the average NP salary in Georgia as $93, 346 (low) to $102,049 (high).  I am used to handling a heavy patient load, so I would consult at least 24 patients per day. I would establish my salary based upon two conditions: how long I plan to stay with the organization and what the average NP salary was for the area in which I work. For example, I would ask for a higher salary if I worked in the City of Atlanta versus the small town of Columbus, Georgia. If I plan to stay with the organization and seek a contract renewal once my initial contract was up, I would ask for a little less no matter what area of Georgia I work.

This means I value the organization and want to leave salary room for a raise. I do not want to cap out because I will have to find another job that meets my criteria. Keeping the BLS salary and the salary.com figures in mind, I would ask for $97,000 annual salary. An NPs salary is indicative of the investment the NP made in his or her career and his or her level of skill/ expertise; years of experience means I can command a higher income (Dillion & Hoyson, 2014). Besides, as a professional nurse who has earned a master’s degree, I should make no less than $46.12 per hour (Dillion & Hoyson, 2014).

A nurse, especially a nurse with a higher degree, can never be compensated for what they are worth—but they can sure come close. Nursing is long, hard, back-breaking work. It is mental and emotionally taxing. Nursing is a calling, but this does not mean we should not be compensated. Nurses invest a lot of money and time into becoming invaluable medical professionals. The nursing shortage is real. If nurses are worried about paying off school loans, driving unreliable cars, and unable to comfortably take care of their families, no amount of love for the profession or their patients can get them to stay.

References

Dillion, D., & Hoyson, P. M. (2014). Beginning employment: A guide for the new nurse practitioner. The Journal for Nurse Practitioners10(1), 55-59. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2013.09.009

A Sample Answer 9 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

I can understand my employer’s concern about me not seeing enough patients; however, there is nothing I can do about patient traffic since I do not book patients. Weirdly, this falls under unrealistic employer requests. My genuine mindset is, patients will call in for appointments or they do not. Also, booking patients is the job of the office manager or patient consultant. However, I also understand the necessity of me being a team player and fostering interprofessional teamwork outside of a clinical setting (Poghosyan, Norful, & Martsolf, 2017). I want to avoid offending my employer, so I can suggest the office manager or patient intake nurse make a follow-up call to all patients to check on their health statuses—this way the office person can “suggest” a visit if the patient mentions any serious health concerns.

I am not an advocate of patients getting a checkup every time a tweak or an uncomfortable feeling arises. But, this is a good way to catch up with patients and prompt them to book the NP to conduct a preventative or wellness exam. I can also suggest the employer make use of my other nursing skills. I can review patient charts and make health-based suggestions/interventions; I can pass out my employer’s information at health and community fairs. I can also create an infographic or ppt about patient information the employer can use later to assess services and satisfaction of services among patients.  NPs are trained and skilled in many areas of nursing to include office and computer-based work; diagnosing patients and administering care are not the only skillsets NPs have (Poghosyan et al., 2017).

References

Poghosyan, L., Norful, A. A., & Martsolf, G. R. (2017). Primary care nurse practitioner practice characteristics: Barriers and opportunities for interprofessional teamwork. The Journal of Ambulatory Care Management, 40(1), 77–86. Retrieved from http://doi.org/10.1097/JAC.0000000000000156

A Sample Answer 10 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

I have actually thought about this recently when I was looking to get an appointment with my PCP.  His schedule was very full and I was not able to get in with him for a couple of weeks.  The scheduler offered me an appointment with the PA first thing in the morning for the next day, or one of the other doctors in the practice later that day.  Of course I wanted to see my doctor, but I took the PA appointment.  I have heard patients in our ER ask why they were seeing a PA or NP instead of a doctor and I think there are a fair number of patients who will always prefer an MD.  I feel that the schedulers are in a position to “talk up” scheduling patients with the NP who may have a schedule that allows for more appointments. 

Schedulers should be educated on the role of an NP and how to respond to patients that may make comments about not seeing the NP.  That is one small suggestion.  Some other ways to increase overall appointments would be to have the NP’s name listed on the door along with the MD’s who work for the practice.  This way patients coming to the office see the NP as a provider, not just as support staff.  The NP’s business card should also be included where the MD’s cards are.  I think this works as good advertising as well.  In my case I was offered an appointment and I remembered seeing the PA’s name on the door quite awhile ago.  It made me think that she must be a good provider if she is still there, and she isn’t

When I chose my current job, I took whatever salary I was offered to me because I wanted the job so badly. It was the standard contract salary for all the new nurses fresh out of school. After seeing newer nurses with less experience come in making more than me, I am curious to how the hospital or nurse negotiated that. I always knew that Nurse Practitioners made more money, but I never researched salaries or considered the higher pay as part of my choice to go back to school. As a newer, inexperienced nurse that takes fewer patients, I would expect to make less. As I start to gain confidence and see more patients, I need the skills to negotiate a higher salary. Research has also shown that NPs make different wages based on specialty setting and other social factors (Greene, El-Banna, Briggs, & Park, 2017). A 2017 survey of Nurse Practitioners showed the average salary for a female NP was $96330 (Greene et al., 2017).

If I were seeing about 20 patients a day at a 90 percent collection rate, I would expect the average salary of the 15 patient and 24 patient NP. 103,000 sounds like a reasonable take-home salary for my patient load of 20 (Buppert, 2011). This salary is slightly higher than the average NP salary, but I could also show my boss salaries from the state and my specific specialty to back up my request. I would have realistic goals and expectations. There has been a shift in PCP pay based on performance and patient experiences (Gannon & Becker, 2013).

As a future FNP, I have a role in transforming healthcare and giving my patients better care experiences. ACNPs have strong communication skills, improve work culture, and decrease Emergency Room visits (Gannon & Becker, 2013). Patients treated by NPs perceive better care and give higher scores on HCAHPS, leading to better Medicaid reimbursement (Gannon & Becker, 2013). With higher reimbursement rates, I deserve at the minimum the national average for pay, if not more for my patient load. 

Greene, J., El-Banna, M. M., Briggs, L. A., & Park, J. (2017). Gender differences in nurse practitioner salaries. Journal of The American Association of Nurse Practitioners, 29(11), 667-672. doi:10.1002/2327-6924.12512

Buppert, C. (2011). Nurse practitioner’s business practice & legal guide. (4) Gannon, W. D., & Becker, D. (2013). The acute care nurse practitioner and the transition to pay for performance. Journal for Nurse Practitioners, 9(4), 249-251. doi:10.1016/j.nurpra.2013.01.014

A Sample Answer 11 For the Assignment: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

Title: NR 510 Week 3 Discussion Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two

I can relate to you so well.  When I was a new nurse, fresh out of school I was so excited that I settled for any offer just because I was able to work as a new nurse in the ICU. However, as time went on I started to see new nurse come on with no experience making more than myself that became a little disturbing.  However, after reading and participating in this discussion, it makes me wonder should I have negotiated my offer.  It also makes me wonder if I should discuss my current pay rate with my manager during my annual evaluation/performance.  For my future career as a FNP, I did not consider the career path as a FNP related to the pay for FNP when I decided to return to school but I knew that NPs made a higher salary. 

I know that many people may feel that research is irrelevant, but this is a great case, discussion where research can play a critical role with evidence-based facts to support or request a higher pay or a reasonable pay. It will be hard to argue or disagree a request for a desire pay with research as the supporting data.  Many healthcare organizations strongly encourage the use of EBP and the use of EBP with a request for a higher pay would be a great. 

Signing a new or renewing contract salary is a delicate issue that the NP’s need to pay attention to. It is essential to know what your worth and average salary you are eligible to receive. Understanding the terms and conditions of the contract are vital to avoiding conflict. The first thing that needs to be known is what the state salary averages are. My base salary should be based on her geographic area averages (Taylor, 2007). If my base salary for 24 patients is $127, 699 then by calculations (127,699 divided by 24 times 20) a base salary for 20 patients would be $106,415 (Buppert, 2011).

Nurse Journal.org has a great salary by state webpage that is very helpful in determining median averages (Nurse Practitioner Salary by State, 2015). Since I would be new to the practice suggest asking for a salary close to the previous calculations. I would negotiate for a base early salary of $110,000. However, I believe it is possible to see 24 patients per day and would opt to negotiate this and thus ask for a base yearly salary of $130,000.

Your work ethic will induce the decision maker to renew your contract and give you what you are asking for. Be prepared to show the performance and the quality of your services such as patient satisfaction, increasing in repeat customers, decreasing of no-show appointments, and gain of additional patients. A good reputation is an important asset for the practice. High levels of patient satisfaction attract more patients which translate to more business for the practice, consistent profitability and more revenue (Shirley, & Sanders, 2013).

Buppert, C. (2011). The employed nurse practitioner. In Nurse practitioner’s business practice and legal guide (4th ed., pp. 319-320). Sudbury, MA: Jones and Bartlett.

Nurse Practitioner Salary by State. (2015). Retrieved from http://nursejournal.org/nurse-practitioner/nurse-practitioner-salary-statistics/Links to an external site.

Shirley, E. D., & Sanders, J. O. (2013). Patient satisfaction: implications and predictors of success. J Bone Joint Surg Am, 95(10), e69. doi: 10.2106/JBJS.L.01048

Links to an external site.

Taylor, L. (2007, March 6). Contract negotiation. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Contract-Negotiation-2.aspxLinks to an external site.