Employment Contract Negotiation for Nurse Practitioners

By Labor and Employment Attorney Jennifer Lankford

Preparing for and successfully mastering an interview is an important part of the nurse practitioner job search. Once you complete that anxiety-ridden process and receive the coveted job offer, complete with employment contract, you should celebrate! But first, a word to the wise-before signing the dotted line, it is critical that you consider your options and negotiate a mutually beneficial contractual relationship.

All terms of a nurse practitioner’s employment relationship should be clearly defined. Verbal agreement or a handshake will simply not suffice. By memorializing the parameters of your employment relationship in an official signed contract, you are legally protecting yourself should a dispute arise.

Easier said than done, right? How does the negotiation process start? What should you do? Your gut instinct is to hire a knowledgeable attorney to review the contract, but counsel is expensive and you have not even started to receive compensation. Second, hiring an attorney seems so formal, and you don’t want to start your job on the wrong foot, right?

These are common concerns-ones that must be set aside to ensure a successful employment relationship. A savvy nurse practitioner will put discomfort aside and face the negotiation process head-on. The cost-benefit analysis of hiring an attorney easily weighs in the NPs favor-competent negotiation will help you avoid future inconveniences or even litigation, while ensuring that the best possible salary and benefits are afforded to you. What’s more-the conversation does not have to be awkward. In fact, often the best way to involve an attorney in the contract negotiation process is to take what I call the “Wizards of Oz” approach. In other words, the attorney should stay behind the curtain, so to speak-working legal magic while never revealing their existence. Similar to a ghostwriter, the attorney meets the NP and alters provisions of the contract, while coaching the practitioner on negotiation strategies-where to stand firm and where to compromise.

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With or without a “ghostwriter,” there are main areas for nurse practitioners to consider before signing an employment agreement:

1. Compensation & Benefits

Financial considerations are certainly one of the most heavily negotiated terms within an employment contract. When offering compensation, your employer will likely consider overhead, insurance, etc., and weigh those factors against the business you will bring into the company. For the nurse practitioner, the main concern is ensuring that your compensation rate is fair and takes into account the cost of living in the area of employment. You will also want to consider your entitlement to bonuses and ability to receive pay raises. As it pertains to bonuses and pay raises, the criteria for each should be clearly defined within the agreement. You will want to know how salary increases are awarded and, equally a important, when you will be up for consideration for such raises.

Benefits are equally important and a nurse practitioner should be prepared to articulate his or her expectations. A good contract negotiation irons out specifics regarding your insurance cost and coverage, sick leave, vacation days, retirement options, allowance for continuing education (and whether you are entitled to additional leave time to complete these courses), as well as costs of membership in professional organizations.

2. Job Expectations

To perform a job successfully (and ensure qualification for those future bonuses), a nurse practitioner should be sure his or her job expectations are clear. Hours of work and job duties should be carefully described. Given the licensure requirements of your position, it is important to confirm that your future employer will not expect you to operate outside of your practice limitations. Additionally, if your employer expects you to take call, you should determine what restrictions come with on-call rotations and what compensation you will receive for these sacrifices.

3. Length of Relationship & Effect of Leaving

Finally, a job position is more than your pay and vacation days, it is also your employer’s expectations as to when the work relationship will end. If your contract contains a renewal provision, it should be closely examined. For job security purposes, a nurse practitioner will prefer that the contract only dissolve upon his or her voluntary written notice or “for cause” termination. A “for cause” termination provision ensures that the nurse practitioner can only be fired if he or she fails to meet certain requirements or commits specific infractions. If a progressive disciplinary procedure is built into such “for cause” termination-even better.

Frequently, a nurse practitioner’s employment contract will contain a provision restricting the practitioner’s ability to compete with his or her employer once the relationship ends. A non-compete will generally require that the nurse practitioner not practice within a certain geographic period for a specific period of time. An employer will not want you to establish a patient base only to leave and take those patients with you. At the same time, you want to ensure that your future opportunities are not overly limited. Failure to understand and/or abide by these restrictive covenants can be costly. There is a common misconception that these restrictive covenants are unforeseeable, Don’t be fooled-if you read and sign, courts typically hold you to your promise. At best, the court will typically only modify the restrictions against you to ensure reasonableness, but not void the restriction altogether.

In sum, it is essential that nurse practitioners understand the terms of their employment agreement before signing a binding contract. At the very least, the above three areas should be carefully considered. Remember-don’t be shy about engaging in the negotiation process. In today’s workforce, it is as expected as it is essential.


Jennifer Lankford is an associate attorney at Thompson Burton, focusing her practice on labor and employment law. If you have a question about your employment agreement, Jennifer can be reached at jennifer@thompsonburton.com.





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2 thoughts on “Employment Contract Negotiation for Nurse Practitioners”

  1. I am curious whether it is better to have a contract than not. I currently work for a clinic that required a contract upon initial hire. Of course over the last two years of working with the clinic there has been contract issues that have arose including not meeting the salary, bonuses, and full time hours as negotiated. And I am also stuck with a non-compete clause where I can not work in the same specialty while at this job. I am now going to be going down to part time so I can start working part time at another clinic. This new clinic does not make contracts. My question is again- Do you think it is better to have a contract that may pigeon hole you into certain requirements, or is it better to not have one in order to negotiate terms later as needed, or make changes as they arise. Thanks!

  2. Jennifer Lankford


    Your question exemplifies the age-old debate: to contract or not to contract? As you imply, there are definite down-sides to a contractual relationship – restrictive covenants (non-competes) and how to properly reacte when your employer fails to meet its obligations. In your case, obligations weren’t met, and while suing for breach of contract is an option – it is not one that you want to exercise. Instead, you end up having awkward conversations where you point to your contract and remind your boss of their responsibilities. The up-side, there are responsibilities owed to you. Without a contract, then, depending on the state of your employment, you may be terminated at any time, for a good reason, a bad reason, or no reason at all. In contrast, a contract ensures that, absent a flagrant violation by you, you will receive a certain compensation for a specified period of time. In other words, the job security is attractive.

    With pros and cons to both, I will offer you my personal preference – no contract. In my opinion, employees should be permitted to take advantage of future opportunities as they see fit, and likewise, employers should be permitted to terminate an employee who fails to perform to their expectations. That being said, contractual relationships are not always avoidable. In fact, in your profession, they are often the norm. With this in mind, the best thing that you can do is read before you sign and face the negotiation process head-on. With the appropriate terms written into your contract, you can ensure that you maintain the advantages that come with employment at-will, i.e., non-contractual employment.

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