Top managers in England's NHS trusts received average pay rises of nearly 7% in 2008-09, compared with less than 3% granted to nurses, a report says.
An Incomes Data Services report into boardroom pay at more than 380 trusts found chief executives earned seven times more than the average nurse.
Senior managers in NHS trusts typically earned £147,500, the report said.
The NHS Confederation said trusts needed top managers to help them through financial challenges.
Unions have questioned why bosses have had above-inflation rises when ordinary workers have had much lower rises, but senior managers have responded by saying that NHS trusts are immensely complicated organisations to run, with budgets of many millions of pounds.
The report into boardroom pay at more than 380 NHS trusts in England found chief executives received a 6.9% average pay increase in 2008/09 - more than double that given to nurses.
Primary care, mental health and ambulance trusts were included.
Chief executives at NHS foundation trusts received £10,000 more a year on average than those managing less "gold standard" trusts.
In 2008/09, senior managers in NHS trusts linked to a national pay agreement received a 2.2% rise, while nurses got 2.75% in 2008/09 and 2.5% in April this year.
Monday's report showed the 6.9% pay increase for chief executives in 2008/09 came on top of a 6.4% rise in 2007/08.
The highest-paid chief executive was at Guy's and St Thomas' NHS Foundation Trust in London, with £270,000, the report said.
A spokesman for Guy's and St Thomas' said: "The pay of our chief executive, Ron Kerr, reflects the experience, expertise and responsibility that the role demands, and we are delighted to have a chief executive of his calibre to lead the organisation.
"Guy's and St Thomas' is one of the largest, most complex and successful NHS Foundation Trusts in the country."
The Department of Health said trusts were independent organisations that set their own levels of senior pay.
A spokesman said: "In December 2009 the Senior Salaries Review Body was asked to carry out benchmarking on all executive pay in the public sector, including foundation trusts.
"All pay arrangements over £150,000 a year must also now be publicly justified.
"NHS senior managers whose pay falls within the national framework will receive a 0% uplift for the 2010/11 financial year."
At Heart of England NHS Foundation Trust, the chief executive received £237,500 while at Cambridge University Hospitals NHS Foundation Trust, the chief executive was paid £217,500.
Report author Steve Tatton said: "Our annual survey of NHS boardroom remuneration will not make comfortable reading for those wishing to see those at the top of the service leading from the front on wage restraint.
"These are undoubtedly testing times for those making decisions about how much to pay NHS chiefs - balancing recruitment and motivation against the need to keep tight control of the public purse - but it seems that the equation has fallen on the side of high salary awards with pay continuing to run ahead of the rest of the workforce."
A union official with Unison, Mike Jackson, said managers did need to be paid a decent salary, but "it is not right for senior staff to get above inflation pay hikes, while the rest of the workforce get a below inflation pay deal."