The Best States to Work as a Nurse in 2024

As a nurse, you’ve faced complex challenges in patient care, made tremendous sacrifices, and experienced moments of intense joy and sorrow. The places where you’ve worked helped shape these experiences and the nurse you have become.

Nurses who decide to seek greener pastures face an exciting but difficult choice. Factors such as state laws and regulations, patient populations and demographics, cost of living, and regional demand influence your options.

To help decode these factors, NurseJournal collected and analyzed twelve data points across every state. With input from nurses, we weighted these data points based on importance to determine a ranking of the best states to work as a nurse.

Whether you are a nursing student considering relocating or an experienced nurse looking for different career opportunities, this guide can help you decide where your nursing career may take you next.

Learn about start dates, transferring credits, availability of financial aid, and more by contacting the universities below.

Find Out Below Where Your State Ranks.

The nurse career opportunity category makes up roughly 25% of each state’s final ranking. Nursing offers diverse career paths with abundant opportunities for growth and specialization. However, the opportunities can vary significantly between states.

The data in the table below was gathered from the U.S. Bureau of Labor Statistics. Cost of living data from the U.S. Bureau of Economic Analysis was then used to adjust median annual salaries. After adjusting for the cost of living, the top three paying states are California, Hawaii, and Oregon.

Hawaii and California are among the most expensive states to live in the U.S., but they also report some of the highest nursing salaries in the country. These earnings are enough to offset the high cost of living. It is important to consider that many nurses in these states may work outside major cities where the cost of living is lower yet continue to receive higher-than-average salaries. Nurses in Nevada report lower median salaries but also enjoy a lower cost of living (about 5% less than the national average).

The final ranking of best states for career opportunities also considers RN occupation density (the number of RN jobs per 1,000 jobs available) and projected employment growth over the next decade. Arizona, Colorado, and Nevada are projected to see the largest employment growth for RNs.

Safety in the workplace is paramount to ensuring quality patient care and staff well-being. A safe environment fosters confidence, reduces stress, and prevents injury, upholding integrity in healthcare.

We measured the best states for nurse safety based on the presence of safe staffing regulations, the rate of nurse injury or illness, and the projected supply of new nurses to meet healthcare facility demand.

California, Oregon, New York, and Massachusetts each appear in the top states for safety, thanks to safe staffing regulations that mandate nurse-to-patient ratios state-wide or by specific unit. We also considered the presence of hospital-based staffing committees and public reporting requirements.

Kansas and Louisiana reported the lowest rates of nurse injury or illness. Vermont had the best-projected supply to meet demand by 2035 and the third-lowest rate of injury and illness.

Elizabeth Clarke, a board-certified family nurse practitioner, believes a healthy nurse-to-patient ratio is the most important factor when considering a move. “It means safer staffing, less risk of mistakes being made, and lower rates of burnout. In today’s world of patients being sicker than ever, having multiple comorbidities and hospitals constantly having staffing shortages, I would want to ensure the state I am interested in has a legislature in place to ensure adequate nursing staffing numbers,” she said.

BSN-prepared nurses have advanced clinical knowledge, critical thinking skills, and leadership abilities. Research has regularly demonstrated these skills translate to better patient outcomes, improved decision-making, and greater adaptability to complex healthcare environments.

Nursing education is critical when determining the best states to work as a nurse, and these factors typically reflect regions with strong investments in education through grants, financial aid opportunities, experienced educators, and career mobility programs.

Two measures used to evaluate the level of education in the state were the percentage of practicing nurses with a BSN or higher and the first-time pass rate on the NCLEX-RN. A greater number of BSN-prepared nurses indicates greater educational advancement opportunities. The NCLEX-RN pass rate is a general reflection of the quality of nursing education in the state.

Colorado ranked first for nurse education overall. Colorado placed in the top five among all states for first-time NCLEX-RN pass rate and the percentage of nurses with a BSN or higher. New Hampshire holds the top position for the highest NCLEX-RN pass rate but did not appear on the final ranking due to only 63% of nurses having a BSN or higher.

Job satisfaction and reducing burnout are crucial for staff retention and identifying cities or states that are supportive of nursing careers. These factors impact morale and well-being.

Addressing satisfaction and burnout improves retention, enhances patient care, and reduces turnover costs. Burnout data was collected from the American Nurses Association Mental Health and Wellness Survey. Satisfaction data was collected from the National Sample Survey of Registered Nurses. Data from 18 states on burnout was omitted due to sample size, which is reflected in the chart below.

There was no state where the percentage of nurses extremely satisfied with their jobs reached 50% or greater. Utah ranked highest with 47.1%, and Washington D.C. was lowest with 31.2% of nurses reporting extreme satisfaction. Of the states with a cohort large enough to measure, the percentage experiencing burnout ranged from 70% in Oregon to 46% in Georgia.

Hospitals with high ratings or Magnet status offer greater supportive working environments, more professional development opportunities, and emphasize nursing contributions. Healthcare institutions prioritize staff well-being and excellence, which fosters better patient outcomes. The overall hospital ratings were collected from the Centers for Medicare and Medicaid (CMS).

The ratings are based on measurements of mortality rates, patient experience, readmission rates, and safety, effectiveness, and timeliness of care. Instead of listing the number of Magnet hospitals per state, the data was adjusted for the population to reflect the number per 10,000 nurses. This prevented rewarding higher population states that had a greater number of Magnet-designated hospitals. Overall, Texas (62), California (54), and New York (46) have the most Magnet hospitals.

The ranking of the best states for nurses is a fluid measurement. You’ll find that conditions vary between individual facilities, nursing roles, employers, and counties within each state. Many of the top 10 states in our ranking performed above or below average in at least one or two measured metrics.

The best state for you may depend on factors most important to your situation. These rankings will likely change as the metrics they were based on also evolve. For example, advocacy has triggered changes in nurse-to-patient ratio guidelines and legislation.

Federal, state, and local efforts are underway to reduce the nursing shortage, which can impact staffing guidelines, nurse satisfaction, patient outcomes, and burnout. Technological advances can help reduce non-nursing tasks, impacting satisfaction and burnout. As you consider the best states to work as a nurse, remember to consider how the professional environment ranks and how those rankings impact your circumstances.

The best states to work as a nurse were determined using a weighted average ranking across 12 different metrics grouped into five categories, including RN salary adjusted for cost of living, RN occupation density, the percentage change in RN employment, nurse-to-patient ratio legislation, RN supply and demand, rate RN injuries and illnesses, first-time NCLEX pass rate, percentage of RNs with a BSN or higher, RN job satisfaction, RN rate of burnout, overall hospital ratings, and the number of magnet hospitals per licensed RNs. Data was collected between December 1st, 2023 and January 4th, 2024.

Each metric was normalized across states by calculating an index score in which states with the highest value received a score of 100. Indices were then weighted and averaged across states based on their importance according to input from Elizabeth Clarke, FNP, MSN, RN, MSSW.

Median RN salary and occupation density were collected from the U.S. Bureau of Labor Statistics, Occupational Employment and Wage Survey. The average RN salary reflects 2022 wages and was adjusted using state regional price parity, according to the Bureau of Economic Analysis.

Nurse-to-patient ratio legislation was determined according to the American Nurses Association. States were assigned a score based on the legislation and guidelines enacted in the state. States that require mandatory nurse-to-patient ratios received the highest score, followed by states that require hospital-based staffing committees and mandated disclosure of staffing levels.

NCLEX-RN pass rate was collected from the National Council of State Boards of Nursing and reflects first-time pass rates for U.S.-educated candidates in 2022.

The projected percentage of nurse supply meeting demand was collected from the Health Resources Administration, Nurse Workforce Projections 2020-2035. States were scored based on how closely the projected nurse supply met projected nurse demand in 2035 (the latest available year).

Job satisfaction and the percentage of nurses with a BSN or higher were collected from the Health Resources and Services Administration, Nursing Workforce Dashboard 2018. Job satisfaction reflects the percentage of RNs who answered that they are extremely satisfied.

Burnout was collected from the American Nurses Association, Mental Health and Wellness Survey 4. Burnout reflects the percentage of RNs who answered that they were experiencing any symptoms of burnout between April 24th and May 26th, 2023. Data for 18 states were omitted due to the low sample size. Weighted average formulas were adjusted to account for omitted data.

Average overall hospital ratings were collected from the Centers for Medicare & Medicaid Services, General Hospital Data. Overall, hospital ratings reflect the quality of care a hospital may provide compared to other hospitals based on quality measures, including mortality, safety of care, readmission, patient

experience, and timely and effective care. Hospitals are scored on a scale of one to five, with five indicating the best overall hospital rating.

The number of magnet hospitals per 10,000 nurses was collected from the American Nurses Association as of January 2nd, 2024. The total number of magnet hospitals was adjusted for population based on the total number of licensed nurses in each state.

The annual rate of injuries and illnesses per 1,000 nurses was collected from the Bureau of Labor Statistics, Injuries, Illnesses, and Fatalities program. Data reflects the average number of annual RN injuries or illnesses resulting in missed work days from 2017 to 2020. Data for 9 states were not available. Weighted average formulas were adjusted to account for omitted data.

Page last reviewed March 6, 2024