The Best States to Work as a Nurse

The U.S. employs close to 3,000,000 registered nurses (RNs) earning average annual salaries just over $80,000. While employment prospects for healthcare workers remain promising across the country, some states offer nursing professionals greater job opportunities, more favorable work environments, and a better quality of life.

By comparing salaries, employment opportunities, cost of living, and levels of racial diversity in the workforce, nursing students and recent graduates can choose the best fit for their professional and personal needs.

Based on population and occupational data gathered from the U.S. Bureau of Labor Statistics (BLS) and other sources, these rankings utilize a methodology that analyzes eight different metrics, weighted for each of the 50 states. More information about the variables and sources used to construct these rankings for the top states can be found at the end of this guide.

According to the 2020 Occupational Employment and Wage Statistics Report released by the BLS, RNs earn a mean annual salary of $80,010. While relatively high compared to other healthcare workers, RN earnings vary considerably by degree level, work experience, specialties, and geographic location. The lowest 10% make $53,410 a year, while the highest 90% receive $116,230.

This table reports the top 10 states with the highest RN salaries adjusted for cost of living. California takes the lead among the best states for nurses seeking a place to live and work. In the states with the lowest compensation (e.g., Alabama, Iowa, and South Dakota), RNs earn $60,000 or less a year.

Although employers generally tie salaries to the cost of living, job seekers should carefully consider the amount of money needed to cover essentials for themselves and/or their families, including housing, transportation, utilities, taxes, food, and childcare. For example, California tops the list for both the highest RN annual wages and cost of living. For some nurses, the exceptionally high annual salary of $120,560 may offset living expenses.

Significant differences emerge when looking at salaries in relation to living expenses in specific areas within states. While California’s overall cost of living ranks 42.4% above the national average, the cost of living in the major urban center of San Francisco is 86.1% higher than the average. In contrast, the smaller city of Fresno offers more affordable living costs, 2.4% below the national average. Other states in the top 10 may offer nurses lower annual salaries between $76,800 and $96,000 but with significantly lower cost of living indices than California.

Several factors contribute to the projected RN employment growth between 2019 and 2029, including demographic transitions, healthcare reform, and changes in the nursing profession.

As the U.S. population ages, more aging citizens seek primary and preventive healthcare services, while some areas of the country experience nursing shortages. According to the 2019 AMN Healthcare Survey, 86% of nurses over the age of 55 plan to retire within five years, draining the workforce of its most experienced and specialized professionals. As a result of the Affordable Care Act, previously uninsured Americans have gained access to healthcare services, impacting the demand for registered nurses.

At the same time, already overburdened nursing programs face challenges training a new generation of nurses in sufficient numbers to fill the unmet need.

In each of the top 10 states with the highest RN employment growth, demographic shifts emerge as the most significant force pushing the demand for nurses. Because people over the age of 65 have higher rates of healthcare utilization, the projected RN job growth remains higher in states with a large percentage of elderly residents. Delaware’s senior citizens comprise 16.3% of the state’s population, closely followed by Arizona at 15.9%. The U.S. average stands at 14% for the total population.

The population growth rate for young adults between the ages of 25 and 29 in Utah, Washington, Arizona, Delaware, and Colorado ranks higher than the national average. As these millennials enter the workforce and raise families, they will need primary and preventive healthcare services.

These states also deal with rising retirement and turnover vacancies. Georgia’s current nursing shortage has reached a crisis level, especially in public health where the lower salaries hinder both the recruitment and retention of quality nursing professionals.

A diverse and inclusive nursing workforce fosters quality care for all patients regardless of their race or ethnicity. Nursing education increasingly emphasizes the importance of cultural competency, preparing graduates to work effectively with individuals from all backgrounds. For healthcare employers, a diverse workforce that reflects the demographics of their patient community enhances communication and improves services.

These rankings use data from the U.S. Current Population Survey and Simpson’s Diversity Index that measures the presence of racial groups within organizations. Hispanics or Latinos make up only 7.9% of the RN workforce compared to 17.6% in all other U.S. occupations. African Americans comprise 13.4%, marginally above their 12.1% national employment level. The 8.7% rate for Asian RNs slightly exceeds their 6.4% national rate across all occupations.

The states with the most racially diverse workforces have made some progress attracting nursing personnel that more closely reflects the diversity in their populations. However, white females still dominate the workforce and represent the majority of nursing school graduates. Nurses who identify as Asian are slightly overrepresented compared to their percentage in the overall U.S. population.

According to the nursing advocacy group Campaign for Action, Hispanics or Latinos make up almost a third of Nevada’s population but only 14% of its nursing school graduates. Hispanics or Latinos in California and Texas represent less than 30% of nursing school graduates, although they comprise over 39% of the population in each of these states.

Nursing graduates in Nevada who identify as African Americans have not increased beyond 4.2% between 2011 and 2018, although they form 9% of the total state population. In Texas, where African Americans make up 12% of the population, the percentage of nursing graduates has dropped from 12.2% to 11.4% since 2011.

Employment prospects for nursing professionals at all levels in every state have been affected by several national trends. These include demographic shifts, the growth in the aging population, economic conditions, expanded healthcare coverage, and the availability of nursing graduates to fill vacancies resulting from turnovers and retirement.

Although the national nursing shortage has abetted somewhat over the last decade, job seekers just beginning their careers may encounter substantial variations in the demand for RNs. According to the National Center for Health Workforce Analysis, RNs can expect deficits in some states and large variations in supply in other states.

Nurses can continue to find employment prospects across the United States. However, before making any decisions about where to live and work, they should carefully evaluate their opportunities in light of the information presented in this guide.

The best states to work as a nurse were determined using a weighted average ranking across eight different metrics, including RN salary adjusted for cost of living, racial and ethnic diversity among the nursing workforce, projected annual RN openings per population, projected RN employment growth, NCLEX-RN pass rate, patient hospital rating, RN nursing supply and demand, and RN location quotient. Each state received an index score where the best performing state was assigned a value of 100. Indices were then weighted and averaged across states.

Sources include Projections Central, the U.S. Bureau of Labor Statistics, Health Resources & Services Administration, National Council of State Boards of Nursing, the Centers for Medicare & Medicaid Services, and the United States Census Bureau.

Average RN salary, total RN employment, and RN location quotient were collected from the BLS’ 2020 Occupational Employment Survey.

RN salary adjusted for cost of living was calculated using the average 2020 RN nursing salary per state adjusted for the cost of living index per state according to meric.mo.gov.

Racial and ethnic diversity among the nursing workforce was calculated using Simpson’s Diversity Index with data from the U.S. Current Population Survey for nursing occupations from 2016 to 2020.

RN nursing supply and demand was calculated using the 2017 Health Resources & Services Administration’s Supply and Demand Projections of the Nursing Workforce: 2014-2030. States were indexed by projected 2030 registered nurse demand, where the states with the greatest demand received a score of 100.

Data for patient hospital ratings use the Centers for Medicare & Medicaid Services’ Patient Survey updated on December 10th, 2020. States were indexed by the percentage of patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).

Data for projected RN employment growth and projected annual RN openings per population are from ProjectionsCentral.com for 2018-2028. Data was unavailable for Louisiana.