Nursing Salaries in 2020

Nurses have carried a heavy burden since the onset of the COVID-19 pandemic in 2020. Over a year later, they continue to face unprecedented challenges, overwhelmed with patient care responsibilities while risking their own physical and mental health working in underequipped and unsafe conditions.

These unanticipated circumstances have also drawn attention to the critical role nurses play in the healthcare system. The need for healthcare professionals in this time of crisis, combined with the national nursing shortage, has resulted in higher compensation for nurses at every level, which may last beyond the pandemic.

This guide presents data from the U.S. Bureau of Labor Statistics (BLS) on 2020 nursing salaries, released in March of 2021. Nurses just entering the field or those already committed to the profession can explore which states and cities offer the highest salaries, where salaries have increased the most, and how these trends will affect the nursing profession in the future.

Nursing salaries have climbed significantly in the five years preceding the pandemic. Registered nurses (RNs) and advanced practice registered nurses (APRNs) have experienced the highest increases since 2016.

Certified registered nurse anesthetists (CRNAs), certified nurse midwives (CNMs), and nurse practitioners (NPs) all earned median salaries in the six figures in 2020. CRNAs, among the most highly regarded and specialized of all nursing specialties, earned a mean annual wage of over $189,000, according to the most recent BLS data.

The growing demand for postsecondary nursing instructors and teachers to train the next generation of nursing professionals has steadily boosted salaries for these educators. Nursing assistants and licensed practical and vocational nurses (LPN/LVNs) who typically enter the field without four-year degrees continue to earn less than RNs with bachelor’s degrees or higher. Although these nurses make less than the national average of $58,310 for all U.S. occupations, they also received steady pay increases from 2016-2020.

While APRNs earn the highest salaries among all nursing roles, salary increases among nursing occupations in 2020 vary considerably. These differences reflect education levels and specialized certification, as well as changing healthcare needs.

CNMs have experienced the highest salary increase by percentage, with a higher average annual pay than general RNs and nurse practitioners. These earnings have risen, along with the demand for their services, in response to changing perceptions about prenatal care and natural childbirth.

The aging population’s healthcare needs have also resulted in higher salaries for RNs, nursing assistants, and LPN/LVNs providing long-term care, primary care, and preventive patient services.

As nursing shortages continue to affect some areas of the United States, nursing schools have struggled with capacity issues, unable to admit more students or hire the needed faculty to train them, resulting in flat salary levels for nurse educators.

Registered nursing salaries generally reflect state-specific factors, such as population density, nursing shortages in underrepresented communities, labor conditions, and cost of living. The highest-paid nurses work in western states, Alaska, Hawaii, and the upper East Coast, while southern and midwestern states pay the lowest salaries.

California leads all states for overall nursing compensation, with salaries twice as high as those in the lowest-paying states of Alabama, Mississippi, and South Dakota, where RNs earn $61,000 or less annually. The relatively low salaries paid to RNs in Alabama, Mississippi, and South Dakota correspond in part to inadequate state funding for healthcare in rural and underserved areas, along with continuing restrictions against labor unions.

While these states pay less competitive wages than other parts of the country, they offer relatively low living costs for essentials such as groceries, housing, transportation, and utilities. In contrast, Hawaii, Washington, D.C., New York, California, and Oregon, which all rank among the top-paying states for RNs, also report the highest average cost of living figures among all fifty states.

California, with its large geographic area, booming population, and high wages for healthcare workers, reports the biggest increase in RN salaries, growing by 6.5% from 2019-2020. This increase stands in stark contrast to some of the less populated and smaller states, like Alabama, Delaware, and Rhode Island, which offered raises of less than 1%, or, with Washington, D.C., a decrease in RN salaries of 0.5%.

However, other states across the country also report high increases in RN salaries, ranging from almost 4% in Arkansas and North Carolina to 6% in Washington. Some increases came about to help alleviate the growing burden placed on nurses during the COVID-19 crisis.

In states where the nursing workforce had already become overburdened and understaffed before the pandemic began, healthcare administrators and public health officials, concerned about looming nursing shortages, have begun to advocate for higher salaries.

Six metropolitan areas in California top the list of all U.S. cities with the highest registered nursing salaries in both 2019 and 2020. Urban centers around Boston, Massachusetts; Portland, Oregon; Seattle, Washington; and New York City also ranked among the top ten.

In California’s urban areas, where the demand for RNs continues to outweigh the supply, higher salaries help offset the high cost of living. The strong union movement among nurses in the state has bolstered compensation by securing pension and healthcare benefits. The state restricts the scope of practice for LVNs, leading employers to hire RNs and pay them accordingly for the full range of services they provide.

The high salaries for nurses in Portland and Seattle reflect the needs of their rapidly aging populations, high rates of nursing turnover and retirements, and the growing number of healthcare facilities and share of nursing homes. RNs continue to find employment opportunities and competitive salaries in the New York City urban area — home to several of the nation’s best hospitals and medical clinics.

RN salary increases across the country reflect several societal trends. Continuing nursing shortages exacerbated by retirements and turnover, and the growing demand for primary and preventive healthcare by an aging population have driven efforts to offer nurses more competitive salaries and raises.

Salary increases also reflect the newfound appreciation for the value of nurses and the critical healthcare functions they have performed during the pandemic. Urban areas around San Francisco, Los Angeles, San Diego, and Sacramento, which rank among the most expensive places to live, typically offer more competitive salaries to offset housing costs and other essential living expenses.

In 2020, California’s major cities paid RNs the highest average salaries with some of the largest pay increases. The San Francisco-Oakland-Hayward area ranks first for both highest overall average registered nursing salary in the U.S. and largest increase in average RN salary.

Even before COVID-19, nursing salaries had risen in response to population shifts and state-specific economic changes that created nursing shortages and affected employment prospects. Rising salary levels also reflect state and city responses to cost of living, turnover, and retirement among the existing nursing pool.

The demand for skilled nurses has only intensified during the pandemic, as hospitals cope with increased patient loads, overburdened ICU and emergency care units, and lengthy patient stays. Technological innovations, the widening access to telehealth options, and the need for specialized nurses will continue to place upward pressure on RN salaries, contributing to a promising employment outlook in the years ahead.

This article uses data from the BLS, U.S. Department of Labor, and Occupational Employment Statistics, released on March 31st, 2021, and accessed on April 2nd, 2021.

The top metropolitan areas by average RN salary and the percentage increase in average RN salary were limited to the top 50 metropolitan areas by total RN employment to ensure sufficient sample sizes.

The 2020 Occupational Employment Statistics and salary figures may not fully reflect the impacts of the COVID-19 pandemic on the nursing workforce.