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Nurse Practitioner Salaries by State

NurseJournal Staff
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Updated March 23, 2023
    NPs earn significantly more than RNs, but compensation varies by education, certifications, and geography. Learn about current salary trends and the highest-paying states for nurse practitioners.
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    With an average annual salary of $118,040, NPs rank among the highest-paid nurses in the field. In addition to expanding employment opportunities, NPs have experienced an 8.1% increase in median salary in 2022, from $111,680 to $120,680.

    Based on the most up-to-date NP salary data released by the U.S. Bureau of Labor Statistics (BLS), this guide presents information on current compensation trends. Nurses interested in NP careers can learn about NP salary by state, cost of living adjustments, and states with the largest changes in NP earnings.

    What is the Average Nurse Practitioner Salary in 2022?

    • The average annual nurse practitioner salary is $118,040, or $57.75 an hour
    • The median nurse practitioner salary increased by 8.1% from $111,680 to $120,680

    Source: BLS, 2022

    Nurse Practitioner Salaries by State

    This section presents an overview of NP salary distribution across the U.S, using the latest data from the BLS. Readers will find annual average salary figures for all 50 states and a list of the highest-paying states for nurse practitioners.

    Table showing top 10 highest paying states for nurse practitioner salaries

    NP salaries vary significantly across the country. Western and northeastern states dominate this list of the best-paying NP salaries. In contrast, southern states tend to offer the lowest salaries. California tops the list with NPs earning an average of $151,830 annually — over $56,000 more than the lowest-paying state, Tennessee.

    Urban centers tend to offer higher pay than rural areas. For example, northern California is home to thetop five metropolitan areas for NPs in the country.

    Cost of living plays a significant role in compensation. Areas where NP demand continues to increase due to nurse retirements and a growing need for healthcare by an aging population also offer lucrative opportunities. In states with high cost of living figures and high demand for NPs, these nurses can earn well over six figures.

    Southern states with lower living expenses, such as Tennessee, Alabama, and South Carolina, tend to offer lower annual salaries, ranging between $95,000 and $103,000.

    Another factor that may contribute to higher earnings in some states is nursing unions. Western and northeastern states have developed stronger union movements than the southern states. Nursing unions have successfully bolstered compensation rates by negotiating for pensions and other benefits.

    Most states grant NPs full practice authority, which is reflected in higher compensation levels. However, the lowest-paying states, including Tennessee, Alabama, South Carolina, Missouri, and West Virginia, have only authorized restricted or reduced practice authority. States like California that have adoptednurse-to-patient ratio laws to improve patient safety and quality care also offer higher NP salaries.

    The Highest-Paying States Adjusted for Cost of Living

    The cost of living where NPs intend to practice will affect their overall earning potential. This table shows the top ten highest-paying states for NPs adjusted for the cost of living index.

    According to the U.S.Bureau of Economic Analysis (BEA), the cost of living index (or regional price parity) measures how far your earnings will go based on the regional price of goods and services across states. The index, with 100 as the national average, takes into account the cost of essentials such as food, housing, utilities, healthcare, and transportation.

    Table showing top 10 highest paying states for registered nursing salaries with cost of living adjustments

    Source: BLS and BEA, 2022

    Even when adjusted for cost of living, NP earnings in all fifty states top six figures. Adjusted salaries in the top ten highest-paying states range from $124,504-$136,040. California and Oregon rank higher than the national average for cost of living. NPs employed in states with higher cost of living rates may have to adjust their salary expectations in light of how much they need to maintain their desired standard of living and personal and family obligations.

    Based on the annual mean wage adjusted for cost of living, California and Oregon still rank among the top ten best-paying states for NPs, with California maintaining its top rating for the highest NP salaries in the country.

    Top and Bottom States by Change in Nursing Salary

    Overall, NP compensation has grown in almost every region of the country, with particularly large increases in Iowa and South Dakota. States with large rural populations, including Idaho, Tennessee, Wyoming, Missouri, and Utah, report the largest salary decreases.

    States With the Largest Percentage Increase in Median Annual Salary

    • Iowa: 12.5%
    • South Dakota: 9%
    • Oregon: 8.1%
    • Rhode Island: 8.1%
    • Washington, D.C.: 7.9%

    States With the Largest Percentage Decrease in Median Annual Salary

    • Idaho: -7.6%
    • Tennessee: -4.3%
    • Wyoming: -3.6%
    • Missouri: -3.2%
    • Utah: -0.6%

    Many of the same factors that have led to the expanding demand for NPs account for salary increases. The nursing shortage, demand for more healthcare services by the aging population, and growing rate of nurse retirements all contribute to rising compensation levels. As more states experience physician shortages and seek to reduce healthcare costs, they grant broader practice authority to NPs, making them more valuable to employers.

    The COVID-19 pandemic has negatively affected both NP employment and salary levels in some areas. A 2020Medscape nursing compensation survey reports that 20% of advanced practice nurses, including NPs, worked fewer hours during the pandemic. Inpatient treatment for non-emergency conditions and ambulatory visits for routine medical issues both declined during the pandemic, resulting in reduced hours, furloughs, and layoffs for some NPs.

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    Complete List of States by Nurse Practitioner Salary

    If you’re looking for more information on nurse practitioner salaries in all 50 states and the District of Columbia, the following table is a helpful resource that includes adjustments for cost of living. Find your state, a state where you previously lived, or perhaps a state where you might wish to relocate, and compare the data to your personal economic reality, desired lifestyle, and what that state has to offer you and your family.

    Methodology

    Nurse practitioner salary data by state is collected from the BLS Occupational Employment and Wage Statistics program, released on March 31, 2022. Data reflects nurse practitioner salaries as of May 2021. The highest-paying states for nurse practitioners are ranked by average annual salary.

    Cost-of-living data is collected from the U.S Bureau of Economic Analysis Real Personal Income for states and metropolitan areas, released on December 14, 2021. Nurse practitioner salary adjusted for cost of living is calculated by multiplying each state’s RN salary by its regional price parity (RPP). RPP measures differences in the cost of goods and services in a region compared to national prices.

    Sources