Various factors go into determining the best states for nurses. It's more than just which state pays the best salary. There is also cost of living, work environment, job growth, hospitals, and opportunities for education. We crunch the data and find the best and worst states for nursing in many different categories.

The Best States For Nurses


​Just the Facts, Please

What makes one state a great place to work as a nurse and another less appealing? The first criteria are clearly salary and the availability of jobs. Every nurse wants a competitive wage and the opportunity to work. Other factors do come into play, however, such as the cost of living and the nursing environment.

For example, Hawaii pays its nurses very well, but with the median price for a single-family home at $730, 000, it is not easy to afford a house. Likewise, if a state has no mandatory overtime regulations or a poor average ratio of nurses to hospital beds, it will not be an appealing place to work regardless of salary.

The lists and rankings that follow take a look at many different aspects of the nursing life. Anyone who is considering a nursing career should weigh the different rankings according to their lifestyle choices.


Show Us The Money

The states that pay the highest nursing wages are California with an average hourly wage of $42.25, followed by Hawaii, Massachusetts, Oregon, and Alaska. While these states may pay very nice salaries, they are some of the most expensive states in which to live. After adjusting nursing salaries by accounting for the cost of living, the ranks change as follows:

Best State Salaries Adjusted for Cost of Living

  • Arizona
  • Nevada
  • Wyoming
  • Michigan
  • Texas

Worst State Salaries Adjusted for Cost of Living

  • New York
  • Vermont
  • Maryland
  • District of Columbia
  • Hawaii

None of the states in the original top-five rankings were able to hold their spot after the cost of living adjustment. Hawaii has a spectacular fall from number two to dead last.


Show Us The Jobs

documentation nurse

It doesn't do anyone much good to graduate with a nursing degree and have no opportunities for employment. In just about every state, there are job openings for nurses as populations age and need more care. Some states rank better than others, however, in the number and variety of nursing positions.


States With Highest Nursing Demand

  • California - A state-mandated nurse-to-patient ratio has contributed to a shortage of nurses in this state.
  • Florida - This state's popularity as a retirement location means new patients are always arriving.
  • New York - Both rural and urban areas in this state are in great need.
  • Ohio - Some employers in this state are offering tuition reimbursements as incentives.
  • North Carolina - The rapid growth of the metropolitan areas in this state have contributed to hospital expansion.

States With Lowest Nursing Demand

  • Mississippi - This state has one of the lowest ratios of health care facilities per capita, which reduces its demand for nurses.
  • Louisiana - This is another location with a low number of healthcare facilities.
  • Alabama – This state is similar to its two southern neighbors above.
  • Hawaii – This state is a popular place to live, despite the exorbitant cost of living. Therefore, it does not struggle to fill nursing positions.
  • Utah – In this state, hospital funding comes from local and state budgets, which limits their hiring power.

Back To School

nurse training

While not every nurse seeks further education, it is not uncommon for nurses to get more education for a variety of reasons. If an RN has an associate's degree, he or she may wish to pursue a BSN for a jump in the pay scale. Other nurses return to school to get a master's degree in nursing to focus on specialties, such as oncology or women's health.

With this in mind, states that are friendly to nurses should have high-quality nursing schools that offer sufficient degree programs. The top five states for university-level nursing programs are Maryland, North Carolina, Georgia, Pennsylvania, and Washington. Rural states have fewer quality nursing school opportunities. These would include North Dakota, South Dakota, Montana, and Wyoming.


A Practice For The Nurse Practitioner

Nurse Practitioner

Nurse practitioners play an important role in medical care. In areas where there is a shortage of physicians, as in rural or remote locations, a nurse practitioner can treat acute and chronic conditions, diagnose, and prescribe medications. Just like the other nursing professions, some states are better than others for the practicing nurse practitioner.


Best States for Nurse Practitioners

  • Washington – The top state for nurse practitioners, Washington has a high average salary, a great quality of life index, and looser scope of practice laws. NPs in this state are not required to work under a physician.
  • New Hampshire – This is a great place for newly-minted nurse practitioners to work. New Hampshire gives temporary licenses to NPs so they can begin work before earning certification.
  • Alaska – Even with a high cost of living, the average salary for a nurse practitioner in this state is good enough to make it a worthwhile place to work. Another bonus, NPs can practice without a doctor's supervision, and they can begin work as soon as they graduate while certifications are pending.
  • Arizona – Arizona has a nice nurse practitioner average salary and laws that allow NPs to practice without a physician. However, they are not allowed to practice outside of their area of certification.
  • New Mexico – This state actively recruits nurse practitioners and offers a tax credit to NPs willing to work in rural areas. No doctor supervision is necessary to prescribe and practice here.

Worst States for Nurse Practitioners

  • Oklahoma – This state has the lowest average salary for nurse practitioners. In addition, there are restrictive laws in place that prohibit NPs from prescribing medication with a doctors' supervision.
  • Florida – With a lower than average salary and strict practice laws, Florida is not an attractive state for nurse practitioners. Even with a physician's supervision, NPs in Florida are not allowed to prescribe controlled medication.
  • North Carolina – This state offers nurse practitioners an average salary, but the \ practice laws are complicated and strict. For example, to practice in North Carolina, an NP must sign a collaborative agreement with a physician, and there are limits to the prescriptions an NP can write
  • Missouri – Missouri requires nurse practitioners to have 300 hours of guided pharmacological experience, plus another 1,000 practice hours in order to prescribe controlled medications, and that is in addition to a collaborative practice agreement. With a salary that is near the bottom of the pile, there isn't much incentive for NPs to work here.

The State Of The States


Another facet to consider when looking at nursing conditions is the average age of the population of the state. It's no secret that the elderly require more care. This means more jobs for nurses, so states experiencing an elder-boom are often hiring rapidly. However, if you don't care for geriatric medicine or prefer to work in pediatrics, these numbers may influence you to choose a state with a different population make-up.

As retirees head for warmer climes, states such as Florida, New Mexico, and Arizona see their elderly population grow. Rural states, such as Maine, Wyoming, and Montana also have a higher elderly population because the young people tend to leave to find jobs. The states projected to have the youngest populations in the next decade are states that have jobs that attract young single adults who then get married and start families. These states are Georgia, Alaska, District of Columbia, Texas, and Utah.


The More The Merrier

States with more health-care facilities per person tend to have more favorable working environments for nurses. An adequate number of beds means less crowding, less stress, and more time and opportunities to provide quality care. This, of course, should be weighed with other factors, such as the presence or absence of union representation, sufficient numbers of medical staff, and modern equipment and facilities.

The states with the most facilities per capita are South Dakota, Idaho, Nebraska, Iowa, and Minnesota. The states that come in the bottom of this ranking are Delaware, Arizona, Colorado, Illinois, and Nevada.


What It All Means

Clearly, there are many great and wonderful places to work as a nurse, and someone may love nursing in Vermont despite the low adjusted salary due to the beautiful location and proximity to Ben and Jerry's. Therefore, ranking the best states for nurses is a subjective process, yet some states do consistently work their way to the top of the lists. Here are the top five:

The Five Best States for Nurses

  • Wyoming – This state has one of the best salaries adjusted for the cost of living. It is expected to see strong growth in nursing jobs and opportunities.
  • Maine – The population is growing older, and there is great demand. It has an excellent work environment for nurses with friendly ordinances and laws.
  • Michigan – A great place to live with higher than average nursing salaries.
  • Washington – Another state with higher than average wages, tremendous demand, and it's the best choice for NPs.
  • Arizona – The retirees need more medical care, so job growth is fantastic and the salaries are the highest after adjustment.