While nursing practice itself is standardized in the U.S., nurses’ salaries and their willingness to relocate for a job can vary widely between the states, as revealed in Nurse.com’s 2018 Nursing Salary Research Report.
The Nurse.com salary survey of 4,520 nurses in the U.S. uncovered nurses in some states would strongly consider relocating for another job.
Why do some states see such high levels of nurses who are willing to relocate? Jennifer Mensik, PhD, RN, NEA-BC, FAAN, a consultant for Nurse.com by OnCourse Learning who helped develop questions for the survey, analyzed the data and authored the research report, said this is not surprising.
Multiple factors play a role in why nurses in some states look more favorably upon relocation compared to others.
With regards to relocation, the search for higher salaries plays a greater role for nurses from rural states, Mensik said.
“Rural states generally pay lower salaries because their healthcare employers having lower revenue streams compared to urban hospitals due to multiple reasons,” she said.
One reason rural hospitals have less income is because of their patients’ insurance status.
“More patients in rural states are insured by state Medicaid programs and Medicare, both of which reimburse at lower rates versus private insurers, which tend to reimburse at higher rates,” Mensik said. “Urban area hospitals typically have more patients insured by private medical plans, generating more income for these providers.”
Another factor that can impact the flow of revenue for healthcare organizations in rural states is their patient census is more variable, Mensik said.
“Rural hospitals can experience a lower census more often than urban-based hospitals,” she said. “This negatively impacts their income. Less income for employers results in lower pay rates for their employees.”
Seeking new career opportunities also plays a part in a nurses’ willingness to relocate, Mensik said. If a nurse wants to move up the professional ladder and has his or her sights set on working as a nurse manager or in hospital administration, rural states’ hospitals will generally have fewer openings for these types of positions, she said.
“However, rural hospitals are smaller so there are fewer positions to start with,” Mesnik said. “Also, many nurses working in rural areas choose to stay in their positions for several years. For some this choice is due to wanting to stay near their childhood home, while others may have caregiving responsibilities for elderly parents or other relatives. The longer people stay in their jobs, the less frequently positions open up.”
Nursing salaries can run the gamut from high to low – depending on the state
The salary survey’s findings followed the same regions as the American Hospital Association, with some regions of the U.S. seeing much higher nurse salaries than others.
Region 9, which includes California, Hawaii, Nevada, Oregon, Washington and Alaska, pay an average nurse salary of $97,708.
On the flip side, Region 6 which consists of North Dakota, South Dakota, Nebraska, Kansas, Minnesota, Iowa and Missouri, pays the lowest wages to nurses at $62,634.
Another group that studies nursing salaries is the National Council of State Boards of Nursing in partnership with The National Forum of State Nursing Workforce Centers. They conduct a National Nursing Workforce Survey every two years. Their latest survey collected data for the year 2017. Their survey’s findings also indicate more lucrative salaries for nurses in these same states.
Findings from the 2017 National Nursing Workforce Survey will be published in October 2018, according to Richard Smiley, a statistician with National Council of State Boards of Nursing. In the interim, he highlighted some median salary statistics by state. States with the highest salaries were: California — $88,000, Hawaii — $85,000, and New York and Oregon both at $80,000, he said.
States with the lowest salaries included South Dakota at $54,000 and Iowa at $58,000.
“There are five states tied for the third lowest median salaried state at $60,000: Alabama, Mississippi, Montana, North Dakota and Nebraska,” Smiley said.
Regarding salary data, Mensik said states that pay lower salaries to their nurses see higher percentages of nurses willing to relocate, confirming their quests for higher pay.
Mensik said there are several reasons why nurse salaries are higher in some states versus others:
- Higher cost of living
- Higher levels of nursing union activity raises wages
- Presence of more urban areas whose hospitals have higher revenues
“The higher salaries in California benefit nurses in its bordering states, such as Arizona for example, as employers are competing for nursing talent and need to stay competitive, Mensik said.
The good news is when looking at all nurses surveyed by the 2017 National Nursing Workforce Survey and comparing it to the results of their last survey done in 2015, Smiley said there was an overall increase in salaries.
“In the 2015 survey, the median salary for all RNs in the U.S. was $60,000,” he said. “In the 2017 survey, the median salary for all RNs in the U.S. increased to $63,000.”
Gender differences also play into salaries and willingness to relocate
One fact uncovered by numerous surveys, including Nurse.com and the 2017 National Workforce Survey, is male nurses continue to earn higher salaries than females, Smiley said.
“Our 2017 survey data revealed males average a yearly salary of $80,000 versus females at $70,000,” he said.
Mensik said that Nurse.com’s survey saw an average nursing salary for men of $79,688 and $73,090 for women.
“These findings correlate with survey respondents’ answers that men are more likely than women to relocate for a job,” Mensik said. “Men generally change jobs more often than women – both of which give men more opportunities to negotiate their wages on a more frequent basis.