Where Do Nurse Salaries Fare Best After Taxes and Living Costs?

Nurse compensation is under scrutiny as some states, like Iowa, propose capping travel nurse pay, while others, such as Tennessee, are boosting wages up to $32 per hour for new registered nurses. Local government decisions in Indiana and demands for better pay in Minnesota underscore the ongoing negotiations for improved compensation. These trends are creating varied financial outcomes for nurses, deeply influenced by geographic location, tax implications and living costs.

MoneyGeek analyzed nurse salaries in 109 metro areas to find the U.S. cities where nurses make the most after taxes and living expenses. We examined wages for registered nurses (RNs), licensed practical nurses (LPNs), licensed vocational nurses (LVNs) and nurse practitioners (NPs). According to our findings, Southern metro areas offer the most significant stretch on earnings, especially for nurse practitioners.

Nurses' salaries go the furthest in Winston-Salem, North Carolina, with an average take-home pay of $106,721 annually — roughly just $20,000 less than their pre-tax earnings. This area is followed by two Texas metros: San Antonio ($100,576) and Houston ($99,232). The South’s lower cost of living places seven metros in the region in the country’s top 10, with adjusted nurse earnings of $93,000 and higher.

Joining Houston are three other highly populated cities — Dallas, Atlanta and Philadelphia — which all rank in the top 30. Each has living costs on par or slightly below the national average, but the latter two metros have tax burdens nearing 30%. Despite this, nurses in these areas keep over $87,000 of their $119,000 pre-tax salary.

Two Midwestern metros (Des Moines, Iowa, and Minneapolis) and one in the Northeast (Buffalo, New York) rank in the top 10. In these areas, nurses earn over $94,000 after taxes and living expenses.

MoneyGeek also analyzed the metros where registered nurses (RNs) see the highest take-home pay. We found that less than one-third of the 109 U.S. metros studied surpass the national average RN gross pay of $86,070. RNs generally see a 24% reduction in income after accounting for taxes and living costs, but in certain areas, such as Honolulu, the decrease can be as steep as 63%.

Western metropolitan areas — notably in California and Nevada — offer RNs better financial prospects, reducing the toll of taxes and living expenses. California's Sacramento metro stands out as the only metro where RNs see an adjusted salary of over $80,000. Modesto, California, is a close second, with an adjusted salary of $78,942.

A notable feature of metros at the top of the list is a lower-than-average cost of living. Texas metros like Houston, McAllen and Austin are joined by Las Vegas, Minneapolis and Little Rock, Arkansas, in our rank of the top 15 metros.

Two California metro areas with the highest gross wages for licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) are San Jose and San Francisco, averaging $84,500 and $83,650, respectively. However, high living expenses and taxes reduce these by over $48,000 annually.

Reno, Nevada — with the 12th-highest median salary of $71,800 for this group — is the metro where LPN and LVN salaries stretch the furthest. There, the average nurse takes home $56,774 annually after accounting for taxes and living costs. Just one other Western metro, Las Vegas, joins the top of the list with the No. 3 highest take-home pay ($55,298). Select Southern and Midwestern metros also rank well, with LPNs and LVNs retaining roughly $52,000 after taxes and living costs.

The number of nurse practitioners is expected to increase 45% by 2032 — a staggering rate compared to the 3% average expected across all occupations. When it comes to earnings, five of the top 10 metros for nurse practitioners are found in the Lone Star state, with adjusted earnings exceeding $103,000.

Just one Western metro area — Las Vegas —and one Midwestern metro area — Des Moines, Iowa — make the top 10 for this occupation, with post-tax and cost of living incomes of $109,367 and $105,847, respectively. Nurse practitioners in the West are most affected by taxes and cost of living; there, 12 metros place in the bottom 20 with adjusted incomes under $75,300.

Income for nurses in the bottom-ranking 15 metros averages $61,922 after taxes and living costs — about $34,000 less than in the top-ranked areas. Honolulu nurses fare the worst, making $46,988 after 31% taxes and living costs — a percentage 82% above the national average. Similarly, Bridgeport, Connecticut, and San Jose, California, see nurses earning less than $60,000 after taxes and living costs.

Among the worst 15 metros for nurses, San Francisco is the most stark. Its pre-tax salary of $166,788 — the highest of any metro — dwindles to $62,652 after adjustment. Additionally, two of these worst-ranking metros (Baton Rouge, Louisiana, and Lexington, Kentucky) have lower-than-average living costs but still fall short due to their comparatively low pre-tax nurse salaries.

Nurses are essential to our health care system, so it’s no surprise that their shifting incomes are at the center of public discussion. But no matter where you live, following the tips below can help you save money and stretch your nurse salary even more.

To assess the impact of taxes and living expenses on nurse salaries nationwide, MoneyGeek analyzed Occupational Employment and Wage Statistics (OEWS) data from the Bureau of Labor Statistics for 109 U.S. metro areas. For our overall ranking, we factored in a broad range of nurse salaries, including registered nurses, licensed practical and licensed vocational nurses, nurse practitioners, nurse anesthetists and nurse midwives. For our breakdowns of the best metros for registered nurses, licensed practical and licensed vocational nurses and nurse practitioners, we only considered salaries for those specialties.

We calculated net salaries by applying federal, state and local taxes using SmartAsset’s paycheck calculator and then adjusted for local living costs using data from the Council for Community and Economic Research. For example, in the New York City metro area, the post-tax salary for nurses averages $80,154. With living costs 20% above the national average, the actual purchasing power equates to $66,850 when adjusted for these expenses.

Our data sheds light on the financial realities for nurses in different metropolitan areas, from lucrative opportunities to tighter budgets. See the data that shaped our story below.