The Best and Worst States for Nursing Professionals

Nurses are the backbone of the U.S. health care system. The demands of the job and long shifts take a toll on a nurse’s well-being. As MoneyGeek’s study reveals, the best states for nurses provide supportive conditions for these health care professionals to pursue their careers and enjoy work-life balance.

While the U.S. Bureau of Labor Statistics expects nursing jobs to grow by 45% through 2030, pandemic burnout has added to the shortage of nurses across the country. Amid long working hours and an enormous influx of patients, nurses feel the pressure.

Other factors affecting the field include the number of nurses approaching retirement age and increasing education requirements. With high education costs, it’s challenging for recent graduates to pay down student loans or buy their first home.

Given the situation of nursing and growing quit rates in the health care industry, it's essential to ask:

• What are the highest paying states for nurses?
• What’s the job growth rate like in different states?
• What state regulatory environments best support nurses?
• Where do nurses have the best working protections?
• Which states have the most nurses?

The answers to these questions can help determine the best places to work as a nurse today.

To find the best states for nurses, MoneyGeek analyzed key factors, such as wages adjusted for cost of living, working conditions, future job growth, COVID-19 vaccination rates and state regulatory environment.

Ranked as the best place to be a nurse, Washington state features excellent working conditions, impressive job growth and high average salaries. However, it’s worth noting that this state does not participate in the nurse licensure compact (NLC), meaning that a nursing license there can’t be used in other states.

Close behind in MoneyGeek’s top list are Colorado and New Mexico. All three states offer full practice authority for nurse practitioners, allowing them to evaluate, diagnose, order and review diagnostic tests, prescribe medications and treat patients. However, Colorado and New Mexico both don’t have any overtime regulations in place, meaning that nurses can be required to work longer than their scheduled hours.

Working as a nurse means being on call to help others, but this can be challenging under stressful work conditions. This is particularly true in the worst states for nursing, where a lack of overtime regulations, lower-than-average wages and limited growth affect these health care professionals.

MoneyGeek found that Mississippi, Alabama and Louisiana all offer the worst overall conditions for nurses.

Burnout, high turnover rates and the COVID-19 pandemic are serious challenges facing the nursing workforce. Our panel of experts shares their outlook for the industry and advice for nurses today.

To rank the best states for nursing, MoneyGeek analyzed data from the U.S. Census, Bureau of Labor Statistics, Department of Health and Human Services, American Association of Nurse Practitioners, CareerOneStop.org and the National Council of State Boards of Nursing.

The ranking of the top states for nurses was based on six factors:

• Wages adjusted for cost of living
• Working conditions as represented by various ratios of nurses to beds
• Future job growth
• Current job market competition
• State regulatory environment
• COVID-19 vaccination rates

Each factor in the study was scaled to a score between 0 and 1. The factors were calculated as follows:

Wages Adjusted for Cost of Living (Full Weight): The average salary of registered nurses in the state. These wages were adjusted by each state’s cost of living index for comparison between states.

Working Conditions (Full Weight): An equal combination of the ratio of nurses to hospital beds in the state and the ratio of hospital beds to the state population, representing the capacity of the state’s hospital system relative to the population and staffing of nurses. The higher the ratio, the better the working conditions.

Future Job Growth (Full Weight): The forecasted growth in jobs in the nursing profession through 2028.

Current Job Market Competition (Full Weight):

• Job Openings (50%): The ratio of current open nurse jobs scaled based on the state’s population.
• State Job Prevalence/Reliance (50%): The number of jobs in the state that are nursing jobs compared to all jobs.

State Regulatory Environment (Half Weight): Comprised of the following measurements of how friendly the state is towards nursing:

• NLC compact member (⅓): Yes or no flag.
• Nurse Practitioner Practice (⅓): Full is given 100%, reduced is given 50%, restricted is given 0%.
• Presence of Forced Overtime Regulations (⅓): Full 100% value is given if any forced overtime restriction is present.

The data points presented are defined as follows:

• Average Annual Nursing Salary: Average yearly nursing salary
• Nurses to Hospital Beds: Ratio of nurses per hospital bed in the state
• Long-Term Job Growth Fcst: Forecasted growth in nursing jobs through 2028
• State Environment: Summary of the state’s regulatory environment
  • Nurse Practitioners: Full, Reduced or Restricted practices indicate the level of authority and autonomy allowed to nurse practitioners in the state
  • OT Regulated: Indicates the presence of laws that regulate or limit the amount of overtime — if any — that nurses are required to work
  • No OT Regs: Indicates a lack of laws that regulate the amount of overtime that nurses can be required to work
  • NLC Member: Indicates that the state is part of the Nurse Licensure Compact