Hot off the press, Nurse.com weighs in on The Nursing Shortage: Looking Ahead to 2023. The article starts on a positive note by citing that “statistics show the nursing shortage is still a crisis, but 2023 could be a turning point.”
But before we all exhale with relief, the same article warns that almost 30% of nurses surveyed for the 2022 Nurse Salary Research Report were thinking of leaving the profession. This lends credence to the position that “recruiting and retaining good nurses could be the most critical area of focus in determining a hospital’s success.”
The hope for nurses going forward is that hospitals and clinics will start to embrace necessary changes that will help current nurses stay in their chosen profession and attract new nurses to the field. This leaves nurses in a position to “negotiate better salaries, benefits, and working conditions.”
To that end, the report predicts that healthcare leaders will be (some already are) putting in place a number of measures intended to “attract and retain nurses.” These measures “include:
- Higher salaries
- More flexible work schedules
- Sign-on bonuses and relocation packages
- Loan forgiveness
- Tuition assistance
- Incentives for pursuing certifications and other career development opportunities
- Enhanced benefits, such as better retirement plans and child care discounts.”
In 2021, there were an estimated 3,130,600 nurses throughout the country. In 2031, the US Bureau of Labor Statistics estimates we’ll need 3,326,000 nurses, a growth of 195,400.
Survey Outcomes
The information in the report is intended to let you see how your “current salary and benefits compare with those of your peers with similar education and job titles.” It’s a useful guide to help you decide if it’s time to negotiate your current salary or assess a potential job offer.
1. In most groups, nursing salaries are higher.
In the short span of two years, the median RN salary has gone up from $73,000 to $78,000. APRNs saw a dramatic increase in median salaries of $13,000 and a more modest increase of $3,000 for LPNs/LVNs.
The exception to these numbers was for nurses working in American Hospital Association Region 3. These nurses in Delaware, Kentucky, Maryland, North Carolina, Virginia, West Carolina, and the District of Columbia saw a dip in salaries from 2020.
2. COVID-19 has had a “profound impact” on whether nurses want to stay or leave the profession.
At the end of 2022, 18% more nurses seriously consider leaving nursing than those surveyed in 2020. The top factor attributed to this jump in job dissatisfaction was around pay levels; second to payscales was frustration with leadership.
3. The gap in pay between genders grew.
In the 2020 survey, male RNs were paid $7,297 more than female RNs. Contrast this with male RNs, who currently get paid as much as $14,000 more than their female counterparts.
Nursing Degrees
Created to help you map “where you are in your career and where you want to go,” The 2022 Nurse Salary Research Report offers insights into potential salary, benefits, education, and more for:
- Advanced practice registered nurses (APRNs)
- Licensed practical nurses/licensed vocational nurses (LPNs/LVNs)
- Registered nurses (RNs)
Advanced practice registered nurses
These types of nurses have either a Master’s or a doctoral-level degree. They are qualified to “assess, diagnose, and manage patient problems, order tests, and prescribe medications.”
The four types of APRNs include:
- Certified nurse practitioner (CNP)
- Clinical nurse specialist (CNS)
- Certified registered nurse anesthetist (CRNA)
- Certified nurse-midwife (CNM)
Licensed practical nurses/licensed vocational nurses
LPNs are registered nurses who have completed an “abbreviated amount of coursework and clinical hours.” LVNs are not registered nurses.
They provide “quality care and comfort to patients under the supervision of registered nurses.”
Registered nurses
There’s sometimes a bit of confusion regarding RNs versus BSNs. The difference can best be described like this: the degree you earn is called a BSN, and the license you get through your state is called an RN. The Bureau of Labor Statistics’ Occupational Outlook Handbook defines the practical difference as “….registered nurses who have a bachelor of science degree in nursing (BSN) will have better job prospects than those without one.”
While you can become an RN with an associate’s degree, the “future of nursing” seems firmly oriented toward making the BSN degree the standard for nurses. The Institute of Medicine (IOM) calls for 80% of all nurses to have this designation, and New York State now requires all nurses to earn a “BSN within ten years of receiving an initial RN license.“
Completing a Bachelor of Science in Nursing takes four years and 120 credits. The course load is a combination of classwork and clinical training. The primary accrediting bodies in nursing are:
- The Commission on the Collegiate Nursing Education (CCNE)
- The Accreditation Commission for Education in Nursing (ACEN)
- The Council on Accreditation of Nurse Anesthesia Educational Programs (COA)
- The American College of Nurse-Midwives Division of Accreditation (ACNM)
BSN Salary Guidelines
Again, according to the Nurse Salary Research Report 2022, the median salary for a BSN/RN was $78,000.
The nine divisional salary breakdowns look like this:
- Division 1 — New England, pays $77,750 and includes:
- Connecticut
- Maine
- Massachusetts
- New Hampshire
- Rhode Island
- Vermont
- Division 2 — Middle Atlantic, pays $85,000 and includes:
- New Jersey
- New York
- Pennsylvania
- Division 3 — East North Central, pays $68,000 and includes:
- Illinois
- Indiana
- Michigan
- Ohio
- Wisconsin
- Division 4 — West North Central, pays $70,000 and includes:
- Iowa
- Kansas
- Minnesota
- Missouri
- Nebraska
- North Dakota
- South Dakota
- Division 5 — South Atlantic, pays $74,000 and includes:
- Delaware
- District of Columbia
- Florida
- Georgia
- Maryland
- North Carolina
- South Carolina
- Virginia
- West Virginia
- Division 6 — East South Central, pays $69,000 and includes:
- Alabama
- Kentucky
- Mississippi
- Tennessee
- Division 7 — West South Central, pays $75,000 and includes:
- Arkansas
- Louisiana
- Oklahoma
- Texas
- Division 8 — Mountain, pays $80,000 and includes:
- Arizona
- Colorado
- Idaho
- Montana
- Nevada
- New Mexico
- Utah
- Wyoming
- Division 9 — Pacific, pays $100,000 and includes:
- Alaska
- California
- Hawaii
- Oregon
- Washington
If you’re a man, you can anticipate earning a median primary salary of $90,000. If you’re a woman, you can anticipate earning a median primary salary of $76,000.
One potential reason for this discrepancy could be that male nurses are more likely to press for and negotiate higher salaries. A full 30% of nurses surveyed reported they “never negotiate [their] salary.”
When it comes to benefits for BSNs/RNs, the ones received through employers look like this:
- 81% Paid time off
- 76% 401(k)
- 73% Dental
- 72% Medical
- 68% Life insurance
- 50% Long-term disability
- 50% Short-term disability
- 47% Health savings account
- 44% Tuition reimbursement
- 38% Reimbursed or paid continuing education
- 37% Wellness resources
- 31% Bonus
- 9% Other
- 8% Malpractice insurance
- 4% Profit sharing
- 2% Child care
- 2% Concierge service
In the spring of 2022, a New England university compiled an infographic of 16 types of nurses. These are the most popular types of nursing, listing their salaries and required nursing degrees. I’ve only included ones that require a BSN, although you may qualify for some of these with just an Associate’s Degree in Nursing (ADN):
- Surgical assistant registered nurse
- 2021 average salary of $101,700
- A Bachelor of Science in Nursing (BSN) preferred
- Health informatics nurse specialist
- 2021 average salary of $93,390
- A Bachelor of Science in Nursing (BSN)
- Critical care registered nurse
- 2021 average salary of $79,800
- A Bachelor of Science in Nursing (BSN)
- Oncology registered nurse
- 2021 average salary of $79,320
- A Bachelor of Science in Nursing (BSN)
- Emergency room registered nurse
- 2021 average salary of $79,300
- A Bachelor of Science in Nursing (BSN)
- Registered nurse (RN)
- 2021 median salary of $77,600
- A Bachelor of Science in Nursing (BSN) required
- Labor and delivery nurse
- 2021 average salary of $76,400
- A Bachelor of Science in Nursing (BSN)
- Clinical nurse supervisor
- 2021 average salary of $76,145
- A Bachelor of Science in Nursing (BSN)
- Nurse case manager
- 2021 average salary of $66,155
- A Bachelor of Science in Nursing (BSN)
- Home care registered nurse
- 2021 average salary of $53,000
- A Bachelor of Science in Nursing (BSN)
Nursing Salaries By State, Area, and City
Checking once again with the US Bureau of Labor Statistics, I found the most recent breakdown of nurses’ salaries by state, which listed these five states as the highest-paying states for registered nurses:
- California $124,000
- Hawaii $106,530
- Oregon $98,630
- District of Columbia $98,540
- Alaska $97,230
The remaining states’ registered nurses’ salaries:
- Massachusetts $92,140
- Washington $82,670
- Nevada $85,620
- New York $85,610
- New Jersey $82,750
- Connecticut $81,220
- Minnesota $78,920
- Rhode Island $78,420
- Arizona $77,000
- Maryland $76,820
- Delaware $74,800
- Colorado $74,240
- Illinois $73,890
- Texas $72,890
- New Hampshire $72,760
- New Mexico $71,730
- Wisconsin $71,470
- Michigan $71,330
- Pennsylvania $70,390
- Virginia $69,790
- Vermont $69,160
- Georgia $68,950
- Maine $67,610
- Montana $67,450
- Wyoming $67,360
- Idaho $67,110
- Ohio $66,820
- Florida $66,210
- North Dakota $65,740
- Utah $65,670
- Missouri $65,130
- South Carolina $64,940
- Indiana $64,860
- North Carolina $64,850
- Nebraska $64,470
- Louisiana $63,970
- Kentucky $63,100
- Oklahoma $63,080
- West Virginia $61,780
- Virgin Islands $61,550
- Tennessee $61,320
- Kansas $61,030
- Arkansas $60,780
- Alabama $59,470
- Iowa $59,130
- Guam $59,030
- Mississippi $58,490
- South Dakota $58,340
- Puerto Rico $34,940
The highest-paying metropolitan areas for registered nurses are:
- San Jose-Sunnyvale-Santa Clara, CA $155,230
- San Francisco-Oakland-Hayward, CA $151,640
- Vallejo-Fairfield, CA $146,360
- Santa Rosa, CA $141,440
- Napa, CA $139,680
- Santa Cruz-Watsonville, CA $139,590
- Sacramento – Roseville – Arden-Arcade, CA $135,490
- Salina, CA $130,520
- Modesto, CA $127,730
- Hanford-Corcoran, CA $124,790
The highest-paying nonmetropolitan areas for registered nurses are:
- North Valley-Northern Mountains Region of California nonmetropolitan area $115,160
- North Coast Region of California nonmetropolitan area $110,760
- Eastern Sierra-Mother Lode Region of California nonmetropolitan area $109,990
- Alaska nonmetropolitan area $100,470
- Hawaii / Kauai nonmetropolitan area $100,050
According to Incredible Health, the highest-paying cities for registered nurses are all in California. It’s not until you scroll down to number 20 on the list that you find a non-Californian city — Honolulu.
The top ten highest-paying cities in California for registered nurses are:
- San Jose-Sunnyvale-Santa Clara, CA $155,230
- San Francisco-Oakland, CA $151,640
- Vallejo-Fairfield, CA $146,360
- Santa Rosa, CA $141,440
- Napa, CA $139,680
- Santa Cruz-Watsonville, CA $139,590
- Sacramento-Roseville, CA $135,490
- Salinas, CA $130,520
- Modesto, CA $127,730
- Hanford-Corcoran, CA $124,790
The top ten highest-paying outside cities in California for registered nurses are:
- Urban Honolulu, HI $107,680
- Kahului-Wailuku-Lahaina, HI $107,600
- Portland-Vancouver, OR-WA $101,710
- Boston-Cambridge, MA-NH $99,950
- Seattle-Tacoma, WA $99,310
- New York-Newark, NY-NJ-PA $98,460
- Eugene, OR $97,330
- Anchorage, AK $96,160
- Medford, OR $95,020
- Albany, OR $94,820
Of course, just learning what you can get paid for working as a registered nurse in various cities around the country, you’ll also need to factor in how much it costs to live in those areas.
The cost of living is how much money is needed to cover “basic expenses such as housing, food, taxes, and healthcare in a certain place and time period.” This is used to compare how expensive it is to live in one place or another.
One way to calculate the cost of living index is by asking, “How many goods and services does a given sum of money purchase in a certain location?” For instance, a loaf of bread costs more in Arkansas than in New York or California.
The top five highest-paying cities in California for registered nurses and adjusted for cost of living are:
- San Jose-Sunnyvale-Santa Clara, CA $138,475
- Vallejo-Fairfield, CA $135,018
- Hanford-Corcoran, CA $129,854
- San Francisco-Oakland, CA $129,164
- Santa Rosa, CA $128,816
The top five highest-paying cities outside of California for registered nurses and adjusted for cost of living are:
- Kahului-Wailuku, HI $98,716
- Eugene, OR $97,427
- Portland-Vancouver, OR-WA $96,225
- Medford, OR $95,402
- Honolulu, HI $94,622
Negotiating Your BSN/RN Salary
Only some have the flexibility and freedom to move simply based on wanting the highest possible salary. Some of us have ties to family and community and want to stay in a certain area.
So, how do you negotiate the best possible salary for yourself?
Daily Nurse offers five tips to help you negotiate from a position of strength when looking for the best salary and lifestyle for your work as a registered nurse. I found three of these tips to be worth passing on.
- Do your homework. Search online to find the salary range of similar positions in your area.
- Know your worth. Clearly understand your strengths and skills and how you bring value to your work situations.
- Sell your own story. Beyond communicating your hard and soft skills, tell your current or future employer your own story — how you came to be interested in the nursing field and the passion you feel for it.
If you need help with negotiating your best salary, reach out and let me know! It’s what I’m all about, as my passion is to help doctors (and nurses) build a profitable business that gives you time, freedom, and fulfillment.
