RN Earnings Are Still Best in the West

November 02, 2016

Registered nurses (RNs) in the West and Northeast continued to take home the biggest pay checks in 2015, according to Medscape's second survey on nurse compensation.

RNs in the Western states of Alaska, California, and Hawaii earned on average $98,000 in 2015, more than anybody else. The number 2 spot for earnings belonged to the Northeast, at $85,000. Trailing the pack were RNs in the North Central states ($70,000). Nationwide, annual earnings for RNs stood at $78,000 last year.

The West and Northeast also ranked 1 and 2 in Medscape's survey of RN compensation in 2014. Better pay on the coasts largely reflects the higher cost of living there, said Peter McMenamin, PhD, a senior policy fellow and health economist at the American Nurses Association (ANA). The presence of a robust nurses' union, particularly in California, also helps explains why RN wages are higher in these regions, Dr McMenamin told Medscape Medical News.

On the whole, regional variations in earnings for licensed practical nurses (LPNs) followed the same pattern. LPN compensation was highest in the West ($50,000), with the Northeast ($49,000) and Southwest ($49,000) trailing close behind. LPNs in the North Central states posted the lowest annual earnings ($39,000) in the nation.

These findings emerge from an online survey of roughly 10,000 RNs, LPNs, and advanced practice registered nurses (APRNs) conducted earlier this year. LPNs include the similar professional cadre of licensed vocational nurses. Medscape Medical News will analyze the earnings of APRNs in a future article.

RN Pay Is a Matter of Degree — Academic, That Is

Fifty-six percent of RNs work in hospitals, with 41% providing inpatient care and another 15% practicing in hospital outpatient or clinic settings. Perhaps not surprisingly, hospitals represent the best money in 2015, aside from military or government employment.

Table 1. RN Earnings by Practice Setting

Practice Setting Earnings in 2015 ($)
Military/government 84,000
Hospital: inpatient care 82,000
Hospital: outpatient or clinic 78,000
Academic setting (faculty) 76,000
Skilled nursing facility/other long-term care 74,000
Home health/visiting nurse 72,000
Public health/occupational health 71,000
Non–hospital-based medical office/urgent care clinic 68,000
School/college health services 61,000


RN compensation also varied by educational degree. RNs with a doctorate were on top with earnings of $90,000 last year. A master's degree meant $86,000; a bachelor's, $79,000; an RN diploma, $75,000; and an associate's degree, $71,000. The ANA wants to see 80% of RNs holding a bachelor's degree by 2020.

Almost Half of RNs Log Overtime

As in other profession, there's a gender gap in nursing when it comes to pay. Male RNs, who account for 8% of the profession, reported annual earnings of $83,000, 6% more than the $78,000 reported by their female counterparts.

It's not a matter of employers brazenly paying male RNs more than female RNs for the same work, said the ANA's Dr McMenamin. "Male RNs tend to work more hours and moonlight more," he said.

More significantly, many female RNs temporarily drop out of the labor force, sometimes for several years, to have children. "And when you come back, you don't come back at the salary you would have had if you had stayed in," said Dr McMenamin.

Yet another explanation for the gender gap in compensation, he said, is that women constitute the vast majority of senior nurses, whose earnings tend to plateau or even decline as their careers wind down.

Across the profession, 47% of RNs reported regularly putting in overtime, with nearly half of them logging an additional 6 or more hours per week. As with pay, overtime hours varied by practice setting. RNs in skilled nursing and other long-term facilities were the most likely to work extra hours (59%), while those in public and occupational health were the least likely (31%).

Overtime was just one way some RNs were able to boost their income in 2015. Fatter paychecks mostly stemmed from raises.

Table 2. Reasons for RN Earnings Increases in 2015

Reason for Increase Survey Response (%)
Received a merit or cost-of-living raise 76
Worked more hours/went full-time/did more overtime or call 15
Received a promotion 8
Advanced on a clinical ladder 6
Took on a second job 3


The percentage of RNs who believe that they were fairly compensated rose from 53% in 2014 to 55% in 2015. Higher-earning male RNs (58%) were more likely to think that way than female RNs (55%).

More information on RN and LPN compensation is available here.

Follow Robert Lowes on Twitter @LowesRobert


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