Trusted Guide to Nurse Pay
There are so many factors to consider when thinking about where to work as a nurse – ratios, unions, quality of life, etc. But one answer everyone wants to know is “how much money can I make?”
Unfortunately, the answer is not quite as simple as the question. Nursing is such a nuanced profession that the compensation varies greatly between cities, specialties, care settings, and facilities. So what is the clear differentiator?
How much money you keep is likely much more important than how much money you make.
There are places where nurses are paid top dollar but in exchange must pay an arm and a leg to live in (hello, San Francisco). But of course, we must also consider the economic concept of utility when thinking about total compensation.
And the questions don’t end there! Money is important.
How Much Money Can You Make as a Nurse?
The most common questions we hear about nurse salaries are:
- What is my take-home pay?
- How much will I make after taxes?
- What does it cost to live there?
- Which nursing specialty pays the most?
1. What is my take-home pay? And how much will I make after taxes?
Most clinical nurses are hourly employees. Unless you’re in a management, education, or an advanced practice position (where you're likely to receive a yearly nursing salary), you’ll likely be paid by the hour. So the amount of money you make is directly tied to how much time you put in (which is a good or bad thing depending on how you view it).
Here are some factors that go into what you're paid as a nurse:
Depending on where you work, you can possibly make an extra pretty penny by working the less desirable shifts. For example, one hospital here in SF pays a 13% shift differential for night shift. So chronic night shifters make, on average, 13% more than their day shift counterparts!
Temporary, staff, part-time, per diem, on-call, etc. One of the coolest things about our profession is that there are so many different ways (and frequencies) in which to do it!
Depending on your needs, one type of classification can be more "lucrative" than another. Some staff nurses receive robust benefits – from highly discounted insurance, 401k, pension, or flexible sick and vacation time. But, if you don’t need all those benefits, going part-time or per-diem might be a better bet because the hourly compensation tends to be higher.
Some facilities pay higher than others, for sheer purposes of attracting talent or because the nurses that work there are represented by unions. So be careful of making blanket assumptions that nurses working in a certain city or zip code are compensated the same!
Salary by State
In California, it is mandatory that employers that haven’t established an alternative work week compensate employees at 1.5x standard rate of pay for any hours over 8 worked in a day. For any time worked beyond 12 hours in a day, it is 2x standard rate of pay, or double-time. This can mean that registered nurses picking up an extra shift or staying a few hours beyond their shifts can be extremely lucrative.
For travel nurses, whose taxable rates, or standard rates of pay, tend to be lower, the overtime or double time multiplier is applied to a much lower number. This can translate to travelers being less incentivized to work overtime, as it’s not nearly as advantageous. For an in-depth look at nurse salaries by state, check out Nurse Salary Explorer.
Some employment classifications, such as travel contract opportunities, may enable nurses to qualify for tax-free stipends. This qualification is discussed further in the Trusted Guide to Travel Nurse Taxes. Stipends for nurses typically come in three forms: lodging, meals and incidents, and relocation.
The amount of stipends paid for lodging and meals and incidentals are also called per diems and are determined by the government based on zip code. These amounts can be found at GSA.gov and indicate the daily maximum allowance for each category and reflect the cost of living in that particular area.
Relocation stipends can cover reimbursable expenses incurred when relocating for employment. These stipends are also tax-free.
"Bonus" has such a good reputation: sign-on bonus, completion bonus, extension bonus, referral bonus, etc. Everyone loves a bonus – especially the IRS. Bonuses are typically categorized as supplemental wages and thus get taxed in 1 of 2 ways: via the Percentage Method or the Aggregate Method. Regardless of which applies, you’ll be paying taxes on that bonus at a potentially higher tax rate than your regular wages AND depending on the amount of the bonus, it may bump you into a higher tax bracket.
We all know taxes are painful, but money is money and even taxable money is almost always more beneficial than no money, or bonus! Just be sure to set your expectations to avoid being bummed when that bonus doesn’t look as good in your bank account as it did on paper!
What does it cost to live there?
Remember, how much money you keep is likely much more important than how much money you make. That said, making more to begin with can have a huge effect balancing out your cost of living.
Where do nurses make the most money? When considering averages across the United States, California not only takes the cake but is a clean sweep in that it is also home to the top four paying metropolitan areas in the country: San Jose, Oakland, San Francisco, and Sacramento. Those, of course, come with a price tag (which we’ll get into below).
Following California pay rates, the state runner ups are Hawaii, Washington D.C., Massachusetts, and Oregon (in which nursing jobs earn an average of $91,000/year). See below in terms of hourly pay/salary, but keep in mind these are averages and there can be a ton of variability in these numbers!
- California: $49.37/$102,700
- Hawaii: $46.63/$96,990
- District of Columbia (DC): $43.32/$90,110
- Massachussetts: $42.95/$89,330
- Oregon: $42.68/$88,770
If you come from a smaller or suburban town, you might experience a touch of sticker shock when you start looking for housing in city where the cost of living is astronomically higher, such as San Francisco, New York City, Philadelphia, etc. While these numbers may scare some away from popular cities like San Francisco, where there is a will, there is a way!
Before taking one glance at the rent and immediately being discouraged, consider that salaries and wages tend to be tied to the cost of living. There are definitely affordable options within and around each of these cities. There may be commutable places close by that have a more reasonable cost of living – especially if the position only requires commuting three times a week.
Which specialty pays the most?
Not surprisingly, compensation can vary depending on your specialty. The general rule of thumb tends to be that the more specialized it is or specialty experience it requires, the higher the compensation (i.e. CRNA). This is especially true for travel opportunities as they follow standard market supply/demand.
In some places though, RNs are paid the same across the board regardless of specialty. This can be partly attributed to unions. In these cases, years of experience are often more important, so whether you're entry level or have long-term work experience can make a greater impact.
Top Paying Nursing Specialties:
- Operating Room (especially CVOR)
- Cath Lab
- Critical Care (especially pediatric)
- Case Management/Utilization Review
- Radiology/Interventional Radiology
- Labor & Delivery
For the actual amount of pay these nursing specialties make, check out this compensation report.
Let’s be real, it’s pretty uncommon that someone chooses the nursing profession for the compensation. But that doesn’t mean that it can’t be extremely rewarding in a financial way as well! If you want to dive deeper into the world of nurse finances, check out this series on how nurses can actually retire wealthier than doctors!
Compare Nursing Salaries Across Cities and States
Use Salary Explorer to compare nursing salaries across the country, and find out how much you could be making.