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Best States for RN's and NP's both in terms of pay and practice?

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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So as a new grad. PMHNP I'm considering leaving Florida. My SO has been practicing "here" since 2016, but she entered the profession with a telepsych job paying $85.00 per hour and these jobs now seem to want a minimum of two years experience to even be considered.  Based upon the 500 or so jobs nationwide that I have applied for here are my impressions of the best pay and practice for NP's. I will throw in RN for good measure based upon past experience.

NP's

1.  Washington State-  Good pay, good practice environment, independent practice. Good climate and good natural beauty. Also no state income tax.

2.  Oregon. Same as above, but the pay for NP's may be slightly less. No sales tax.

3.  Nevada- Same as above, but you need 2000 hours (I believe for IP practice). No state income tax.

4.  Pay may be as good as Washington state, but the practice environment is worse. Shorter appointment times (for medical management) . The rule seems to be 20 minutes rather than the "Washington 30, standard".  Less of a chance that Medicaid patients will get therapy. Partial hospitalization, art therapy, ACT teams are relatively rare (compared to Washington). 

5.  I'm going to put New York State out there. Yes their state income tax is horrible, but their practice environment in terms of Medicaid services, and pay seems to be excellent. Upstate the cost of living isn't bad either and it is quite scenic. On the other hand maybe someone might make a better case for New Hampshire which also has IP (unlike New York) and no state income tax.  

For RN's.

1. California-  The only state with ratio laws "with teeth" and really good pay despite high cost of living.

2.  New York State- Strong nursing unions (albeit no strong ratio laws). Really good pay.

3.  Nevada. I seem to remember that they had the best RN pay when adjusted for cost of living. Also no state income tax.

4. Washington. You are in a great state to become an NP if nothing else. Also, I believe the RN pay is decent.

5.  Mass.  I keep hearing that the hospital environment is top notch for RN's and the pay really good.  

I would be interested in some diverse perspectives on this list. Keep in mind my NP list is largely from a PMHNP perspective and other NP's (such as FNP's) may differ.  

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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California hands down has the highest NP pay at $124K.  Most of California is actually very affordable.  The expensive cities/metro areas are San Francisco, Los Angeles, and San Diego.  That leaves the rest of a very large and populous state as very affordable.

PMHNPs - new grad should start at at least $140K, likely to get $150K or higher (salary plus bonus).

California has a severe mental health provider shortage.  It is especially acute in areas outside the 3 major coastal cities.  There are quite large cities like Fresno, Bakersfield, Sacramento, Modesto, Stockton that are affordable.  You can buy a small house in Bakersfield for $100K.  There are also some very nice smaller cities like Redding and Chico.  And there are lots of small towns and rural areas as well.

California does not have FPA, but NPs are pretty much treated as if they do.  You're a new grad, so you are going to need supervision for awhile, anyway.  

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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I excluded California for NP's because getting a license there is pretty much like getting "a second degree".  Consider that you must get a California RN license (a process that can take six months unless you can afford to fly in, in person), then get ARNP license (which in California unlike most states requires your school to fill out specialized paper work, this can be a real challenge). Then you need a "furnishing license", then a DEA application.  After all of that you still need to find a California psychiatrist to associate with (and they are limited to four NP's I believe).  The process is so complicated that it would probably take close to a year for most people who do not already live there.  

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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2 minutes ago, myoglobin said:

I excluded California for NP's because getting a license there is pretty much like getting "a second degree".  Consider that you must get a California RN license (a process that can take six months unless you can afford to fly in, in person), then get ARNP license (which in California unlike most states requires your school to fill out specialized paper work, this can be a real challenge). Then you need a "furnishing license", then a DEA application.  After all of that you still need to find a California psychiatrist to associate with (and they are limited to four NP's I believe).  The process is so complicated that it would probably take close to a year for most people who do not already live there.  

Well, I got my RN license in 10 weeks, then it took 3 months for NP license. The furnishing is fast.  No matter where you work, you have to get the DEA.  You don't have to find a psychiatrist - your employer will take care of that.  I didn't go to school in California and had no issues with regard to my school.  Flying into get your fingerprints here does help, but there are cheap flights.  Some employers will also make you an offer without you having the CA license already and just hold the job for you until the license is received.  

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myoglobin has 12 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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I applied to about 50 jobs in California (on Indeed) and all of them said they would need a license "in hand".  Conversely, I have had second and third interviews with places in Washington, Oregon, and New York with salaries ranging from 130K to 160K.

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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3 hours ago, myoglobin said:

I applied to about 50 jobs in California (on Indeed) and all of them said they would need a license "in hand".  Conversely, I have had second and third interviews with places in Washington, Oregon, and New York with salaries ranging from 130K to 160K.

I got a job offer in California before I had even completed my MSN for a psych NP position.  They didn't require a PMHNP because they would train themselves.  That ended up not working out, unfortunately.  But maybe things have changed.

I want to clarify for others interested in California that you can apply for the RN and NP licenses, along with the furnishing, together.  That will take 10 to 12 weeks.  However, you can also apply for temporary licenses at the same time, which will knock 2-3 weeks off of that.

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BCgradnurse has 11 years experience as a MSN, RN, NP and specializes in allergy and asthma, urgent care.

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Rhode Island is a good state to practice in as a NP.  It's an independent practice state, and salaries are just about on par with MA., but housing costs are lower.  Licenses are processed fairly quickly.

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SopranoKris is a BSN, RN and specializes in Critical Care.

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The pay may be higher in CA, but it's off-set by the cost of living. Even less populated areas are still more expensive than in other states.

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20 hours ago, FullGlass said:

Well, I got my RN license in 10 weeks, then it took 3 months for NP license. The furnishing is fast.  No matter where you work, you have to get the DEA.  You don't have to find a psychiatrist - your employer will take care of that.  I didn't go to school in California and had no issues with regard to my school.  Flying into get your fingerprints here does help, but there are cheap flights.  Some employers will also make you an offer without you having the CA license already and just hold the job for you until the license is received.  

There is the rule, and then there is the exception...

I live in California and I have to say that I agree with Myoglobin. Although the pay is great, the state income tax is INSANE! We are also a very restrictive state in regards to practice, which is frustrating because I would very much desire working independently in the near future. When you add all of the negative aspects (high state income tax, restrictive state, high cost of living in desirable places one may want to live) with the positives of pay, I can see why others may want to move out of this state to work.

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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3 hours ago, SopranoKris said:

The pay may be higher in CA, but it's off-set by the cost of living. Even less populated areas are still more expensive than in other states.

It depends on where you are living.  No, less populated areas are not more expensive than other states.  I have no idea where you are getting your information.  I am renting a 2 BR 2 BA house with a yard for $800 per month.  As I said, you can buy a small house in Bakersfield for $100K.  You could buy a nicer house with a swimming pool and so forth for $250K.  Given that NP pay is so much higher in CA, I still come out ahead.  You actually make more money in California if you go inland, because there is a shortage of NPs.

As a primary care NP, first year comp $124K with the cost of living described above.  Now, I am going to be starting my 2nd job with a little over one year experience.  $150K base plus $6000 sign on plus there will be productivity bonuses, so I should make over $160K in my second year of practice as a primary care NP.  If anyone out there thinks they can do better, please share.

It has been discussed that there are RNs in the Sacramento area making $200K per year.  Sacramento is a bit pricey, but still reasonable.  You can rent a nice apartment there for around $1000 per month, which is quite good for a big city.

With regard to FPA, that is an issue in California, but every year we get closer to getting it and it will happen, probably within 10 years.  California NPs are treated like they have FPA in practice.  And for a new grad, you're not going to get FPA no matter where you live, because even in states with FPA, there are experience requirements before it is granted.

Given that I constantly read on this forum about the crappy pay and lack of jobs in many parts of the US, it is kind of surprising that people want to complain about California, which has the highest pay for NPs and a great job market, with plenty of very affordable areas!  

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SopranoKris is a BSN, RN and specializes in Critical Care.

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41 minutes ago, FullGlass said:

I have no idea where you are getting your information. 

From friends who are NPs who actually live in CA.

Just because your own personal experience is different, doesn't mean it's the only perspective out there. You live in CA, you're used to higher prices for housing & gasoline. For folks who live in other areas of the country, your idea of "inexpensive" might be "expensive" to them. 

 

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FullGlass has 2 years experience as a BSN, MSN, NP and specializes in Adult and Geriatric Primary Care.

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37 minutes ago, SopranoKris said:

From friends who are NPs who actually live in CA.

Just because your own personal experience is different, doesn't mean it's the only perspective out there. You live in CA, you're used to higher prices for housing & gasoline. For folks who live in other areas of the country, your idea of "inexpensive" might be "expensive" to them. 

 

I also live and work in CA.  I've also lived in Maryland.  Evidently, you don't live in CA.

We need NPs in most of CA, so I don't want people to just assume they can't afford to live and work in CA.  

While some parts of CA are expensive, most of the state is not expensive.  CA has high taxes, but not the highest in the nation.  

Let's look and the pros and cons of CA for an NP:

Pros:

1.  Highest pay in the nation, by far

2.  Great job market for NPs in most of the state - no trouble finding a job and multiple job offers are common.  So, if you end up with a crappy job, you won't be stuck there.

3.  Generally great weather

4.  Good social services.  California took the Medicaid Expansion and has many excellent FQHCs and free clinics.

5.  Great colleges and universities.  There are still good public schools if you live in a good school district.  If you want to advance your nursing career with additional graduate level studies, CA has the best public college system in the nation, and among the most affordable.  Community colleges are the cheapest in the country, with many CC's offering completely free tuition, fees, and even a book allowance for low income students.

6.  High quality food - most of the nation's fruits and veggies are grown here.  Most of the state has a wealth of ethnic food choices both restaurants and ethnic grocery stores.

7.  Extremely diverse population

8.  Incredible recreation activities in one state - beaches, mountains (skiing and other winter sports), hiking, backpacking, deserts, lakes, rivers, fresh water and ocean boating, easy access to Las Vegas, Hawaii, and other Western states.  Depending on where you live, you could literally go to the beach, then go skiing, then go to the desert in one day!

9.  An increasing number of NP residency programs

10.  In most places, you don't need winter heating, or very little.  In many places, you don't need A/C, either.  Those are huge expenses in some parts of the USA.

11.  You don't need to live in SF, LA, or San Diego to easily enjoy their recreation, arts, shopping, and dining options.  For example, you could live and work in Bakersfield and be in LA within 1 to 2 hours, depending on where in LA and traffic.  That's perfect for a weekend getaway or just a nice day trip.  Sacramento to SF is about 2 hours and there is also a train.  (Yes, we do have trains).  

Cons:

1.  Parts of CA are too expensive (parts of the coast).  The rest of the state is quite affordable

2.  Overall high combined taxes, but not the highest in the country.  

3.  Still restricted practice state, but FPA likely to occur within next 10 years.  If you're a new grad, you're not going to have FPA in any state until you have experience.  Given that CA has a shortage of providers in many areas, there are lots of options for new grads.

 

Summary:

Well, it's a personal decision.  Right now, I'm happy to be an NP in CA.  I may not stay here the rest of my life, but plan to be here for the next 5-7 years, at least.

My advice to RNs and NPs considering CA is to get your licenses, so you have them in hand.  Look at rental and home prices in the cities you are interested in, as they vary so widely by location.  Use Trulia, Zillow, Redfin, and craigslist for this.  

As for taxes, I'd rather pay 10% state income tax on $150K income (15,000) than 0% state income tax on $80K.  Even with 10% tax, I'd net $135K vs $80K.  And I'd have the comfort of knowing I can easily get another job and great prospects for continuing to increase my earnings as I advance my career.  Note:  people don't pay 10% income tax, that is the top bracket, but I gave it as a simple example.  In other words, you have to sit down and do the math for you individual situation.

Edited by FullGlass

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