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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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PMFB-RN has 16 years experience as a BSN, RN and specializes in burn ICU, SICU, ER, Traum Rapid Response.

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I spent several years researching the best place to be an RN.

    The Twin Cities of Minnesota had the highest pay vs cost of living I found. Working conditions are pretty good and a high rate of unionization. 

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traumaRUs has 27 years experience as a MSN, APRN, CNS and specializes in Nephrology, Cardiology, ER, ICU.

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On 11/10/2019 at 2:42 PM, FullGlass said:

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.

I consider CA and MD to both be very high cost states and I have lived in multiple states all over the US. I currently live in IL (central IL, rural area) and my pay is excellent for this area with 13+ years APRN experience. A very nice 2000+ sq foot house will run anywhere from $150 up.

And I take exception to your statement that " High quality food - most of the nation's fruits and veggies are grown here." Most of the corn, wheat and dairy come from the midwest. 

Iowa produced the most corn in the United States in 2016 followed by Illinois & Nebraska. Iowa and Illinois both produced over 2 billion bushels in 2016. Four states produced over 1 billion bushels of corn in 2016: Iowa, Illinois, Nebraska, & Minnesota

https://beef2live.com/story-states-produce-corn-0-107129

 

 

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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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50 minutes ago, traumaRUs - Judy said:

I consider CA and MD to both be very high cost states and I have lived in multiple states all over the US. I currently live in IL (central IL, rural area) and my pay is excellent for this area with 13+ years APRN experience. A very nice 2000+ sq foot house will run anywhere from $150 up.

And I take exception to your statement that " High quality food - most of the nation's fruits and veggies are grown here." Most of the corn, wheat and dairy come from the midwest. 

Iowa produced the most corn in the United States in 2016 followed by Illinois & Nebraska. Iowa and Illinois both produced over 2 billion bushels in 2016. Four states produced over 1 billion bushels of corn in 2016: Iowa, Illinois, Nebraska, & Minnesota

https://beef2live.com/story-states-produce-corn-0-107129

 

 

I am glad that you are happy in central IL.  

While you may consider CA and MD to be high cost states, cost of living varies widely by area within those states.  

As for my statement about food, I fail to understand why you take exception.  I specifically stated California grows most of the fruits and veggies in the US.  That is a simple fact.  So we get a great selection of very fresh produce.  I wasn't talking about commodities like corn, wheat, etc., as these are generally not consumed in their "raw" state, but must be processed for human consumption.  People do eat fresh corn on the cob and frozen and canned corn, but it is not a major part of a healthy diet.  There is a lot of concern that corn is not the healthiest food choice.  In addition, corn is primarily produced for animals; only about 10% is consumed by humans.

As for dairy, California has a huge dairy sector, and our groceries are full of milk and other dairy products from California cows.

California is also a major rice producer.  "California (CA) rice is grown on soils unsuitable for other crops because of poor drainage. This land is ideal for rice production and produces the world’s highest rice crop yields."

http://www.accrice.com/sustainability/the-facts-about-california-rice-production/

California is a major economic powerhouse, with the largest economy of any US state.  If it were an independent country, it would have the 5th largest economy in the world.  

https://markets.businessinsider.com/news/stocks/california-economy-16-mind-blowing-facts-2019-4-1028142608#california-makes-81-of-all-us-wine6

81% of all US wine comes from California

Entertainment capital of the US

High tech capital of the US

Best public university and college system in the US

2 largest seaports in the US

Largest biotech hub(s) in the WORLD

 

Edited by FullGlass

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

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2 hours ago, FullGlass said:

California is a major economic powerhouse, with the largest economy of any US state.  If it were an independent country, it would have the 5th largest economy in the world. 

Well, living here sometimes it does feel like I'm in a foreign country! Lol. I meant that in the most lighthearted way. While we both love it here I have to say it's certainly not for everyone's liking. It's OK for people to have a variety of tastes and preferences. Californians do exude that air as if the sun rises and sets in California alone and for good reason as you illuminated in your post. However, I still recommend that people weigh all personal factors in making moving decisions. Quality of life as I'm sure you know is not just about money. I found the quality of life better here despite the cost of living but another person may not feel the same way. 

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ICUman specializes in Cardiac Cath Lab.

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On 11/12/2019 at 4:03 PM, PMFB-RN said:

I spent several years researching the best place to be an RN.

    The Twin Cities of Minnesota had the highest pay vs cost of living I found. Working conditions are pretty good and a high rate of unionization. 

Are you sure on the Minneapolis area? I'm in Las Vegas. We have no state income tax here, we have union representation by CNA (California nurses association), new grads start at $39/hr at these select hospitals, and COL here is reasonably low.  I feel like nurses make good $ here compared to COL. Most nurses with >20 years experience are making $55/hr or more. 

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

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5 hours ago, ICUman said:

Are you sure on the Minneapolis area? I'm in Las Vegas. We have no state income tax here, we have union representation by CNA (California nurses association), new grads start at $39/hr at these select hospitals, and COL here is reasonably low.  I feel like nurses make good $ here compared to COL. Most nurses with >20 years experience are making $55/hr or more. 

Also, if you are looking to open a NP practice the “24 hour” nature of Vegas presents unique opportunities for being open late at night (or 24 hours). Nevada however is NOT IP from day one as I believe you need about 1000 hours supervised practice to prescribe.

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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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Please let us know where you end up

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steve no is a RN and specializes in psych and geri.

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interesting because i am moving to vancouver wa and i am coming from western nc mountains where weather is usually nice and colors are nice but as an rn i will probaly never see more than 25 an hour with no shift diff and its 22 at the hospital i am in bsn program and that may get me an extra dollar but thts it. I see pay in the 40s online out west and im thinking what am i doing here?

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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 am seeing lots of offers around Seattle for about  $50.00 per hour for an RN (granted I have about 12 years experience).  Also, the extra 5% boost for not having income tax is worth considering.  Also, if you live near Oregon you can "shop" in Oregon (which unlike Washington doesn't have a sales tax but does have an income tax) and live in Washington State.  Maybe you can join me on some hikes into the Mountains searching for the mythical Bigfoot (then again NC has plenty of Bigfoot sightings as well).  

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