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

[myoglobin]

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.

[PMFB-RN, RN]

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.

[traumaRUs, MSN, APRN]

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

[FullGlass, BSN, MSN, NP]

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

[Corey Narry, MSN, RN, NP]

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.

[guest769224]

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.

[myoglobin, ASN, BSN, MSN]

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.

[FullGlass, BSN, MSN, NP]

Please let us know where you end up

[steve no, RN]

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?

[myoglobin, ASN, BSN, MSN]

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).

[KokoBell, APRN]

Where did you decide to move to?

I live in Seattle and I must say though the pay is good, it's quite expensive to live here. Psych NPs make more here than FNPs and I am both certified.

[Emergent, RN]

On 11/20/2019 at 2:21 PM, myoglobin said:

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).

I live in Washington State. Of course I can go to Oregon relatively easily, and was passing through there a couple years ago. I needed an item from a hardware store.

I looked in the Oregon store, and then I called my local hardware store that was also an Ace Hardware Store. It turns out that the store in Oregon had jacked up the price to what it would be in my hometown with the tax. I waited until I got home.

After that, I will never be fooled into thinking that I'm getting a special deal in Oregon because of the tax laws.

[myoglobin, ASN, BSN, MSN]

I lived in Washington state for about a month before moving back to Florida due to Covid (I now work remotely). I did not notice store prices being that much higher than central Florida. I did note that restaurant prices were higher and that buffets were rare (now entirely gone of course everywhere for the most part post Covid). Gas was also much more expensive. As for cost of living I was paying $1200.00 to rent a "bedroom" in a house on AirBnb and for me this was miserable, but a different house might have been better (the owners little dog would bark extensively every time I came home, and the owner did a great deal of THC, and had a very "loud" personality so I essentially stayed in my bedroom all the time). By way of comparison in Davenport Florida we rent a four bedroom house with a pool (it used to be five but we had to move) for about $1800.00 per month.