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.

[adventure_rn, MSN, NP]

On 6/20/2020 at 3:02 PM, myoglobin said:

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.

Dude, last fall I specifically remember telling you that Seattle wasn't the financial panacea you were expecting because the cost of living is quite high (even compared to the higher-than-average salaries), and that it wouldn't be practical for you to live out of your van, shower at the gym, and eat exclusively at buffets due to the high cost of housing/parking/fuel/gyms/food, and the painfully long/slow commutes. You replied that I didn't know what I was talking about.

This. This is what I was talking about. Living 'comfortably' in Seattle means paying $800,000 for a dated 3 bed, 1 bath, 1000 sq ft house, or about $2,200 a month for a 1 bed, 500 sq foot apartment.

I know it it's fully maximizing your return, but it sounds like you've found a place where you're making 'enough' money and aren't entirely miserable.

[myoglobin, ASN, BSN, MSN]

I would not have the 200k dollar per year job that I have now had I not moved to Seattle.

[FullGlass, BSN, MSN, NP]

4 hours ago, myoglobin said:

I would not have the 200k dollar per year job that I have now had I not moved to Seattle.

Are you really making $200k a year now? Last time we heard from you, you were working part-time in psych and also had 1 or 2 other part-time gigs.

If you can make a Seattle salary and live in Florida, then more power to you.

[myoglobin, ASN, BSN, MSN]

My main "job" is grossing (before taxes) about $16,500 per month working three 12 hour days (and a 4th day charting). My "second" job hasn't paid me since a 3K advance and about six hundred in two small checks (even though I was working two days per week there seeing about 30% of the patients as at my main job. I believe it was mainly an insurance issue. I'm done with the disability evaluations (those were in person only) and they ended up paying me about $1800.00 total for seven Sunday's seeing patients (and many days writing the reports up). My initial evaluations are 90minutes in length (at my main job) and my "followups" are 30minutes in length. I may end up going back to Seattle one week per month to see initial ADHD clients if the Ryan Haight Act goes back in to effect after Covid (although many of my interventions are CAM, I do use stimulants). I get about 20 calls per week from my Psychology Today add and I honestly believe that with a little more marketing I could probably do almost as well taking "cash only" charging about $200 for initial evaluations and $75.00 for tele health followups and expanding coverage to not only the entire state of Washington, but also Arizona and Colorado (where I am also licensed).

[steve no, 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).

OK im down because guess what I actually moved here to vancouver washington and everything is as above got started working right before covid didn't get to explore the area much but its nice people are definitely different...

[FullGlass, BSN, MSN, NP]

1 hour ago, myoglobin said:

My main "job" is grossing (before taxes) about $16,500 per month working three 12 hour days (and a 4th day charting). My "second" job hasn't paid me since a 3K advance and about six hundred in two small checks (even though I was working two days per week there seeing about 30% of the patients as at my main job.

Glad you were able to get a good job. That job with the $3k advance sounded sketchy to me. I also do VA disability exams, but physical issues only, and boy is the paperwork a pain! LOL Again, glad things worked out for you

[SuziQ1978]

On 11/9/2019 at 4:03 PM, FullGlass said:

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.

What about the state income taxes? That keeps me away from California. No Thank you.

[Thanksforthedonuts, MSN, APRN]

4 hours ago, myoglobin said:

My main "job" is grossing (before taxes) about $16,500 per month working three 12 hour days (and a 4th day charting). My "second" job hasn't paid me since a 3K advance and about six hundred in two small checks (even though I was working two days per week there seeing about 30% of the patients as at my main job. I believe it was mainly an insurance issue. I'm done with the disability evaluations (those were in person only) and they ended up paying me about $1800.00 total for seven Sunday's seeing patients (and many days writing the reports up). My initial evaluations are 90minutes in length (at my main job) and my "followups" are 30minutes in length. I may end up going back to Seattle one week per month to see initial ADHD clients if the Ryan Haight Act goes back in to effect after Covid (although many of my interventions are CAM, I do use stimulants). I get about 20 calls per week from my Psychology Today add and I honestly believe that with a little more marketing I could probably do almost as well taking "cash only" charging about $200 for initial evaluations and $75.00 for tele health followups and expanding coverage to not only the entire state of Washington, but also Arizona and Colorado (where I am also licensed).

Not sure if it’s relevant. In the Seattle areA, I charge $400 cash just for a LTC nursing assessment. And $200 for nurse delegations and $75 for review every 90days... you *might* want to boost your numbers up as an ARNP is your doing advanced practice work.

[myoglobin, ASN, BSN, MSN]

I’m talking about if we went straight “cash only” no insurance (since getting signed up on our own and billing are beyond me at this point). Thus, if we were independent we would need to be very competitive on price, service and hours.

[Thanksforthedonuts, MSN, APRN]

1 hour ago, myoglobin said:

I’m talking about if we went straight “cash only” no insurance (since getting signed up on our own and billing are beyond me at this point). Thus, if we were independent we would need to be very competitive on price, service and hours.

I still think you could charge more even straight cash.

Private RN nurse managers Charge $175 an hr in my area for mediocre supervision. I also charge $50 hr. just to drive seniors to appointment or attend an appoint, which is crazy cheap but I do it as a courtesy.

[myoglobin, ASN, BSN, MSN]

12 hours ago, Thanksforthedonuts said:

I still think you could charge more even straight cash.

Private RN nurse managers Charge $175 an hr in my area for mediocre supervision. I also charge $50 hr. just to drive seniors to appointment or attend an appoint, which is crazy cheap but I do it as a courtesy.

Maybe, I'm just not sure what people are willing to pay for teleservice appointments for Psychiatric issues when they cannot bill their insurance. My private pay rate at Mindful is $300.00 for initials (about 90 minutes) and $150.00 for followups (about 30 minutes) and my sliding scale rate (for those with need or without insurance) is $150.00 and $75.00. However, 90% of my clients have insurance. My thought would be to take one of the "extra" two days that I'm gaining by no longer working at Light Heart in Redmond and building a "cash service" as a bit of "security" in case things ever get rocky at my primary company and long term to have a bit more security. I work in a pretty progressive market (Seattle) and I tend to be Libertarian and opinionated so it's just a matter of time until I say something that isn't politically correct and gets me in hot water (not to mention in to things like UFO's, Bigfoot alternative medicine and PSI type stuff). I tend to make both the right and the left upset when I speak even a hint of my my mind.

[Thanksforthedonuts, MSN, APRN]

Libertarian and opinionated fit in well for Seattle ?

I’m conservative and opinionated so I’ll just stick to Bellevue ?. Although, conservatives are dissappearing in this area.

Anyway...

I do think you could charge $150 cash for a Telehealth appointment. I was speaking to a new HH agency out of Seattle that does not accept insurance, I believe their per hour rate for RN services was $175 an hour. Mind you this is for injections, IV management, & wound care In the community health setting. And as I pointed before, nurse concierge services, which are slowly becoming more popular, charge $175 an hour for providing nursing recommendations and services.