Is Nor Cal nursing all it's cracked up to be?

**NickiLaughs, ADN, BSN, RN** · Mar 30, 2016

I'm pretty happy in the Sacramento suburbs. Bakersfield and Fresno for the most part Pay less. I worked at the lowest paying hospital in the region and would be making 55 or 56$ an hour base plus 6$ hr for every hour after 3 pm. Not too shabby. Especially when you can buy nice homes here for under 400k. I bought mine, it's older but remodeled on almost a quarter acre and only owe 295k in a great neighborhood and fantastic school district. Plus I live 10 minutes from a lake. This house was bought a couple years ago and prices have gone up. I currently work for the highest paying hospital system in the region and make 70$ hr base. I have 8 years of RN experience.

My husband is a stay at home dad and I'm able to pay all our bills including mortgage, one car payment, exorbitant student loan payments. Etc.

We have rivers, great nature hikes and are less than two hours from snow and 2 hours from SF. Moving here was the best decision I made in my life as in Southern California I was barely getting by paycheck to paycheck. The trick is getting that first job here.

:)

TheCommuter, BSN, RN · Mar 31, 2016

I lived in Bakersfield for two years and still have family there.

Reasons exist for the low cost of living there...it is not the most glamorous or cosmopolitan place to live. The city has an agricultural stench, some of the worst air quality in the country, and poverty rates that rival Appalachia.

adventure_rn, MSN, NP · Mar 31, 2016

Hi guys, thanks for the input, exactly what I was wondering.

It sounds like these cities are great places for families with the suburban sprawl and relatively low cost of living relative to salary, but maybe not the best for young single people or couples without kids looking for adventures.

I know this isn't the traveler section, but I'm wondering if any travelers can speak to the conditions and pay relative to other regions. Are you there, Ned?

RunBabyRN · Apr 2, 2016

I work in San Francisco, and few of my coworkers live in the city because it's so expensive. Even the surrounding areas are expensive, and for what I make, I still have to be careful about my spending (I'm a single mom, so it's my income only). We just renegotiated our contract with CNA, so we have increases coming, but still.

Bakersfield, Modesto and Fresno are not very desirable places to live, which is why they are actively recruiting all the time. Many hospitals throughout the state are looking for experienced nurses, and I know Kaiser, which is one of the better paying system here, has been actively recruiting (at least for labor and delivery).

What kinds of things are you looking for, weather-wise, city sized-wise, resource-wise, etc? Maybe we can help steer you in the right direction.

adventure_rn, MSN, NP · Apr 2, 2016

I work in San Francisco, and few of my coworkers live in the city because it's so expensive. Even the surrounding areas are expensive, and for what I make, I still have to be careful about my spending (I'm a single mom, so it's my income only). We just renegotiated our contract with CNA, so we have increases coming, but still.
Bakersfield, Modesto and Fresno are not very desirable places to live, which is why they are actively recruiting all the time. Many hospitals throughout the state are looking for experienced nurses, and I know Kaiser, which is one of the better paying system here, has been actively recruiting (at least for labor and delivery).
What kinds of things are you looking for, weather-wise, city sized-wise, resource-wise, etc? Maybe we can help steer you in the right direction.

So helpful, thank you!!

I'm in NICU, not actively seeking a new job right now. Rather, I just read a Forbes article that made the argument that instead of scrimping and saving pennies (i.e. not buying your daily Starbucks), you're actually better off working to increase your income by asking for a raise. Obviously you can't do that in nursing since most raise schedules are set, but I realized: the work that I do as a NICU nurse in my current state (in the southeast) is the exact same as the work I'd do in any other part of the country, yet it has a vast difference in pay even when adjusted for cost of living.

From what I've read, non-SF Nor Cal, Arizona, and urban Texas have the best nursing salaries relative to cost of living.

Then again, I'm not only interested in salary. My hospital has a reputation for not paying well relative to the rest of the state, but I'm still able to pay my bills, carry no debt, and put money into savings and retirement account. I'm single, interested in eventually getting married but probably no kids.

I do love the idea of the Pacific NW. Very intellectually-engaged and scenic views, with a middle-of-the-road salary vs cost of living (although pretty pitiful compared to Nor Cal).

Do you find that you have manageable patient ratios? I'm not just interested in compensation on units, but also the quality of the unit culture given the strong union presence.

guest769224 · Apr 2, 2016

From what I've read, non-SF Nor Cal, Arizona, and urban Texas have the best nursing salaries relative to cost of living.

Las Vegas, Nevada pays a ton in comparison to cost of living! I was offered $38/hr as a new grad a few months go. I spoke with a nurse recruiter in Vegas who told me their pet diem rates are 64/hr for critical care and due to rise.

You'd have to really like hot and dry weather though! I know I do.

By the way, I think NedRN only frequents the travel forum so you'd have to wander over there and ask.

NedRN · Apr 3, 2016

In the travel nurse forums, Las Vegas has perhaps the worst reputation of any city in the country - for crappy working conditions, not having fun. The cost of living there is not so high, so there is a reason why they have to pay nurses well. You will be able to find posts on Allnurses without too much trouble with more details. I would think hard about starting your career somewhere else. If you can get an offer at a great teaching hospital, take it. Even if the pay means you will just be above water financially. Pay your dues and your career is based on a sound foundation. If that is your offer in Las Vegas, I would still look elsewhere and keep Vegas as a backup in case.

**NickiLaughs, ADN, BSN, RN** · Apr 3, 2016

Ratio in California is mostly enforced in nor cal. The ERs sometimes have issues. ICU is 1:1 or 1:2 depending on the patient. Step down 1:3, tele 1:4. Med surg 1:5. I couldn't imagine having more patients and doing my charting.

guest769224 · Apr 3, 2016

I would think hard about starting your career somewhere else.

I took an ICU job in a neighboring state (much lower wage). LV hospitals can't be that bad thoughâ€¦or else they'd have no nurses working for them. A few nurses there have told me that the CNA has moved in and brought unions from CA, and that it has made working conditions much better in the last few years. As a traveler, I'm sure conditions are unwelcoming. But as a staff RN in Vegas, it doesn't sound half bad. I only spoke with the Dignity Health system, though. Which has a better reputation.

I have wondered why LV pays staff nurses so well. Do you have additional details?

NedRN · Apr 3, 2016

As you know, I put some thought into workplace dynamics from an economic focus. Why so much pay is always an interesting question, but one that requires expert answers. I'm not really qualified. Perhaps a sociologist and/or an economist could provide better answers. The American workforce is much mobile than most if not all other countries, but only to a point. You will get the wrong ideas from hanging out on the travel forum too long! That is not the norm for nurses.

Every hospital has a catchment area for not only patients, but for staff too. Most staff grew up in the area, or became attached for other reasons, perhaps school or significant other. You will find most staffers, while griping, only see their options as other local hospitals and don't want to turn their lives upside down by moving to where the grass may or may not be greener. Most are unlikely to see the big picture or even imagine that working conditions might be better somewhere else. So will, and do move. But that doesn't drive a lot of turnover of staff because they move out of the area. And usually those moves are not nursing related, rather that spouse got a better job somewhere else or there was some other compelling family story.

Thus the market for staff is a captive one typically, which would appear to skew the law of supply and demand. Perhaps it does, or perhaps that is just a known factor. Certainly if nurses were completely mobile and based their decision on compensation versus workload (how good is it to work there), true free market conditions would mean that supply and demand would quickly be in balance with compensation stable. That doesn't happen, and an economist would tell you that because of that, it is not an "efficient" market, where cost really reflects value at a given moment. The inertia of large staff populations and slow recruiting or staff departures in a changing economy may mean a lag of years (seems likely to me) to balance supply an demand.

In the meantime, hospitals must adapt. When there is oversupply, wages are static or go down. You can certainly see that regionally in this country when you look at pay in the South or lower Midwest. When needs go up, as in Las Vegas after the Great Recession (they were hit particularly hard), strategies include the use of contingent labor such as travelers. No large business can afford a huge increase in staff pay for fast reaction to shortages (and later dropping pay is not politically feasible), but if managed properly with minimum contingent labor while recruiting, it doesn't cost anywhere near the cost of bringing staff pay up to balance supply and demand. Contingent labor, while costly, is confined to a small percentage of overall staffing costs when well managed.

Contingent labor includes not only travelers, but local agency, and in-house per diem staff. Per diem staff pay can be quickly adjusted for current conditions as might be the case in Las Vegas with your $64 citation. And back down again when needs are lower without affecting staff pay. Much of the per diem staff in many hospitals are regular staff picking up extra shifts. Here is perhaps a new idea for you but growing in practice at many hospitals: technology that allows staff to bid on extra shifts. That is an example of an efficient market where pay reflects actual value to the nurses bidding, just as does the stock market.

Just to remind you, per diem is non-benefited, and similar to traveler, the effective cash per hour is higher than regular staff. Really what you want to know when considering a job out of nursing school (primary thought should be what they can teach you in my opinion) is what is starting pay, and what can I make after 5 years. Per diem pay is irrelevant or at best minor after getting those two figures.

And yes, Dignity hospitals are probably your best bet for working conditions in Las Vegas from what I read. Mind you, compensation is not the only factor in local markets. Dignity has fewer openings and is more competitive than other local hospitals for staff - harder to get a job there than other local hospitals that may pay more - for a reason. But your best option in Las Vegas still doesn't bring working conditions up to say California standards.

guest769224 · Apr 3, 2016

Really what you want to know when considering a job out of nursing school (primary thought should be what they can teach you in my opinion) is what is starting pay, and what can I make after 5 years. Per diem pay is irrelevant or at best minor after getting those two figures.

Hence, I went with quality over quantity and declined my LV offer. This position opens doors for me. Howeverâ€¦I do plan to apply per diem and work in LV still, after a year-ish experience, as the commute to LV for me is rather short. That's why I had looked into it. Why is starting pay and earning potential after 5 years so important here? I don't plan to stay full-time staff with my hospital system, unless I wanted to make under $30/hr for the rest of my working nurse career. Which is why I'm drawn to per diem and the LV area, after gaining experience I'll have earning potential near triple to my current situation. I am in a rush to pay off my student loans, one reason I'm drawn to travel nursing.

I feel like if I have the wit to land myself a new grad ICU position in a large hospital, that I can excel and ace a Dignity Health interview, and it would certainly be worth it. I have heard they are the most competitive to be hired by.

Could you explain technology that allows staff to bid on extra shifts? I am unfamiliar with what that means.