Highest Paying States for Nurses in 2026: Complete Salary Breakdown

If you're a nurse wondering whether you're being paid fairly, the answer might depend less on your skills and more on your zip code.

Nurse salaries vary dramatically by state. We're not talking about small differences. We're talking about $30,000 to $50,000 annual differences for the exact same job.

Same credentials. Same experience. Same responsibilities. Completely different paychecks.

This isn't fair, but it's reality. And understanding where nurses get paid the most can inform your career decisions, whether you're considering relocation or negotiating your current salary.

Based on current data, here are the states where registered nurses earn the highest average salaries:

1. California **Average RN Salary: $124,000 - $137,000**

California consistently tops the list for nurse compensation. Why?

• Strong nurse-to-patient ratio laws that protect working conditions
• Powerful nursing unions (California Nurses Association)
• High cost of living, particularly in major metros
• Large healthcare systems competing for talent
• State regulations that have historically supported nursing advocacy

Cities like San Francisco, Los Angeles, and San Diego offer some of the highest nurse salaries in the country. Even smaller California cities typically pay significantly above the national average.

**What makes California different:** Unions have successfully negotiated strong contracts. The state enforces safe staffing ratios. There's a culture of valuing and compensating nurses appropriately.

2. Hawaii **Average RN Salary: $106,000 - $113,000**

Hawaii's high cost of living drives higher wages across the board, and nursing is no exception.

• Extreme cost of living, especially housing
• Limited nursing workforce on the islands creates competition for talent
• Tourism-based economy generates healthcare demand
• Geographic isolation means recruiting mainland nurses requires competitive pay

**Consideration:** While salaries are high, so is the cost of living. A gallon of milk can cost $8-9, and housing is among the most expensive in the nation.

3. Oregon **Average RN Salary: $98,000 - $108,000**

Oregon offers strong nurse compensation without quite the cost of living of California or Hawaii.

• Progressive healthcare policies
• Strong union presence
• Growing healthcare industry in Portland metro area
• No sales tax (though income tax is relatively high)

4. District of Columbia **Average RN Salary: $95,000 - $105,000**

DC's concentration of major medical centers and federal healthcare facilities drives high nurse wages.

• Major teaching hospitals and research institutions
• Federal government healthcare facilities
• High cost of living in the metro area
• Competitive market for specialized nursing roles

5. Alaska **Average RN Salary: $93,000 - $103,000**

Alaska pays nurses well to attract talent to remote, challenging locations.

• Geographic isolation and harsh climate require higher compensation
• Limited nursing workforce
• Cost of living is high, particularly for goods that must be shipped
• Challenging working conditions in rural and frontier areas

6. Massachusetts **Average RN Salary: $92,000 - $101,000**

Massachusetts, particularly the Boston area, is a major healthcare hub with world-renowned hospitals.

• Concentration of top-tier teaching hospitals (Mass General, Brigham and Women's, etc.)
• Strong union presence
• High cost of living in Greater Boston
• Robust healthcare industry with significant research and specialty care

7. Washington **Average RN Salary: $91,000 - $100,000**

Washington state, particularly the Seattle area, offers competitive nurse salaries.

• Growing tech industry has driven up overall wages
• Strong healthcare systems in Seattle and Tacoma
• Progressive healthcare policies
• No state income tax (though sales tax and cost of living are high)

8. New York **Average RN Salary: $88,000 - $98,000**

New York's nurse salaries vary significantly between NYC and upstate regions.

• NYC hospitals pay at the top end, upstate hospitals considerably less
• Strong nursing unions, particularly in NYC
• High cost of living in NYC, moderate to low upstate
• Major medical centers and teaching hospitals

9. New Jersey **Average RN Salary: $87,000 - $95,000**

New Jersey offers proximity to major metro areas with somewhat lower cost of living than NYC.

• High population density creates healthcare demand
• Proximity to NYC and Philadelphia
• Strong union representation
• Mix of urban, suburban, and rural facilities

10. Nevada **Average RN Salary: $86,000 - $94,000**

Nevada's healthcare industry, particularly in Las Vegas and Reno, offers competitive nurse pay.

• Tourism industry drives healthcare demand
• Growing population
• No state income tax
• Moderate to low cost of living outside Las Vegas

The differences aren't random. Several factors drive geographic pay disparities:

Cost of Living

States with higher costs of living generally pay nurses more. California and Hawaii top the salary charts partly because you can't survive there on less.

But this relationship isn't always linear. Some states pay well relative to their cost of living (more on that later).

Union Strength

States with strong nursing unions tend to have higher nurse salaries. California's powerful California Nurses Association has successfully negotiated strong contracts for decades.

Union presence correlates with better pay, better ratios, and stronger workplace protections.

State Regulations

States that enforce safe staffing ratios and have strong nurse practice acts tend to pay better. When working conditions are regulated to be safer, compensation often follows.

Market Competition

Areas with multiple healthcare systems competing for nurses drive up wages. A single dominant health system in a region has less pressure to pay competitively.

Population and Demographics

States with aging populations and high healthcare utilization create more nursing demand, which can drive up salaries.

State Budget and Economic Health

Wealthier states with robust tax bases tend to invest more in healthcare and pay healthcare workers better.

For context, here are states on the lower end of nurse compensation:

• **South Dakota:** $58,000 - $66,000
• **Mississippi:** $59,000 - $68,000
• **Iowa:** $60,000 - $69,000
• **Alabama:** $61,000 - $70,000
• **Arkansas:** $62,000 - $71,000

These states have significantly lower costs of living, but even accounting for that, the purchasing power difference is substantial.

State averages can be misleading. Within each state, salaries vary significantly:

Urban vs Rural

Urban hospitals typically pay more than rural facilities, though not always enough to offset higher urban living costs.

**Example:** In California, a nurse in San Francisco might make $145,000 while a nurse in rural Northern California makes $95,000 - both well above the national average, but a $50,000 difference.

Facility Type

• **Academic medical centers and teaching hospitals** typically pay more
• **For-profit hospitals** may pay more or less depending on their business model
• **Critical access hospitals** in rural areas sometimes offer competitive pay to attract staff
• **Long-term care facilities** typically pay less than acute care

Specialty

Specialized nursing roles command higher salaries across all states:

• ICU and critical care nurses
• OR and procedural nurses
• Emergency department nurses
• Nurse anesthetists (highest-paid nursing role)
• Nurse practitioners and advanced practice nurses

If You're Considering Relocation

Compare not just salaries, but purchasing power. A $140,000 salary in San Francisco might offer less disposable income than $85,000 in Texas or North Carolina.

Use the salary calculator on this site to compare what you could make in different states, then research cost of living in those specific areas.

If You're Negotiating Current Pay

Research what nurses in your state are actually making. If you're below the state average for your experience and specialty, you have clear data to support a raise request.

"Nurses with my experience in [state] average $X, and I'm currently at $Y" is a compelling argument.

If You're a New Grad Choosing Where to Start

Your first nursing job sets your salary baseline. Starting in a higher-paying state means every subsequent raise builds on that higher base.

Even if you don't plan to stay forever, starting with higher compensation can benefit you long-term.

The fact that the same nurse doing the same job can make $60,000 in one state and $110,000 in another is fundamentally unfair.

It's not based on skill. It's not based on quality of care. It's based on where hospital systems can get away with paying less.

• Nurses talking openly about compensation (which is legally protected)
• Nurses being willing to relocate for better pay, forcing lower-paying areas to compete
• Union organizing in states without strong nursing unions
• State-level advocacy for safe staffing laws and fair compensation
• Transparency about what nurses actually make

Use this as a general guide. Actual salaries vary by experience, specialty, shift, and specific employer:

**$90,000+ Average:** - California, Hawaii, Oregon, Washington, DC, Alaska, Massachusetts

**$80,000-$90,000 Average:** - New York, New Jersey, Connecticut, Nevada, Rhode Island, Delaware

**$70,000-$80,000 Average:** - Maryland, New Hampshire, Minnesota, Colorado, Vermont, Arizona

**$60,000-$70,000 Average:** - Texas, Florida, Pennsylvania, Ohio, Illinois, Virginia, North Carolina

**Under $60,000 Average:** - South Dakota, Mississippi, Alabama, Arkansas, West Virginia

These are averages. Experienced nurses in high-demand specialties earn significantly more. New grads and nurses in lower-acuity settings earn less.

Geographic location dramatically impacts nurse pay. If you're underpaid, it might not be your employer - it might be your state.

You have options:

• Use this data to negotiate better pay where you are
• Consider relocating to a higher-paying state
• Factor in cost of living, not just raw salary numbers
• Research specific cities and facilities, not just state averages
• Join or support nursing unions advocating for better compensation

The nursing shortage gives nurses leverage. Use it. Whether that means asking for more where you are or taking your skills somewhere that values them appropriately.

You deserve fair compensation regardless of geography. Until that's reality, know what you're worth and make decisions accordingly.