Highest Paying States for Nursing Professionals in 2021

by Jennifer L. Gaskin and The Senior List Team | Last Updated, May 24, 2021

Over the next decade, the U.S. is poised to add about 2.4 million healthcare jobs, the most of any occupational group, according to data from the U.S. Bureau of Labor Statistics. While physicians and surgeons get a lot of the glory, nursing-related occupations account for a great deal of the expected growth.

Nursing professionals are vital to the entire healthcare system, as they provide most of the care in hospitals and long-term care settings, both of which are vitally important to older Americans. As the Baby Boomer generation continues to age, it’s expected that nursing shortages will continue and intensify in many places.

We wanted a better idea of how this landscape might shift over the next several years, so we studied salary, wage, employment, and housing data for each state to determine which ones are the best for nursing professionals in 2021 — and beyond.

Key findings

  • New York is the best state overall for nursing professionals. Maryland is second, and California is third. Alabama is last, while Mississippi and Oklahoma make up the remainder of the bottom three.
  • Wages for nursing professionals are on the rise over the past 10 years, but registered nurses’ income hasn’t kept up with inflation. Income levels are highest in California and lowest in Alabama, but low-income states tend to have cheaper housing than high-income states.
  • Nurse practitioners and home health/personal care aides will see rapid growth in job openings through the end of the decade. Nurse practitioner employment is expected to grow by about 50 percent nationally.
  • New York has the highest average growth rate for nurse employment (40 percent), while Mississippi’s is the lowest (eight percent).

Best States for Nursing Professionals: Overall Rankings

New York is the best state overall for nursing professionals, with Maryland in a distant second. Three Western states — California, Colorado, and Oregon — round out the rest of the top five. The bottom six states are all in the South, while Alabama had the lowest overall ranking.

New York #1
Maryland #2
California #3
Colorado #4
Oregon #5
Delaware #6
Washington #7
Massachusetts #8
New Hampshire #9
Arizona #10 (tie)
New Jersey #10 (tie)
Connecticut #12
Minnesota #13
North Dakota #14
Hawaii #15
Alaska #16
Pennsylvania #17
Rhode Island #18
Nevada #19
Wyoming #20
District of
Columbia
#21
Utah #22
Iowa #23
Vermont #24
Virginia #25
Missouri #26 (tie)
Texas #26 (tie)
Georgia #28
Montana #29
Maine #30
New Mexico #31
Wisconsin #32
Indiana #33
Illinois #34
Ohio #35
Arkansas #36
Nebraska #37
Florida #38
Idaho #39 (tie)
Kentucky #39 (tie)
Tennessee #41
Michigan #42
West Virginia #43
South Dakota #44
Kansas #45
North Carolina #46
South Carolina #47
Louisiana #48
Oklahoma #49
Mississippi #50
Alabama #51

Which Nursing Jobs Get Paid the Most?

Generally, the more educated the nursing care provider, the more money they can expect to earn. The average nurse practitioner (NP) in the U.S. makes more than $110,000 per year, which is more than four times higher than the median national wage for home health and personal care aides. In most states, NPs are required to have at least a master’s degree, while all other jobs require a bachelor’s degree or less.

U.S. median wage, select nursing occupations

Nurse practitioners $111,680
Registered nurses $75,330
Nursing assistants $30,850
Home health/personal care aides $27,080

Each of these jobs has seen wages grow over the past decade, but in one case, the increase hasn’t kept up with the rate of inflation. Ten years ago, none of these jobs came with a median national wage over $100,000, and the typical NP made just under $90,000. The cumulative inflation rate since 2011 is about 15 percent, which means that nationally, RNs have basically taken a pay cut since their median wage has only gone up by 14 percent.

Percentage change in median wage, 2011-2020

Home health/personal care aides 34%
Nursing assistants 26%
Nurse practitioners 24%
Registered nurses 14%

And while the four jobs combined have seen employment rise by nearly 30 percent, the most skilled (NPs) and least skilled (home health/personal care aides) have seen the biggest increases. Jobs for nursing assistants have declined over the past 10 years, according to our analysis.

Percentage change in total employment, 2011-2020

Nurse practitioners 100%
Home health/personal care aides 84%
Registered nurses 10%
Nursing assistants -3%

All the jobs we analyzed are expected to become more common over the next few years and through the end of the decade. Long-term growth rates are quite high, but some jobs will see rapid expansion through the end of next year.

Projected change in total employment, short-term vs. long-term*

Timeframe Home health/
personal care aides
Nursing
assistants
Registered
nurses
Nurse
practitioners
Short-term 6% 2% 3% 10%
Long-term 37% 9% 12% 28%

* Short-term = 2020-2022; long-term = 2018-2028

Nursing Salaries Are Highest in California, Lowest in Alabama

As we mentioned, NPs have the best chance of earning a high wage, while home health/personal care aides tend to have the lowest wages. In many states, the median wage for registered nurses (RNs) is in six figures, while the lowest RN wage is Alabama’s $58,630. The lowest-paid of all four nursing jobs we studied was home health/personal care aides in Louisiana; these individuals earn a median wage of just under $19,000 per year. 

Overall, California offers the best wages for nursing professionals, coming in first for both NPs and RNs, while Alabama’s wage offerings were all in the bottom three. The national average annual median wage for the four jobs is just under $60,000, but as we’ve already seen, there’s a ton of variation depending on the job.

State Home health/
personal care aides
Nursing
assistants
Registered
nurses
Nurse
practitioners
Alabama $19,930 $24,410 $58,630 $97,610
Alaska $34,640 $40,930 $94,070 $116,950
Arizona $26,420 $33,420 $79,010 $115,950
Arkansas $22,810 $25,570 $62,330 $101,920
California $29,230 $37,560 $118,410 $135,480
Colorado $28,760 $34,550 $76,500 $110,740
Connecticut $28,320 $34,900 $82,770 $118,740
Delaware $24,230 $32,640 $72,110 $110,290
District of Columbia $31,280 $34,580 $89,440 $115,790
Florida $24,160 $28,070 $67,510 $100,930
Georgia $23,240 $26,530 $69,630 $104,090
Hawaii $27,760 $38,020 $110,410 $124,260
Idaho $24,230 $28,960 $71,280 $112,830
Illinois $27,990 $30,190 $72,610 $110,890
Indiana $24,190 $29,270 $65,000 $109,450
Iowa $27,520 $30,420 $61,130 $106,710
Kansas $22,820 $28,470 $62,550 $103,640
Kentucky $24,730 $27,670 $63,060 $99,500
Louisiana $18,800 $23,460 $66,240 $107,350
Maine $28,710 $32,010 $69,510 $110,050
Maryland $28,110 $32,570 $79,810 $112,730
Massachusetts $34,060 $35,900 $90,290 $123,960
Michigan $24,640 $31,570 $73,040 $107,170
Minnesota $29,120 $36,060 $79,540 $120,860
Mississippi $21,320 $23,460 $59,850 $106,570
Missouri $23,800 $25,930 $64,220 $104,050
Montana $26,660 $31,070 $68,740 $114,970
Nebraska $26,420 $30,300 $68,010 $106,900
Nevada $24,310 $33,430 $87,960 $118,440
New Hampshire $28,160 $34,020 $74,840 $111,440
New Jersey $26,540 $32,070 $84,990 $122,970
New Mexico $21,890 $29,510 $75,350 $115,810
New York $30,920 $40,760 $89,840 $124,020
North Carolina $22,340 $27,610 $66,820 $106,770
North Dakota $33,730 $35,490 $68,800 $109,380
Ohio $23,740 $29,350 $67,580 $105,420
Oklahoma $20,390 $26,520 $65,680 $109,690
Oregon $29,800 $36,680 $96,790 $119,110
Pennsylvania $25,800 $32,260 $72,970 $104,020
Rhode Island $29,920 $33,580 $83,060 $117,440
South Carolina $22,890 $26,860 $66,050 $98,940
South Dakota $27,210 $28,560 $60,000 $102,620
Tennessee $22,620 $27,660 $62,220 $99,300
Texas $21,040 $28,240 $75,320 $113,800
Utah $27,340 $29,740 $67,180 $111,200
Vermont $30,930 $32,480 $69,670 $105,930
Virginia $22,240 $29,060 $72,420 $108,530
Washington $31,480 $35,970 $89,650 $127,700
West Virginia $20,740 $26,710 $63,180 $100,080
Wisconsin $25,630 $31,980 $73,540 $113,100
Wyoming $27,760 $31,790 $70,450 $115,380

High income only goes so far in places like California where housing costs are high. So, while the Golden State offers the nation’s highest average wage for nursing professionals, almost one-quarter of their income is eaten by housing costs, putting California in 40th. West Virginia, which has the second-lowest average wage, is the most affordable for nursing care providers.

Average annual housing cost as a
percentage of annual wage by state

State Home health/
personal care aides
Nursing
assistants
Registered
nurses
Nurse
practitioners
Alabama 47% 38% 16% 10%
Alaska 42% 36% 16% 13%
Arizona 45% 36% 15% 10%
Arkansas 38% 34% 14% 9%
California 64% 50% 16% 14%
Colorado 52% 43% 19% 13%
Connecticut 59% 48% 20% 14%
Delaware 52% 38% 17% 11%
District of Columbia 64% 58% 22% 17%
Florida 54% 47% 19% 13%
Georgia 50% 44% 17% 11%
Hawaii 67% 49% 17% 15%
Idaho 42% 35% 14% 9%
Illinois 48% 44% 18% 12%
Indiana 40% 33% 15% 9%
Iowa 37% 34% 17% 10%
Kansas 48% 39% 18% 11%
Kentucky 38% 34% 15% 9%
Louisiana 53% 42% 15% 9%
Maine 39% 35% 16% 10%
Maryland 57% 49% 20% 14%
Massachusetts 52% 50% 20% 14%
Michigan 43% 34% 15% 10%
Minnesota 43% 35% 16% 10%
Mississippi 43% 39% 15% 9%
Missouri 43% 39% 16% 10%
Montana 41% 35% 16% 10%
Nebraska 43% 37% 17% 11%
Nevada 52% 38% 14% 11%
New Hampshire 56% 46% 21% 14%
New Jersey 73% 60% 23% 16%
New Mexico 45% 33% 13% 9%
New York 55% 42% 19% 14%
North Carolina 47% 38% 16% 10%
North Dakota 32% 31% 16% 10%
Ohio 43% 35% 15% 10%
Oklahoma 48% 37% 15% 9%
Oregon 47% 38% 14% 12%
Pennsylvania 46% 37% 16% 11%
Rhode Island 48% 43% 17% 12%
South Carolina 44% 38% 15% 10%
South Dakota 39% 37% 18% 10%
Tennessee 45% 37% 16% 10%
Texas 63% 47% 17% 12%
Utah 46% 42% 19% 11%
Vermont 42% 40% 19% 12%
Virginia 63% 49% 19% 13%
Washington 50% 44% 17% 12%
West Virginia 41% 31% 13% 8%
Wisconsin 44% 35% 15% 10%
Wyoming 38% 33% 15% 9%

Nursing Employment Opportunities: Strong Today, Even Better Tomorrow

Jobs for registered nurses are the most common, although home health/personal care aides are a close second and growing rapidly. The only job of the four we analyzed that’s expected to grow more over the next decade? Nurse practitioner.

NP positions are expected to expand by more than 50 percent through 2029, while home health and personal care aide employment should grow by 34 percent, according to April 2021 BLS projections. This varies from the rate included in our analysis because the BLS has not yet released detailed state-by-state projections through 2029. What that indicates is that the growth rates in our report are likely to be conservative estimates and the long-term outlook could be even better for nursing care providers.


New York has the highest overall combined employment rate per 1,000 jobs for nursing professionals, while Maine received the most points in the category. That’s because New York has by far the highest proportion of home health and personal care aides, likely related to the population density in New York City, but the state ranks in the top 10 only for that job. Maine has a more consistent level of high employment rates for nursing professionals.

Combined nursing professional employment per 1,000 jobs

New York 85.6
Pennsylvania 77.0
Minnesota 75.9
Massachusetts 71.8
Maine 71.6
Missouri 69.2
New Mexico 69.0
West Virginia 67.3
Rhode Island 65.3
Wisconsin 63.4
North Dakota 62.0
California 61.9
Vermont 60.5
Mississippi 59.5
Connecticut 59.4
Delaware 58.9
Kansas 58.6
Ohio 57.2
Arkansas 56.7
Louisiana 56.6
Michigan 56.0
South Dakota 55.9
Nebraska 53.9
Iowa 53.8
Idaho 52.5
Montana 51.9
North Carolina 51.7
Alaska 51.6
Arizona 51.2
Texas 51.2
Kentucky 51.1
Illinois 50.1
Alabama 49.7
New Jersey 49.1
Indiana 48.8
Washington 48.6
New Hampshire 48.3
Oklahoma 47.0
South Carolina 47.0
Oregon 46.2
Maryland 45.5
Wyoming 45.2
Virginia 45.1
Colorado 44.0
Hawaii 43.1
Tennessee 42.9
Florida 41.9
District of
Columbia
37.5
Nevada 37.4
Georgia 36.4
Utah 35.0

Utah has the lowest combined employment rate and scored the lowest for current job opportunities, but there’s reason for optimism in the Beehive State. That’s because nurse jobs are expected to grow by almost 40 percent over the next decade, one of the most rapid growth rates in the country.

Projected increase in nursing employment by state, 2018-2028

State Home health/
personal care aides
Nursing
assistants
Registered
nurses
Nurse
practitioners
Alabama 22.8% 5.5% 10.2% 24.2%
Alaska 19.4% 8.1% 6.8% 8.6%
Arizona 31.4% 22.2% 35.0% 50.9%
Arkansas 30.7% 12.9% 13.5% 31.5%
California 25.6% 14.3% 16.7% 30.5%
Colorado 47.0% 24.8% 29.5% 44.7%
Connecticut 29.6% 6.6% 7.3% 20.5%
Delaware 34.9% 13.1% 20.0% 30.8%
District of Columbia 28.7% 8.2% 8.8% 24.1%
Florida 27.5% 11.0% 16.1% 36.9%
Georgia 41.8% 15.0% 22.5% 41.4%
Hawaii 35.0% 11.2% 12.2% 23.8%
Idaho 22.6% 18.1% 19.9% 24.4%
Illinois 19.2% -0.2% 12.4% 31.1%
Indiana 37.9% 8.0% 12.4% 29.4%
Iowa 33.0% 10.8% 15.1% 30.1%
Kansas 27.2% 2.4% 8.1% 18.3%
Kentucky 34.4% 8.7% 13.1% 22.3%
Louisiana 21.5%
Maine 8.1% 1.7% 6.5% 20.6%
Maryland 42.8% 18.4% 21.7% 34.9%
Massachusetts 19.8% 4.1% 8.2% 16.2%
Michigan 23.3% 1.7% 9.8% 16.1%
Minnesota 27.5% 4.4% 12.4% 23.0%
Mississippi 9.8% 8.8% 6.1% 7.1%
Missouri 26.8% 9.0% 16.2% 29.7%
Montana 29.3% 7.5% 10.4% 26.5%
Nebraska 23.3% 6.8% 11.1% 19.7%
Nevada 39.4% 20.2% 22.3% 28.6%
New Hampshire 36.2% 7.9% 12.7% 29.9%
New Jersey 38.5% 5.5% 11.3% 28.2%
New Mexico 31.9% 9.5% 11.3% 27.6%
New York 60.8% 13.9% 24.6% 41.3%
North Carolina 23.1% 9.3% 10.8% 30.4%
North Dakota 24.1% 7.8% 16.5% 31.4%
Ohio 31.3% 3.5% 9.6% 24.6%
Oklahoma 32.4% 4.5% 9.1% 19.4%
Oregon 28.9% 13.7% 15.2% 32.0%
Pennsylvania 27.5% 10.3% 12.5% 26.5%
Rhode Island 18.0% 5.4% 4.0% 14.3%
South Carolina 36.5% 8.5% 9.4% 25.6%
South Dakota 21.7% 7.5% 13.1% 27.3%
Tennessee 39.6% 11.6% 12.3% 34.7%
Texas 27.7% 11.6% 16.8% 31.9%
Utah 50.9% 23.8% 28.2% 34.3%
Vermont 27.9% 7.7% 8.0% 16.1%
Virginia 34.5% 14.6% 11.7% 30.7%
Washington 21.0% 11.6% 20.5% 28.5%
West Virginia 28.8% 8.1% 14.9% 24.8%
Wisconsin 16.4% 1.6% 7.8% 23.0%
Wyoming 37.0% 11.2% 16.2% 30.0%

Note: Employment projection data for Louisiana was available only for home health/personal care aides;
the lack of other data did not count against the state in the final calculations

Most states did not have data available when it comes to the short-term growth rates projected for nursing assistants, and many were missing data for home health/personal care aides. For this reason, short-term growth projections were excluded from our final tally; that said, looking at the near-term reveals a few interesting findings.

Over the next year, many states are expected to see rapid growth in nursing professional employment. New Hampshire is projected to see NP jobs expand by more than 24 percent between 2020 and 2022, and 14 other states are expected to see NP employment rise by double digits. Every state should see nurse practitioner jobs increase, according to the government’s projections.

Average projected growth rate for
nursing professional employment, 2020-2022*

Nurse practitioners 10%
Home health/personal care aides 6%
Registered nurses 3%
Nursing assistants 2%

* Among states with available data; for nursing assistants, most states do not have available data

Forty-two states are expected to see jobs for registered nurses rise through the end of next year, while six are projected to have a net job loss for RNs. South Carolina’s is the biggest projected decline, about two percent.

Massachusetts should have the highest increase in home health/personal care aides with employment in that role rising about 17 percent through 2022; these jobs will decline by about two percent in Michigan.

Conclusion

Nursing professionals provide most of the care in hospitals and long-term care centers, such as senior living communities. Nearly nine in 10 nurse practitioners practice primary care, and as the median age in the U.S. keeps climbing, nursing assistants and home health/personal care aides will continue to be in high demand. For individuals and families on the receiving end of this care, it’s important to understand how attractive your state is for nursing professionals today and over the next decade.

Methodology

To create our analysis of which states are best for nursing professionals, we consulted several governmental data sources:

  • U.S. Bureau of Labor Statistics: Our analysis covered median wages and employment rates, which is a measure of jobs in a particular occupation compared to all jobs, for four nursing occupations — registered nurse, nurse practitioner, home health/personal care aide, and nursing assistant. These are the most common nursing jobs, which gave us the best chance of having expansive available data. This information was most recently updated for 2020, and the next installment is expected in March 2022.
  • Projections Central: We analyzed the percentage by which each of our nursing jobs is expected to expand in each state and the U.S. as a whole between 2018 and 2028. Like BLS data, these figures are updated annually, and the long-term projections we used were most recently updated in March 2021.
  • U.S. Census Bureau: To determine how affordable each state is for the average nursing professional, we compared annual housing costs to annual income. The housing figures we used covered median rent and median owner costs for both mortgaged and non-mortgaged housing units. This information was most recently updated in September 2020.

Every state was assigned a point value relative to its ranking in the category; the higher a state ranked, the more points it scored up to 51 per category across these 17 metrics. Note that because of variations in how the government reports this data, for wages and employment, home health aides and personal care aides are reported in a single category, but they are separate for job growth projections.

  • Median annual wage for registered nurses
  • Median annual wage for nurse practitioners
  • Median annual wage for home health/personal care aides
  • Median annual wage for nursing assistants
  • Registered nurse employment per 1,000 jobs
  • Nurse practitioner employment per 1,000 jobs
  • Home health/personal care aide employment per 1,000 jobs
  • Nursing assistant employment per 1,000 jobs
  • Projected growth in registered nurse employment, 2018-2028
  • Projected growth in nurse practitioner employment, 2018-2028
  • Projected growth in home health aide employment, 2018-2028
  • Projected growth in personal care aide employment, 2018-2028
  • Projected growth in nursing assistant employment, 2018-2028
  • Median annual rent
  • Median annual owner costs, housing units with a mortgage
  • Median annual owner costs, housing units without a mortgage
  • Average median housing cost (rent combined with mortgage costs) as percentage of average median annual income

Here is a complete list of states and their scores: 

Highest possible score = 867

New York 688
Maryland 565
California 558
Colorado 555
Oregon 547
Delaware 546
Washington 543
Massachusetts 536
New Hampshire 528
Arizona 527
New Jersey 527
Connecticut 523
Minnesota 521
North Dakota 518
Hawaii 506
Alaska 489
Pennsylvania 485
Rhode Island 479
Nevada 478
Wyoming 461
District of
Columbia
455
Utah 454
Iowa 442
Vermont 436
Virginia 428
Missouri 427
Texas 427
Georgia 426
Montana 424
Maine 421
New Mexico 411
Wisconsin 408
Indiana 402
Illinois 401
Ohio 391
Arkansas 390
Nebraska 389
Florida 380
Idaho 375
Kentucky 375
Tennessee 365
Michigan 361
West Virginia 356
South Dakota 352
Kansas 350
North Carolina 341
South Carolina 307
Louisiana 286
Oklahoma 284
Mississippi 275
Alabama 249