2021’s Best & Worst States for Nurses

The U.S. has gained a profound appreciation for nurses during the coronavirus pandemic, as they risk their lives every day to minimize the spread of the disease, and are now helping the country get vaccinated so things can return to normal. Sadly, nurses have experienced extremely dangerous working conditions during the pandemic, with critical shortages of respirators, surgical masks, gloves, gowns and other necessary protective treatment. It's more important now than ever for states to step up and make sure that nurses are properly equipped to do their jobs and have the best work environment possible.

Despite the stresses of the occupation, nurses are generally well-rewarded for their life-saving work. Nursing occupations are some of the most lucrative careers, with a median base salary of over $100,000 and some of the lowest unemployment rates in the U.S. In fact, the industry is expected to grow at nearly double the rate of the average occupation through 2029.

In light of the current crisis and the industry’s projections for the future, WalletHub took stock of the nursing industry to help registered nurses, particularly new graduates, pick a place to live that will bring success. We did so by comparing the 50 states across 22 key metrics that collectively speak to the nursing-job opportunities in each market. Below, you can check out our findings, commentary from a panel of experts and a complete description of our methodology.

Main Findings

Best Places to Work as a Nurse

Note: With the exception of “Total Score,” all of the columns in the table above depict the relative rank of that state, where a rank of 1 represents the best conditions for that metric category.

Ask the Experts

WalletHub turned to a panel of nursing-industry experts for insight into the future of the profession and how recent graduates can find success. You can check out their bios and thoughts below.

1. Given the toll of the coronavirus pandemic on frontline healthcare workers, what are the best ways the authorities and local non-profit organizations can support nurses and all medical personnel to navigate this crisis?
2. What is the long-term outlook for the field of nursing?
3. What tips do you have for recent nursing school grads looking for a place to live and work?
4. What can local governments and health systems do to attract and retain high quality nurses?
5. Are unions beneficial to nurses?
6. Prior to the pandemic, nurses were already facing a high burnout rate, with nearly four out of 10 nurses reporting they felt burned out. What are some strategies for combating nurse burnout during the pandemic?

Methodology

In order to determine the best and worst states for nurses, WalletHub compared the 50 states across two key dimensions, “Opportunity & Competition” and “Work Environment.”

We evaluated those dimensions using 22 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the most favorable conditions for nurses.

We then determined each state’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order the states.

Opportunity & Competition – Total Points: 70

• Monthly Average Starting Salary for Nurses: Full Weight (~6.67 Points)
  Note: This metric was adjusted for the cost of living.
• Average Annual Salary for Nurses: Double Weight (~13.33 Points)
  Note: This metric was adjusted for the cost of living.
• Health-Care Facilities per Capita: Full Weight (~6.67 Points)
• Share of Population Living in a Primary-Care HPSA: Full Weight (~6.67 Points)
  Note: “HPSAs,” as defined by the Health Resources & Services Administration, “are designations that indicate health care provider shortages in: Primary care; Dental health; or Mental Health” and “may be geographic-, population-, or facility-based.”
• Projected Share of Elderly Population in 2030: Full Weight (~6.67 Points)
  Note: “Elderly population” includes adults aged 65 and older.
• Quality of Nursing Schools: Half Weight (~3.33 Points)
• Tuition Cost per Credit for BSN Online Program: Full Weight (~6.67 Points)
• Nursing-Job Openings per Capita: Full Weight (~6.67 Points)
• Nurses per 1,000 Residents: Full Weight (~6.67 Points)
• Projected Competition in 2028: Full Weight (~6.67 Points)
  Note: “Competition” refers to the number of nurses per 1,000 residents.

Work Environment – Total Points: 30

• COVID-19 Positive Tests in the Past Week per Capita: Double Weight (~4.00 Points)
• COVID-19 Death Rate in the Past Week per Capita: Double Weight (~4.00 Points)
• Mandatory Overtime Restrictions: Double Weight (~4.00 Points)
• Ratio of Nurses to Hospital Beds: Full Weight (~2.00 Points)
• Nurses Job Growth (2020 vs 2016): Double Weight (~4.00 Points)
• Presence of Nursing Licensure Compact Law: Full Weight (~2.00 Points)
  Note: This metric considers the presence or absence of a Nursing Licensure Compact law in the state. The compact allows nurses to practice in their home state and other participating states.
• Regulatory Requirement for Nurse Practitioners: Full Weight (~2.00 Points)
• Share of Best Nursing Homes: Full Weight (~2.00 Points)
  Note: This metric is based on U.S. News & World Report’s Best Nursing Homes rating.
• Quality of Public Hospital System: Full Weight (~2.00 Points)
  Note: This metric is based on data from the Centers for Medicare & Medicaid Services.
• Friendliness Toward Working Moms: Full Weight (~2.00 Points)
  Note: This metric is based on WalletHub’s “Best & Worst States for Working Moms” ranking. In 2011, there were 3.5 million employed nurses in the U.S., and about 3.2 million were female.
• Average Number of Work Hours: Half Weight (~1.00 Points)
• Average Commute Time: Half Weight (~1.00 Points)

 
Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Bureau of Labor Statistics, Council for Community and Economic Research, Centers for Disease Control and Prevention, HRSA Data Warehouse, Indeed.com, National Council of State Boards of Nursing, Centers for Medicare & Medicaid Services, U.S. News & World Report, Projections Central - State Occupational Projections, Nurse.org, Wage//Advocates, American Association of Nurse Practitioners and WalletHub research.

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