Nursing Salaries and the Cost of Living, The Nurse Keith Show, EPS 103

On episode 102 of The Nurse Keith Show, I gave you a view into the latest Bureau of Labor Statistics data on nurses and nursing jobs here in the United States. That data is important, and it leads us to also consider where in the U.S. the highest-paying nursing jobs really are here on episode 103.

For those of you outside of the U.S., find your own country’s jobs data and use the information in the blog post and this podcast episode to discover what’s happening in your part of the world when it comes to nursing jobs. And please share your findings with me; I’d like to know what’s happening in other countries in relation to nursing jobs and employment.

Show me the money

Some of you may know that I’m the Nurse Liaison and Content Strategist over at, a powerful career site for nurses. Some of our recent blog posts elucidate what’s going on, and our comprehensive list of median salaries for nurses in 50 states (plus the District of Columbia) is a great place to begin.

Annual Salaries, Hourly Wages, and Nurses

Did you know that South Dakota has the lowest paid nurses in the country? This midwestern state is #51 on the list (The District of Columbia makes expands the list to 51).With a mean annual salary of $54,380 and a mean hourly rate of $26.14, the approximately 12,000 South Dakotan nurses working to care for patients find themselves at the bottom of the nursing salary ladder.

And here’s the nursing Jeopardy question of the week: What state do you think is #1 for nursing salaries? If you guessed it was New York, you’re wrong; but if you guessed California, you’ve won our prize! In California, nurses enjoy a median annual salary of $100,460 and a median hourly wage of $48.30. There are more than 274,000 nurses in California, so you can imagine that the job market there is highly competitive.

And who do you think is #2 on the list? Well, aloha, it’s Hawaii, with a median annual salary of $91,020 and a median hourly wage of $43.76. There are approximately 11,000 nurses in the Hawaiian nursing workforce, and I wonder if you want to become one of them now. (Don’t forget to pack sunscreen, a hat, and a bathing suit.)

If you’re curious about the entire list, will give you the comprehensive lowdown. But here’s a few more tidbits:

Oregon (#3) has a median annual salary of $88,010.

Alaska (#4) clocks in at $85,310.

Massachusetts (my old home state and #5 on the list) delivers a respectable $84,410

#50 (remember, South Dakota is #51 since we include the District of Columbia, so there’s 51 slots, not 50) is  Iowa, with a mean annual salary of $55,310 and a mean hourly wage of $26.59 for its 32,370 nurses.

But What About Cost of Living? 

Friends, a high-paying job in Hawaii would be awesome, and you’d have access to volcanos, jungles, beautiful beaches, and all of the cultural richness of this amazing archipelago of islands in the Pacific Ocean.

Not to throw cold water on your dreams of beaches and Pina Coladas after work, but salary is only one part of the equation. What about the cost of living?

Here’s how it breaks down in Hawaii, according to 

The cost of living in Hawaii is 36% above the national average, and Honolulu itself is 53% above the national average! So, if you consider the relatively high salaries, you’re not necessarily earning much more than a nurse in Texas or Colorado in the end. In fact, since childcare, food, taxes, housing, and transportation are all above the national average, you may be economically squeezed. Only healthcare ranks below the US average in terms of costs. Sorry to burst your Hawaiian bubble.

And if you’d like to live in South Dakota, #51 on the list, here’s what you’d find in terms of cost of living: 

South Dakota may have low salaries for nurses, but the overall cost of living is 10% below the national average. Healthcare and transportation are above the national average, but childcare, housing, and taxes fall below.

And what about California, where nurses earn the most of any nursing professional in the US? 

Well, California’s cost of living is 15% above the national average. And when you look at individual cities, here’s what we find:

  • San Francisco: 53% above average cost of living
  • San Jose-Sunnyvale-Santa Clara: 40% above average cost of living
  • Oakland-Fremont: 35% above average cost of living
  • San Diego-Carlsbad-San Marcos: 23% above average cost of living
  • Los Angeles-Long Beach: 20% above average cost of living
  • Redding: 6% above average cost of living

California obviously has some pretty high costs for some citizens in metro areas; if you’re a nurse who wants to work in San Francisco, your earnings are going to have to keep up with the cost of living in order to makes ends meet.

Are you in California? Are you making it financially? If so, how does it work for you? What are your secrets? What are your struggles?

And because I live in New Mexico, the Land of Enchantment (some say “Entrapment”), I have to talk about our poor little state. 

We are 7% below the national average in terms of cost of living, and we surprisingly clock in at #20 in terms of salaries. Here in the state capital of Santa Fe (population: 80,000, with Santa Fe County around 150,000 — including the city), we are 1% below the national average for cost of living.

Quality of Life Matters Too

Nurses (and non-nurses), when we’re deciding where to live, salary is only one part of the equation. Cost of living is important, of course, but we also need to consider quality of life.

There are myriad websites listing quality of public and private schools by city, state, or region, not to mention real estate prices and other indices with which to make a decision.

In 2016, CNBC published their list of the 10 best states to call home, and they measured by many different factors, including “livability, crime, health, the environment, things to see and do, and inclusiveness.”  Their top 10 are:

  1. Hawaii
  2. Minnesota
  3. Vermont
  4. New Hampshire
  5. Maine
  6. Oregon
  7. North Dakota
  8. Washington
  9. Iowa
  10. Montana

Now, you may measure quality of life on bicycle and pedestrian safety, which would guide you towards cities like Boston and Portland, Oregon. Or you might want a place where you don’t need a car and there’s a great public transportation system. If maybe you want to live on 5 acres outside of a beautiful small city like Santa Fe just like I do — it’s a very individual thing, isn’t it?

Confused? Don’t Be!

Wrapping it all up, you may feel confused. Hawaii was ranked #1 for quality of life by CNBC, but the cost of living is super high. Then again, wages are the pretty darn high, too. What to do?

It all comes down to these factors, folks:

  • Your needs
  • Your family’s needs
  • What you want out of life
  • The lifestyle you want
  • The workstyle you want
  • The opportunities available that match your career goals
  • What will make you happiest

Don’t fret, nurses. Do your due diligence. Do your research. Talk to people. Go on vacation to the city or state where you might want to live. Take a travel assignment or two in a city you’re considering and check it out more intensively.

Life’s a series of decisions, and the kind of data I’m quoting on this podcast can help you sort out what you want and where you can get what you want. Enjoy the ride!

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The Nurse Keith Show is adroitly edited and produced by Tim Hallowell of The; social media and promotion are expertly handled by Mark Capispisan.

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Be well, dig deep, and keep in touch!

Keith Carlson, RN, BSN, NC-BCKeith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind and the well-known blog, Digital Doorway.

Keith is co-host of, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses. Keith was previously the resident nursing career expert at

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century.”

He has also contributed chapters to a number of books related to the nursing profession, and has written for,, MultiViews News Service, LPNtoBSNOnline, StaffGarden, Working Nurse Magazine, and other online platforms.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, holistic career coach, writer, and well-known successful nurse entrepreneur.

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