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These Are the Best & Worst States for Nurse Practitioners in 2021

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Some people follow their job, moving wherever their position takes them. Others know exactly where they want to live and then find a job that fits their needs. If you’re a nurse practitioner, it doesn’t matter which of these camps you fall into. The latest employment data shows that not only are your skills in high demand across the country, but also that employers are willing to pay very good money to have you work for them. Now, the only question you need to answer is: do you stay where you are, or do you move someplace else?

To help you figure this out, we collected data and rankings for each state along 5 metrics that play a key role in an NP's professional and personal lives:

  • Salary
  • Cost of Living
  • Job Demand/Growth
  • Quality of Life
  • Scope of Practice

Together, all these pieces of information can help give you a better idea of what states would be most ideal for you to live and work, based on your priorities and preferences.

Below, we've provided you with a high-level summary of the best and worst states for NPs in 2021 across those 5 key metrics. If you want to dig deeper into the data, we've also provided detailed explanations of how each metric was calculated, along with state-by-state rankings for all 50 states.

SUMMARY: The Best & Worst States for Nurse Practitioners in 2021

For your skimming pleasure, here's a high-level summary of the best and worst states for NPs in 2021 across the 5 key metrics.

The Best & Worst States for Nurse Practitioners: Salaries

The 5 Highest-Paying States for Nurse Practitioners
1. California: $138,660/year
2. Washington: $126,920/year
3. Hawaii: $124,000/year
4. New Jersey: $123,810/year
5. Minnesota: $122,850/year
The 5 Lowest-Paying States for Nurse Practitioners
46. South Carolina: $100,680
47. Kansas: $100,550
48. Alabama: $99,570
49. Kentucky: $99,560
50. Tennessee: $96,510

Source: Bureau of Labor Statistics (BLS) - "Occupational Employment and
Wages Data for Nurse Practitioners - May 2019"
(Last accessed March 2021)


The Best & Worst States for Nurse Practitioners: Cost of Living

The 5 Most Affordable States for Nurse Practitioners
1. Ohio
2. Oklahoma
3. Michigan
4. Iowa
5. Missouri
The 5 Least Affordable States for Nurse Practitioners
46. Oregon
47. Alaska
48. Massachusetts
49. California
50. Hawaii

Source: U.S. News & World Report - "Best States of 2021 - Affordability Rankings" (Last accessed March 2021)


The Best & Worst States for Nurse Practitioners: Job Growth

The 5 States With the Highest Projected Demand for Nurse Practitioners
1. New York
2. California
3. Texas
4. Florida
5. Illinois
The 5 States With the Lowest Projected Demand for Nurse Practitioners
46. Wyoming
47. Mississippi
48. Nevada
49. Idaho
50. Alaska

Source: ProjectionsCentral.com - "Long-Term Occupational Projections: 2018-2028" (Last accessed March 2021)


The Best & Worst States for Nurse Practitioners: Quality of Life

The 5 Best States for Nurse Practitioners' Quality of Life
1. Washington
2. Minnesota
3. Utah
4. New Hampshire
5. Idaho
The 5 Worst States for Nurse Practitioners' Quality of Life
46. Alabama
47. West Virginia
48. New Mexico
49. Mississippi
50. Louisiana

Source: U.S. News & World Report - "Best States of 2021 Rankings" (Last accessed March 2021)

The Best & Worst States for Nurse Practitioners: Scope of Practice

The Best States for Nurse Practitioners: Full Practice Authority
Alaska Arizona
Colorado Connecticut
District of Columbia Hawaii
Idaho Iowa
Maine Maryland
Massachusetts Minnesota
Montana Nebraska
Nevada New Hampshire
New Mexico North Dakota
Oregon Rhode Island
South Dakota Vermont
Washington Wyoming
The Worst States for Nurse Practitioners: Restricted Practice Authority States
California Florida
Georgia Michigan
Missouri North Carolina
Oklahoma South Carolina
Tennessee Texas
Virginia

Source: American Association of Nurse Practitioners (AANP) - "State Practice Environment" (Last accessed March 2021)

Nurse Practitioner Salaries: By State

It goes without saying that money is a great motivator, particularly when it comes to making career-related decisions. That said, salaries tend to vary (and sometimes significantly) from state to state. To show you what your earning potential could be in each state, we've shared the latest BLS salary data for NPs below. (Keep in mind that all BLS data reflects the employment and wage numbers for NPs as of May 2019, which the BLS published in May 2020.)

Nurse Practitioner Salaries: State by State

Rank State Average Annual Salary for Nurse Practitioners Average Hourly Pay for Nurse Practitioners
1 California $138,660 $66.66
2 Washington $126,920 $61.02
3 Hawaii $124,000 $59.62
4 New Jersey $123,810 $59.52
5 Minnesota $122,850 $59.06
6 New York $122,550 $58.92
7 Massachusetts $122,240 $58.77
8 Wyoming $118,110 $56.78
9 Nevada $115,970 $55.75
10 Alaska $115,890 $55.72
11 Texas $115,440 $55.50
12 Rhode Island $115,310 $55.44
13 Connecticut $115,140 $55.36
14 Oregon $113,430 $54.53
15 Oklahoma $113,200 $54.42
16 Delaware $112,430 $54.05
17 Wisconsin $112,130 $53.91
18 New Mexico $111,930 $53.81
19 Maryland $111,800 $53.75
20 Arizona $111,480 $53.60
21 North Dakota $110,950 $53.34
22 Idaho $110,860 $53.30
23 Mississippi $110,740 $53.24
24 New Hampshire $110,680 $53.21
25 Iowa $109,910 $52.84
26 Montana $109,120 $52.46
27 Virginia $109,110 $52.46
28 Michigan $108,660 $52.24
29 Illinois $107,860 $51.86
30 Maine $106,960 $51.43
31 Colorado $106,760 $51.33
32 Indiana $106,380 $51.14
33 Louisiana $106,240 $51.08
34 North Carolina $105,890 $50.91
35 Arkansas $105,840 $50.88
36 Vermont $105,840 $50.88
37 Georgia $105,670 $50.80
38 Nebraska $105,450 $50.70
39 Utah $105,240 $50.60
40 Missouri $105,050 $50.50
41 Ohio $103,780 $49.89
42 West Virginia $103,170 $49.60
43 South Dakota $102,230 $49.15
44 Pennsylvania $101,950 $49.02
45 Florida $101,510 $48.80
46 South Carolina $100,680 $48.41
47 Kansas $100,550 $48.34
48 Alabama $99,570 $47.87
49 Kentucky $99,560 $47.87
50 Tennessee $96,510 $46.40

Cost of Living for Nurse Practitioners: By State

Of course, no conversation around salary can be complete without also taking into account the cost of living for a given area. While having raw salary data can be helpful to give you a general idea of your earning potential, you'll get a much more realistic picture of your actual income when you understand just how much of it will be going toward living and housing expenses. For example, if you have a high-paying job in a state that tends to have a very high cost of living, then you would expect to see most (if not all) of your paycheck going toward your living expenses. But, if you had an average salary in a state with a low cost of living, you’d be more likely to have some money left over to spend however you wanted.

To help you get a better picture of your earning potential in different states, we turned to U.S. News's 2021 Affordability Rankings, which was part of their larger Overall Best States of 2021 ranking (more on this later). To determine how affordable each state was, U.S. News gave them scores on 2 metrics: cost of living and housing affordability. Based on those scores, each state then received an overall ranking on a scale of 1 to 50, with 1 being the most affordable and 50 being the least affordable.

Below, you'll find U.S. News's Affordability rankings for all 50 states, along with their respective scores across the 2 metrics.

2021 Cost of Living Rankings: State by State

Overall Rank State Cost of Living Score Housing Affordability Score
1 Ohio 6 2
2 Oklahoma 8 3
3 Michigan 4 7
4 Iowa 17 1
5 Missouri 3 9
6 Indiana 11 4
7 Arkansas 2 13
8 West Virginia 13 5
9 Kentucky 7 15
10 Mississippi 1 20
11 Nebraska 21 6
12 Kansas 16 12
13 Georgia 9 18
14 South Dakota 23 11
15 Pennsylvania 26 8
16 Illinois 19 14
17 Tennessee 5 26
18 Alabama 10 25
19 Wisconsin 20 16
20 Louisiana 15 23
21 North Dakota 33 10
22 Texas 14 28
23 Minnesota 28 17
24 North Carolina 12 31
25 South Carolina 18 32
26 New Mexico 24 35
27 Delaware 34 24
28 Virginia 30 34
29 Arizona 27 37
30 Idaho 22 42
31 Florida 25 41
32 Montana 29 44
33 Wyoming 32 39
34 Utah 31 45
35 Maine 39 30
36 New York 37 38
37 New Jersey 42 22
38 New Hampshire 43 21
39 Vermont 41 29
40 Connecticut 46 19
41 Nevada 35 43
42 Maryland 44 27
43 Colorado 36 48
44 Washington 38 47
45 Rhode Island 45 33
46 Oregon 40 46
47 Alaska 48 36
48 Massachusetts 47 40
49 California 50 49
50 Hawaii 49 50

Demand/Job Growth for Nurse Practitioners: By State

The more job openings there are, the greater the need there is for a specific profession. This is particularly true for NPs, who should expect to see the number of available jobs increase by about 52% between 2019 and 2029. (This should translate to about 110,700 new jobs opening up during that time.)

The only problem is that this significant job growth won’t be spread equally across the U.S. Naturally, some states will see higher rates of job growth than others. Below, we’ve shared occupational projection numbers from Projections Central to show you how much demand there will be for NPs on a state-by-state basis between now and 2028, both in terms of raw job opening numbers and job growth percentage.

You’ll notice that there are some two-way ties in the number of job openings. Within those tied pairs, we ranked them based on who had the higher job growth percentage.

Projected Job Demand for Nurse Practitioners, 2018-2028: State by State

Overall Rank State Average Annual Job Openings for Nurse Practitioners Job Growth Percentage (2018-2028)
1 New York 1,640 41.3%
2 California 1,390 30.5%
3 Texas 1,170 31.9%
4 Florida 1,110 36.9%
5 Illinois 760 31.1%
6 Tennessee 730 34.7%
7 Georgia 660 41.4%
8 Ohio 650 24.6%
9 Pennsylvania 570 26.5%
10 New Jersey 560 28.2%
11 Massachusetts 540 16.2%
12 Washington 480 28.5%
13 Virginia 450 30.7%
14 Indiana 450 29.4%
15 North Carolina 440 30.4%
16 Missouri 420 29.7%
17 Maryland 390 34.9%
18 Michigan 340 16.1%
19 Colorado 330 44.7%
20 Minnesota 330 23.0%
21 Alabama 320 24.2%
22 Kentucky 270 22.3%
23 Wisconsin 250 23.0%
24 Connecticut 240 20.5%
25 Oregon 210 32.0%
26 Arizona 200 50.9%
27 South Carolina 200 25.6%
28 Arkansas 190 31.5%
29 Kansas 190 18.3%
30 Utah 170 34.3%
31 Oklahoma 140 19.4%
32 Iowa 130 30.1%
33 New Hampshire 110 29.9%
34 Maine 110 20.6%
35 West Virginia 100 24.8%
36 New Mexico 90 27.6%
37 Nebraska 90 19.7%
38 Delaware 70 30.8%
39 Montana 60 26.5%
40 Rhode Island 60 14.3%
41 North Dakota 50 31.4%
42 South Dakota 50 27.3%
43 Hawaii 40 23.8%
44 Vermont 40 16.1%
45 Wyoming 30 30.0%
46 Mississippi 30 7.1%
47 Nevada 20 28.6%
48 Idaho 20 24.4%
49 Alaska 20 8.6%
50 Louisiana No Data Available No Data Available

Quality of Life for Nurse Practitioners: By State

Once we got a better understanding of what each state could offer NPs as far as earning potential, job growth, and cost of living, we decided to find out the kind of quality of life NPs could expect to have in each area. To do this, we turned to U.S. News’ 2021 Best States Rankings, which considered a whole host of natural and social environment factors on a state-by-state basis. They determined each state's rank by first scoring them along the following 8 metrics:

  • Healthcare
  • Education
  • Economy
  • Infrastructure
  • Opportunity
  • Fiscal Stability
  • Crime & Corrections
  • Natural Environment

The scores were on a scale of 1 to 50, with 1 being the best and 50 best the worst. They then used those scores to provide an overall ranking for each state. (You can read more about their methodology here.) Below, we've provided you with quality of life rankings for all 50 states, along with their scores for each of the 8 individual metrics.

2021 Quality of Life Rankings: State by State

Overall Rank State Healthcare Score Education Score Economy Score Infrastructure Score Opportunity Score Fiscal Stability Score Crime & Corrections Score Natural Environment Score
1 Washington 8 4 4 3 25 6 19 15
2 Minnesota 16 17 15 9 2 21 15 10
3 Utah 11 10 1 5 30 5 8 47
4 New Hampshire 13 13 11 34 3 33 1 2
5 Idaho 24 29 3 10 24 4 10 12
6 Nebraska 28 9 20 6 10 17 31 6
7 Virginia 12 12 13 39 8 18 9 19
8 Wisconsin 15 8 26 24 9 9 25 17
9 Massachusetts 2 2 5 42 36 43 4 4
10 Florida 25 3 8 20 33 8 26 18
11 Vermont 18 15 25 12 17 37 3 9
12 Iowa 20 18 27 19 1 23 14 20
13 North Carolina 30 7 17 22 28 7 20 27
14 North Dakota 27 25 32 4 23 16 18 8
15 South Dakota 29 19 30 14 27 2 35 3
16 Colorado 10 5 2 15 41 45 41 23
17 Maryland 6 14 35 38 15 29 22 11
18 Georgia 43 26 12 11 13 11 29 25
19 New Jersey 4 1 33 41 19 49 5 33
20 Connecticut 3 6 22 46 45 30 6 28
21 New York 7 16 43 30 46 20 11 5
22 Oregon 17 35 14 2 31 13 40 42
23 Delaware 14 24 24 25 14 12 39 45
24 California 5 20 10 31 50 36 28 35
25 Hawaii 1 27 46 33 34 46 12 1
26 Kansas 41 23 31 7 16 39 27 16
27 Maine 26 28 36 37 29 26 2 14
28 Missouri 42 30 23 27 4 15 45 21
29 Tennesse 40 33 16 17 21 3 42 39
30 Illinois 23 11 39 26 12 50 16 43
31 Texas 31 34 9 16 39 10 37 40
32 Indiana 32 22 21 32 7 32 24 48
33 Montana 36 32 19 13 35 19 34 24
34 Rhode Island 9 39 28 49 32 44 7 7
35 Wyoming 38 21 45 8 42 34 21 13
36 Ohio 37 31 34 29 6 24 32 44
37 Nevada 39 40 6 1 47 27 36 50
38 Michigan 35 38 29 35 5 38 30 32
39 Arizona 21 46 7 23 40 40 38 41
40 Pennsylvania 19 37 42 44 11 47 17 38
41 Kentucky 44 36 40 18 20 48 13 29
42 South Carolina 34 44 18 36 38 31 46 26
43 Oklahoma 48 42 37 21 26 25 44 34
44 Arkansas 49 41 41 43 22 14 48 30
45 Alaska 22 49 50 40 43 1 49 46
46 Alabama 45 47 38 28 37 22 43 37
47 West Virginia 47 45 48 50 18 28 23 36
48 New Mexico 33 50 44 45 49 35 47 31
49 Mississippi 50 43 49 48 44 41 33 22
50 Louisiana 46 48 47 47 48 42 50 49

Nurse Practitioner Scope of Practice: By State

Practice authority is the amount of restriction and oversight an NP needs to practice in any given state — and each state’s laws and regulations will differ. The American Association of Nurse Practitioners (AANP) categorizes state practice environments into three groups:

  • Full Practice Authority: According to the AANP, “State practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.” These are the best states for NPs looking to open their own practice.
  • Reduced Practice Authority: “State practice and licensure laws reduce the ability of NPs to engage in at least one element of NP practice. State law requires a career-long regulated collaborative agreement with another health provider in order for the NP to provide patient care, or it limits the setting of one or more elements of NP practice.”
  • Restricted Practice Authority: “State practice and licensure laws restrict the ability of NPs to engage in at least one element of NP practice. State law requires career-long supervision, delegation or team management by another health provider in order for the NP to provide patient care.”

Currently, most U.S. states give NPs full practice authority, but there are still a considerable number that don’t. Here’s how it breaks down:

The Best & Worst States for Nurse Practitioners' Scope of Practice

Full Practice Authority States
Alaska Arizona
Colorado Connecticut
District of Columbia Hawaii
Idaho Iowa
Maine Maryland
Massachusetts Minnesota
Montana Nebraska
Nevada New Hampshire
New Mexico North Dakota
Oregon Rhode Island
South Dakota Vermont
Washington Wyoming
Reduced Practice Authority States
Alabama Arkansas
Delaware Indiana
Illinois Kansas
Kentucky Louisiana
Mississippi New Jersey
New York Ohio
Pennsylvania Utah
West Virginia Wisconsin
Restricted Practice Authority States
California Florida
Georgia Michigan
Missouri North Carolina
Oklahoma South Carolina
Tennessee Texas
Virginia

Originally published on August 23, 2019.
Updated on March 1, 2021.


Image courtesy of iStock.com/Warchi


The views expressed in this article are those of the author and do not necessarily reflect those of Berxi™ or Berkshire Hathaway Specialty Insurance Company. This article (subject to change without notice) is for informational purposes only, and does not constitute professional advice.

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