Best Cities and States for Nurses: RN Salaries Adjusted for Cost of Living

Imagine earning a six-figure salary as a nurse, only to struggle to make ends meet. Or taking a pay cut to move to a new city but suddenly feeling flush with cash. Welcome to the complex world of nursing salaries, where your paycheck's true value isn't just about the numbers on your stub. It's about how far those dollars stretch in your hometown.

Choosing where to practice can impact your financial future in an era of nursing shortages and soaring costs of living. But which cities and states offer the best deal for nurses? Our investigation reveals surprising answers that could change how you think about your next career move.

Although the job requirements are generally the same across the country, registered nurse salaries vary greatly depending on location. For example, California nurses can earn as much as $137,690 annually, while those in South Dakota might make $69,030. However, the cost of living in San Francisco is higher than in St. Louis, meaning the same salary won’t stretch as far as in the City by the Bay as in the Gateway City.

We compared nurse salaries adjusted for the cost of living using the Council for Community and Economic Research’s Cost of Living Index (COLI) to get an accurate picture of the best places for RNs to live and work. The COLI Index score represents the purchasing power of each city relative to the national average. The higher the COLI score, the lower the purchasing power of a dollar in that city. Our final ranking was determined by each city’s COLI-adjusted salary, representing the purchasing power of each city’s average wage relative to the national cost of living.

Key Findings

• Oakland is the best city for nurses. Salaries are 85% higher than the national average, and a COLI score is only 39.5% above the national average, resulting in the highest COLI-adjusted wage in the country at $124,996 ($60.09 hourly).
• Minnesota is the best state for nurses. It offers a six-figure COLI-adjusted salary ($100,032 or $48.09 hourly), a cost of living 5.2% below the national average, and average salaries slightly (less than 1%) above the national average.
• Hawaii is the worst state for nurses. It has the highest COLI score in the country at 86.2% above the national average. The salaries are only 26.7% above average, leaving nurses in the Aloha State with a COLI-adjusted wage of $64,291.08 ($30.91 hourly).

Why do nurse salaries vary in the U.S.?

There are many reasons, but here are a few key factors:

• Nursing shortage: Due to a shortage of nursing educators, an aging population, increasing nurse retirement rates, and other trends, the United States needs 78,610 more nurses. Overworking the insufficient workforce leads to poor job satisfaction and stress, driving some to other careers and exacerbating the shortage. In states like Washington, Georgia, and California, the supply and demand of qualified nurses has driven up salary rates and will continue as long as the shortage exists.
• Unions: Nurse union participation in the United States rose steadily between 1995 and 2006, with union and nonunion wages mirroring changes. Like other industries, nursing unions demand higher wages, better working conditions, and standardization. Areas with heavier union participation often see higher wages due to stronger bargaining power. Union-led strikes more than tripled between 2020 and 2023 as the nursing shortage grows.
• Cost of living: The prices of housing, goods and services vary significantly across the United States due to factors such as population density, housing stock, and food costs. A city’s average cost of goods, services, and housing (excluding taxes) measures its cost of living. Purchasing power, or the value of money in the marketplace, is used to understand it. For example, a dollar in Indianapolis may buy a 20-ounce soda, while a dollar in Los Angeles may only buy a 12-ounce soda. Therefore, Indianapolis has a higher purchasing power compared to Los Angeles.

What are the best states for nurses?

1. Minnesota

Annual Salary: $94,830

Hourly Salary: $45.59

COLI: 94.8

COLI-Adjusted Annual Salary: $100,032

COLI-Adjusted Hourly Salary: $48.09

Minnesota tops our list as the number one state for nurses with a COLI-adjusted salary 5.5% above the national average, home to two of the top 10 best cities for nurses. The world-renowned Mayo Clinic and a robust health care infrastructure contribute to this. Affordable cities and rural counties also contribute to a 5% lower-than-average cost of living. The average RN salary exceeds the national average by less than 1%. This combination of low cost of living and above-average salaries makes Minnesota the only state with a COLI-adjusted six-figure wage.

2. Oregon

Average Salary: $113,440

Hourly Salary: $54.54

COLI: 114.1

COLI-Adjusted Annual Salary: $99,421

COLI-Adjusted Hourly Salary: $48.09

Oregon’s cost of living is 14% above the national average. Its 20% higher nursing salaries put it second on our list, with a COLI-adjusted salary 5% higher than the national average. The state’s high salaries are likely due to its high cost of living and strong union participation. Staff-to-patient ratio regulations also contribute to higher wages, increasing the demand for nurses amid the ongoing shortage.

3. Georgia

Average Salary: $90,000

Hourly Salary: $43.27

COLI: 91.3

COLI-Adjusted Annual Salary: $98,576

COLI-Adjusted Hourly Salary: $47.39

Georgia ranks third in the predicted nursing shortage by 2035. The state’s average salary is below the national average, but its low cost of living gives nurses COLI-adjusted salaries 4% above the national average because of its affordable housing and low utility costs.

4. New Mexico

Average Salary: $92,140

Hourly Salary: $44.30

COLI: 93.6

COLI-Adjusted Annual Salary: $98,440

COLI-Adjusted Hourly Salary: $47.33

Nursing salaries in New Mexico are 2.5% below the national average, but the cost of living is 6.4% lower, ranking it fourth on our list. The state benefits from a favorable housing market and lower utility costs. While most goods and services are cheaper than the national average, health care costs are 1% higher.

5. Texas

Average Salary: $90,210

Hourly Salary: $43.47

COLI: 92.4

COLI-Adjusted Annual Salary: $97,630

COLI-Adjusted Hourly Salary: $46.94

They say everything’s bigger in Texas, so it’s fitting that Texas has a “bigger” than average COLI-adjusted salary. Texas has a COLI-adjusted salary 3% above the national average because its lower-than-average salaries are outpaced by its cost of living. It benefits from a favorable housing market, low population density, and low gas costs due to its oil industry, resulting in a cost of living 7.6% below the national average.

What are the best cities for nurses?

1. Oakland, California

Annual Salary: $174,370

Hourly Salary: $83.83

COLI Index: 139.5

COLI-Adjusted Annual Salary: $124,996

COLI-Adjusted Hourly Salary: $60.09

Oakland ranks highest in nurse salaries when adjusted for the cost of living. Despite high living expenses, the premium that Oakland nurses earn more than compensates for this. They earn 85% more than the average nurse, with an annual salary of $174,370 compared to $94,480. Factors contributing to their high score include competitive Bay Area salaries, a lower cost of living than neighboring San Francisco, robust union support, and a significant nursing shortage in California, which currently needs 36,000 nurses.

2. Redding, California

Annual Salary: $129,250

Hourly Salary: $62.14

COLI: 111.9

COLI-Adjusted Annual Salary: $115,505

COLI-Adjusted Hourly Salary: $55.53

Redding, California, ranks second, located 200 miles north of the Bay Area. Registered nurses in Redding earn 36% more than the national average while facing a cost of living slightly above the national average and 34 points below California’s COLI score. Consequently, nurses in Redding have a higher COLI-Adjusted Salary than most nurses. Like Oakland, Redding is affected by California’s nursing shortage, contributing to its higher salaries. Its rural location gives it a lower living cost compared to the rest of California.

3. Bakersfield, California

Annual Salary: $122,540

Hourly Salary: $58.92

COLI: 112.0

COLI-Adjusted Annual Salary: $109,411

COLI-Adjusted Hourly Salary: $52.61

Bakersfield is the third-best city for nurses. Bakersfield, like the previous two spots, is affected by California’s statewide nurse shortage. Registered nurses earn 30% more than the national average and have a cost of living only 12% above the national average. Like Redding, it has a COLI score 33 points lower than the state score, giving it a favorable cost of living within the state. With RN salaries surpassing the cost of living, Bakersfield boasts the nation’s third-highest COLI-adjusted salary.

4. Dalton, Georgia

Annual Salary: $92,730

Hourly Salary: $44.58

COLI: 85.7

COLI-Adjusted Salary: $108,203

COLI-Adjusted Hourly: $52.02

Dalton, Georgia—about 30 miles southeast of Chattanooga, Tennessee—ranks fourth on the list, the first location outside of California. Registered nurses in Dalton earn 2% less than the national average, but the cost of living is 14.3% less. This is likely due to Dalton’s rural setting in the foothills of the Blue Ridge Mountains. Unlike California cities, Dalton’s lower cost of living outweighs its lower salaries, allowing nurses to benefit from the fourth-highest COLI-adjusted wage in the nation.

5. Kennewick-Richland-Pasco, Washington

Annual Salary: $104,600

Hourly: $50.29

COLI: 97.2

COLI-Adjusted Annual Salary: $107,613

COLI-Adjusted Hourly Salary: $51.74

Kennewick, Richland and Pasco, Washington, known as the Tri-Cities, rank fifth on our list of best cities for nurses. They are located in a rural region on the Oregon border and have a 3% lower cost of living than the national average. Paired with an average salary 11% higher than the national average, registered nurses in the Tri-Cities earn a higher-than-average wage.

6. Conroe, Texas

Annual Salary: $94,390

Hourly Salary: $45.38

COLI: 88.7

COLI-Adjusted Annual Salary: $106,415

COLI-Adjusted Hourly Salary: $51.16

Conroe, Texas, located 40 miles north of Houston, has a cost of living 11.3% lower than the national average. Nursing salaries are on par with the national average, resulting in a COLI-adjusted high wage. Conroe’s low cost of living is likely due to Texas’s favorable housing market. It also benefits from a connection to Houston’s economic opportunities while being in a rural area surrounded by the East Texas Piney Woods.

7. St. Paul, Minnesota

Annual Salary: $98,550

Hourly Salary: $47.38

COLI: 92.9

COLI-Adjusted Annual Salary: $106,081

COLI-Adjusted Hourly Salary: $51.00

Both Twin Cities made our top 10 list. They have the same above-national-average salaries and lower cost of living. St. Paul’s lower cost of living gave it the edge over Minneapolis—92.9 vs. 93.3 on the index—partly due to its lower population and housing costs. In November 2021, St. Paul enacted strict rent control laws to curb rising housing costs.

8. Minneapolis, Minnesota

Annual Salary: $98,550

Hourly Salary: $47.38

COLI: 93.3

COLI-Adjusted Annual Salary: $105,627

COLI-Adjusted Hourly Salary: $50.78

Minneapolis has a strong health care infrastructure similar to St. Paul. This infrastructure supports higher salaries and reasonable living costs. Its slightly higher cost of living, due to housing and utility costs, means nurses in Minneapolis have less purchasing power than those in St. Paul, by only 0.4%. While St. Paul uses rent control to address housing shortfalls, Minneapolis is focused on changing zoning laws to encourage new multifamily housing. The cost of living differences between Minneapolis and St. Paul may change. (https://upjohn.org/research-highlights/affordable-housing-minneapolis-st-paul-tale-twin-cities)

9. Spokane, Washington

Annual Salary: $103,910

Hourly Salary: $49.96

COLI: 93.3

COLI-Adjusted Annual Salary: $104,854

COLI-Hourly Salary: $50.41

Spokane’s moderate cost of living and demand for health care services make it a strong contender for maximizing an RN salary. The city’s health care system and economic environment support competitive salaries. Salaries in Spokane are 10% higher than the national average, while the overall cost of living in Spokane is 7% below the national average, thanks to its affordable housing market and low utility costs.

10. South Bend, Indiana

Average Salary: $93,390

COLI: 90.1

COLI-Adjusted Annual Salary: $103,652

COLI-Adjusted Hourly Salary: $49.83

South Bend, Indiana, is located 75 miles east of Chicago and next to the University of Notre Dame. Nurses there benefit from salaries on par with the country and a cost of living 9.9% below the national average. The cost of living in South Bend is driven by its health care, transportation, and general goods and services costs, all below the state and national average. While housing in South Bend is higher than the state average, it is far below the national average, lowering the cost of living.

Methodology

We used the mean salary data from the Bureau of Labor Statistics (BLS) Occupational Employment and Wage Statistics (OEWS) and adjusted it using the Q1 2024 cost of living index (COLI) from the Council for Community and Economic Research (C2ER) and the Missouri Economic Research and Information Center (MERIC).

The formula we used:

COLI-Adjusted RN Wage = (RN Wage/Cost-of-Living Index)×100

Bottom Line

Nursing salaries across the United States are more complex than dollar figures suggest. Our analysis reveals that the most lucrative opportunities for nurses often lie in unexpected places, creating optimal financial conditions with higher-than-average salaries and reasonable living costs.

Cities like Oakland and Redding in California offer strong purchasing power for nurses despite the state's high costs. Meanwhile, states like Minnesota and Georgia show that a lower cost of living can be as valuable as a higher salary.

It's important to remember that these rankings can change due to economic conditions, policy changes, and shifts in the health care landscape. Nurses considering a move should watch for emerging trends, such as the nursing shortage, unionization efforts, and housing markets, which could reshape these rankings in the coming years.

Financial considerations are important, but not the only factor in career satisfaction. The quality of life, professional development opportunities, work-life balance, and personal preferences are crucial in determining the "best" place to work as a nurse.

This data is a valuable starting point for nurses evaluating their career options. Nurses can make informed decisions about where to build their careers by understanding how salaries measure up against living costs. Whether you're a new graduate or an experienced nurse, remember: in nursing salaries, context is everything. The biggest paycheck doesn't always lead to the most fulfilling life.