10 best states to work as a nurse practitioner
There are more than 355,000 nurse practitioners (NPs) licensed in the United States. NPs are the fastest-growing occupation in the U.S. One of the benefits of being an NP is the flexibility and opportunities for advancement. NPs can work in states that offer the best place to start or continue their careers.
NurseJournal ranks the best states for NPs to work in. We also sought the help of Elizabeth Clarke, FNP, MSN, RN, MSSW, and Joelle Y. Jean, FNP-C, BSN, RN, who helped rank which factors are most important to NPs when choosing the best state.
Our methodology is based on metrics Clarke and Jean confirmed were important for NPs. These metrics include scores across nine different variables:
- Independent Practice
- Pre-Pandemic Job Satisfaction (2018)
- Projected Job Growth
- Projected NP Job Openings Per Year
- NPs Currently Employed
- Average Hourly Salary
- Purchasing Power
- Outpatient NPs' Annual Average Salary Adjusted for Cost of Living
- Hospital NPs' Annual Average Salary Adjusted for Cost of Living
The top 10 states for nurse practitioners
Nurse practitioners play an essential role in delivering health care — one of the reasons why their work/life balance is so important.
Referencing the Bureau of Labor Statistics (BLS) and Projections Central for average salaries and projected job openings for each state, these are the top 10 states where NPs can thrive.
1. Arizona
Arizona takes the top spot as the best state to work in as an NP. With full practice authority and prescriptive privileges, nurse practitioners can work independently without a collaborating agreement with a physician. Known for its warm climate — hot summers and mild winters — Arizona is a great place to set up shop.
- Weighted Average Score: 0.940
- Average Annual NP Hourly Salary: $58.37
- Projected NP Job Openings Per Year between 2020-2030: 910
- Top Three Strengths: Projected job growth, projected NP job openings per year, independent practice
- Top Three Weaknesses: Outpatient salary for cost of living, average hourly salary, purchasing power
2. New Mexico
New Mexico NPs earn above the national average annual salary, making $62.29 per hour. Another perk is that the state offers full practice authority and prescription privileges. The downside is it has only 1,400 projected job openings from 2020-2030.
- Weighted Average Score: 0.896
- Average Annual NP Hourly Salary: $62.29
- Projected NP Job Openings Per Year between 2020-2030: 140
- Top Three Strengths: Independent practice, outpatient salary for cost of living, hospital salary for cost of living
- Top Three Weaknesses: Projected NP job openings per year, NPs currently employed, average hourly salary
3. Iowa
Nurse practitioners in Iowa can enjoy independent practice and prescriptive authority. NPs who work in hospitals can also enjoy a comfortable cost of living. In the next 10 years, NP job openings are expected to be under 3,000. NPs will have plenty of job opportunities while also enjoying the weather, as Iowa has four distinct seasons.
- Weighted Average Score: 0.893
- Average Annual NP Hourly Salary: $61.62
- Projected NP Job Openings Per Year between 2020-2030: 260
- Top Three Strengths: Independent practice, hospital salary for cost of living, projected job growth
- Top Three Weaknesses: Projected NP Job openings per year, NPs currently employed, pre-pandemic job satisfaction
4. New York
New York is always top in the rankings for best states for nurses to work. With a great mix of city and suburban life, New York NPs gain top salaries and will have choices for job openings for the next decade. NPs can also enjoy independent practice by opening clinics and experiencing entrepreneurship. However, a downside is pre-pandemic job satisfaction. Only 40% of NPs in 2018 were satisfied with their jobs compared to 47% of NPs nationally. The cost of living is also high in New York, depending on where you live.
- Weighted Average Score: 0.884
- Average Annual NP Hourly Salary: $64.39
- Projected NP Job Openings Per Year between 2020-2030: 2,060
- Top Three Strengths: Projected NP job openings per year, NPs currently employed, independent practice
- Top Three Weaknesses: Pre-Pandemic job satisfaction, purchasing power, outpatient salary for cost of living
5. Oregon
Oregon is another state with full practice authority and prescription privileges for NPs. It also has the fourth-highest hourly salary at $65.51. Oregon also has one of the highest job growths, according to BLS. Although NPs have a higher-than-average hourly rate, a downside is the cost of living. In Oregon, the cost of living can be high depending on where you live. The state also has mixed weather patterns due to its diverse landscapes.
- Weighted Average Score: 0.883
- Average Annual NP Hourly Salary: $65.51
- Projected NP Job Openings Per Year between 2020-2030: 300
- Top Three Strengths: Independent practice, projected job growth, average hourly salary
- Top Three Weaknesses: NPs currently employed, projected NP job openings per year, purchasing power
6. Minnesota
Home of the twin cities, Minnesota NPs can enjoy independent practice, a higher average hourly salary at $61.62, and a comfortable salary adjusted for the cost of living if NPs decide to work in a hospital. The state offers distinct seasons with snowy winters and warm summers. With a population of 5.7 million, the projected NP job openings in the next 10 years are 4,500.
- Weighted Average Score: 0.883
- Average Annual NP Hourly Salary: $61.62
- Projected NP Job Openings Per Year between 2020-2030: 450
- Top Three Strengths: Independent practice, average hourly salary, hospital salary for cost of living
- Top Three Weaknesses: Outpatient salary for cost of living, projected NP job openings per year, projected job growth
7. Washington
Washington offers great salaries for NPs. NPs also can take advantage of independent practice and prescription privileges. As of 2022, Washington has a population of around 7.7 million, with a projected NP job opening of 6,900 in the next 10 years. NPs can enjoy a mix of an outdoor lifestyle and urban living.
- Weighted Average Score: 0.878
- Average Annual NP Hourly Salary: $65.19
- Projected NP Job Openings Per Year between 2020-2030: 690
- Top Three Strengths: Independent practice, projected NP job openings per year, average hourly salary
- Top Three Weaknesses: NPs currently employed, outpatient salary for cost of living, purchasing power
8. Montana
In 2018, Montana NPs reported a 50% pre-pandemic job satisfaction rate. NPs can also practice independently and have prescription privileges. The job growth in Montana is also promising, and the cost of living is close to the national average. Often called the "Big Sky Country" and home to the Rocky Mountains, NPs can enjoy an outdoor lifestyle.
- Weighted Average Score: 0.856
- Average Annual NP Hourly Salary: $57.67
- Projected NP Job Openings Per Year between 2020-2030: 80
- Top Three Strengths: Independent practice, pre-pandemic job satisfaction, projected job growth
- Top Three Weaknesses: NPs currently employed, projected NP job openings per year, outpatient salary for cost of living
9. New Hampshire
New Hampshire is known for its outdoor activities. It is also a great place for an NP due to its higher-than-average national salary and independent practice and prescription privileges. However, New Hampshire is ranked lower for pre-pandemic job satisfaction, at 38%.
- Weighted Average Score: 0.834
- Average Annual NP Hourly Salary: $60.47
- Projected NP Job Openings Per Year between 2020-2030: 140
- Top Three Strengths: Average hourly salary, independent practice, and hospital NP salary adjusted for cost of living
- Top Three Weaknesses: Projected NP job openings per year, projected job growth, and NPs currently employed
10. North Dakota
Although the projected NP job openings in the next 10 years are 900—the second lowest, right behind Montana—NPs can make over $130,000 annually after their salary is adjusted for the cost of living if they decide to work in a hospital setting. NPs also will enjoy independent practice and prescription privileges. North Dakota has a wide temperature variation, so be prepared for cold and warm temperatures.
- Weighted Average Score: 0.832
- Average Annual NP Hourly Salary: $54.78
- Projected NP Job Openings Per Year between 2020-2030: 90
- Top Three Strengths: Purchasing power, independent practice, and hospital NP salary adjusted for cost of living
- Top Three Weaknesses: Projected NP job openings per year, projected job growth, and NPs currently employed
States that offer nurse practitioners the largest scope of practice
There are advantages for NPs who work in states with the largest scope of practice. These states allow NPs to work at the highest level of care without the supervision of a collaborating physician.
NPs should consider independent practice authority and prescriptive privileges because it allows for professional autonomy and improves access to care, especially in marginalized communities and rural areas.
In these states, nurse practitioners can practice at the top of their licenses:
- Alaska
- Arizona
- Washington D.C.
- Idaho
- Iowa
- Minnesota
- Montana
- New Hampshire
- New Mexico
- North Dakota
- Oregon
- Rhode Island
- Washington
- Wyoming
According to the American Association of Nurse Practitioners, states that offer full practice authority allow 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."
For example, NPs in Alaska have prescriptive, controlled substance, and dispensing authority. NPs practicing in states with reduced or restricted authority can only prescribe medications with permission and sign-off from a doctor.
But even full-practice authority states have additional laws and requirements.
What full-authority NPs are allowed to do under their license varies by state. For example, NPs in New York must have written practice agreements with collaborating physicians unless they have met 3,600 clinical experiences. Other states allow NPs to practice without a collaborating physician and prior clinical experience outside the required amount in their NP programs.
Full-practice authority states recognize that NPs are providing high-quality care to patients. They know the need to improve access to care for the most vulnerable communities. For reduced and restricted states to become full-practice authorities, legislation must be passed.
The states with the most opportunities for nurse practitioners
The states with the most job opportunities can attract NPs starting their careers or looking for a change. These states can offer job security, professional retention and development, higher pay, and improved health care outcomes. However, NPs should be aware that states with the highest projected job growth may not be the states with the highest number of openings for NPs.
It's important to explore job opportunities and demand for NPs before making a decision. For example, states with the highest demand for NPs, according to Clarke, may signify job dissatisfaction.
"High turnover typically means low job satisfaction. The less turnover or fewer openings means higher job satisfaction," Clarke says.
The best states for nurse practitioner salaries
According to the BLS, NPs earned a mean annual salary of $124,680 in 2022 or an average hourly wage of $59.94. However, NPs can make up to $2-$16 more if they work in the top 10 states with the best salaries for NPs.
When deciding to work in a certain state, it's important to consider the cost of living and salary potential. NPs should feel comfortable negotiating their salaries and incorporating the cost of living expenses, which include housing, food, and transportation, into their contracts.
If an NP has difficulty finding a salary that fits their needs, choosing between working in a hospital versus an outpatient center may be the deciding factor. NPs who work for a hospital make significantly more than those in outpatient centers.
For example, New Mexico NPs who work in the hospital make an annual average salary of $151,313. In contrast, outpatient NPs make $144,104 annually when their salaries are adjusted for New Mexico's cost of living.
Another factor that we examined is purchasing power. For example, NP salaries in Iowa and New Mexico can purchase 10% more goods than the national average.
Methodology and sources
Our list of the best states to work as an NP was determined using a weighted average ranking comprised of nine different metrics, including the scope of practice, NP average hourly salary, state purchasing power, outpatient NP average annual salary adjusted for cost of living, hospital NP annual average salary adjusted for cost of living, projected job growth, projected NP job openings per year, NPs currently employed, and pre-pandemic job satisfaction.
The salary index score is a simple average of the average hourly salary index, the average annual salary for outpatient NPs adjusted for the cost of living index, and the average annual salary for hospital NPs adjusted for the cost of living index. The opportunity index is an average of each state's projected NP annual openings index and current NP employment index.
Sources include Projections Central, the Bureau of Labor Statistics, American Association of Nurse Practitioners, BEA Regional Price Parity, Health Resources and Services Administration (HRSA) Nursing Workforce Dashboard, American Medical Association's State law chart: Nurse Practitioner Prescriptive Authority from 2017, and The U.S. Department of Justice's Mid-Level Practitioner Controlled Substance Authorization by State Guide, which was last updated in 2022
Nurse practitioner practice authority was taken from the American Association of Nurse Practitioners. Prescriptive authority was taken from the American Medical Association's State law chart: Nurse Practitioner Prescriptive Authority from 2017 and The U.S. Department of Justice's Mid-Level Practitioner Controlled Substance Authorization by State Guide, which was last updated in 2022.
Projected NP job openings per year and projected job growth were taken from Projections Central's data for 2020-2030. Purchasing power was the 2021 regional price parity from the BEA Regional Price Parity in each state. NPs currently employed and average hourly salary were collected from Bureau of Labor Statistics data from 2022. NP salary data for New York is from 2021 because 2022 data was unavailable.
The purchasing power tells NPs how much more or fewer goods and services they can buy with their paycheck in their state compared to the national purchasing power. Each state's average outpatient NP salary and average NP salary were multiplied by the purchasing power to get the outpatient NP salary and hospital NP salary in each state adjusted for cost of living.
Job satisfaction was measured by what percentage of NPs in each state reported being "extremely satisfied" with their role, according to the Health Resources and Services Administration (HRSA) Nursing Workforce Dashboard, which, at the time of publication, uses 2018 data. Since this data was collected, NP job satisfaction has been affected by the COVID-19 pandemic, and the HRSA has not released more recent data on how the pandemic affected job satisfaction among NPs.
In several states, as much as 24% of NPs did not report their job satisfaction to the HRSA. The sample size in some states, like Wyoming and Montana or North and South Dakota, was so small that the data from two states were reported together. When that occurred, the same percentage was used for both states.
This story was produced by NurseJournal and reviewed and distributed by Stacker Media.
