There were more than 3,175,000 registered nurses (RNs) working in the U.S. as of May 2023 according to the U.S. Bureau of Labor Statistics (BLS).  RNs work in varied healthcare settings, including hospitals, physician offices, home healthcare agencies, skilled nursing facilities, and outpatient care centers. Like many other healthcare professionals with advanced training and skills, registered nurses usually earn higher salaries and wages than workers in most other occupations.  Per BLS estimates, as of May 2023, the national mean wage for registered nurses was $94,480 per year.  While RNs realize better than average pay in comparison to most workers, the annual mean wage for registered nurses varies widely from state to state.  Per BLS data, as of May 2023, these were the ten best and worst states for registered nurse pay based on annual mean wage levels:

The Best and Worst States for Registered Nurse Pay

Best Paying States
California	$137,690
Hawaii	$119,710
Oregon	$113,440
Washington	$111,030
Alaska	$109,210
Massachusetts	$108,850
District of Columbia	$106,850
New York	$106,620
New Jersey	$101,960
Connecticut	$101,840

Worst Paying States
North Dakota	$79,190
Tennessee	$78,240
Missouri	$77,590
Kansas	$76,240
West Virginia	$75,990
Mississippi	$75,510
Iowa	$74,610
Arkansas	$72,900
Alabama	$71,370
South Dakota	$69,030

Source: U.S. Bureau of Labor Statistics OES. Data extracted on April 22, 2024

Protecting the Public: State Nursing Boards

 Registered nurses (RNs), vocational or practical nurses (LVNs or LPNs), advanced practice registered nurses (APRNs), and various other nursing professionals must be licensed in the states in which they practice.  In most states, it is a State Nursing Board, or the equivalent, that provides regulatory oversight of the nursing professions.  With more than four (4) million RNs, LVNs, LPNs and other nursing professionals employed in the United States, effective oversight is significant task for state licensing authorities.  These regulatory authorities protect the health and safety of the public by determining licensure qualifications for new nursing professionals, establishing standards for practitioners to follow in order to maintain their license to practice, disciplining licensees who fail to adhere to those requirements, and promoting the delivery of the high quality nursing care. In addition to nurses and other nursing professionals, in many states the Nursing Board, or its equivalent, provides regulatory oversight of various institutions that provide nurse training and education.  To find the Nursing Board, or the equivalent, serving in each state, check out our resource guide:

State Nursing Boards | Health Guide USA

Nursing Specialty Certification Boards

All nurses must be licensed by the state's in which they work.  While licensing requirements vary some from state-to-state, individuals must demonstrate a specific level of education and competency in their chosen nursing profession in order to obtain, and maintain, a license to practice in a state.  Much like doctors and dentists, nurses can attain specialty designations in specific practice areas, such as ambulatory care, gerontology, oncology, orthopedics, pediatrics and other advanced clinical specialties. Nurses can attain such specialist designation by demonstrating, to a national certification organization, a specified level of clinical knowledge and proficiency in a particular nursing practice area. Although certification is usually voluntary, it demonstrates a specific level of competency that nursing employers often desire.

There are more than twenty national boards that confer specialty certifications to nursing professionals who meet their certification (or recertification) standards.  To find these national nursing specialty certification organizations and to learn more about their contribution to establishing and maintaining professional nursing standards, visit our resource page:

Nursing Specialty Certification Boards | Health Guide USA

Ten States with the Most Registered Nurses

In the parlance of analysts with the U.S. Bureau of Labor Statistics, a location quotient is measure of an occupation's prevalence in a census area in relation to that occupation's prevalence throughout the nation as a whole.  A location quotient above 1.0 indicates that an occupation has a bigger share of employment in a given census area than it does on a national basis.  On the other hand, a location quotient below 1.0 indicates that an occupation has a smaller share of employment in a particular area than it does nationally.

Looking at just the raw numbers, it is almost always the biggest population States that have the largest employment bases when examining healthcare occupations.  However, a different picture emerges when one looks at a relative measure like the location quotient.  It is smaller States that dominate the list of Ten States with the Most Registered Nurses on a relative basis.

The Ten States with the Most Registered Nurses on an absolute basis is dominated by the large population States, with only Ohio and Massachusetts making the top 10 on both lists.

Ten States Most Under-Served by Registered Nurses

According to Area Health Resource Files (AHRF) data available from the Health Resources and Services Administration, there are 839 registered nurses employed for every 100,000 people here in the United States .  Among all health professions, that is the largest number of practitioners per 100,000 population in the U.S., which is not really surprising given the essential role registered nurses (RNs) play in quality healthcare delivery.  What may be more surprising is how much disparity exists in registered nurse employment from State to State.  As this map of registered nurse employment per 100,000 population reveals, some areas of the country are much better served by RNs than are others:

There are 31 States in all that have registered nurse employment that exceeds the 839 per 100,000 population national average.  And within this group there are a dozen States, mainly in the Northeast and Great Plains regions, that are particularly well served by registered nurses with employment greater than 1,000 registered nurses per 100,000 population.  But while some States are well served by RNs, there are 19 States, predominantly in the South and West, where registered nurse employment lags behind the national average. Some of these laggards, like California and Texas, actually have RN employment numbers among the highest in the nation in absolute terms.  But even in these two big States, RN employment is proportionately weak given their size.  With 719 RNs employed per 100,000 population, only 9 States are more under-served by registered nurses than Texas.  And the situation in California is poorer still, where just 657 RNs employed per 100,000 population makes the State more under-served by registered nurses than all but three States.  The State most under-served by registered nurses is Nevada, which has just 609 RNs employed per 100,000 people.  Unfortunately, for Nevada and other States that lag behind the national average, the situation could easily get worse in coming years.  The job outlook for RNs indicates a growing need for registered nurses due to a variety of demographic and technological factors.  This trend will will only exert more pressure on States already struggling to attract RNs.  Besides Nevada, California and Texas, here are the Ten States Most Under-Served by Registered Nurses based on current HRSA data: