Best States To Work As A Nurse Practitioner (NP)

In the United States, there are over 355,000 licensed nurse practitioners (NPs), making it the fastest-growing occupation. NPs enjoy the benefits of flexibility and ample opportunities for career advancement. They have the freedom to choose the states that provide the best environment to start or continue their professional journey.

To determine the best states for NPs to work in, NurseJournal conducted a data-driven analysis. Moreover, we collaborated with Elizabeth Clarke, FNP, MSN, RN, MSSW and Joelle Y. Jean, FNP-C, BSN, RN, who provided valuable insights to rank the factors that NPs consider most crucial when selecting an ideal state.

Our methodology is based on metrics that Clarke and Jean identified as significant for NPs. These metrics encompass a comprehensive evaluation of 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

Discover the top states for Nurse Practitioners (NPs), where you’ll find higher salaries, independence in practice, job satisfaction, and abundant professional development opportunities.

The Top 10 States for Nurse Practitioners

Nurse Practitioners (NPs) have a crucial role in healthcare delivery, making their work/life balance a key consideration. Discover the top 10 states where NPs can truly flourish, backed by data from the Bureau of Labor Statistics (BLS) and Projections Central. We’ve examined average salaries and projected job openings for each state to provide you with valuable insights.

Find out Where Your State Ranks

States that Offer Nurse Practitioners (NP) the Largest Scope of Practice

Nurse practitioners (NPs) in states with the broadest scope of practice enjoy significant benefits. These states empower NPs to provide the highest level of care independently, without the need for physician supervision. NPs should strongly consider pursuing independent practice authority and prescriptive privileges. These privileges not only enhance professional autonomy but also expand access to healthcare, particularly in underserved communities and rural areas. By optimizing NPs’ ability to serve, we can bridge the gaps in healthcare and ensure quality care for all.

List of States Where 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.”

In Alaska, for instance, nurse practitioners (NPs) possess prescriptive, controlled substance, and dispensing authority. However, in states where NPs have limited or restricted authority, they can only prescribe medications with explicit permission and approval from a physician. Nevertheless, it is important to note that even in states where NPs have full-practice authority, there are still additional laws and requirements to adhere to.

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.

States that grant full-practice authority to nurse practitioners (NPs) acknowledge their ability to deliver exceptional care to patients. These states also acknowledge the pressing need to enhance healthcare access for vulnerable communities. However, in order for states with reduced and restricted authority to transition to full-practice authority, appropriate legislation must be enacted.

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 healthcare 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.

Before making a decision, it is crucial to thoroughly investigate job prospects and demand for NPs. For instance, according to Clarke, states with the greatest demand for NPs might indicate low job satisfaction. Clarke states, “High turnover is often indicative of low job satisfaction, whereas low turnover or fewer job openings suggest higher job satisfaction.” Remember to consider these factors when assessing your options.

The Best States for Nurse Practitioner (NP) 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 considering working in a specific state, it’s crucial to take into account the cost of living and salary potential. Nurse practitioners (NPs) should feel empowered to negotiate their salaries and incorporate living expenses, such as housing, food, and transportation, into their contracts.

If NPs encounter difficulty finding a salary that aligns with their needs, the choice between working in a hospital or an outpatient center may become the deciding factor. NPs employed by hospitals tend to earn significantly higher salaries compared to those working in outpatient centers.

For instance, NPs practicing in New Mexico and employed by hospitals earn an average annual salary of $151,313. Conversely, outpatient NPs in New Mexico receive an annual salary of $144,104, accounting for the state’s cost of living.

Furthermore, we analyzed the purchasing power of NP salaries. In states like Iowa and New Mexico, NP salaries can purchase goods that are 10% more affordable than the national average.

The Complete Ranking of the Best States to Work as a Nurse Practitioner (NP)

Methodology and Sources

We determined the best states for NP employment by calculating a weighted average ranking across nine key metrics. These metrics include scope of practice, average hourly salary for NPs, state purchasing power, adjusted average annual salary for outpatient NPs based on cost of living, adjusted average annual salary for hospital NPs based on cost of living, projected job growth, projected NP job openings per year, number of NPs currently employed, and pre-pandemic job satisfaction.

The salary index score is calculated as the 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. Similarly, the opportunity index is calculated as the 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

The authority to practice as a nurse practitioner was transferred from the American Association of Nurse Practitioners. The power to prescribe medications was derived from the State law chart on Nurse Practitioner Prescriptive Authority from 2017, published by the American Medical Association, and The U.S. Department of Justice’s Mid-Level Practitioner Controlled Substance Authorization by State Guide, which was last updated in 2022.

Data on projected job openings per year and job growth for nurse practitioners were sourced from Projections Central’s 2020-2030 data. Purchasing power was determined using the 2021 regional price parity from the BEA Regional Price Parity in each state. Information on currently employed nurse practitioners and average hourly salary was collected from Bureau of Labor Statistics data from 2022. For New York, salary data from 2021 was used due to the unavailability of 2022 data.

Purchasing power allows nurse practitioners to understand the relative value of their paycheck in their state compared to the national purchasing power. By multiplying each state’s average outpatient nurse practitioner salary and average nurse practitioner salary by the purchasing power, we were able to determine the adjusted outpatient and hospital nurse practitioner salaries in each state, accounting for the cost of living.

Job satisfaction was assessed based on the percentage of NPs in each state who reported being “extremely satisfied” with their role, as per the Health Resources and Services Administration (HRSA) Nursing Workforce Dashboard. The dashboard, which employed 2018 data at the time of publication, lacks information on how the COVID-19 pandemic influenced NP job satisfaction as more recent data has not been released by the HRSA.

Interestingly, in several states, up to 24% of NPs refrained from reporting their job satisfaction to the HRSA. In cases where the sample size was small, such as Wyoming and Montana or North and South Dakota, the data from these states were combined, resulting in the utilization of the same percentage for both states.

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