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Look beyond nurse pay rates to find the right job
EDITOR'S NOTE: Heather Stringer is a freelance writer.
Nurses with at least three years of experience can expect a starting annual salary of about $132,000 at University of California, San Francisco, Medical Center, said Susan Walczak, MS, RN, NE-BC, lead talent acquisition consultant at the hospital. While this may seem like an unusually high wage, the RNs who accept these positions are working in a city with one of the highest costs of living in the U.S.
“The salaries can vary dramatically in different regions of the country, but the disposable income could be the same due to factors like housing and transportation costs,” said Judee Berg, MS, RN, FACHE, president of the National Forum of State Nursing Workforce Centers.
The cities of McAllen and Harlingen in Texas, for example, have the lowest costs of living in the country, while the mean annual nursing wage of $67,000 in that region is higher than the mean in some southeastern states, according to data from the Council for Community and Economic Research and the Bureau of Labor Statistics.
Berg and recruiters like Walczak say it’s crucial for nurses to look beyond salary numbers when they are considering job offers. The area with the highest cost of living nationwide is New York City’s Manhattan borough, followed by Honolulu; San Francisco; New York’s Brooklyn borough; Orange County, Calif.; and Washington, D.C., according to the CCER’s Cost of Living Index. The index is based on six components: housing, utilities, grocery items, transportation, healthcare and miscellaneous goods and services.
Although California includes cities with high costs of living, data from the BLS suggests nursing salaries in the state’s larger cities take these costs into account. All five top-paying metropolitan areas in the country for nurses were in California: San Francisco, Santa Cruz, Vallejo, San Jose and Salinas, according to the BLS. The annual mean wages in these areas are all $120,000 or more, a salary that is correlated to the high median home value in California of $497,000, according to Zillow.
By contrast, the mean average salary in two counties on Long Island in New York was about $85,700, according to the BLS. Although the salaries in this area are not the highest in the country, organizations like MJHS in New York have created other financial incentives to draw nurses.

MJHS, which provides home care, palliative and hospice care, managed care, rehabilitation and long-term care, offers sign-on bonuses and differentials for nurses who are interested in pursuing more education, said Mary S. McCarthy, BS, RN, assistant vice president of human resources at MJHS. The organization also offers extra pay for nurses who are bilingual and speak Spanish or Chinese in addition to English. Nurses receive an additional $1,000 in annual salary for each year of internal experience within the organization and for each year of experience accrued outside the organization.
The salaries can vary dramatically in different regions of the country, but the disposable income could be the same due to factors like housing and transportation costs.”
- Judee Berg, RN
Even though salary and cost of living are important considerations when applying for a new job, non-financial factors are equally — if not more — important to nurses, said Deborah Rowe, MS, RN, PHR, CHCR, vice president of staffing at Genesis HealthCare. Genesis connects nurses with positions in rehabilitation, skilled nursing and long-term and short-term post-acute care facilities.
“I expected to see some variance in what nurses were looking for in jobs, but by and large the facilities that provide a healthy work environment, good benefits and educational opportunities are the most appealing to nurses, no matter where they live in the country,” Rowe said.
To determine the states with the best work environments for nurses, the Genesis assessed Department of Labor data from 2016. States were evaluated based on criteria that include professional opportunities, childcare options and work-life balance. Connecticut, Minnesota, Massachusetts, New Hampshire and Illinois were rated as the top states for these aspects of a work environment.
Facilities that offer tuition reimbursement also are particularly valuable as hospitals increasingly look for nurses with a BSN, Berg said. “It’s also important to look for employers that will give you the flexibility to attend classes or get clinical experience toward a BSN,” she said. “Large academic centers and Magnet facilities are known for being supportive of further education."
Beyond financial benefits
Other facilities are attracting nurses by offering training programs onsite for sub-specialties. At University of Pennsylvania Health System, nurses have an opportunity to participate in gateway programs that prepare them to work in critical care or operating rooms. The hospital created the programs in response to a surging demand for nurses trained in these specialties, said Rhonda Zaleski, MS, RN, CHPN, corporate director of clinical talent acquisition and workforce planning for the health system.
“We are currently facing a national shortage of OR nurses due to the growing number outpatient centers,” she said. “Outpatient settings provide a flexible work schedule without night or weekend rotations, and experienced OR nurses are leaving hospitals to go to outpatient areas.”
Similarly, critical care nursing is “intense work treating very sick patients, and this is difficult to maintain mid to late career without a break,” Zaleski said.
Experienced nurses with this high level of skill can find work in areas such as admission triage, infectious disease or clinical education, or can they return to school to become advanced practice nurses, she said.
Nurses looking for jobs may also find that there are more opportunities now than a couple of years ago because demand is increasing in general, Rowe said. “Nurses are starting to retire and reduce their hours, and I’m seeing an increase in sign-on bonuses and requests for supplemental staffing,” she said.
This is in line with the BLS’ market projection that nursing employment will grow 16% from 2014 to 2024. Modupe Savage, MSN, MBA, RN, NEA-BC, assistant director of nursing recruitment and workforce planning at Johns Hopkins Hospital in Maryland, has seen this trend toward more nursing job opportunities at her facility, which hired 20% more nurses within the last year than in each of the last several years.
“It’s a candidate’s market right now,” she said. “Baby boomers are getting older, the Affordable Care Act has led to increased inpatient volumes, and more nurses are moving to outpatient settings and retiring, all of which give nurses an opportunity to choose the facility that best fits their needs.
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Cost of living and other factors can be a big draw — or a drawback
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By Heather Stringer
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