The Best States To Work As A Nurse In 2024

Where you practice shapes your pay, your safety, and your odds of burning out. This 2024 ranking scored every state on twelve data points across five categories: career opportunity, safety, education, satisfaction and burnout, and hospitals and facilities. Working nurses weighted the metrics, ranking salary adjusted for cost of living, nurse-to-patient ratio laws, RN injury and illness rates, and job satisfaction as the factors that matter most.

Use it as a starting point. Conditions vary by facility, role, employer, and county, so treat the rankings as a guide, not a verdict.

The Top 10 States for Nurses

1. California

Career opportunity #2, safety #1, education #5, satisfaction and burnout #38, hospitals and facilities #25. Average annual RN salary: $133,340.

California held the top spot for the second year, performing well in nearly every category nurses weighted highest. Legislated nurse-to-patient ratios drive its number-one safety ranking and second-place finish for career opportunities. Even against a high cost of living, California RNs out-earn nurses in every other state, per BLS and Bureau of Economic Analysis data. More than 70% of California RNs hold a BSN, and BSN-prepared nurses are linked to better patient outcomes.

The weak spot is satisfaction. In a 2023 McKinsey survey, 42% of California nurses said they were extremely satisfied with their jobs, and 60% reported at least some burnout, against a national average of 56%.

2. Colorado

Career opportunity #7, safety #13, education #1, satisfaction and burnout #14, hospitals and facilities #5. Average annual RN salary: $86,590.

Colorado ranked first in education, combining the highest blend of NCLEX-RN pass rate and BSN-prepared nurses among all states and Washington, D.C. It is projected to see the second-largest RN employment increase over the next decade (28.6%) and has one of the most progressive Nurse Practitioner Acts, granting NPs a broad scope of practice. Strong programs, professional organizations, and the outdoor lifestyle round out the appeal.

3. Massachusetts

Career opportunity #11, safety #6, education #9, satisfaction and burnout #25, hospitals and facilities #23. Average annual RN salary: $104,150.

Massachusetts posted relatively high marks across the board. In 2014 it became the second state to pass a nurse-to-patient ratio law, mandating a 1:1 or 1:2 ratio for ICU patients. Nearly 70% of its RNs hold a BSN or higher, and the state has the highest concentration of nursing jobs among the top 20. Nurses there continue to push for better conditions; the governor has argued the problem is not a nurse shortage but working conditions that drive nurses from the bedside.

4. Oregon

Career opportunity #5, safety #2, education #22, satisfaction and burnout #51, hospitals and facilities #22. Average annual RN salary: $106,610.

Oregon ranks in the top half everywhere except satisfaction, and it has the third-highest median RN salary after adjusting for cost of living. The state has required hospital RN staffing committees since 2001, and House Bill 2697, passed in 2023, made it the second state to adopt mandatory nurse staffing ratios, effective June 1, 2024. Even so, Oregon ranked last in satisfaction and burnout: 70% of its nurses reported at least some burnout in the American Nurses Foundation's 2023 survey, against a 56% national rate. New staffing rules may move those numbers over time.

5. Ohio

Career opportunity #35, safety #9, education #19, satisfaction and burnout #6, hospitals and facilities #7. Average annual RN salary: $78,450.

Ohio pairs highly rated hospitals, low injury and illness rates, and strong satisfaction scores with a low cost of living that stretches its $78,450 average salary. Hospitals have been required to maintain staffing committees of at least 50% critical care nurses since 2008, and in September 2023 the Ohio Nurses Association introduced the Nurse Workforce and Safe Patient Care Act to set enforceable minimum staffing standards and a $20M loan-to-grant program. World-class institutions include Ohio State's Wexner Medical Center and Cincinnati Children's Hospital. Ohio recently joined the Nurse Licensure Compact.

6. New York

Career opportunity #10, safety #4, education #30, satisfaction and burnout #42, hospitals and facilities #21. Average annual RN salary: $100,130.

New York's safe-staffing push drives its fourth-place safety ranking, including 2023 regulations mandating a minimum 1:2 nurse-to-patient ratio for critical care patients. Data from 2017 to 2020 showed some of the highest nurse injury and illness rates in the country, especially during COVID-19, so the new rules may need time and enforcement to pay off. RNs there earn strong salaries even against a high cost of living, and more than 40 magnet hospitals create real room for advancement.

7. Texas

Career opportunity #17, safety #11, education #23, satisfaction and burnout #24, hospitals and facilities #12. Average annual RN salary: $84,320.

In 2002, Texas became the first state to require regulatory staffing committees, mandating that at least 60% of members be RNs in direct patient care. BLS data shows Texas nurses report lower injury and illness rates than most states. As a Nurse Licensure Compact member, Texas RNs can practice across member states without a second license. The state also leads the nation with 62 magnet hospitals, including Houston Methodist, UT Southwestern, and Baylor University Medical Center.

8. Vermont

Career opportunity #36, safety #7, education #34, satisfaction and burnout #29, hospitals and facilities #4. Average annual RN salary: $79,990.

With just under 7,000 employed RNs, Vermont is the smallest state in the top ten, yet it rates high for hospital quality and safety. It mandates nurse-to-patient ratios and public staffing reports, and it posted the third-lowest rate of nursing injuries and illnesses. Vermont joined the Compact in 2022. The tradeoffs are lower cost-of-living-adjusted salaries and fewer BSN-prepared nurses.

9. Kansas

Career opportunity #46, safety #3, education #24, satisfaction and burnout #3, hospitals and facilities #35. Average annual RN salary: $71,990.

Kansas had the lowest nurse injury and illness rate of any state from 2017 to 2020, and 46% of its nurses said they were extremely satisfied with their jobs, among the highest in the country. It ranks 46th in career opportunity on low salaries (even after cost-of-living adjustment) and a projected 7.3% RN employment increase over the decade. For nurses who prioritize work-life balance and safety, Kansas delivers.

10. Arizona

Career opportunity #1, safety #36, education #11, satisfaction and burnout #19, hospitals and facilities #26. Average annual RN salary: $86,740.

Arizona tops the career-opportunity category on a large projected employment increase and strong cost-of-living-adjusted pay. Projections Central forecasts a 22% rise in RNs from 2022 to 2032. Some 68% of its RNs hold a BSN or higher, and reputable systems like Mayo Clinic and Banner-University Medical Center Tucson anchor the state.

How the Categories Break Down

Career opportunity

This category is about a quarter of each state's score. It combines median annual salary (adjusted for cost of living using Bureau of Economic Analysis data), RN occupation density, and projected employment growth. After cost-of-living adjustment, the top three paying states are California, Hawaii, and Oregon; Arizona, Colorado, and Nevada are projected for the largest RN employment growth.

Safety

Safety scores reflect safe-staffing regulations, the rate of nurse injury or illness, and the projected supply of new nurses to meet demand. California, Oregon, New York, and Massachusetts all rank near the top on staffing laws that mandate ratios statewide or by unit. Kansas and Louisiana reported the lowest injury and illness rates; Vermont had the best projected supply to meet demand by 2035.

Elizabeth Clarke, a board-certified family nurse practitioner, calls a healthy nurse-to-patient ratio the single most important factor when considering a move. "It means safer staffing, less risk of mistakes being made, and lower rates of burnout. In today's world of patients being sicker than ever, having multiple comorbidities and hospitals constantly having staffing shortages, I would want to ensure the state I am interested in has a legislature in place to ensure adequate nursing staffing numbers," she said.

Education

Two measures drive this category: the share of practicing nurses with a BSN or higher, and the first-time NCLEX-RN pass rate. Colorado ranked first, placing in the top five on both. New Hampshire had the highest pass rate but missed the final ranking because only 63% of its nurses hold a BSN or higher.

Satisfaction and burnout

No state cracked 50% of nurses reporting extreme satisfaction. Utah ranked highest at 47.1%, and Washington, D.C., was lowest at 31.2%. Among states with large enough samples, burnout ranged from 70% in Oregon to 46% in Georgia. Data from 18 states was omitted for small sample size.

Hospitals and facilities

Scores combine CMS overall hospital ratings (mortality, patient experience, readmissions, safety, effectiveness, and timeliness) with magnet hospitals per 10,000 nurses, adjusted for population so high-population states do not win on raw counts alone. Texas (62), California (54), and New York (46) have the most magnet hospitals overall.

A Moving Target

These rankings shift as the underlying metrics change. Advocacy is reshaping nurse-to-patient ratio laws, federal and state efforts are chipping at the nursing shortage, and new technology is cutting non-nursing tasks that fuel burnout. The best state for you depends on which of these factors weighs heaviest in your own situation.