Nurse practitioner salaries: Highest and lowest paying states

The latest data from the Bureau of Labor Statistics highlights how diverse nurse practitioner (NP) salaries are across different states. Right now, the median average NP salary is $129,480. 

As the population ages and as healthcare reforms come into play, these salary variations reflect the huge difference in economic and healthcare landscapes in the United States. As the demand for healthcare services continues to grow, understanding these salary trends is key for both current and aspiring NPs.

In this article, we explore the highest and lowest earning states for nurse practitioners — plus ways NPs can increase their earnings.

The top 5 states for nurse practitioners are currently:

To optimize your NP salary, these are the hottest spots. However, it’s important to recognize that the highest-paying states are accompanied by a higher cost of living. For instance, California ranks higher than the national average for cost of living.

Western and northeastern states are among the best-paying NP salaries, while southern states such as Florida, Georgia, and Alabama pay much less than West Coast and New England states. The difference can be significant — in some cases, over $40,000.

Nursing unions can be a reason for higher earnings in some states. Both western and northeastern states are further ahead with union movements than the southern states. Where nursing unions are strong, NP salaries are boosted by the successful negotiation of pensions and other benefits.

The lowest earning states for nurse practitioners are currently:

The main reason for the NP salary disparity is a lower cost of living. Employers in these areas may offer lower wages because the housing and goods are less expensive compared to high-cost states like California or New York. 

Economic conditions, including state budgets and healthcare funding, can also impact NP salaries. This is because states with limited economic resources may allocate less funding to healthcare — a factor which certainly affects the salaries of nurse practitioners. In states with lower demand for healthcare services, often due to smaller populations or fewer healthcare facilities, NPs may have less bargaining power for higher salaries. 

Even if you’re in a lower-paying state, there are some ways you can increase your NP salary. 

Typically, some of the highest paying NP specialties include neonatal nurse practitioners, pediatric nurse practitioners, and psychiatric nurse practitioners. If you have an interest in a certain speciality, check out how much of a salary difference there is between your current role and a more specialized one. 

Preparing a solid negotiation strategy can significantly impact your earnings. This involves:

Shift patterns will attract higher-paying salaries. So, if you can be flexible, explore shift differentials for evening, night, weekend, and holiday hours. 

Nurse practitioners interested in starting or working in independent practices may have more opportunity to enhance their earnings. States that offer full practice authority recognize NPs as autonomous providers who can provide care directly to patients.

By owning an independent practice, you have the autonomy to set their own fees and manage your business operations, which can lead to increased revenue. The ability to bill directly for services under your own national provider identifier (NPI) allows you to capture the full revenue from patient visits and procedures. This is instead of sharing it with a supervising physician or healthcare organization.

Working in an independent practice is often a good route to enhancing earnings. This nurse practitioner laws by state article goes into depth by each state. 

Attaining further education as an NP can significantly influence career opportunities and earning potential. Advanced degrees, such as a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP), are often prerequisites for higher-paying positions and specialized roles.

Some states with notable universities offering NP programs include:

Find answers to the following nurse practitioner salary FAQs.

The NP specialty with the highest salary is the acute care nurse practitioner. This role offers an average annual salary of approximately $157,580. This specialty involves providing care for patients with acute, severe illnesses, often in hospital settings, which requires advanced skills and decision-making abilities. 

Other high-paying NP specialties include neonatal nurse practitioners, who earn around $138,081, and psychiatric nurse practitioners, who earn around $134,571. These specialties demand specific expertise and are often in high demand, contributing to their higher compensation levels.

The highest salary for a psychiatric mental health nurse practitioner (PMHNP) can vary significantly based on factors such as location, experience, and specific employment settings. 

The average annual psych NP salary in high-paying cities like New York can be as much as $161,313 annually.

Nurse practitioner salaries are influenced by a number of factors: geographic location, speciality, years of experience, and specific work settings. The overall demand for healthcare services in a particular area or specialty can also significantly influence salaries. 

This answer varies from year to year. However, according to the most recent research, the highest-paying locations for NPs are:

To increase your NP salary, there are a few approaches you can take:

Yes — different healthcare settings do pay NPs different salaries. For example, a mental health NP salary is less than a psychiatric NP salary. NPs working in outpatient care centers often earn competitive salaries. For instance, they make around $129,190 annually, which is higher than many other settings. 

Home care health settings offer one of the highest average salaries for NPs, at around $133,170 per year. This is due to the rise in the demand for home health services. 

The highest-paid nurse practitioners earn $180,570 per year on average working in business support services. The second-highest-paying sector for nurse practitioners is residential intellectual and developmental disability, mental health, and substance abuse facilities. This sector employs a significant number of NPs and offers an average annual salary of $158,140. 

For aspiring NPs, understanding salary trends across states is key for making informed career decisions. 

Here are your actionable next steps:

For more information on starting an independent NP practice, check out Tebra’s Independent Provider Playbook. Also, learn about how one nurse practitioner saw 500% new patient growth at her practice after leveraging Tebra.