Best & Worst States to Practice Nursing in 2014

To be certain, there’s plenty of misunderstanding about what exactly Nurses do, and who exactly Nurses are.

So, to clear the air, let’s set the record straight, and get a quick backgrounder before diving into the deep end.

In whatever state they choose to practice, all 50 states requires all Nurses to be licensed before they begin practice. Licensed Vocational Nurses (LNVs) are considered technicians, while Registered Nurses (RNs) are professionals.

The LPN (Licensed Practical Nurse), which in some states is called LVN (Licensed Vocational Nurse), most often has earned a certificate in less than a year, and has a significantly different educational track than a Registered Nurse (RN), even when the RN has an ADN (Associate Degree Nursing). The RN utilizes critical thinking skills, and the responsibilities the RN has are more complex, and therefore always supervisory in nature over the LVN/LPN. Because of the complexities and advances in healthcare, and patient care, LVNs are NOT permitted by license to do the same things as a RN. Pay, of course, comes along for the ride, and RNs are paid more.

Registered Nurses may begin practice by earning an Associate’s Degree Nursing (a two-year degree) typically at a Junior or Community College, or by earning a Bachelor of Science Nursing (BSN), a four-year degree most often earned from a University. Both the ADN & BSN must pass the NCLEX – the National Council Licensure Examination – before they can practice Registered Nursing.

Advanced Practice Nurses (APNs) are BSN-prepared RNs whom have obtained additional education and training, typically a Master of Science Nursing (MSN) in a specialty area of Nursing practice such as Gerontology (specialized care for the elderly), Family Nurse Practitioner (FNP), Acute Care Nurse Practitioner (ACNP), Pediatric Nurse Practitioner (PNP), Certified Registered Nurse Anesthetist (CRNA), etc. Frequently, following earning their MSNs, APNs have also obtained National Certification in their area of specialty, and many have prescriptive authority, depending upon the laws of the state in which they practice. Because they have more education, more experience, and more responsibility, they are also paid more. APNs may also continue education and training to the doctoral and post-doctoral levels.

In some states, APNs are allowed independent practice, and are not required by law to be supervised by a physician. Other states have laws that limit practice of APNs – even though they may be Board Certified – and require physicians to collaborate with them, or in some cases, to oversee their work. Alaska, Arizona, Colorado, Hawaii, Idaho, Iowa, Maine, Montana, New Mexico, Nevada, New Hampshire, North Dakota, Rhode Island, Oregon, Vermont, Washington, Wyoming, and the District of Columbia all allow APNs to practice independently. Alabama is one such state which does not allow Board Certified Advanced Practice Nurses independent practice. According to the American Association of Colleges of Nursing, “in at least 45 states, advanced practice nurses can prescribe medications, while 16 states have granted APNs authority to practice independently without physician collaboration or supervision.”

There’s an entirely different can of worms when comparing the practice of APNs and physicians. One of the ways they differ, are that States regulate Nursing practice, while physicians’ professional organizations set guidelines for physician practice, not the States. Of course, an ophthalmologist (eye surgeon) couldn’t go to a hospital and perform back surgery, because it wouldn’t be included in the type of procedures the ophthalmologist is permitted to perform at the hospital where the physician had privileges. Further, insurance companies would not reimburse an ophthalmologist for spinal surgery, and malpractice insurance companies would not cover an ophthalmologist to perform spinal surgery. But the point is, that no State law would prohibit an ophthalmologist from performing spinal surgery.

In stark contrast to the physician model wherein state government does not regulate physician practice, the AACN notes that the Nurse Practitioner’s (sometimes also referred to as APN, or Advanced Practice Nurse) “educational time is 100% concentrated on the clinical area where the NP clinician will actually be practicing.” Interestingly, the Institute of Medicine and National Council of State Boards of Nursing both recommend to “remove scope-of-practice barriers” and adopt the Full Independent Practice model.

Now, having mentioned the foregoing, it should be also understood that Nurses (RNs) practice in a variety of settings, some in traditional clinical settings (hospitals & surgery centers), while others may deliver healthcare in community based settings, such as schools. Some may work in Health Insurance, or perform Research, while others may work independently in Consultancy & Advisory capacities and draft policy for governments and agencies domestically, or internationally.

With respect for all the above, the following report is directed at the Nurse in clinical-based practice, again, which is most often the RN.

Best and Worst States for Nurses 2014

Which States Provide the Best, and Worst, Environments for Nurses to Practice?

Andrea Santiago is a freelance writer, and graduated from the University of Georgia with a Bachelor of Science degree in Education, cum laude.

 

Photo by Thomas Barwick/Stone/Getty Images

An annual report from WalletHub analyzed the best and worst states for nurses. The company compared the 50 states and the District of Columbia using 15 key metrics, including current and future (projected) average nurse salaries in those states.

Other factors that impacted each state’s ranking regarding nurse employment include the number of health care facilities per capita, competition for nursing jobs (based on the volume of nurses per capita, and the amount of job openings for nurses in each state), age of the population, and unemployment rate.

Based on the metrics, the top ten best states for nurses to practice as of 2014 are:

1. Oregon
2. Washington
3. South Dakota
4. Arizona
5. New Mexico
6. Alaska
7. Wyoming
8. Minnesota
9. Texas
10. Maryland

According to the same metrics, the following ten states are the worst states for nurses to practice as of 2014:

• 42. District of Columbia
• 43. Delaware
• 44. Arkansas
• 45. Georgia
• 46. Kentucky
• 47. West Virginia
• 48. Tennessee
• 49. Alabama
• 50. Louisiana
• 51. Mississippi

What the State Rankings Mean for Nurses:

How should nurses use these rankings when making their career decisions, if at all? Odysseas Papadimitriou, CEO of WalletHub, says this about the state rankings for nursing careers:

“First and foremost, our rankings are designed to promote awareness among new entrants into the nursing profession about the most pressing issues facing the field and how the policies used in different states and by different employers can affect the tenor of their day to day activities. This may lead both recent graduates and currently employed nurses in low ranking states to look across borders for their next job, or it may force them to be more discerning about which hospital or health care facility they sign with locally. Either way, they’ll know a bit more about what they’re getting into.”

According to the executives at WalletHub, the following nursing credentials were included in their analysis:

• Registered Nurses (RN)
• Licensed Practical Nurses (LPN) / Licensed Vocational Nurses (LVN)
• Nurse Anesthetists (CRNA)
• Nurse Midwives
• Nurse Practitioners (NP)

More Key Findings and a Few Surprising Results:

WalletHub execs say that the results of this report revealed a few surprising facts. For example, the entire southeast region of the United States ranked very poorly. The southeastern region appears, as a whole, to be a relatively unfriendly environment for nurses, unfortunately for nursing professionals in those states.

There were also some interesting extremes revealed in the report, between high- and low-ranking states. Based on the sub-metrics, the following gaps became apparent:

• Washington DC (#42 on the list) has 16 times more nursing job openings per capita than Alabama (#49).
• Washington DC has almost triple the amount of nurses per capita than Nevada (#34).
• Oregon (#1) has almost five times more health care facilities per capita than Delaware (#43).

The top three states based solely on nursing salaries were Texas, Nevada, and Arizona. Nurses in Washington DC and Hawaii are paid the least, on average.

States with the oldest population (percentage over age 65) projected by 2030 were Florida, Maine, and Wyoming. The states with the lowest concentration of residents over 65 in projected for 2030 are Alaska, Washington DC, and Utah.

More About the Report:

In addition to the aforementioned metrics, WalletHub also took into account the rankings of local nursing schools in each state, the number of medically underserved areas in each state, mandatory overtime restrictions, quality of nursing homes in the state, average commute times, average work hours, and how the state ranked in the “Best States for Working Moms” list.

The writers of the report used data from the census bureau, the Bureau of Labor Statistics, Indeed.com, American Nurses Association, among others.

To view the full report with graphs, and methodology, view it on WalletHub.com.

2014′s Best & Worst States for Nurses

by John S Kiernan

The nursing industry – like most segments of the economy – is in a state of significant transition under the weight of major overarching socioeconomic dynamics, from the aging U.S. population and the Affordable Care Act to the student loan crisis and concerns about the future of key entitlement programs. It’s therefore understandable if recent nursing school grads aren’t sure where to turn once they receive their diploma.

That concern is not unique among recent graduates, regardless of industry, but both the magnitude of the issue – the nursing industry is expected to grow far faster than the average occupation through 2022 – and the various day-to-day demands placed on nursing professionals – from overstaffing and mandatory overtime to unionization and allegations of systematic disrespect – are indeed profession-specific. With that in mind, WalletHub decided to take stock of the nursing industry in order to help nurses, particularly the newly minted of the bunch, lay down roots in areas that are conducive to both personal and professional success.

We compared the 50 states and the District of Columbia in terms of 15 key metrics that collectively speak to the job opportunities that exist for nurses in each market, how much competition there is for each position, differences in the workplace environment, and projections for the future. You can check out our findings as well as the methodology we used to conduct this report and expert commentary on the state of the nursing industry below.

15 Measurements (as described below under Methodology) were factored to rank the 50 states for Opportunity, Competition, and Work Environment for Nurses

http://d2e70e9yced57e.cloudfront.net/common/wallethub/best-states-for-nurses.html

Overall Rank	State Name	Opportunity Rank	Competition Rank	Work Environment Rank
1	Oregon	2	5	1
2	Washington	4	6	12
3	South Dakota	1	17	15
4	Arizona	9	4	22
5	New Mexico	20	3	28
6	Alaska	37	1	5
7	Wyoming	22	2	42
8	Minnesota	5	47	1
9	Texas	8	11	36
10	Maryland	30	10	20
11	Nebraska	6	29	13
12	Colorado	24	14	29
13	California	11	25	25
14	North Dakota	23	28	7
15	Maine	28	15	20
16	Idaho	31	19	15
T-17	Kansas	18	24	23
T-17	Montana	21	19	30
19	Massachusetts	29	29	6
20	North Carolina	7	27	39
21	Florida	17	21	39
22	Wisconsin	15	36	11
23	Ohio	3	48	19
24	Oklahoma	32	8	45
25	Connecticut	34	32	4
26	South Carolina	16	26	43
27	Iowa	13	38	24
28	New Hampshire	48	9	9
29	Pennsylvania	14	36	26
30	Virginia	25	18	48
31	Indiana	12	35	34
32	Vermont	49	11	10
33	Michigan	26	34	31
34	Nevada	44	11	38
35	Missouri	10	45	35
36	Hawaii	50	7	32
37	Rhode Island	45	41	3
38	Illinois	35	31	27
39	New York	36	40	17
40	Utah	43	16	44
41	New Jersey	51	22	17
42	District of Columbia	39	39	14
43	Delaware	42	44	8
44	Arkansas	38	33	33
45	Georgia	33	22	51
46	Kentucky	19	51	39
47	West Virginia	27	50	47
48	Tennessee	40	43	46
49	Alabama	46	49	37
50	Louisiana	41	45	50
51	Mississippi	47	42	49

BEST & WORST States to Practice Nursing, 2014

Methodology

WalletHub took 15 key metrics into account in assessing the relative activeness of the 50 states and the District of Columbia to nurses. In doing so, we considered trends both short- and long-term related to the employment opportunities that exist in each state, the quality of the jobs that are available, the amount of competition that does and will exist in the local job market, and the nature of the workplace environment in which nurses operate.

You can check out the metrics as well as the corresponding weights we used to construct our overall rankings below. The three categories under which the metrics are listed were used for organizational purposes only and did not factor in to our overall rankings.

Opportunity

• Monthly Median Starting Salary for Nurses, Adjusted for Cost of Living: 0.5
• Average Annual Salary for Nurses, Adjusted for Cost of Living: 1
• Number of Health Care Facilities per Capita: 1
• Medically Underserved Areas: 1
• Projected Percentage of the Population Over 65 (2030): 0.5
• Nursing Schools Rank: 1

Competition

• Nursing Job Openings per Capita: 1
• Number of Nurses per Capita: 0.5
• Projected Number of Nurses per Capita (2020): 1
• Unemployment Rate: 0.5

Work Environment

• Mandatory Overtime Restrictions: 1
• States with the Largest Share of the Best Nursing Homes: 0.5
• Best States for Working Moms Rank: 0.5
• Average Number of Hours Worked: 0.5
• Average Commute Time: 0.5

Source: Data used to create these rankings is courtesy of the U.S. Census Bureau, the U.S. Bureau of Labor Statistics, the Missouri Economic Research & Information Center, Indeed.com, the US Department of Health and Human Services Health Resources and Services Administration, U.S. News & World Report, the American Nurses Association and WalletHub research.

About the Author:
John Kiernan is Senior Writer & Editor at Evolution Finance. He graduated from the University of Maryland with a BA in Journalism, a minor in Sport Commerce & Culture, and the University Honors Citation. His previous work experience includes USA TODAY and The Washington Post. Mr. Kiernan is a Washington, D.C. native and an avid fan of the Nats, Skins, Caps and Wizards. His favorite activities are golf and surfing.

http://healthcareers.about.com/od/wheretowork/fl/Best-and-Worst-States-for-Nurses-2014.htm

http://wallethub.com/edu/best-states-for-nurses/4041/