2026 U.S. RN Demand & Salary Guide

Classic vintage map of the United States in a historical book, showcasing detailed state borders.

The Most In Demand Nursing Specialties, Settings and RN Salaries Across All 50 States

For registered nurses considering the United States, the most useful question is not simply which state pays the most.

A better question is where salary, nursing demand, specialty opportunities and long term workforce needs come together.

That answer changes considerably from one state to another.

According to the U.S. Bureau of Labor Statistics, the median annual wage for registered nurses was $97,550 in May 2025. The lowest 10 percent earned less than $68,940, while the highest 10 percent earned more than $137,470. BLS projects RN employment to grow 6 percent from 2025 through 2035, with approximately 180,800 openings per year over the decade.

Those national numbers are useful, but they do not tell the whole story.

The May 2025 BLS data shows median RN wages ranging from $140,270 in California to $77,080 in Alabama among the 50 states. That is a difference of more than $63,000 in annual median pay.

At the same time, the Health Resources and Services Administration projects that the United States will continue to experience an RN shortage through 2038. HRSA projects an 8 percent national shortage in 2028 and a 3 percent shortage in 2038, equivalent to approximately 108,960 full time equivalent RNs. The projected shortage is considerably larger in nonmetropolitan areas, where HRSA projects an 11 percent shortage in 2038 compared with 2 percent in metropolitan areas.

This creates a nursing market that is much more complicated than a simple salary ranking.

The highest paying state is not automatically the state with the strongest opportunity for every nurse.

A nurse’s specialty, experience, preferred setting and willingness to relocate can matter just as much as the headline salary.


1. Where U.S. RNs work

Before looking at specialties, it helps to understand the major employment settings.

BLS reports the following median annual wages for RNs in May 2025:

Employment settingMedian annual RN wage
Government$110,780
Hospitals$100,220
Ambulatory healthcare services$91,230
Nursing and residential care facilities$84,300
Educational services$78,620

These figures describe the RN occupation across each industry and are not specialty specific.

Hospitals

Hospitals remain the center of the U.S. RN labor market.

BLS reports that general medical and surgical hospitals account for approximately 56 percent of RN employment, making hospitals by far the largest employment environment for registered nurses.

Hospital opportunities span a wide range of specialties, including:

• Medical surgical nursing
• Intensive care
• Emergency nursing
• Telemetry
• Progressive care
• Operating room
• Labor and delivery
• Pediatrics
• Oncology
• Cardiac nursing

For internationally educated nurses, hospital experience can be particularly valuable because it can open the door to multiple specialties and employers.

Ambulatory healthcare

Ambulatory healthcare includes care delivered outside traditional inpatient hospitals.

This includes outpatient clinics, physician offices, surgery centers, specialty practices, infusion services and other healthcare services.

BLS reports a median RN wage of $91,230 in ambulatory healthcare services.

The sector is also strategically important because healthcare is increasingly being delivered outside the traditional inpatient hospital.

Government

Government is a smaller employment category for RNs but had the highest median wage among the major industries listed by BLS at $110,780 in May 2025.

Government nursing can include federal, state and local healthcare employers.

Compensation is only one consideration in these positions. Benefits, retirement programs, job stability and eligibility requirements can significantly affect the overall employment package.

Nursing and residential care

Nursing and residential care facilities had a median RN wage of $84,300 in May 2025.

This category includes long term care and residential healthcare.

Although wages are generally lower than hospital wages, this sector should not be overlooked. The aging U.S. population is expected to continue increasing demand for nurses who can care for older adults and patients with chronic conditions.

Education

Educational services had a median RN wage of $78,620 in May 2025.

This category is more relevant to nurses pursuing school health, university health services or education related careers than to nurses seeking their first U.S. hospital position.


2. The nursing specialties with the largest workforce presence

There is an important distinction between the largest nursing specialties and the specialties experiencing the greatest recruiting difficulty.

They are not necessarily the same thing.

The 2024 National Nursing Workforce Study from the National Council of State Boards of Nursing provides one of the best national pictures of RN specialty distribution.

Among RNs in 2024, the most commonly reported primary specialties included:

RankPrimary specialtyShare of RNs
1Acute care / critical care13.9%
2Medical surgical8.8%
3Emergency / trauma6.6%
4Perioperative6.1%
5Geriatric / gerontology4.8%
6Maternal child health / obstetrics4.5%
7Pediatrics4.3%
8Cardiology3.4%
9Home health3.2%
10Oncology3.1%

Acute care and critical care remained the largest reported RN specialty in the 2024 study, although its share declined from 16.5 percent in 2022 to 13.9 percent in 2024. Medical surgical and emergency/trauma followed.

This is useful because it shows where the largest pools of experienced nurses are located.

It does not, however, prove that these are the ten specialties with the greatest shortage in every state.

That distinction is important when analyzing recruitment opportunities.


3. How to measure nursing demand

There is no single federal database that publishes an official ranking of the three most in demand RN specialties for every state.

BLS provides state level employment and wage information for registered nurses as an occupation. HRSA provides workforce supply and demand projections. NCSBN provides detailed information about the nursing workforce and specialty distribution.

Other organizations, including staffing companies, provide real time or recent job posting data.

Each source answers a different question.

For this reason, the state specialty recommendations in this guide should be viewed as market signals rather than official federal rankings.

One useful example is Nomad Health’s 2025 analysis of its own live job data. The company identified Labor and Delivery and Vascular Interventional Radiology as leading specialties in California, Labor and Delivery and Cath Lab in Texas, Emergency and Medical Surgical in New York, CT and Cardio Invasive roles in Florida, Med Surg, Telemetry and PACU in Georgia and North Carolina, and Long Term Care and Labor and Delivery in Minnesota.

This type of information can complement government workforce data because it shows where employers were actively posting jobs on that particular staffing platform.

It should not be confused with a national government shortage ranking.


4. RN salaries and specialty opportunities across all 50 states

The following salary figures are the May 2025 BLS median annual wages for registered nurses.

The specialty column is not an official federal ranking. It identifies nursing markets that are reasonable areas for nurses to investigate based on the size of the healthcare market, workforce projections and available specialty job market data.

StateMedian RN salarySpecialty markets to investigate
Alabama$77,080Medical surgical, ICU, Emergency
Alaska$109,480Medical surgical, Emergency, Critical care
Arizona$99,500ICU, Emergency, Medical surgical / Telemetry
Arkansas$78,940Medical surgical, ICU, Emergency
California$140,270Labor and Delivery, Critical care, Emergency
Colorado$100,260ICU, Emergency, Operating room
Connecticut$102,740ICU, Emergency, Medical surgical
Delaware$99,520Medical surgical, ICU, Emergency
Florida$84,190CT, Cardiac, Medical surgical / Telemetry
Georgia$93,550Medical surgical / Telemetry, PACU, ICU
Hawaii$136,320Medical surgical, ICU, Emergency
Idaho$92,460Medical surgical, ICU, Emergency
Illinois$95,990Medical surgical, ICU, Emergency
Indiana$83,500Medical surgical, ICU, Emergency
Iowa$78,630Medical surgical, ICU, Emergency
Kansas$79,320Medical surgical, ICU, Emergency
Kentucky$81,040Medical surgical / Telemetry, Critical care, Emergency
Louisiana$80,230ICU, Emergency, Medical surgical
Maine$86,990Medical surgical, Long term care, Emergency
Maryland$99,790ICU, Emergency, Medical surgical
Massachusetts$104,550ICU, Emergency, Operating room
Michigan$94,300Medical surgical, ICU, Emergency
Minnesota$101,510Long term care, Labor and Delivery, ICU
Mississippi$77,090Medical surgical, ICU, Emergency
Missouri$81,780Telemetry, Vascular / IR, ICU
Montana$85,280Medical surgical, Emergency, Critical care
Nebraska$84,730Medical surgical, ICU, Emergency
Nevada$103,670ICU, Emergency, Medical surgical
New Hampshire$99,700ICU, Emergency, Medical surgical
New Jersey$106,500ICU, Emergency, Medical surgical
New Mexico$94,340Emergency, ICU, Medical surgical
New York$109,440Emergency, Medical surgical, ICU
North Carolina$84,350Medical surgical / Telemetry, PACU, ICU
North Dakota$80,730Medical surgical, Emergency, Critical care
Ohio$82,510Medical surgical, ICU, Emergency
Oklahoma$82,920ICU, Emergency, Medical surgical
Oregon$129,010ICU, Emergency, Labor and Delivery
Pennsylvania$96,430Medical surgical, ICU, Emergency
Rhode Island$100,640ICU, Emergency, Medical surgical
South Carolina$82,360Medical surgical, ICU, Emergency
South Dakota$78,060Medical surgical, Emergency, Critical care
Tennessee$81,500ICU, Emergency, Medical surgical
Texas$95,970Labor and Delivery, Cath Lab, ICU
Utah$84,600ICU, Emergency, Medical surgical
Vermont$97,460Medical surgical, Emergency, ICU
Virginia$93,600ICU, Emergency, Medical surgical
Washington$124,200ICU, Labor and Delivery, Emergency
West Virginia$80,130Medical surgical, ICU, Emergency
Wisconsin$95,530ICU, Medical surgical, Emergency
Wyoming$83,760Emergency, Medical surgical, Critical care

The state wage figures are based on the May 2025 BLS Occupational Employment and Wage Statistics data.

The specialty recommendations should be treated as areas for further investigation rather than precise state rankings.


5. The states with the largest projected RN shortages

Salary tells only part of the story.

HRSA’s December 2025 workforce model provides another way to look at the market by projecting RN supply and demand through 2038.

The states with the largest projected RN shortages in 2038 include:

StateProjected RN shortageProjected FTE shortage
California22%84,750
North Carolina20%25,710
Georgia20%25,110
Michigan18%20,290
Washington17%15,020
Maryland16%10,890
Oklahoma13%5,900
South Carolina12%7,250
Louisiana11%5,680
Virginia8%8,020

HRSA defines these shortages in terms of full time equivalent positions. The figures therefore should not be interpreted as the number of individual nurses who will necessarily be missing from the workforce.

This table produces a very different picture from a salary ranking.

California is particularly notable because it combines the highest median RN wage in the country with the largest projected absolute RN shortage.


6. California: high salary and high projected shortage

California is unusual because it sits at the top of two important measures.

The state’s May 2025 median RN wage was $140,270, the highest among the 50 states.

HRSA projects a 22 percent RN shortage by 2038, representing approximately 84,750 FTE RNs.

That does not mean every California hospital is experiencing a shortage or that every specialty is equally difficult to recruit.

It does mean that California represents one of the most significant RN workforce markets in the country.

Specialty recruiting data also shows meaningful activity in areas such as Labor and Delivery and Vascular Interventional Radiology.

California is therefore an important market for nurses who can meet the state’s licensing and employment requirements and who are comfortable with its relatively high cost of living.


7. North Carolina: lower salary, major workforce need

North Carolina illustrates why salary alone can be misleading.

The state’s median RN wage was $84,350 in May 2025.

That is substantially below California’s $140,270.

Yet HRSA projects a 20 percent RN shortage by 2038, equivalent to approximately 25,710 FTE RNs.

North Carolina also appeared in Nomad Health’s 2025 job data as a market with activity in Med Surg, Telemetry and PACU.

For nurses who are geographically flexible, this is the type of state that deserves attention.

The compensation may not be among the nation’s highest, but the workforce need is significant.


8. Georgia: another important shortage market

Georgia combines a May 2025 median RN wage of $93,550 with a projected 20 percent RN shortage by 2038.

HRSA estimates the shortage at approximately 25,110 FTE RNs.

Nomad’s 2025 live job data identified Med Surg, Telemetry and PACU among the leading specialties in Georgia and North Carolina.

Georgia therefore offers an interesting combination of a large healthcare market, a substantial projected workforce gap and a salary that is closer to the national median than several other high shortage states.


9. Michigan, Maryland and Washington

Three other states deserve attention for different reasons.

Michigan

Michigan had a median RN wage of $94,300 in May 2025.

HRSA projects an 18 percent shortage by 2038, or approximately 20,290 FTE RNs.

Maryland

Maryland had a median RN wage of $99,790.

HRSA projects a 16 percent shortage, equivalent to approximately 10,890 FTE RNs.

Washington

Washington is one of the strongest combinations of salary and projected shortage.

The May 2025 median RN wage was $124,200, while HRSA projects a 17 percent shortage by 2038, representing approximately 15,020 FTE RNs.

These differences illustrate why nurses should look at both compensation and workforce projections when comparing states.


10. Medical surgical nursing

Medical surgical nursing remains one of the largest RN specialties in the country.

NCSBN’s 2024 workforce study found that 8.8 percent of RNs reported medical surgical nursing as their primary specialty.

The strength of Med Surg is its breadth.

Nearly every major hospital requires nurses who can care for medical and postoperative patients.

For internationally educated nurses, this can be particularly valuable because Med Surg experience is relevant across a large number of hospital systems.

It can also provide a foundation for moving into specialties such as telemetry, progressive care, emergency nursing and critical care.


11. Critical care and ICU nursing

Acute care and critical care represented 13.9 percent of the RN workforce in the 2024 NCSBN study, making it the largest reported primary specialty.

Critical care nurses are needed across:

• Academic medical centers
• Level I trauma centers
• Cardiac hospitals
• Surgical hospitals
• Regional referral centers
• Community hospitals

Current staffing market data also tracks ICU as one of the major nursing specialty categories.

The Hospital Council’s 2026 national nursing market snapshot, for example, tracks ICU alongside Emergency, Labor and Delivery, Medical Surgical, Operating Room, Stepdown and Telemetry.

For experienced ICU nurses, the opportunity is therefore not limited to the largest metropolitan hospitals.

Regional hospitals can also be important recruiting markets.


12. Emergency nursing

Emergency and trauma nursing represented 6.6 percent of RNs in the 2024 NCSBN study.

Emergency nurses work across:

• Trauma centers
• Academic medical centers
• Community hospitals
• Rural hospitals
• Regional referral centers

This specialty can offer considerable geographic flexibility because emergency departments are found throughout the country.

For internationally educated nurses, however, employers may place significant emphasis on recent U.S. experience, specialty certifications and the ability to demonstrate competency in the local clinical environment.


13. Perioperative and operating room nursing

Perioperative nursing accounted for approximately 6.1 percent of RNs in the 2024 NCSBN study.

The specialty is smaller than the broad acute care category, but specialized experience can be highly valuable.

OR nurses may find opportunities in:

• General hospitals
• Academic medical centers
• Specialty surgical hospitals
• Ambulatory surgery centers
• Regional hospitals

The Hospital Council’s 2026 market data also tracks Operating Room as one of the major nursing specialty categories in its national snapshot.


14. Labor and Delivery

Labor and Delivery is another specialty where geographic demand can vary considerably.

Nomad Health’s 2025 analysis identified Labor and Delivery among the leading specialties in California and Texas. The company also identified Labor and Delivery among the leading specialties in Minnesota.

The important point is that a specialty does not need to represent a large percentage of the total RN workforce to be commercially valuable.

A specialized nurse can be difficult to replace when the local supply of qualified candidates is limited.


15. Telemetry, Stepdown and cardiac nursing

Cardiology accounted for 3.4 percent of RNs in the 2024 NCSBN workforce study.

Telemetry and stepdown experience can also be valuable because many hospitals operate intermediate acuity units between traditional medical surgical floors and intensive care.

The Hospital Council’s 2026 nursing market snapshot includes both Stepdown and Telemetry among the specialty categories it tracks.

For some internationally educated nurses, telemetry or stepdown experience can also provide a useful pathway toward higher acuity hospital practice.


16. Home health and long term care

The future of nursing will not be limited to hospitals.

The U.S. population is aging, and BLS specifically identifies older adults and chronic conditions as important drivers of future demand for registered nurses. BLS also expects continuing demand in home healthcare as more older adults receive care at home.

HRSA’s workforce projections reinforce the importance of geography.

By 2038, HRSA projects an 11 percent RN shortage in nonmetropolitan areas compared with 2 percent in metropolitan areas.

That means nurses willing to consider smaller communities may encounter opportunities that are less visible in major metropolitan job markets.

For nurses with experience in:

• Geriatrics
• Long term care
• Home health
• Rehabilitation
• Chronic disease management

this could become increasingly important.


17. The highest paying states for RNs

The highest median RN wages in May 2025 were:

RankStateMedian annual RN wage
1California$140,270
2Hawaii$136,320
3Oregon$129,010
4Washington$124,200
5Alaska$109,480
6New York$109,440
7New Jersey$106,500
8Massachusetts$104,550
9Nevada$103,670
10Connecticut$102,740

These are median wages, not guaranteed salaries.

Actual compensation can vary significantly depending on experience, employer, specialty, shift, location and employment arrangement.

Most importantly, BLS wage data does not adjust for cost of living. A higher salary does not automatically mean greater purchasing power.


18. The lowest paying states can still offer opportunity

The states at the bottom of the salary ranking include:

• Alabama
• Mississippi
• South Dakota
• Iowa
• Arkansas
• North Dakota
• Louisiana
• West Virginia

But lower median pay does not mean there is little demand.

Several lower paying states have significant projected workforce shortages.

Louisiana, Oklahoma, South Carolina, Georgia and North Carolina all appear among HRSA’s states with the largest projected RN shortages in 2038.

This is why compensation should be viewed alongside workforce demand.

A lower salary market can still be attractive when an employer offers a strong overall package, and with a lower cost of living, particularly when the nurse is open to relocation or smaller communities.


19. The 2026 to 2038 outlook

The long term U.S. nursing outlook remains strong, but the challenge is becoming increasingly geographic.

BLS projects RN employment to grow by 6 percent between 2025 and 2035, with approximately 180,800 openings annually.

HRSA’s workforce model reaches a different but complementary conclusion.

It projects:

2028: 8 percent national RN shortage

2033: continued national shortage

2038: 3 percent national RN shortage, equal to approximately 108,960 FTE RNs

The geographic difference is even more striking.

By 2038:

Metropolitan areas: 2 percent projected RN shortage

Nonmetropolitan areas: 11 percent projected RN shortage

The implication is important.

The future U.S. nursing challenge may not simply be whether there are enough nurses nationally.

It will increasingly be about where nurses are located and what specialties they can provide.


20. What this means for internationally educated nurses

For an internationally educated RN, the U.S. market should be evaluated through several factors at the same time.

Specialty

What clinical skills and experience does the nurse already have?

Geography

Which states and regions have the greatest need for those skills?

Setting

Does the nurse want a hospital, outpatient, long term care, home health or another environment?

Compensation

What is the actual salary or total compensation package?

Licensing

What state licensing requirements apply to the nurse?

Immigration

What immigration pathway, if any, is available for that particular nurse and employer?

Relocation

Does the employer provide relocation assistance, temporary housing, reimbursement or other support?

Looking at only one of these factors can produce a misleading picture.

A critical care nurse should not necessarily search for jobs in the same way as a home health nurse.

An OR nurse should not necessarily use the same state strategy as a Med Surg nurse.

And an internationally educated nurse should not automatically assume that the state with the highest median wage is the easiest or most attractive place to obtain a job.


21. A better way to compare U.S. nursing opportunities

A useful way to evaluate an opportunity is to consider five factors together:

1. Specialty demand

Are employers actively recruiting nurses with this experience?

2. Workforce shortage

Does the state or region have a projected shortage?

3. Compensation

How does the employer’s actual offer compare with the state and regional market?

4. Location

What is the cost of living and how difficult is the area for employers to recruit?

5. Access

What licensing, credentialing and immigration requirements apply?

This approach produces a much more realistic picture than a simple list of the highest paying states.


22. Five states worth watching

There is no single “best” state for every RN, but several states stand out when salary and workforce projections are considered together.

California

Median RN wage: $140,270

Projected 2038 shortage: 22 percent

Projected FTE shortage: 84,750

California combines the highest median RN wage in the country with the largest projected absolute RN shortage.

Washington

Median RN wage: $124,200

Projected 2038 shortage: 17 percent

Projected FTE shortage: 15,020

Washington is one of the strongest combinations of high compensation and projected workforce need.

Georgia

Median RN wage: $93,550

Projected 2038 shortage: 20 percent

Projected FTE shortage: 25,110

Georgia stands out because the projected shortage is large despite a salary that is close to the national median.

North Carolina

Median RN wage: $84,350

Projected 2038 shortage: 20 percent

Projected FTE shortage: 25,710

North Carolina demonstrates why a lower median salary can coexist with substantial employer demand.

Michigan

Median RN wage: $94,300

Projected 2038 shortage: 18 percent

Projected FTE shortage: 20,290

Michigan is another example of a state where projected workforce need is considerably more significant than the salary ranking alone would suggest.


23. What should an international RN actually look at?

If the objective is maximum median salary, California, Hawaii, Oregon and Washington immediately stand out but be aware of high cost of living.

If the objective is high salary combined with a significant projected shortage, California and Washington deserve particular attention.

If the objective is shortage driven opportunity, North Carolina, Georgia, Michigan, Maryland, Oklahoma and South Carolina deserve a closer look.

If the objective is access to large hospital markets, California, Texas, Florida, New York and Pennsylvania are important because they have some of the country’s largest RN employment markets. BLS May 2025 employment estimates put California at approximately 339,000 RN jobs, Texas at approximately 271,000 and Florida at approximately 230,000.

If the objective is specialty mobility, Medical Surgical, Acute/Critical Care, Emergency, Perioperative, Telemetry and Labor and Delivery can provide access to a broad range of hospital opportunities.

If the objective is long term demographic demand, home health, geriatrics, long term care and outpatient care deserve increasing attention.

The best choice ultimately depends on the nurse’s experience, specialty, licensing situation, immigration circumstances, financial goals and willingness to relocate.


Conclusion

The U.S. nursing market in 2026 is large, diverse and increasingly regional.

The national median RN wage is $97,550, but median wages across the 50 states range from approximately $77,000 to $140,000. BLS projects 6 percent employment growth through 2035 and approximately 180,800 RN openings each year.

At the same time, HRSA projects a national RN shortage of approximately 108,960 FTEs by 2038.

The shortage will not be distributed evenly.

Nonmetropolitan areas are projected to experience a substantially larger shortage than metropolitan areas, while states such as California, North Carolina, Georgia, Michigan and Washington are projected to face particularly significant workforce gaps.

The most important takeaway is therefore not that one state is the best.

It is that different states offer different combinations of compensation, specialty opportunities and workforce need.

For internationally educated nurses, that creates a much broader opportunity than simply chasing the highest salary.

The nurses who understand where employers need people, which specialties are being recruited, what the local compensation looks like and what licensing and immigration requirements apply will be in a stronger position to identify the right U.S. opportunity.

The U.S. nursing market is not one market.

It is 50 state markets, hundreds of regional labor markets and dozens of specialty markets operating at the same time.

Understanding how those markets intersect is where the real opportunity lies.


Sources

U.S. Bureau of Labor Statistics

BLS Registered Nurses Occupational Outlook Handbook

National RN wages, employment outlook, annual openings and wages by major employment setting.

BLS May 2025 State Occupational Employment and Wage Estimates

Official state level occupational employment and wage data.

Health Resources and Services Administration

HRSA Nurse Workforce Projections, 2023 to 2038

National, state and metropolitan versus nonmetropolitan RN supply and demand projections.

HRSA Health Workforce Projections

Workforce supply and demand projections from the National Center for Health Workforce Analysis.

National Council of State Boards of Nursing

NCSBN 2024 National Nursing Workforce Study

National nursing workforce data, employment settings, specialty distribution and workforce trends.

Specialty labor market data

Nomad Health specialty demand analysis

Specialty demand based on Nomad Health’s internal live job data, including state and regional examples.

Hospital Council National Nursing Market Snapshot

Recent nursing market indicators covering Emergency, ICU, Labor and Delivery, Medical Surgical, Operating Room, Stepdown and Telemetry.

State salary comparison

BLS based RN median pay by state, published by Becker’s Hospital Review

Secondary presentation of May 2025 BLS median RN wage data for the 50 states and Washington, D.C.

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