The best and worst states to be a nurse, according to WalletHub

Wisconsin is the best state in the country for nurses, according to a WalletHub report published last week.

Report details

For the report, WalletHub researchers assessed states on 18 weighted metrics. Seventy percent of a state's score was based on 10 metrics related to opportunity and competition, while 30 percent of the score was based on eight metrics related to work environment. The report included rankings for all 50 states and Washington, D.C.

The 10 metrics used to calculate opportunity and competition scores included:

  • The educational opportunities available in a state, based on quality of nursing schools;
  • The monthly average starting salary for nurses in a state, which was adjusted for cost of living;
  • The number of nursing-job openings per capita in a state; and
  • The number of nurses per 1,000 residents in a state.

The eight metrics used to calculate work environment scores included:

  • Any mandatory overtime restrictions in a state;
  • The quality of a state's public hospital system;
  • The ratio of nurses to hospital beds in a state;
  • The share of nursing homes in a state that are rated among U.S. News & World Report's "Best Nursing Homes"; and
  • Whether a state has a nursing licensure compact law.

How to engage nurses, no matter where you live

State rankings

WalletHub in the report ranked the five best states for nurses as:

  1. Wisconsin;
  2. New Mexico;
  3. Iowa;
  4. Texas; and
  5. Colorado.

WalletHub ranked Washington, D.C., as the worst for nurses, followed by:

  1. Hawaii;
  2. New York;
  3. Louisiana;
  4. Alabama; and
  5. Alaska.

According to the report, several states fared better in one category than the other. For example, Nevada ranked fourth in the opportunity and competition category, but it ranked the worst in the work environment category.

Conversely, New Hampshire and Rhode Island ranked third and fourth, respectively, in the work environment category, but ranked in the bottom 10 states in the opportunity and competition category.

Experts comment on outlook of nursing field, ACA's effects

Experts told WalletHub that the nursing field's long-term outlook is positive.

Elaine Smith, acting dean of Adelphi University's College of Nursing and Public Health, said areas of high-demand for nurses will include ambulatory care, home care, and preoperative care. To attract and retain quality nurses, she said local governments and health systems should focus on providing "healthy work environments that promote a focus on employee health and wellness," which "often includes a value system promoting a positive work/life balance."

Carol Myers, an associate professor at the University of Tennessee's College of Nursing, said the Affordable Care Act (ACA) has helped to "facilitat[e] changes" that have resulted in "progress … in areas such as increasing nursing education levels and the number of states with full practice authority for [advanced practice registered nurses." However, she said the ACA's "potential … has been limited by the law's implementation," adding that some of the law's provisions have been underfunded or not fully pursued.

Allison Squires, a research assistant professor in the department of medicine at New York University's School of Medicine, said the ACA has benefited the nursing field by reducing the number of uninsured patients hospitals treat. "Fewer uninsured patients means hospitals can actually afford to hire the staff they need," which includes nurses, she said (Minemyer, FierceHealthcare, 5/3; WalletHub report, 5/3).

How to engage nurses, no matter where you live

The National Prescription for Nurse Engagement

It's more important than ever for frontline nurses to be engaged in their work, committed to their organization's mission, and capable of delivering high-quality care in a complex and constantly changing environment.

This report identifies the unique challenges of engaging nurses and equips nurse leaders with five strategies for building a highly engaged workforce.

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