By Nick Jachim

A variety of factors have contributed to the national nursing shortage that has affected the U.S. over the past several years. One of these factors in particular is adequate pay, or lack thereof.

The search for a better salary has caused some nurses to travel the country or to drop out of the profession altogether. Uncompetitive pay has also caused nurses across the country to grab their picket signs and go on strike for raises and better working conditions.

According to a study which analyzed nurses’ salaries in over 100 metro areas in the U.S., compensation can vary drastically based on location, tax implications, and living costs. Not to mention local governments in some states make decisions that either help or hurt nurses in the area.

The average salary for a registered nurse in the U.S. is $86,070 in gross pay. Of the metro areas that were analyzed, less than one-third surpass that average. When adjusted for taxes and the cost-of-living index, you’re left with $65,414 on average.

For metro areas where registered nurses are making the least, it isn’t always that the salary is low. In many cases, it’s that the cost of living and taxes in these areas affect take-home pay drastically.

For example, at No. 1, Washington D.C.’s pre-tax salary is $98,000, but the adjusted take-home pay is $48,000, according to the analysis. That’s nearly half of the salary lost to high cost of living and taxes.

Honolulu isn’t far behind D.C. with $50,000 adjusted take-home pay, but in this case the gross pay is much higher: almost $134,000.

The metro areas that are toughest for registered nurses, after you consider taxes and local cost of living, are:

On the other end, two states in particular had several metro areas that surpassed the average salary for registered nurses: California and Texas.

California has four cities ranked in the top 10 for registered nurse salaries after the cost of living and taxes are taken out. The Sacramento area finished No. 1, with registered nurses taking home $88,847, almost $10,000 more than any other metro area in the country.

Texas had three cities in the top 10, with Houston sliding into No. 2 at $79,520.

Here’s the top 10 list of metro areas where registerd nurses are taking home the most money:

Most travel nurses work 13-week contracts and are free to move from one role to another with each new contract, meaning they can choose where to go to make the most money by year’s end.

Factors such as the time of year or a crisis in an area can also boost pay for travel nurses. During COVID, some travel nurses were making up to $5,000 per week.