How Much Do Nurses Make? RN, LPN and CNA Pay Explained

"How much do nurses make?" sounds like it should have a simple answer. It doesn't. Two RNs who graduated in the same class can be $40,000 a year apart three years later. It depends on which state they live in, whether they work nights, which specialty they chose, whether they picked up extra shifts, and whether one of them went travel. The same goes for LPNs and CNAs.

This guide sets out realistic pay for registered nurses, licensed practical nurses and certified nursing assistants in the United States. It also covers the pieces of a nursing paycheck that most salary articles skip, and the moves that actually raise your earnings. We use federal data where we can and plain explanations everywhere else.

National pay at a glance

The U.S. Bureau of Labor Statistics (BLS) publishes wage data every year through its Occupational Employment and Wage Statistics program. Based on the May 2024 figures, median annual pay looked roughly like this:

A median is the middle of the pack: half of workers earn more and half earn less. It isn't a starting salary. New graduates usually start below it, and experienced nurses in high-paying states or specialties can earn well above it. Treat these numbers as a reference point, then adjust for the factors below. For the newest figures, check the BLS Occupational Outlook Handbook, which is updated each year.

The biggest factor: where you work

Location moves nurse pay more than anything else. RNs in the highest-paying states can earn 60 to 80 percent more than RNs in the lowest-paying ones.

States that tend to pay the most

California has been the top-paying state for RNs for years. Its mandated nurse-to-patient ratios and strong union presence keep wages high. Hawaii, Oregon, Washington, Alaska, Massachusetts, New York, New Jersey and Nevada also regularly rank near the top. Big metro areas within those states, such as the San Francisco Bay Area, Los Angeles, Seattle, Portland, Boston and New York City, often pay well above the state average.

States that tend to pay less

Several states in the South and parts of the Midwest and Mountain West sit at the lower end of the scale. That includes Alabama, Mississippi, Arkansas, South Dakota, Iowa and Tennessee, among others.

Why the paycheck isn't the whole story

A $130,000 salary in San Jose and an $80,000 salary in Little Rock can leave you with similar spending money once you pay rent. Before you move for pay alone, compare housing costs, state income tax, commute and childcare. Texas, Florida, Tennessee and Washington have no state income tax on wages, and that adds a few thousand dollars a year to your take-home pay.

You can see current pay on open roles by browsing nursing jobs by state or by city. Many listings on TheNurs.com include the pay range.

Setting and specialty

Hospitals generally pay RNs more than nursing homes, clinics or schools. Hospitals also tend to have more structured pay scales and differentials. For LPNs the picture flips somewhat. Skilled nursing facilities and home health agencies are the biggest LPN employers and often pay competitively, because they depend so heavily on LPNs.

Within hospitals, high-acuity specialties usually come with higher base pay or more opportunity for premium shifts. That includes ICU, ER, operating room, labor and delivery, cath lab and NICU. Certification also helps: many employers add a per-hour bump for credentials like CCRN, CEN or CNOR. For the full ranking, see our breakdown of the highest-paying nursing jobs.

What's actually in a nursing paycheck

Base rate is only part of the story. If you're comparing offers, ask about each of these.

Shift differentials

Most hospitals and many long-term care facilities pay extra for evenings, nights and weekends. A night differential of a few dollars an hour sounds small. Spread over 36 hours a week for a year, it can add several thousand dollars. Some facilities pay a percentage instead of a flat amount, which grows as your base rate grows.

Overtime

Under federal law, hourly nurses earn time and a half for hours over 40 in a workweek. Some hospitals use a different arrangement called the 8/80 system, which calculates overtime over a two-week period. Some states, including California, also require daily overtime after a set number of hours. Check how your employer calculates it.

Incentive and bonus shifts

When units are short, facilities often post "incentive" or "crisis" shifts that pay a flat bonus or a much higher hourly rate. Nurses who are flexible can boost their income a lot this way, but it's unpredictable and it can wear you down.

Sign-on and retention bonuses

Sign-on bonuses are common for hard-to-fill roles. Read the fine print. Most require you to stay a set time, often one to two years, and make you pay back some or all of the bonus if you leave early.

Certification and education pay

Some employers pay more for a BSN, and many pay a premium for specialty certification. Clinical ladder programs reward precepting, committee work and projects with a higher hourly rate.

Benefits

Health insurance, retirement matching, paid time off and tuition reimbursement can be worth 20 to 30 percent on top of your wages. Higher-paying per diem jobs usually come without benefits. That's one reason the per diem hourly rate is higher.

Per diem and travel pay

Per diem (PRN) nurses typically earn a higher hourly rate than staff nurses in the same facility, in exchange for no benefits and no guaranteed hours. If you already have health insurance through a spouse or another job, picking up per diem shifts can be one of the simplest ways to earn more. Our per diem nursing guide explains the trade-offs in detail.

Travel nurses are paid differently. A travel package usually combines a taxable hourly wage with tax-free stipends for housing and meals, which are only tax-free if you keep a real tax home. Weekly totals can be much higher than staff pay, especially in high-demand markets and seasons. But you take on housing costs, travel costs and contract risk. Read our guide on how to become a travel nurse before comparing a travel offer to a staff job.

LPN pay in more detail

LPNs earn noticeably more than CNAs after only about a year of extra training. That makes the LPN license one of the best returns on time in healthcare. LPNs in long-term care often work as charge nurses or handle medication passes for a whole hall. Those roles can come with differentials, and IV certification can add to your value. The usual ceiling for LPN pay is the license itself. LPNs who want a big jump in earnings usually go through an LPN-to-RN bridge program. See our guide to becoming an LPN for how those bridges work.

CNA pay in more detail

CNA wages are the lowest of the three, but they've risen in many markets as nursing homes compete for staff. CNAs can raise their pay by working nights and weekends, choosing hospitals over some long-term care settings, or adding skills such as phlebotomy, EKG or medication aide certification (CMA, in states that allow it). Picking up per diem shifts at a second facility also helps. Many CNAs use their job as a paid stepping stone while they go to LPN or RN school, and some employers will help pay for it. Read how to become a CNA if you're just starting out.

How pay grows with experience

Most hospital RN pay scales are built on years of experience, with annual steps. The steepest climb usually comes in the first five years. After that, raises tend to come from moving up rather than staying put: charge nurse roles, certification, switching specialties, moving into education or management, or going back to school as a nurse practitioner, nurse anesthetist or clinical nurse specialist.

Changing employers is also one of the fastest ways to raise your rate. Facilities competing for experienced nurses often place new hires higher on the scale than they'd move existing staff in a single year. That isn't a reason to job-hop every year. It's a reason to know your market rate.

How to negotiate a better offer

1. Know the range before the call. Look at posted pay for similar jobs in your area. Many states now require employers to include salary ranges in job postings.
2. Ask how they placed you on the scale. Make sure all your relevant experience is counted, including LPN years, specialty time and time at other facilities.
3. Negotiate more than the base rate. If the hourly rate is fixed, ask about your start date, your schedule, paid certification, tuition support or a higher step on the clinical ladder.
4. Get it in writing. Your offer letter should list the base rate, differentials, any bonus and its repayment terms.

The bottom line

Nursing pays a solid middle-class wage almost anywhere in the country, and a very strong one in the right state, specialty or arrangement. The nurses who earn the most aren't always the ones at the most prestigious hospitals. They're the ones who understand differentials, aren't afraid to pick up per diem or travel work when it suits them, and keep their skills and certifications current.

To see what employers are paying right now, browse open nursing jobs on TheNurs.com. You can filter by license type and state, and many listings show the pay range up front. Creating a free nurse profile lets facilities find you when a better-paying role opens.