The Highest Nursing Salary Could Come at a Cost: Why You Should Research the Board of Nursing Before You Relocate
As nurses, we work incredibly hard for our money. We spend long hours on our feet, miss holidays with our families, work weekends, and carry the tremendous responsibility of caring for human lives. We deserve to be compensated well for the education, expertise, and compassion we bring to our profession.
So, when I see articles about which states pay nurses the highest salaries, I understand why nurses get excited. Who wouldn’t want to earn another $20,000, $30,000, or even more each year doing the work they already love? According to Nurse.org’s nursing salary guide, nursing salaries vary significantly depending on where you live and work. Some states offer substantially higher compensation than others, making relocation an attractive option for nurses looking to improve their financial futures.
But as both a nurse and an attorney who represents nurses before Boards of Nursing, I want you to consider something that rarely makes it into these salary comparisons.
Before you chase the highest nursing salary, take a close look at the Board of Nursing that will regulate your practice.
Because a bigger paycheck may not be worth it if you find yourself practicing in a state with an overly punitive regulatory environment.
Not All Boards of Nursing Are Created Equal
Every state has a Board of Nursing whose primary responsibility is to protect the public. I absolutely support that mission. Patients deserve safe, competent nursing care, and nurses who engage in unsafe practices should be held accountable.
However, there can be significant differences in how states investigate complaints, interpret their Nurse Practice Acts, and discipline nurses.
Some states offer opportunities for remediation, education, and alternative-to-discipline programs. Others may take a more punitive approach to certain violations.
And that distinction matters. No nurse wakes up at night wondering if they will be called before the Board of Nursing, but you should wonder.
Imagine moving across the country for a wonderful nursing position with a substantial salary increase. You are excited about the opportunity, the new community, and the financial security it promises.
Then something happens at work. Maybe there is a documentation discrepancy, a medication error, or a complaint from a disgruntled patient or employer.
Suddenly, you find yourself facing an investigation by the Board of Nursing.
Depending on the circumstances and the state’s laws and procedures, you could be dealing with an investigation, legal expenses, public discipline, or restrictions on your ability to practice. Many states have investigators who are NOT nurses.
That wonderful salary increase may not seem quite so wonderful anymore.
I have represented nurses for years, and one thing I know is that good nurses can find themselves facing Board investigations. An allegation does not automatically mean a nurse has done something wrong, but even defending yourself against an allegation can be emotionally and financially draining.
Your nursing license is your livelihood. It deserves at least as much consideration as your paycheck.
Do Your Homework Before Accepting That Dream Job
When nurses consider relocating, they typically research salaries, housing costs, taxes, school systems, and the quality of life in their new communities.
I would encourage you to add one more important item to that research: the state’s nursing regulatory environment.
Look at the state’s Nurse Practice Act. Review the Board of Nursing’s disciplinary procedures and publicly available disciplinary decisions. Does the state offer alternative-to-discipline programs? How does it handle minor practice errors? Are there opportunities for remediation rather than punishment when appropriate? What rights do nurses have during investigations and hearings? Look for the number of nurses practicing in that state and the percentage that get disciplined. The lower the percentage, the better.
Consider whether the Board’s approach appears fair, transparent, and consistent with due process.
Remember that the number of disciplinary cases alone does not tell the whole story. A state with more nurses may naturally have more complaints. What matters is how allegations are evaluated and whether disciplinary responses are proportionate to the conduct involved.
I also encourage nurses to investigate the working conditions at prospective employers. A higher salary means little if you are constantly working short-staffed, being pressured to accept unsafe assignments, or practicing in an environment where nurses are blamed for systemic failures. Be sure to check Glassdoor.com, speak to former employees and check the Department of Health for complaints against the facility.
You want an employer that values your nursing judgment, supports patient safety, and treats nurses as professionals.
There Are So Many Opportunities. You Are Not Stuck!
Here is the part I really want every nurse to hear.
You do not have to stay where you are simply because that is where you started your nursing career.
One of the greatest advantages of being a nurse is the incredible number of opportunities available to us.
You can explore opportunities in another state, pursue travel nursing, move into case management, work in telehealth, become a legal nurse consultant, pursue advanced practice, or even start your own nurse-owned business.
You can change specialties, change employers, change locations, or completely reinvent how you use your nursing knowledge.
And sometimes, the best opportunity is not the one offering the highest salary. It is the one that gives you more freedom, professional respect, better working conditions, and peace of mind.
I have seen too many nurses stay in jobs where they are miserable because they believe they have no other choice. They feel trapped by their benefits, their seniority, their schedule, or simply the fear of making a change.
But you have options!
Your nursing education, experience, and clinical judgment are valuable. Those skills can open doors you may not have even considered.
The key is to make informed decisions rather than allowing fear or the promise of a bigger paycheck to make those decisions for you.
A Word About the Nurse Licensure Compact
The Nurse Licensure Compact has made it easier for eligible nurses to practice in multiple participating states through a multistate license. However, that does not mean you can simply choose whichever Board of Nursing you prefer to issue your compact license.
Your multistate license is tied to your primary state of legal residence, and if you permanently relocate, you will need to obtain a new license. You are also subject to the nursing laws and regulations of the state where your patient is located.
Furthermore, disciplinary action in one state can have consequences for your ability to practice in other states.
In other words, moving to a new state does not necessarily allow you to escape a licensing issue, and practicing under a compact license does not eliminate your responsibility to understand the laws of every state where you practice.
Your Career Is Worth More Than a Paycheck
I want nurses to earn every dollar they deserve. I want nurses to negotiate better salaries, pursue exciting opportunities, and build financially rewarding careers.
But I also want nurses to protect the license they worked so hard to earn.
When evaluating your next opportunity, don’t just ask, “How much will I make?”
Ask yourself, “Will I be supported? Will I be respected? Will I be able to practice safely? And if something goes wrong, will I be treated fairly?”
Sometimes the best career move is across the country. Sometimes it is across town. And sometimes it is leaving traditional bedside nursing altogether and creating a business or career that gives you the freedom you have always wanted.
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