The Real Reasons Why Some Nurses Make So Little

Nurses play an essential role in healthcare delivery and the day-to-day operations of medical infrastructure around the United States.

While it truly is a noble profession, there remains a lot of debate surrounding the issue of nurse compensation.

While some nurses earn competitive salaries, many earn below what many deem to consider fair compensation for a well-trained medical professional.

Some nurses make so little because they work in low-paying states, lack experience, are not licensed, or are specialized in a field that pays less. It may also be true that some make so little because they lack the skills and the assertiveness to negotiate their salaries with their employers. 

The rest of this article will assess why some nurses make so little compared to others who seem better compensated.

I’ll discuss the industry standards and dissect why some nurses earn below that. If you’d like to understand more about the salary discrepancy between professionals of the same field, keep reading.

What Is the Average Salary of Nurses?

The national average salary for nurses in the US is estimated at around $80,010 per year. However, salary rates vary in each state, with some paying quite well while others leaving much to be desired when compensating their nurses. 

However, $80,010 is the average base pay of a nurse working in the US.

Some professionals earn higher than that because of overtime pay.

Some can also take on more than one job and moonlight in other hospitals on their days off at the hospital where they are employed full time.

Taking all of this into account, the average salary for a nurse can be considered decent income since it exceeds the median household income in the US, which is approximately $60,336. However, this isn’t true across the board. Many nurses earn significantly less at around $44,000 and under annually. 

Why Some Nurses Make Less Than Others

A single reason cannot explain the difference in nurse salary rates across the board. Many factors determine salary rates, some modifiable; others not so much. Here are some of the reasons why some nurses make less than others:

  • They work in low-paying states.
  • They lack experience.
  • They are not BSN prepared.
  • They have a nursing level that pays less.
  • They lack the skills to negotiate their salaries.

Now let’s take a closer look at each reason. 

They Work in Low-Paying States

It bears repeating: different states, different rates. Topping the list of high-paying states is Hawaii, surpassing California, the highest-paying state in 2020. By 2021, the Aloha State had stolen the lead, with nurses earning an average of $104,060; that’s 89% more than the average wage for all other occupations. Paradise indeed. 

In 2020, Alabama was the lowest-paying state, with nurses making an average of $60,230. Alabama was followed by South Dakota, with nurses earning an average of $60,960 annually. According to Nightingale College, other states where nurses make below the national average are ranked as follows.

StateAverage Salary for NursesMonthly SalaryHourly RateHours Worked to Afford Median Rent for Nurses
Alabama $60,230$5,019$28.9627.9
Arkansas $63,640$5,303$30.6025.2
Colorado $77,860$6,488$37.4337.4
Florida $69,510$5,792$33.42 38.1
Georgia $71,510$5,959$34.3831.4
Idaho $71,640$5,970$34.4426.3
Indiana $66.560$5,624$32.45 26.3
Iowa $62,570 $5,214$30.0827.7
Kansas $64,200$5,350$30.8728.7
Kentucky $64,730$5,394  $31.1225.2
Louisiana $68,010$5,668$32.7027.4
Mississippi  $61,250$5,104$29.4527
Montanna $70,530$5,878  $33.91 24.9
Nebraska $69,480$5,790$33.4124.9
New Hampshire$75,970 $6,330$36.52 32.3
New Mexico $75,700$6,308$36.4024
North Carolina $68,950$5,745$33.1529.1
North Dakota$69,630$33.15$34.4725.2
Oklahoma $66,600$5,550$32.0226.1
Pennsylvania $74,170$6,180$35.6627.7
South Carolina $67,140$5,595$32.2829.6
South Dakota $60,960 $5,080$29.3026.9
Tennessee $64,120$5,343$30.8330.1
Virginia $74,380$6,198$35.7636.
West Virginia$65,130$5,427$31.3123.9
Wisconsin $74,760$6,230$35.9424.8
Wyoming$72,600 $6,050$34.9024.9

There are 15 states where nurses earn above the national average. I don’t want to inspire a mass exodus of nurses to the higher-paying states, but this is one of those non-modifiable factors affecting nurse income. One of your only real options is to cross state lines and follow the money. But of course, as nurses, it’s not all about the salary. 

For all their hard work, nurses constantly find themselves barely making ends meet even if their income is considered quite decent. If this is you, here’s some expert advice on how to stretch your money and be able to collect up to $10,000 of savings per year.. 

They Lack Experience

Entry-level nurses cannot expect to be earning the same amount as their more seasoned colleagues. Skills are learned through experience. Many healthcare facilities utilize payment models that factor your skill level and competency when deciding your base salary. 

Competency assessment tools and quarterly appraisals are done in many institutions that track your professional growth. Your base rate will be adjusted according to your work performance and competency level. 

If you’re only getting started on your nursing career, click here for an insightful reading on how to live comfortably on a less than average annual income until you get that hard-earned bump in your pay. 

They Are Not BSN-Prepared

To understand why some RNs earn less than BSN-prepared nurses, I first have to explain the difference between RN and BSN. The associate degree and diploma nursing programs make you eligible to take the nurse licensure exam. These programs only take two years to complete. RN programs teach basic nursing skills, focusing on nursing theory and clinical practice. 

A BSN, on the other hand, takes four years to complete at an accredited college, university, or nursing school. BSN programs expound on all you learn in RN programs with advanced training that you don’t get from an associate degree. BSN-prepared nurses have the edge of advancing to higher-earning positions as a BSN is now becoming the standard of nursing education. 

Some nurses make relatively little compared to others because of the educational attainment factor. Simply put, the more you learn, the more you earn. The average salary of a BSN-prepared nurse is $93,590. If we do the math, this puts the difference between RN and BSN salaries at around $13,580. Now that is a significant difference by any standard. 

Here is a side by side comparison of RN and BSN-prepared salaries:

StateAverage RN SalaryAverage BSN-Prepared Salary
District of Columbia$90,050$105,180
New Hampshire$75,970$88,170
New Jersey$85,720$99,080
New Mexico$75,700$85,070
New York$89,760$106,330
North Carolina$68,950$79,770
Rhode Island$82,790$96,300
South Carolina$67,140$77,630
South Dakota$60,960$70,020
West Virginia$65,130$76,210

If you are considering starting a career in nursing, consider which direction you would like to take in terms of training and education. Remember, the more you learn, the more you earn. If education costs are an obstacle for you, check out this link for some great tips on how you can earn passively while in college. 

They Have a Nursing Level That Pays Less

Different nursing levels have their own corresponding salaries. As you will see, there are even nursing levels that earn more than the BSN-prepared. Let’s take a look at the salary expectations of each nursing role. 

Nurse RoleAverage Hourly RateAverage Yearly Income
Licensed Practical Nurses$23.75$49,409
Registered Nurses$35.97$74,811
Nurse EducatorN/A$78,758
Nurse Midwives$52.11$108,395
Nurse Practitioners$53.92$112,159
Nurse Anesthetists$89.59$186,351

The higher the skill requirement, the higher the salary. The more complex the nursing role and the more advanced the competencies, the higher the liability, so it’s only fair that the compensation is also higher. 

They Lack the Skills To Negotiate Their Salaries

Nurses have different competency levels, so salary expectations will also vary. Most nurses do not negotiate their salaries; however, being able to negotiate your salary should be the norm in any progressive and world-class healthcare system. Some institutions pay a fixed rate instead of compensating their nurses according to their skill level.

Here are some ways you can negotiate better pay with your employers:

  • Do your research. Familiarize yourself with industry salary trends. Know your state’s average and if you are earning below it, let your employer know this is something you would like to change. 
  • Do the time. Before negotiating pay, make sure you’ve put in the time to gain experience and skills. Your growth should be traceable and attested by your managers.
  • Provide proof that you are invested in your nursing career. Remote learning has boomed since the start of the pandemic, and many seminars are now offered online. Nurses who make an effort to expand their knowledge by taking nursing-related seminars deserve a raise. Show your certificates from these seminars to your employer.
  • Practice your delivery. You should have an outline of what to say when you bring your case to your employer. Commit it to memory until you can speak it with confidence. 
  • Be confident but not demanding. When stating why you believe you deserve a raise, do so in a way that sells your skills without sounding entitled.  
  • Put everything in writing. To give everything a sense of formality, put your concerns in writing. Outline the skills you have acquired since you started working with the institution. 
  • Accept rejection with grace. If, at first, your requests are not met with a favorable response, thank your superior for taking the time to hear your concerns and tell them you hope that when the budget for a pay raise becomes available, they will keep you in mind. 

Final Thoughts

Nursing is a noble profession. Nurses work long hours, take on night shifts, and sacrifice work-life balance–sometimes to the detriment of their own health. In a perfect world, nurses would all be paid well. The limitations in our healthcare system can only be addressed by first becoming informed as to why the under-compensation of nurses continues to be an issue in many modern healthcare systems. 


Hi’ my name is Simon. I am the owner of Top Work Life.

Together with a my team, I write content about income generating ideas, entreprenurship and growth as a person

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