Which nursing careers pay the highest annual salary or hourly rates? Nursing jobs vary by specialty, setting, location, degree, and certification requirements. Nurses can specialize in treating a population (geriatrics, pediatrics, etc.) or specialize in a therapeutic area (oncology, dermatology, etc.) Additionally, shifts low in supply and high in demand can cause pay rates to grow in certain types of jobs.
Below are the nursing careers that generally pay the highest salary across all locations, specialties, and clinical settings. Most of the highest-paid nursing careers are APRNs, or advanced practice registered nurses, which are registered nurses who obtain a master’s level degree and additional experience or specialization after completing their Bachelor of Science in Nursing degree and RN certification.
1. Nurse Anesthetist (CRNA) – Nurse anesthetists administer anesthesia to patients who are undergoing medical procedures in a hospital, outpatient surgery center, or medical office. With additional documented experience in ICU or surgery, plus completing an additional program and passing certification requirements, RNs can become CRNAs and earn an average of $181,040 annually, according to the Bureau of Labor Statistics. CRNAs can make up to $230,000 annually, while most CRNA salaries range between $171,130 and $205,506, according to Salary.com.
2. Nurse Practitioner (NP) – Nurse practitioners also complete additional training and education to get their NP degree which enables them to treat patients more autonomously than many other types of nurses. Some states allow NPs to practice independently and prescribe medications while other states require NPs to work with a licensed physician. As of February 2021, nurse practitioners earn an average of $109,025 annually, according to data from ZipRecruiter.com.
3. Clinical Nurse Specialist (CNS) – A clinical nurse specialist has obtained a minimum of a master’s degree, plus additional training in a specialized area of nursing practice, according to Nurse.org, which reports that the median salary for clinical nurse specialists as of May 2020 is $106,604. Clinical nurse specialists may specialize in a therapeutic area or population, and specialty certifications are available in gerontology, pediatrics, and neonatal care, according to the National Association of Clinical Nurse Specialists.
Honorable Mention - Registered Nurse (RN) – While not among the very top-paying jobs, RNs are well-paid. Additionally, becoming an RN is somewhat of the “gateway” milestone along the way to achieving higher-paying advanced practice nursing jobs. Completing an RN opens many doors and provides nurses with many more options for advanced degrees and more lucrative nursing roles. According to the Bureau of Labor Statistics, the average (mean) income for RNs nationally as of 2019 (the most recent BLS data available) is $37.24 per hour which translates to $77,460 annually, assuming a full-time schedule of about 40 hours per week.
Of the nearly three million RNs employed nationwide, the highest earners are those who work in outpatient care centers or hospital settings, with an average hourly income of $40.73 ($84,720 annually), and $38.20 per hour ($79,460 annually) respectively.
Where you work as an RN also impacts your hourly wage and annual income. California and Hawaii are the top-paying states for RNs, with hourly rates of $54.44 and 50.03, respectively, followed by Washington, D.C., Massachusetts, and Oregon as top-paying states, where the cost of living is also higher.
Other ways nurses may increase their annual income
In addition to high-paying clinical nursing careers, another way to grow your nursing career and annual income is to shift into leadership, administration, or teaching. Nurse administrators such as hospital CNOs, medical directors, etc. earn more than $100,000, and nurse instructors earn an average of $83,160 annually and up to $133,000 in the 90th percentile.
Changes in supply and demand can also factor into nursing salaries, causing pay fluctuations in either direction. For example, critical care nursing is in unusually high demand in 2020-2021 due to the coronavirus pandemic. This is causing pay rates in some areas to quadruple, as demand also grows by a reported 400-500%, multiple experts report. Switching practice areas may be a more feasible career change than obtaining a new advanced degree for some nurses.
If none of the above are an option, another way for nurses to potentially grow their annual income is to consider trying out a new part-time side-gig for a few extra hours a week. This may be a more realistic method to increase earnings for nurses who are unable to shift full-time into a new, higher-paying nursing career.