Posted by: John S Kiernan

Like most segments of the economy, the nursing industry changes based on the country’s socioeconomics. Key issues include the aging U.S. population, the student-loan crisis and concerns about the future of key entitlement programs. But such concerns are shared by recent graduates in all industries.

More specific to nursing professionals are the various day-to-day demands placed on them, such as mandatory overtime, overstaffing, unionization and disrespectful behavior by patients. Despite those challenges, however, aspiring nurses have much to look forward to upon certification. Nursing occupations are some of the most lucrative careers with the lowest unemployment rates in the U.S. In fact, the industry is expected to grow at more than double the rate of the average occupation through 2026.

With such bright projections, WalletHub took stock of the nursing industry to help registered nurses, particularly new graduates, pick a place to live that will bring success. We did so by comparing the 50 states and the District of Columbia across 21 key metrics that collectively speak to the nursing-job opportunities in each market. Below, you can check out our findings, commentary from a panel of experts and a complete description of our methodology.

1. Main Findings
2. Ask the Experts: The State of the Nursing Industry
3. Methodology

Main Findings

Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/4041/nurses-geochart1.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="https://ift.tt/2reBRcM>  

Best Places to Work as a Nurse

Overall Rank (1=Best)	State	Total Score	‘Opportunity & Competition’ Rank	‘Work Environment’ Rank
1	Maine	62.96	16	2
2	Montana	62.07	5	10
3	Washington	61.41	6	12
4	Wyoming	61.31	1	32
5	New Mexico	61.11	2	31
6	Minnesota	60.87	29	1
7	Arizona	59.89	7	16
8	New Hampshire	59.39	37	3
9	Oregon	59.17	36	4
10	Colorado	58.67	20	6
11	Nevada	58.34	3	35
12	Texas	58.08	13	14
13	Florida	57.72	4	33
14	West Virginia	57.21	11	23
15	North Dakota	57.17	9	26
16	Iowa	56.99	12	24
17	Nebraska	56.07	35	9
18	Wisconsin	55.32	14	29
19	Connecticut	55.26	41	7
20	Illinois	54.78	32	15
21	Utah	54.62	26	20
22	Idaho	54.53	33	17
23	California	54.51	25	21
24	Maryland	54.48	47	5
25	Missouri	54.21	19	27
26	Alaska	54.06	31	22
27	Georgia	53.91	8	40
28	Rhode Island	53.60	43	11
29	South Carolina	53.23	10	43
30	Delaware	53.03	44	8
31	South Dakota	52.95	34	25
32	Pennsylvania	52.95	38	19
33	Kansas	52.47	15	39
34	North Carolina	52.41	24	30
35	Indiana	51.77	18	37
36	Virginia	51.30	21	36
37	Arkansas	49.99	23	41
38	Massachusetts	49.93	46	18
39	New Jersey	49.73	49	13
40	Michigan	48.91	17	50
41	Kentucky	48.36	40	38
42	Ohio	48.26	27	47
43	Mississippi	48.16	28	46
44	Oklahoma	47.95	22	49
45	New York	47.80	48	28
46	Tennessee	47.62	39	42
47	Louisiana	46.27	30	51
48	Alabama	45.58	42	48
49	Vermont	44.88	45	44
50	Hawaii	38.49	50	34
51	District of Columbia	33.08	51	45

Ask the Experts: The State of the Nursing Industry

WalletHub turned to a panel of nursing-industry experts for insight into the future of the profession and how recent graduates can find success. You can check out their bios and thoughts below.

1. What are the biggest issues facing nurses today?
2. What is the long-term outlook for the field of nursing?
3. What tips do you have for recent nursing school grads looking for a place to live and work?
4. What can local governments and health systems do to attract and retain high quality nurses?
5. Are the new policies implemented by the Trump administration a net positive or net negative for the work life of nurses?
6. Are unions beneficial to nurses?

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• Sara Horton-Deutsch Professor and Watson Caring Science Endowed Chair at the University of Colorado Anschutz Medical Campus
• Michael D. Bumbach Clinical Assistant Professor in the Department of Family, Community and Health System Science and Family DNP Track Coordinator at the University of Florida College of Nursing
• Leslie Neal-Boylan Associate Dean for Academic Affairs and Program Innovation and Professor at MGH Institute Of Health Professions

Sara Horton-Deutsch Professor and Watson Caring Science Endowed Chair at the University of Colorado Anschutz Medical Campus

What are the biggest issues facing nurses today?

Burnout and compassion fatigue are two of the biggest issues facing the profession. Today's nursing graduates are often ill-prepared for the heavy toll of their day-to-day workload, and its impact on their ability to care for others.

What is the long-term outlook for the field of nursing?

I think the profession is at great risk. If we don't clearly articulate our purpose and have a language for what we do, we do not exist. In an effort to acquire autonomy, in many ways, nurses, particularly Advanced Practice Nurses, have become more like physicians. As a result, these nurses face the same pressures as physicians -- how many patients can I see in the shortest amount of time. Nursing has historically been the heart and soul of health care -- this needs to be reclaimed and mandated not only in nursing, but all health professions education. We have lost our way, need to reconnect to caring, healing, listening and seeing the whole person situated in a family and a community over objectifying a body or body part and focusing solely on a quick fix, cure and pharmaceutical interventions alone. These may work fine for acute illnesses, but the majority of Americans in our country are dealing with chronic conditions that require whole-person interventions.

The alternative medicine community has this figured out. Americans, with the resources, are spending billions of dollars on holistic approaches to care that they can no longer access in most hospitals and clinics in this country.

What tips do you have for recent nursing school grads looking for a place to live and work?

I recommend nurses look closely at the philosophy, vision, and mission statement of the organization and how it is lived out. Are the values clearly articulated and visible when you walk in the building? What is the practice model for the organization? Does it fit with their own? How is it apparent in day-to-day practice? Does the organization support life-long learning and continuing education? How and how often? Are there meaningful recognition programs that acknowledge teamwork, quality, safety and care? How does the organization help nurses reduce stress, prevent burnout, and improve resiliency? Are there programs or initiatives in place?

What can local governments and health systems do to attract and retain high quality nurses?

Many of the answers lie in my response to the question above. Be clear on philosophy, vision, mission, and values and live by them. Systems need to care for their caregivers -- so they can care for patients. Health care systems and leaders need to create healthy work environments, where nurses have adequate breaks, time to eat, time to go to the bathroom, time to rejuvenate. This is pretty basic stuff but, somehow, we have lost our way. Valuing profit over people takes its toll.

Are unions beneficial to nurses?

I have no personal experience with unions, but ironically, I have just accepted a new position at a unionized organization. I would like to think unions are not needed at the professional level, but when organizations do not value or care for their employees and put profit above all else, I am not sure how we get by without them.

Michael D. Bumbach Clinical Assistant Professor in the Department of Family, Community and Health System Science and Family DNP Track Coordinator at the University of Florida College of Nursing

What are the biggest issues facing nurses today?

The long-standing issue in nursing is the struggle to be able to work to the full scope of practice. This has been a huge issue, especially now as we are getting into Advanced Nursing Practice (Nurse Practitioners). Mostly, the AMA and the physician groups, hold a significant amount of control at the state level, and subsequently lobby very hard against the advancement of nursing. There are several states, mostly the rural states, that are very friendly to nurses. This is because otherwise, they would not have providers for patient care. So, I would say the largest issue facing nursing is the political struggle to fully practice.

What is the long-term outlook for the field of nursing?

Awesome -- the beauty of nursing and health care in general, there will always be patients as long as there are people. There is a huge nursing shortage, increasing over the past 20 years, which doesn't seem to be going away; from this, it is not difficult to find meaningful and substantial work. Nursing is so embedded in modern health care, it will not disappear anytime soon.

What tips do you have for recent nursing school grads looking for a place to live and work?

Go big. Get experience where you can, worthwhile experience that you think will help you shape your career, and then go for it. There are seldom limitations to finding work, especially if you trained at a reputable institution.

What can local governments and health systems do to attract and retain high quality nurses?

Recognize that the physician groups want to maintain the old hierarchy in health care, which is inconsistent with modern research and patient care. Local, and especially state governments, can let nursing regulate nursing and stop impeding the growing practice of nursing. There is no limit or license to information and knowledge.

Are the new policies introduced by Trump's administration a net positive or net negative for the work life of nurses?

This is to be determined. Anytime funding is cut, this hurts the field. But I have also seen significant inconsistencies with the Affordable Care Act. To date, there is no one solution, and often, politics plays a much bigger role in health care than anyone would like to admit.

Are unions beneficial to nurses?

Yes and no. I don't think unions necessarily help health care, but at the same time, they act as a unified voice. Unfortunately, the focused agenda of a union may impede patient care by allowing groups to protest. Although, if nurses feel compelled to use the unions' strengths, there must have been greater issues that needed to be addressed, subsequently, the nurses were likely not to satisfied with their work. This dissatisfaction has been shown to worsen patient care and increase patient complications.

Leslie Neal-Boylan Associate Dean for Academic Affairs and Program Innovation and Professor at MGH Institute Of Health Professions

What are the biggest issues facing nurses today?8-

Nurses are aging and we are not preparing new nurses fast enough to replace those who will retire. Many new nurses burn out quickly. They underestimate how difficult and challenging nursing is. Many nurses are still caring for patients without sufficient staff support -- meaning staffing shortages. Nurses tend to work very long hours without adequate compensation or sufficient respect. Safety concerns -- high pressure responsibilities, nurse fatigue, nurse injury. The image of nursing has come a long way but people still think nurses become nurses because they're not smart enough to become physicians and don't recognize that these are very different professions. Nurses are still striving for "a seat at the table."

What is the long-term outlook for the field of nursing?

People will always need nurses; however, other health professions are increasingly taking on responsibilities and activities that were once the purview of nurses. The increase in interprofessionalism is wonderful and welcome but the blurring of responsibilities is confusing to patients and some health care professionals may be performing functions for which they are not adequately prepared. I think nursing will incorporate increased use of technology to supplement vital hands-on care. Nurses will increasingly influence health care policy and play key roles in preventing and treating illnesses related to climate change.

What tips do you have for recent nursing school grads looking for a place to live and work?

Don't just look within hospital settings. Nurses work in a variety of settings and there is often more autonomy in community settings. The nurse can provide truly holistic care where people live and work. Be open to different types of nursing work and gain experience before going to graduate school to make sure you have solid experience and enough background to help you choose the right program for you.

What can local governments and health systems do to attract and retain high quality nurses?

• Offer sufficient pay and benefits;
• Be willing to pay for baccalaureate prepared registered nurses because there is a large body of research to show that RNs improve patient outcomes;
• Support independent practice for nurse practitioners because research shows their outcomes match those of physicians and patients feel very comfortable with NPs;
• Include nurses and advanced practice registered nurses at the table in committees and health and non-health related discussions because nurses are the first line when it comes to health care;
• Do not employ non-RNs to perform nursing jobs because you then jeopardize the health and safety of patients;
• Offer tuition reimbursement.

Are the new policies introduced by Trump's administration a net positive or net negative for the work life of nurses?

The Trump administration should support funding/grants for nursing education so we can educate more nurses to care for our growing older adult population and those living longer with chronic illnesses or disabilities. The administration must support nursing and healthcare research and the ACA. Otherwise, millions of people will go back to having no or little access to healthcare. The administration should vehemently oppose racism in all its forms and support providing high quality and equitable healthcare to all people, including immigrants and people who are new to this country.

Methodology

In order to determine the best and worst states for nurses, WalletHub compared the 50 states and the District of Columbia across two key dimensions, “Opportunity & Competition” and “Work Environment.”

We evaluated those dimensions using 21 relevant metrics, which are listed below with their corresponding weights. Each metric was graded on a 100-point scale, with a score of 100 representing the most favorable conditions for nurses.

We then determined each state and the District’s weighted average across all metrics to calculate its overall score and used the resulting scores to rank-order our sample.

Opportunity & Competition – Total Points: 70

• Monthly Average Starting Salary for Nurses: Full Weight (~6.09 Points)Note: This metric was adjusted for the cost of living.
• Average Annual Salary for Nurses: Double Weight (~12.15 Points)
• Health-Care Facilities per Capita: Full Weight (~6.09 Points)
• Share of Population Living in a Primary-Care HPSA: Full Weight (~6.09 Points)Note: “HPSAs,” as defined by the Health Resources & Services Administration, “are designations that indicate health care provider shortages in: Primary care; Dental health; or Mental Health” and “may be geographic-, population-, or facility-based.”
• Projected Share of Elderly Population in 2030: Full Weight (~6.09 Points)Note: “Elderly population” includes adults aged 65 and older.
• Quality of Nursing Schools: Half Weight (~3.04 Points)
• Tuition Cost per Credit for BSN Online Program: Full Weight (~6.09 Points)
• Share of Licensed Nursing Professionals Not Working in Nursing: Full Weight (~6.09 Points)
• Nursing-Job Openings per Capita: Full Weight (~6.09 Points)
• Nurses per 1,000 Residents: Full Weight (~6.09 Points)
• Projected Competition in 2024: Full Weight (~6.09 Points)Note: “Competition” refers to the number of nurses per 1,000 residents.

Work Environment – Total Points: 30

• Mandatory Overtime Restrictions: Double Weight (~5.45 Points)
• Ratio of Nurses to Hospital Beds: Full Weight (~2.73 Points)
• Nurses Job Growth (2017 vs 2013): Double Weight (~5.45 Points)
• Presence of Nursing Licensure Compact Law: Full Weight (~2.73 Points)Note: This metric considers the presence or absence of a Nursing Licensure Compact law in the state. The compact allows nurses to practice in their home state and other participating states.
• Regulatory Requirement for Nurse Practitioners: Full Weight (~2.73 Points)
• Share of Best Nursing Homes: Full Weight (~2.73 Points)Note: This metric is based on U.S. News & World Report’s Best Nursing Homes rating.
• Quality of Public Hospital System: Full Weight (~2.73 Points)Note: This metric is based on data from the Centers for Medicare & Medicaid Services.
• Friendliness Toward Working Moms: Full Weight (~2.73 Points)Note: This metric is based on WalletHub’s Best & Worst States for Working Moms ranking. In 2011, there were 3.5 million employed nurses in the U.S., and about 3.2 million were female.
• Average Number of Work Hours: Half Weight (~1.36 Points)
• Average Commute Time: Half Weight (~1.36 Points)

 Sources: Data used to create this ranking were collected from the U.S. Census Bureau, Bureau of Labor Statistics, Council for Community and Economic Research, HRSA Data Warehouse, Center on Education and the Workforce, Indeed.com, National Council of State Boards of Nursing, Centers for Medicare & Medicaid Services, U.S. News & World Report, Projections Central - State Occupational Projections, Nurse.org, Nursing Economic$, The Journal for Health Care Leaders, American Association of Nurse Practitioners and WalletHub research.

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