Top Paying RN Specialties and Settings
By Debra Wood, RN, contributor
Overall, nursing pays a competitive wage, but some specialties pay more than others. As a general rule, more education, supply and demand, and relative responsibility contribute to higher salaries, but earning potential should be just one consideration when choosing to specialize.
“What a nurse enjoys is the number one factor,” said Donna W. Cardillo, RN, MA, an author, consultant and recognized expert on nursing careers, based in New Jersey. “Money may draw you into a job, but it will never keep you there. It’s not just doing work you love but working in an environment that is supportive of nurses.”
Nurses should consider the entire compensation package, Cardillo advised. That includes the benefits available, opportunities for education and personal development, and a workplace with a congenial manager and supportive peers.
“When selecting a job, if you just look at hourly rate or annual salary, it’s short sighted,” Cardillo said.
That being said, the U.S. Bureau of Labor Statistics reports a mean average wage for nurses of $67,720 annually. However, experienced pediatric endocrinology nurses, endocrinology nurses, electrophysiology nurses and otolaryngology nurses can earn significantly more, according to salary averages at Indeed.com, a job search engine.
Kari E. McConnell, RN, CORLN, immediate past president of the Society of Otorhinolaryngology and Head-Neck Nurses, said she thinks otolaryngology nurses demand a higher salary because there are so few experts. She estimates there are only 200 certified otorhinolaryngology nurses in the country. Most procedures are outpatient, and those patients in the hospital require complex care, such as airway management and reconstructive head and neck surgery.
“They are rare,” McConnell said. “And care of the head and neck patient is specific. You have to know airways and how to position patients.”
Cardillo agreed that nurses experienced in narrow, highly specialized fields may earn more. However, she cautions there remains variability between facilities.
Nurse researchers, pediatric and adult cardiology nurses, neonatal nurses and orthopaedic nurses’ salaries average more than the norm, according to Indeed.com, as do oncology nurses, critical care nurses, certified diabetes educators, and enterostomal nurses.
While the dollar figures vary, Monster.com reports similar rankings, with nurse researchers leading the way, followed by pediatric endocrinology nurses, orthopaedic nurses and neonatal nurses.
Practice setting also makes a difference. The Bureau of Labor Statistics (BLS) reported in May 2010 that nurses in general medical and surgical hospitals earn a mean wage of $68,610, while nurses working in home health, nursing care facilities and outpatient clinics earn less, $63,850, $59,990 and $67,550 respectively. Nurses in specialty hospitals earn more, averaging $73,280 annually, and those in psychiatric hospitals a little less, at $65,600.
Cardillo cautioned that hospital averages may include shift differentials, overtime and holiday pay.
Nurses working in the pharmaceutical industry enjoy higher earnings, or $74,940 on average, just slightly more than nurses working for medical equipment manufacturers, averaging $74,930, and college and universities at $74,180, according to the BLS.
“Health care is shifting out of the hospital to the community and other nontraditional areas, as are nursing jobs,” Cardillo said. “Currently and in the future, there are a lot of well-paying opportunities for nurses beyond the hospital, in areas like the insurance industry, the pharmaceutical industry and occupational health.”
Those jobs also offer greater potential for growth than a hospital setting and opportunities to negotiate a better salary, benefits or working conditions, Cardillo added.
Karon Gibson, RN, of Chicago, said that independent practice nurses, such as herself, often earn more than average. She is a producer of educational and entertaining television programs and co-author of the book Nurses on Our Own.
Wendie A. Howland, RN-BC, MN, CRRN, CCM, CNLCP, NLCP-C, principal of Howland Health Consulting in Massachusetts, also has pursued a more independent practice as a certified nurse life care planner. She grossed about $120,000 last year, but knows of colleagues who earn in the $300,000 range. She prepares and reviews life care plans, estimating medical and nonmedical needs of people with a catastrophic injury or chronic illness over an estimated life span. Howland said that in addition to traditional nursing roles, many opportunities exist for nurses to positively affect the country’s health.
The part of the country where a nurse works also affects average income, with California nurses topping the earnings at $87,480 annually, and South Dakota nurses taking in on average $54,730 annually, according to the BLS.
Certain metropolitan areas also pay better, government reports show. Nurses in Boston, for instance, earn an average of $92,600 annually, while nurses in Florence, South Carolina, earn significantly less at $56,030 on average. Nurses in San Jose, California, earn the most of any city, averaging $116,150 annually.
Cardillo said that the salaries, in general, are higher on the East and West coasts and in major metropolitan areas, while they will likely be lower the middle of the country and in rural areas. But that is also relative to the cost of living.
“Again, that’s why you have to look at the big picture: is housing less? Goods and services?” Cardillo said. “Try to take the focus off money, money, money.”
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