Nursing Jobs, Cost of Living, & Where to Hang Your Hat

In my work as a career coach for nurses and healthcare professionals, I frequently witness those who work in nursing struggling with decisions related to finding work and the relative cost of living in terms of where they live or where they might move.

Making decisions about your workstyle and lifestyle can be fraught with anxiety and concern about the future -- let's unpack that conundrum.

Photo by Joey Csunyo on Unsplash

Workstyle and Lifestyle

Figuring out where to live and work can be a difficult choice. On the one hand, you want to earn up to your potential and receive the highest possible wage according to your level of experience and expertise. On the other hand, the highest salaries are generally in large popular metropolitan areas where the cost of living is through the roof and the relatively high salary will just barely (if at all) make up the difference when compared to more moderately priced cities or towns.

A single working professional may have much more freedom of movement than one who is married, but finding a way to afford single life in more expensive areas can be a challenge.

Choosing a new domicile becomes even more complicated when children are in the picture. Whereas a single person may simply look at nightlife, cultural amenities, cost of living, safety, etc, the nursing professional with children must also consider school quality and everything that comes with the needs of growing children.

Choosing an underserved rural area may offer a quiet place to live and low cost of living for someone who loves the outdoors, but for a nurse with a regular habit of going out to movies, theater, and other nightlife activities, the flip side will be discovering how to have those amenities in the city without breaking the bank.

Your chosen lifestyle and workstyle need to be fairly aligned; if you have a spouse and kids, these decisions are more complex but not impossible to overcome. And while work can sometimes take up a third or more of your life, it can't always be the sole factor that determines where you rest your head at night.

The Best Places to Live

Here in the United States, there is a wide diversity of choices related to climate, safety, way of life, economics, diversity, educational opportunities, housing costs, crime, and culture. And we all know that one person's paradise can be another's purgatory.

Money Magazine and Realtor.com crunched the numbers for 2018, creating a list of the 50 best places to live in the United States. The communities were examined using a methodology that looked at areas with populations over 50,000; the rankings were compiled based on the examination of over 70 types of data, including those mentioned in the preceding paragraph.

Somewhat surprisingly (or not), the 50 winners aren't all household names like San Francisco, Boulder, or Dallas. Here are the top 10:

1. Frisco, Texas
2. Ashburn, Virginia
3. Carmel, Indiana
4. Ellicott City, Maryland
5. Cary, North Carolina
6. Franklin, Tennessee
7. Dublin, California
8. Highlands Ranch, Colorado
9. Sammamish, Washington
10. Woodbury, Minnesota

Two small cities within the metropolitan halo of Boston made the cut: Newton and Brookline. In relation to the New York City region, only Union and Parsipanny/Troy Hills, NJ were on the list. Near Atlanta, we find the suburb of Alpharetta as a highly prized location (my mother lived there very happily in the last few years of her life). And the only selections in the entire state of California are Dublin, a city of 60,000 located 30 miles east of Oakland, and Eastvale, a city an hour east of downtown LA. Sorry, Hawaii and Alaska -- you didn't even make the top 50.

Anyway, here's Money Magazine's list of the best places to live in each state.

We can't entirely live our lives according to the results from this kind of research, but such information can serve as a jumping off point for further exploration and can support us in doing our due diligence and making prudent choices.

Now For the Jobs per U.S. News

When considering relocation and where to settle down, other tools also come in handy. U.S. News & World Report's "The 25 Best Jobs of 2018" can help us to piece the puzzle together. While software developer clinched the #1 spot for 2018, rest assured that healthcare jobs dominate the list, with the following health-related careers making appearances:

#2: Dentist
#3: Physician Assistant
#4: Nurse Practitioner
#5: Orthodontist
#7: Pediatrician
#8: A tie between Obstetrician/Gynecologist; Oral and Maxillofacial Surgeon; & Physician
#11: Occupational Therapist
#12: Physical Therapist
#13: A tie between Anesthesiologist & Surgeon
#15: Psychiatrist
#16: Prosthodontist
#17: Dental Hygienist
#18: Registered Nurse
#20: Physical Therapy Assistant
#21: Respiratory Therapist
#22: Nurse Anesthetist
#23: Optometrist

If you're thinking of switching out of healthcare entirely, see the list for the details, but rest assured that you'd do well as an actuary, marketing manager, statistician, or mathematician.

If you're wondering about the difference between NPs, nurse anesthetists, and RNs, look no further:

Nurse Anesthetist
Median salary: $160,270
Unemployment rate: 2.7 percent

Nurse Practitioner
Median salary: $100,910
Unemployment rate: 0.7 percent

Registered Nurse
Median salary: $68,450
Unemployment rate: 1.2 percent

One thing we have no reliable data on is how much nurses are earning when they reach the PhD or DNP level, so the operative question remains whether pursuing those terminal nursing degrees repay the earnest (and highly indebted) nurse with high salaries and low unemployment.

Similarly, the Bureau of Labor Statistics also does nothing to parse these differences either. Don't get me wrong, BLS data is a useful resource but doesn't give us the full breakdown we truly need (likely because those BLS folks have no idea what a DNP is, and it's even less likely that they even know what DNPs are capable of.)

The 25 Best Nursing Jobs

According to an article posted on TopRNtoBSN.com, nursing jobs of course have their own hierarchy of popularity and career mojo. Unfortunately, no methodology is shared, thus we're left in the dark as to how they arrived at these conclusions. While the only hard statistics we're given are median salaries, the list includes:

1. Ambulatory Care Nurse
2. Camp Nurse
3. Case Management Nurse
4. Correctional Nurse
5. Flight Nurse
6. Forensic Nurse
7. Home Health Nurse
8. Hospice Nurse
9. Informatics Nurse
10. IV Therapy Nurse
11. International Nurse
12. Long-Term Care Nurse
13. Medical Supplies or Pharmaceutical Rep
14. Nurse Advocate
15. Nurse Educator
16. Nurse Manager
17. Nurse Researcher
18. Psychiatric Nurse
19. Public Health Nurse
20. School Nurse
21. Substance Abuse Nurse
22. Telephone Triage Nurse
23. Transplant Nurse
24. Travel Nurse
25. Wound, Ostomy, & Continence Nurse

You likely already noticed that many of the listed nursing jobs are removed from acute care, demonstrating to curious nurses that there is indeed life beyond the hospital (I've known this for decades, myself, but so many nurses seem unaware that any potential for work exists outside of the hospital milieu. Don't get me started about those who say real nurses only work in hospitals!).

And remember that nurse entrepreneurs and other outside-the-box nurses (like myself) never get air time on mainstream healthcare and career websites.

Choose Your Own Adventure

Nursing offers varying entry points into the profession, with some students now choosing an entry-level MSN as their starting place, especially when coming from another professional career. That said, RN and BSN programs are still robust in terms of how many people are clamoring for admission, as are the many types of MSN and NP programs.

In essence, nursing is a "choose your own adventure" undertaking, with as yet many unknowns for each individual. Those unknowns may include the twists and turns of the economy; potential changes in healthcare reform and the Affordable Care Act (ACA) and the number of insured Americans; student loan program changes; as well as cost of living and other factors covered in the first half of this post.

Between cost of living, your family's needs, potential salaries, and the lifestyle you prefer to lead, your choice of a nursing specialty and a place to put down roots is truly up to you. If you're single or otherwise able to explore the country as a travel nurse, that could be one way of doing your research. Otherwise, networking, conversations, informational interviews, and deeper research is called for.

The possibilities are endless, nurses -- do your due diligence and see what the roulette wheel of life and career hold in store for you.

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

As of May of 2018, Keith is the host of Mastering Nursing, an interview-style podcast showcasing inspiring, forward-thinking nurse thought leaders and innovators. 

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the  nursing profession. Keith has written for Nurse.com, Nurse.org, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, NursingCE.com, American Nurse Today, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives, and his adorable and remarkably intelligent cat, George.