Certified registered nurse anesthetists (CRNAs) are the highest-paid nurses in the United States, earning a median salary of $223,210 per year as of May 2024. That’s nearly $130,000 more than the typical registered nurse, who earns a median of $93,600. Between those two extremes, several nursing paths offer six-figure salaries depending on your education, specialty, and where you work.
Nurse Anesthetists Lead by a Wide Margin
CRNAs administer anesthesia for surgeries and procedures, often working independently in hospitals, surgical centers, and dental offices. Their median annual salary of $223,210 makes them not just the highest-paid nurses but among the highest-paid professionals in healthcare outside of physicians. The role requires a Doctor of Nursing Practice (DNP) or a master’s degree in nurse anesthesia, plus national certification, and programs typically take three to four years beyond a bachelor’s in nursing. You also need at least one year of critical care experience before applying.
The investment pays off. Even the combined group of advanced practice nurses (which includes CRNAs, nurse practitioners, and nurse midwives) sees its top 10% earning above $217,270. For CRNAs specifically, many earn well above that combined threshold.
Nurse Practitioners and Nurse Midwives
Nurse practitioners (NPs) earn a median of $129,210 per year, while certified nurse midwives come in close behind at $128,790. Both roles require at least a master’s degree in nursing and national board certification, and both can prescribe medications and manage patient care independently in many states.
Within the NP world, your specialty matters. Psychiatric nurse practitioners are in especially high demand, with median pay around $108,570 and top earners crossing $141,000. Pain management nurses average roughly $109,000. Adult-gerontology NPs typically fall between $74,000 and $110,000 depending on experience and setting. These figures shift year to year as demand changes, but psychiatric and acute care specialties consistently pay more than primary care NP roles.
What Registered Nurses Earn
The median RN salary is $93,600 per year, or about $45.00 per hour. That’s the midpoint, meaning half of all RNs earn more and half earn less. Your actual pay depends heavily on where you work, what unit you’re in, and how many years you’ve been at it.
Nurses in high-acuity settings like intensive care units, operating rooms, and emergency departments often earn more than floor nurses, though the Bureau of Labor Statistics doesn’t break out salaries by hospital unit. The premium typically comes through shift differentials and critical care bonuses rather than a higher base rate. Federal employees working the overnight shift (11 p.m. to 8 a.m.) receive a 10% differential, while evening shifts (3 p.m. to midnight) get 7.5%. Private hospitals set their own rates, but similar structures are common across the industry.
Travel Nursing Still Pays a Premium
Travel nurses, who take short-term contracts at facilities facing staffing shortages, earn significantly more than their permanently employed peers. In early 2023, travel nurses averaged $2,657 per week compared to $1,341 for permanent staff nurses. That’s roughly double the weekly pay.
The trade-off is real, though. Travel contracts typically run 8 to 13 weeks, and you’re responsible for your own housing, benefits, and retirement savings (though many contracts include housing stipends). Income can be inconsistent between assignments, and you’re constantly adjusting to new facilities, new electronic health records, and new teams. Still, for nurses willing to relocate frequently, travel nursing remains one of the fastest ways to increase earnings without additional degrees.
Where You Live Changes Everything
Nursing salaries vary dramatically by state, but the highest raw numbers don’t always mean the most money in your pocket. When adjusted for cost of living, the top-paying states for registered nurses look different than you might expect. California leads at $49.22 per hour in adjusted wages, followed by Washington at $46.38. Oklahoma ranks third at $45.91, beating out many coastal states because its cost of living is so much lower. Delaware ($44.36) and Connecticut ($43.29) round out the top five.
The takeaway: a nurse earning $80,000 in Tulsa may have more purchasing power than one earning $110,000 in New York City. If maximizing your real income matters to you, compare salaries against local housing, taxes, and everyday expenses rather than looking at raw numbers alone.
How Education Affects Your Ceiling
The salary tiers in nursing track closely with education level. Licensed practical nurses (LPNs) earn a median of $62,340, registered nurses with an associate’s or bachelor’s degree earn $93,600, and advanced practice nurses with a master’s or doctoral degree earn a median of $132,050. Each step up requires more schooling and certification but opens a distinctly higher pay band.
For nurses already holding a Master of Science in Nursing (MSN), the question of whether a Doctor of Nursing Practice (DNP) is worth the additional investment is common. The salary difference between the two degrees is modest for clinical roles, since both qualify you for the same NP, CRNA, or midwife positions. Where the DNP pulls ahead is in leadership and executive roles. Hospitals and health systems increasingly prefer doctorally prepared nurses for director-level positions, and the degree can make you more competitive in a tight job market even if the starting salary looks similar.
Nursing Roles Ranked by Median Pay
- Certified Registered Nurse Anesthetist: $223,210 per year
- Nurse Practitioner: $129,210 per year
- Certified Nurse Midwife: $128,790 per year
- Registered Nurse: $93,600 per year
- Licensed Practical/Vocational Nurse: $62,340 per year
- Nursing Assistant: $39,430 per year
All figures reflect May 2024 data from the Bureau of Labor Statistics. Actual earnings vary by employer, geographic location, years of experience, certifications, and willingness to work nights, weekends, or travel contracts. The nurses who earn the most generally combine advanced education with a high-demand specialty and strategic choices about where and how they work.