Staff RN · Map My Pay Co-Founder · September 29, 2026
Most nurses assume years are years. Five years is five years, and a county that wants experienced staff will pay for all of them. Madison County's contract with the New York State Nurses Association does not work that way. It sorts your experience into two columns, weighs one column at double the other, and adds up the points. The total sets your hire step, and the hire step sets every raise you get after it.
That makes the points table the most useful page in the whole agreement for a nurse who has not signed yet. A hospital nurse cannot change where she worked, but she can change how those years are described, which roles she lists, and who she asks before she accepts the offer. Madison County public health nurse pay rewards the nurse who does that work.
| At a glance | Madison County RN, 2026 |
|---|---|
| Lowest hire step | Step 1, $37.03 an hour, $77,022 a year |
| Highest hire step | Step 5, $40.28 an hour, $83,782 a year |
| Five hospital years | 3 points, Step 3, $80,142 |
| Five public health years | 6 points, Step 4, $81,744 |
| Experience that counts | Only the last seven years, and only beyond the title minimum |
| Who decides | The Public Health Director, subject to the County HR Director |
| Full-time week | 40 hours, weekdays, no night shift in the Health Department |
What does Madison County pay a nurse at each step?
A Registered Nurse at the county Health Department earns between $77,022 and $83,782 a year in her first year, depending on the step she is hired at. The scale runs on to Step 8 at $88,920, and four longevity rows carry it to $91,416 after 25 years of county service. Every figure here is the January 1, 2026 column of Schedule A, on a 40-hour week, so annual pay is the hourly rate times 2,080.
| Step | Hourly | Per year | Points that reach it |
|---|---|---|---|
| Step 1 | $37.03 | $77,022 | 0 points |
| Step 2 | $37.77 | $78,562 | 1 or 2 points |
| Step 3 | $38.53 | $80,142 | 3 or 4 points |
| Step 4 | $39.30 | $81,744 | 5 or 6 points |
| Step 5 | $40.28 | $83,782 | 7 points, the hire cap |
| Step 8 | $42.75 | $88,920 | Anniversaries only |
| Longevity D | $43.95 | $91,416 | 25 years of county service |
Nurses who hold a four-year nursing degree sit on a separate Public Health Nurse grade that runs about two dollars higher at every step. A Public Health Nurse at Step 4 earns $41.27 an hour, or $85,842 a year, which is $5,700 more than an RN at Step 3. Section 9.06 of the agreement upgrades an RN to that grade as soon as she shows proof of the degree, so the degree pays from the first check.
How does the county decide your starting step?
The county adds up points from two kinds of experience and matches the total to a step. The scale has five landing spots.
Section 2 of the Administration of the Hourly Regular Compensation Rate Schedule lays this out. The Public Health Director applies it, with sign-off from the County Director of Human Resources.
Both columns use the same three marks, one year, three years and five years. The points at each mark differ, and that difference is the whole story of this article.
Directly relevant experience
Nursing the county counts as directly relevant earns 2 points at one year, 4 points at three years and 6 points at five years. The contract does not define the term, and that matters. Public health department work is the clear case. Home care, community health and school nursing can count, but the director makes that call for each job on your application, so treat any of them as a maybe until you hear otherwise.
Other nursing experience
Every other nursing job earns half as much. One year is 1 point, three years is 2 points, and five or more years is 3 points. A hospital floor, a nursing home and a clinic all sit in this column unless the director moves them. Ten years on a med-surg unit scores the same 3 points as five years, because the column stops counting at the five-year mark.
The seven-year window
Only experience from the seven years before your hire date counts. Anything older earns nothing in either column. The years also have to be beyond the civil service minimum for the title you are hired into. For the Registered Nurse title, the minimum is the license, so your working years count. For the Public Health Nurse title, the county's current announcement sets the minimum at a bachelor's degree in nursing plus the New York license, and the same rule applies to the years past that. Part-time work counts in proportion to the hours, so two years at half time scores as one year.
The one-year hold
Whatever step you are hired at, you stay there for one full calendar year. After that, you move to the next step on each anniversary of your hire date. There is no catch-up move, so a nurse placed one step low at hire does not recover that step later. She carries the gap up the whole ladder.
How do you score your own experience?
You list every nursing job from the last seven years, sort each one into a column, take the points for the years in that column, and add the two columns together. The table below runs seven common histories through the rule. Two of them, five hospital years and five public health years, are the pair this whole article turns on.
| Your last seven years | Points | Hire step | 2026 pay |
|---|---|---|---|
| New grad, or all experience older than seven years | 0 | Step 1 | $77,022 |
| 5 years on a hospital floor, nothing else | 3 | Step 3 | $80,142 |
| 10 years on a hospital floor, nothing else | 3 | Step 3 | $80,142 |
| 5 years in public health or home care | 6 | Step 4 | $81,744 |
| 3 years public health, then 2 years hospital | 4 + 1 = 5 | Step 4 | $81,744 |
| 5 years public health, plus 1 year hospital | 6 + 1 = 7 | Step 5 | $83,782 |
| 3 years public health, plus 5 years hospital | 4 + 3 = 7 | Step 5 | $83,782 |
The nurse from the intro sits in the second row. Five years on a hospital floor is five years in the other column, which tops out at 3 points. Three points is Step 3, so her offer letter said $38.53 an hour and she was right to expect more. A nurse who spent those same five years at a visiting nurse service scores 6 points and starts at Step 4, $39.30. Both nurses hold the same license and bring the same five years, and they start $1,602 apart.
The mixed history is where the table gets generous. A nurse with three years at a county health department and five years in a hospital scores 4 points from the first job and 3 from the second. That is 7 in total, and 7 points is Step 5, the highest hire rate the contract allows. She starts at $40.28 an hour, $3,640 a year above the hospital-only nurse, even though the hospital-only nurse has more total years.
The two hospital-only rows together show the wall. Five years and ten years both score 3 points and both start at Step 3. Past the five-year mark, hospital time buys nothing at hire. The same question comes up on the hospital side, where Kaleida Health can place an experienced nurse anywhere from Step 1 to Step 6 under its own contract. The difference in Madison County is that the rule is a fixed table, not a range, so you can run it yourself before anyone else does.
What should you do before you apply?
Your score is set on the application, before you sit down with anyone, so the work happens in the application itself. The county's own Public Health Nurse announcement says the only exam is an evaluation of your training and experience, and it warns that vagueness will not be resolved in your favor. The hire rate comes out of that same evaluation. Four moves put the higher step within reach.
Apply for the Public Health Nurse title if you hold the degree
The Public Health Nurse grade pays about $2 an hour more than the RN grade at every step, and Madison County runs a continuous recruitment announcement for the title, so you can file at any time. The minimums are a bachelor's degree in nursing and a New York RN license. If you already hold both, applying as an RN leaves $1.86 to $2.14 an hour on the table until you file proof of the degree under Section 9.06.
List every community, home care and school nursing role from the last seven years
Write down each job with its dates, hours per week and main duties, exactly the way the announcement asks. A hospital job that included home visits, discharge follow-up calls, or a community clinic rotation is worth describing in those terms, because the director sorts roles by what they involved. A line that says "med-surg RN" goes in the other column by default. A line that says "med-surg RN, ran the unit's transitional care home visits for two years" gives the director something to weigh.
Ask the Public Health Director which of your roles count as directly relevant
The director is the person the contract names, so ask the director, not the recruiter or the HR clerk. Send the list from the step above and ask which jobs fall in which column. You want that answer before you have a start date, because the one-year hold begins the day you start and there is no second review.
Get the placement decision in writing
Ask for the step number and the hourly rate on the offer letter, along with the point total behind it. If the letter says Step 3 and your own count says Step 4, you now have a specific question to raise, and a specific section of the contract to cite. That is a very different conversation from asking for more money.
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What happens after your first year?
You move up one step on each anniversary of your hire date until you reach Step 8. After that, the scale adds four longevity rows at 10, 15, 20 and 25 years of county service. A nurse hired at Step 4 in 2026 reaches Step 8 on her fourth anniversary. A nurse hired at Step 3 gets there on her fifth, and she trails by one step the entire way.
The January raises stack on top of the step moves. Each January, the contract lifts Step 1 by 4% and rebuilds the ladder above it. A nurse who moves from Step 3 to Step 4 on her anniversary in 2027 lands on the 2027 Step 4 rate of $40.87, not the 2026 rate. Two raises, one from the step and one from the year, arrive in the same twelve months.
Two limits apply. Part-time and per diem nurses climb the same steps but stop at Step 8, because the longevity rows are for full-time nurses only. And the contract's last raise is the 2027 column. It runs to January 1, 2028, and the pay for 2028 and after will be whatever the next agreement says.
Is Madison County public health nurse pay worth the trade?
On base pay alone, no step on the RN scale reaches the national median before the 25-year row. The Bureau of Labor Statistics puts the median RN wage at $97,550 as of May 2025. Step 4 here is $81,744. Down the Thruway in Buffalo, a new grad at Erie County Medical Center starts at $42.353 an hour, or $88,094 a year on the same 40-hour week, and clears about $100,574 on nights. The county is not competing with that, and it does not pretend to.
The county pays for that gap in other ways. Health Department nurses work five 8-hour days, Monday through Friday. There is no night shift, so there is no night differential to chase. A scheduled Saturday or Sunday pays 1.5 times base under Section 9.05, which is $58.95 an hour at Step 4. The county pays 90% of the employee health premium. Section 9.02 refunds tuition at 100% for an A and 85% for a B or C, up to $5,000 a year. And the job comes with the New York State pension. A Tier 6 nurse earning between $75,000 and $100,000 contributes 4% of pay under the rates that take effect October 1, 2026. That is about $3,270 a year at Step 4, toward a benefit that pays for life.
Local rent changes how the smaller check feels. Median rent in Oneida, NY, the city next to the county offices, is $840 a month in Map My Pay's city data, or $10,080 a year. A Step 4 nurse pays about $19,224 in federal, state and payroll taxes on $81,744 and keeps $62,520. After Oneida rent, she has about $52,440 for the year, or $4,370 a month, before the pension contribution and health premium share come out. The Step 3 nurse keeps $51,399 after the same rent, so the $1,602 gross gap works out to about $1,041 a year in hand.
I priced the same move for a Buffalo nurse earlier this month. The after-rent gap between a county health department and a hospital shrinks to about $5,600 a year once taxes and local rent come out, and Madison County's numbers point the same direction. The pay cut is money you will feel every payday, and it buys your evenings, your weekends and a pension. Only you can price what the nights were costing you, and that price decides the trade.
The step you start on follows you for years
Madison County will keep hiring nurses this way through the end of this contract. The next agreement will almost certainly carry a version of the same table, because NYSNA county contracts across upstate New York use experience rules like it. The nurses who come out ahead will not be the ones with the most years. They will be the ones who knew which column their years belonged in, wrote them up that way, and asked the right person before they signed. Five years of good nursing is worth Step 4 here. The contract only pays it to the nurse who can show it.
Sources: Agreement between the County of Madison, New York and the New York State Nurses Association, January 1, 2025 to January 1, 2028, Schedule A (January 1, 2026 and January 1, 2027 columns), Administration of the Hourly Regular Compensation Rate Schedule sections 1 to 3, and sections 4.02, 8.03, 9.02, 9.05 and 9.06, with Article 18 for the term. Madison County Department of Human Resources, Civil Service announcement 500-2026, Public Health Nurse, updated August 11, 2026, and the Civil Service Employment Portal vacancy list as of September 29, 2026. New York State and Local Retirement System, Tier 6 contribution rates effective October 1, 2026. Agreement between Erie County Medical Center Corporation and NYSNA, Appendix C-6, for the Buffalo comparison. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Registered Nurses, May 2025 median. Map My Pay city data for Oneida, NY rent. Tax figures use the 2026 federal standard deduction and brackets, 2026 New York State single-filer brackets, and 7.65% FICA, for a single filer with no other income.
Disclaimer: This article is for information only and is not financial, legal or career advice. Contract rates change with each new agreement, step placement is decided by the employer under the contract, and take-home figures are estimates for a single filer. Confirm your own placement and pay with Madison County Human Resources and NYSNA before making a decision.