I scored all 50 states plus Washington, D.C. on seven things that matter to nurses, not just pay. The worst state for nurses was not close. Alabama came in last on almost every single one.
Staff RN · Map My Pay Co-Founder · September 28, 2026
A friend of ours moved to California from Alabama as a travel nurse with her husband. They were living like a king and queen out here. Then she started telling me about the wages back home, and I wanted to see exactly how big the gap really was. So I pulled the numbers on every state.
Most people who talk about the best and worst states for nurses only look at pay. I talk about pay all the time too. But there are other things that decide whether a nursing job is good or bad, and when you add them up, one state sits at the bottom by a mile. If you are thinking about where to work next, this is the one to understand first.
The seven things I scored, and why Alabama is the worst state for nurses
Before I get to the money, here is a quick side by side. This is Alabama against California on all seven things at a glance.
| What I scored | Alabama | California |
|---|---|---|
| Average nurse pay | $62,200 a year | $128,960 a year |
| Kept each month after taxes and rent | $2,740 | $5,360 (state average) |
| Paid sick leave | None | 1 hour for every 30 worked |
| Paid leave for a new baby | None | Up to 52 weeks in total |
| Limit on patients per nurse | None | Yes, by unit |
| Expanded Medicaid | No | Yes |
| Rural hospitals losing money | 67.6% | Far lower |
Alabama has the lowest nurse pay, the second lowest money left after taxes and rent, no paid sick leave, no paid baby leave, no cap on patients, no expanded Medicaid, and the second most hospitals losing money. One caveat before you write it off completely: Alabama is a compact license state, which matters if you want to travel. I get to that at the end.
What a nurse in Alabama actually makes
From all the pay data we have collected, a nurse in Alabama makes about $62,200 a year. That is across every city in the state. But what you earn does not matter much if most of it goes to taxes and rent before you ever see it.
At the top of the pay list you have California, which pays nurses about $128,960 a year. I already know what a lot of you are thinking, because you would expect a place this expensive to eat every extra dollar and then some. That is fair to assume. It is also not what the numbers show once you actually run them.
Here is where every state lands on nurse pay. First the ten states that pay the most, then the ten that pay the least, with Alabama sitting dead last.
| Rank | State | Median nurse pay |
|---|---|---|
| 1 | California | $128,960 |
| 2 | Hawaii | $122,740 |
| 3 | Alaska | $105,070 |
| 4 | Oregon | $101,330 |
| 5 | Washington | $98,265 |
| 6 | Connecticut | $95,590 |
| 7 | Nevada | $90,530 |
| 8 | Massachusetts | $90,280 |
| 9 | New Jersey | $85,865 |
| 10 | Washington, DC | $85,760 |
And the ten states with the lowest nurse pay:
| Rank | State | Median nurse pay |
|---|---|---|
| 1 | Alabama | $62,200 |
| 2 | South Dakota | $62,865 |
| 3 | Missouri | $63,520 |
| 4 | Mississippi | $64,180 |
| 5 | Iowa | $64,215 |
| 6 | Tennessee | $65,020 |
| 7 | Kansas | $65,155 |
| 8 | Indiana | $66,500 |
| 9 | West Virginia | $66,930 |
| 10 | Arkansas | $67,860 |
Monica and I both work per diem in California, where I earn $145 an hour and Monica earns $149 an hour. After all our taxes, which run closer to 30 to 35 percent and not the 50 percent people assume, we are still left with about $80 to $90 an hour. That is our take-home. Most states do not pay their nurses that much before taxes.
What is left after taxes and rent
This is the number that decides your life, so this is the one I scored on. Rent and taxes are the two biggest bills for most nurses, so I took the pay, took out state and federal income tax, took out rent, and looked at what was left.
A nurse in Alabama is left with about $2,740 a month. That is the second lowest in the entire country. A nurse in Sacramento is left with about $6,048 a month after income taxes and rent. That is more than double what the Alabama nurse is left with, even though California costs more to live in.
When you look at the whole map, here are the ten states that leave a nurse with the most money each month, and the ten that leave the least.
| Rank | State | Money left each month |
|---|---|---|
| 1 | California | $5,360 |
| 2 | Alaska | $5,090 |
| 3 | Oregon | $4,394 |
| 4 | Washington | $4,220 |
| 5 | Connecticut | $4,188 |
| 6 | Wyoming | $4,152 |
| 7 | Hawaii | $4,082 |
| 8 | Nevada | $4,066 |
| 9 | Ohio | $3,942 |
| 10 | Wisconsin | $3,880 |
And here are the ten states at the bottom. This is where a nurse keeps the least after taxes and rent, with Alabama sitting second from the very bottom.
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| Rank | State | Money left each month |
|---|---|---|
| 1 | Vermont | $2,689 |
| 2 | Alabama | $2,740 |
| 3 | Florida | $2,912 |
| 4 | Washington, DC | $2,918 |
| 5 | Tennessee | $2,951 |
| 6 | South Carolina | $3,014 |
| 7 | Mississippi | $3,038 |
| 8 | Missouri | $3,110 |
| 9 | New Hampshire | $3,185 |
| 10 | South Dakota | $3,188 |
New York surprises people by not making this list. It is one of the higher paying states, but once you take out the cost of living, a New York nurse is left with much less than many states you would never expect to beat it. You can look through the numbers yourself. We have the rent prices, the home prices, and the median salaries in the app, so you can run it for your own city.
See what your city leaves you after taxes, rent, and your own monthly bills across more than 21,000 cities.
Check your take-home payIt is not only about the state either. Some cities pay far above their state average, so I also pulled the ten cities that leave a nurse with the most money at the end of the month. Every single one of them is in California. Oakland lands at number one. This is also why we put crime rate in the app, because a high paycheck does not help you if you do not make it home safe.
Here are those ten cities, and every one of them is in California:
| Rank | City | Money left each month |
|---|---|---|
| 1 | Oakland, CA | $7,544 |
| 2 | Hayward, CA | $7,344 |
| 3 | Vallejo, CA | $7,241 |
| 4 | Fairfield, CA | $6,974 |
| 5 | Watsonville, CA | $6,634 |
| 6 | Santa Rosa, CA | $6,495 |
| 7 | San Francisco, CA | $6,454 |
| 8 | Santa Cruz, CA | $6,389 |
| 9 | San Jose, CA | $6,342 |
| 10 | Redding, CA | $6,309 |
On the other end, the ten worst cities include three in Florida and one surprise from California: Santa Barbara. A nurse there earns around $130,000, but renting or owning is nearly impossible on that pay, so the money never turns into a life. High pay and high cost do not line up there, and that is the whole point of looking past the salary number. For a fuller walk-through, see our guide to nurse take-home pay by city.
Here are the ten worst cities for money left at the end of the month:
| Rank | City | Money left each month |
|---|---|---|
| 1 | Marco Island, FL | -$1,891 |
| 2 | Naples, FL | -$341 |
| 3 | Hilton Head, SC | $1,271 |
| 4 | Williamsport, PA | $1,579 |
| 5 | Punta Gorda, FL | $1,834 |
| 6 | Scottsdale, AZ | $1,857 |
| 7 | Bluffton, SC | $2,021 |
| 8 | Charleston, SC | $2,090 |
| 9 | Santa Barbara, CA | $2,155 |
| 10 | Fairhope, AL | $2,173 |
Money left each month is the median nurse take-home after taxes and typical rent, across 556 cities. A negative number means typical rent and taxes there cost more than a nurse's take-home, so a median nurse cannot cover a typical rent on one salary.
Sick days, baby leave, and overtime
Now the parts of the job that never show up on a paycheck but change your whole year. Start with paid sick days. In Alabama you get none. Zero. What makes it worse is that the state also blocks its own cities from passing sick-pay laws for their residents.
Here is what that looks like in practice. Monica and I are both per diem. Last year Monica worked under a thousand hours, and she still accrued over 32 hours of paid sick leave, because California gives you one paid hour of sick leave for every 30 hours you work. If she had worked those same hours in Alabama, she would have earned zero paid sick hours. Nothing.
Paid leave for a new baby tells the same story. In California a new mom can take four weeks before the due date, eight to ten weeks after delivery whether it was vaginal or a C-section, and then another eight weeks of baby bonding. Add in pregnancy-related conditions and it can reach up to 52 weeks in total. In Alabama you get no maternal or parental leave at all. Nothing for the mom, nothing for the dad. The only thing you get is federally protected FMLA, which is up to 12 weeks of unpaid time off. There is one narrow exception, where public school and some public employees get up to eight weeks paid for moms and two weeks for dads. Compare that to countries like Sweden and Denmark that offer a full year of paid leave, and it is hard to feel good about eight weeks for a lucky few.
Overtime is another gap. In Alabama you only earn overtime after 40 hours in a week, and there is no such thing as double time. In California you earn overtime once you pass eight hours in a single day, double time after the twelfth hour, and if you work seven days in a row, the seventh day pays double time for the entire shift.
A limit on patients per nurse
This one affects your license and your sanity. In Alabama there is no limit on how many patients a nurse can be handed. In California there is a cap by unit: no more than five patients on med-surg, four on tele, three on stepdown, two in the ICU, and no more than four in the ER.
Alabama is not alone here. Most states have no ratio law. Oregon recently passed one that matches or slightly beats California. Massachusetts and New York have limits only in the ICU, and they are not enforced as tightly as California enforces its own. But the takeaway holds: in Alabama, the number of patients you carry has no ceiling.
Why the worst state for nurses also loses the most hospitals
Coverage for low-income patients sounds like a policy detail until you connect it to your job. Alabama is one of ten states that never expanded Medicaid. That means more uninsured patients walk into the hospital, the hospital does not get paid for that care, and over time that leads to closures and worse shortages. When a hospital runs short, you do a lot more with a lot less.
The small-town hospitals feel it first. 67.6% of Alabama's rural hospitals are losing money every single day, and only one state is worse, which is Kansas. Zoom out and the pattern is clear: in states that expanded Medicaid, rural hospitals lose money at about 34%, and in states that did not, that number jumps to about 52%.
If the hospital is losing money, it cannot hire nurses. If it cannot hire nurses, you are short staffed, and you might be the one who ends up out of a job when it closes. That is why I score hospital finances. It is not an abstract number, it is your schedule and your paycheck. If you want the money side of a move, start with our state-by-state take-home breakdown.
Compare any two cities side by side, including pay, taxes, rent, and crime, before you sign anything.
Compare cities nowThe one thing Alabama got right
I am not here to pile on for the sake of it, so credit where it is due. In January of 2020, Alabama joined the Nurse Licensure Compact. That means one license lets you work in most other compact states without applying all over again. If your plan is to travel or to keep your options open, that compact license is a serious advantage, and it is worth weighing against everything else on this list.
So where does that leave the worst state for nurses. Alabama scored last on pay, near last on money kept, and dead last on almost every protection that makes the work livable. The one bright spot, the compact license, is a door out, not a reason to stay.
A nurse in California is left with more than double what an Alabama nurse is left with, and that is after you factor in income taxes and rent. The state you work in decides how much of your paycheck, your time off, and your peace of mind you actually get to keep, and right now Alabama leaves a nurse with the least of all three.
Before you take a job in any state, see what you would actually keep there every month.
Run your city on Map My PaySources and notes: Pay, take-home, rent, and cost-of-living figures are from the Map My Pay database (2026). Paid sick leave, paid family leave, and overtime rules reflect California and Alabama state statutes. Nurse-to-patient ratios reflect California AB 394 and Oregon's 2023 hospital staffing law. Medicaid expansion status is from the KFF expansion tracker. Rural hospital financial figures are from UNC Sheps Center and related rural health reporting. Nurse Licensure Compact status is from the compact commission. This article is for general information and is not financial, legal, or career advice. Your own numbers will vary by employer, shift, experience, and household.