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What Type of Nurse Makes the Most Money?

Updated On 22 Minute Read

In most cases, a certified registered nurse anesthetist (CRNA) is the highest-paid clinical nursing role. Roles like nurse practitioner (NP) and certified nurse-midwife (CNM) also rank near the top, especially in high-paying states, metro areas, and specialty settings.  

That said, nurse leadership roles (like chief nursing officer) can earn more than bedside and APRN roles in some organizations, because compensation may include bonuses and is strongly tied to the size and complexity of the health system. 

Salary disclaimer and methodology  

Nursing pay varies widely by location, experience, shift differentials, union contracts, staffing model, and setting (hospital vs. ambulatory vs. government). “Typical pay” in this guide reflects either (1) Bureau of Labor Statistics (BLS) national median wages for roles the BLS tracks, or (2) national averages from Salary.com for roles/specialties not tracked as a separate BLS occupation. 

If you show hourly conversions for annual salaries, a common approach is the following: 

Annual salary ÷ 2,080 hours (40 hours per week × 52 weeks) 

Chief nursing officer (CNO) 

At a glance 

  • Typical pay (U.S.): $244,290/year average
  • Education: BSN is required; however, many have advanced degrees, such as MSN, MHA, MBA, and DNP.
  • Experience: Significant leadership/operations background.
  • Helpful credential: Nurse Executive Board Certified certification (NE-BC)
  • Common settings: Hospitals, health systems, large ambulatory networks. 

What CNOs do 

CNOs oversee nursing practice and operations across a facility or system. That can include staffing strategy, quality and safety outcomes, nursing professional development, budgets, regulatory readiness, workforce retention, and coordination with medical staff and executive leadership. In many organizations, CNO is the key leader accountable for nursing-sensitive metrics (falls, pressure injuries, CAUTI/CLABSI performance), patient experience, and clinical excellence initiatives. 

Why this role can pay more 

CNOs carry enterprise-level responsibility for staffing, compliance, and patient outcomes, plus oversight of very large budgets and teams. Compensation reflects scope (number of beds, service lines, sites), complexity (trauma centers, academic medical centers), and performance expectations. 

Education and requirements 

Most CNOs progress through unit/department leadership roles (charge, manager, director) and build operations experience. Many pursue graduate education in leadership/administration. A common optional credential is the American Nurses Credentialing Center’s (ANCC)  Nurse Executive Board Certified certification (NE-BC).  

What most effects pay 

Health system size, span of control (single hospital vs multi-site), region, and whether the role includes additional executive responsibilities (e.g., service line leadership) are major drivers. 

Certified registered nurse anesthetist (CRNA) 

Typical pay (U.S.): $240,180/year average 
Why it pays more: CRNAs provide anesthesia and advanced perioperative care, requiring high acuity, high responsibility, and specialized graduate education. 

What they do (real-world view): 

  • Perform pre-anesthesia assessments, risk screening, and airway planning.
  • Administer anesthesia (general/regional/sedation), manage pain control, and respond to intraoperative emergencies.
  • Monitor hemodynamics and recovery needs alongside the surgical/anesthesia team. 

Education and requirements (typical path): 

  • RN license + BSN (or equivalent).
  • Critical care experience is commonly expected.
  • Graduate nurse anesthesia program + APRN licensure/certification requirements. 

Common workplaces: 

  • Hospitals and health systems (OR, labor & delivery, procedural areas).
  • Ambulatory surgery centers and specialty surgical sites. 

Helpful certifications/credentials: 

  • CRNA certification and licensure requirements vary by state and employer, and national certification is part of the pathway. 

Nursing manager 

At a glance 

  • Typical pay (U.S.): $135,926/year average
  • Education: BSN is often required, but an MSN is preferred.
  • Experience: Several years bedside + leadership.
  • Common settings: Hospitals, specialty units, procedural areas.
  • Core focus: Staffing, outcomes, culture, budgets. 

What nursing managers do 

Nurse managers run day-to-day unit operations — staffing, patient flow, quality metrics, coaching, performance management, scheduling, and collaboration with physicians and interdisciplinary teams. In practice, a strong manager balances clinical priorities (safe care) with operational realities (coverage, retention, throughput), while still building a healthy team culture. 

Why this role can pay more 

Pay increases with unit complexity (ICU/ED/OR), staffing challenges, and accountability for unit outcomes. Managers who oversee multiple units or large teams typically earn more. 

Education and requirements 

Most nurse managers advance from charge roles after developing clinical expertise and leadership skills. Many employers prefer formal leadership training or graduate education for competitive postings. 

Helpful credentials 

Optional leadership credentials (and training in quality improvement, budgeting, and change management) can strengthen candidacy. 

What most effects pay 

Unit type, shift/on-call structure, hospital size, and turnover/recruitment pressure. 

Nurse practitioner (NP) 

Typical pay (U.S.): $116,780/year average 
Why it pays more: NPs diagnose, treat, and prescribe (scope varies by state), often with significant autonomy and specialty expertise. 

Where NPs tend to earn more: 

  • High-demand specialties (psych, acute care, NICU, surgical subspecialties).
  • Underserved areas offering recruitment incentives.
  • States/markets with strong reimbursement and high cost of living. 

Common NP specialties to consider (high demand + strong earning potential): 

  • Family NP (FNP)
  • Adult-gerontology acute care NP (AG-ACNP)
  • Psychiatric mental health NP (PMHNP)
  • Neonatal NP (NNP)
  • Women’s health NP (WHNP) 
      (BLS reports one national median for “nurse practitioners,” so specialty pay may vary around that benchmark.) 

Work settings: 

  • Primary care, urgent care, specialty clinics
  • Hospitals (especially acute care roles)
  • Community health, telehealth, occupational health 

Nurse midwife 

At a glance 

  • Typical pay (U.S.): $113,710/year average
  • Education: MSN or DNP (nurse-midwifery)
  • Licensure: RN + APRN (state-dependent)
  • Credential: Certified nurse midwife (CNM) 
  • Common settings: Hospitals, birth centers, OB/GYN practices, community clinics 

What nurse midwives do 

Nurse midwives provide full-spectrum pregnancy care, prenatal visits, labor and delivery support, postpartum care, plus a wide range of gynecologic and preventive services (contraception counseling, STI screening, routine pelvic exams, perimenopause support). Depending on the setting and state laws, they may prescribe medications, order tests, and manage low-risk pregnancies independently, while collaborating closely with OB/GYNs and maternal-fetal medicine for higher-risk cases. 

Why this role can pay more 

CNMs are advanced practice clinicians with specialized training in women’s health and maternity care. Compensation tends to be higher in organizations where CNMs manage patient panels, take calls, support higher delivery volumes, or fill hard-to-staff coverage needs. 

Education and requirements 

Most CNMs complete an accredited nurse-midwifery graduate program (MSN/DNP), maintain RN licensure, and obtain national certification through the American Midwifery Certification Board (AMCB).  

What most effects pay 

Call requirements, delivery volume, hospital vs. clinic employment, region, and whether the role includes additional women’s health services (e.g., full-scope GYN care) commonly influence compensation. 

Orthopedic nurse 

At a glance 

What orthopedic nurses do 

Ortho nurses care for patients with fractures, joint replacements, spine procedures, and mobility-limiting conditions. They manage post-op assessments, neurovascular checks, pain control, anticoagulation education, mobility and fall prevention planning, wound care, and coordination with PT/OT for safe discharge. 

Why this role can pay more 

In some markets, high-volume joint replacement and spine programs can create demand for experienced ortho nurses. Pay can rise with procedural complexity, leadership, or specialized outpatient roles. 

Education and requirements 

Ortho nurses typically build expertise in post-op care, mobility safety, and patient education. Outpatient ortho roles often value strong triage and care coordination skills. 

Helpful certifications 

The ONC credential is offered by the Orthopedic Nurses Certification Board (ONCB). 

What most effects pay 

Setting (hospital vs outpatient), program volume, and regional demand. 

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Neonatal intensive care unit (NICU) nurse 

At a glance 

  • Typical pay (U.S.): $120,605/year average
  • Education: ADN/BSN, but a BSN is often preferred.
  • Licensure: RN
  • Helpful credential: RNC-NIC (NCC)
  • Common settings: Level II–IV NICUs, children’s hospitals, perinatal centers 

What NICU nurses do 

NICU nurses care for premature and critically ill newborns who may need respiratory support, IV nutrition, medication drips, thermoregulation, and continuous monitoring. They support feeding plans, developmental care, family education, and rapid response to changes in a fragile patient population. Communication with neonatologists and respiratory therapy is constant, and parents often need intensive emotional support and teaching. 

Why this role can pay more 

High-acuity and specialized neonatal skills can drive higher compensation, especially in Level III/IV NICUs and children’s hospitals with complex cases. 

Education and requirements 

Many nurses enter NICU via residency programs or after gaining med-surg/peds experience. Units typically provide extensive onboarding because the learning curve is steep. 

Helpful certifications 

A common specialty credential is RNC-NIC through the National Certification Corporation (NCC). 

What most effects pay 

NICU level (acuity), hospital type, region, and specialty differential policies. 

Nurse informaticist (informatics nurse) 

At a glance 

What informatics nurses do 

Informatics nurses sit at the intersection of patient care and technology. They help design and optimize the EHR, create safer workflows, develop clinical documentation standards, build order sets, support go-lives and upgrades, and translate frontline needs into system improvements. Many also work with data dashboards and quality reporting to improve outcomes and reduce documentation burden. 

Why this role can pay more 

Pay tends to rise when the role includes complex implementations, system-wide EHR ownership, analytics/quality impact, or leadership responsibilities (team lead, project manager). Organizations may pay more for nurses who can reduce downtime, improve clinician adoption, and prevent documentation-related safety issues. 

Education and requirements 

RNs usually enter after gaining clinical experience (often two to five years), then transition into informatics via internal projects, super-user roles, or formal informatics education. 

Helpful certifications 

The ANCC’s Nursing Informatics Certification (NI-BC) is a widely recognized credential for informatics nurses.  

What most effects pay 

System size, scope of EHR responsibility, project complexity, and whether the role is clinical, analyst, or leadership-level. 

RN first assistant (RNFA) 

At a glance 

What RNFAs do 

RN first assistants work in an expanded perioperative role, directly assisting the surgeon during procedures. Duties may include tissue handling, exposure, hemostasis, suturing, and wound management, plus patient advocacy and safety checks. The RNFA role differs from circulating/scrub roles because it focuses on surgical assisting during the intraoperative phase. 

Why this role can pay more 

The RNFA skill set is specialized, procedure-specific, and requires advanced perioperative competence. Compensation often increases when RNFAs support high-complexity surgical cases or fill coverage gaps in busy OR environments. 

Education and requirements 

Most RNFAs are experienced perioperative RNs who complete formal RNFA education aligned with AORN standards and facility privileging processes. A common national credential is the CRNFA, administered by the National Assistant at Surgery Certification (NASC). (Association of periOperative Registered Nurses notes the credentialing body change to NASC.) 

What most effects pay 

Surgical specialty, case complexity, call schedules, and employer privileging structure. 

Nurse researcher 

At a glance 

  • Typical pay (U.S.): $99,764/year average
  • Education: MSN is most common; however, many have PhDs or DNPs.
  • Licensure: RN
  • Helpful credentials: Research coordinator credentials (e.g., CCRC) 
  • Common settings: Universities, academic medical centers, research institutes 

What nurse researchers do 

Nurse researchers design and lead studies that improve patient care and nursing practice. Work can include developing protocols, managing IRB processes, collecting/analyzing data, publishing findings, and translating results into evidence-based practice changes. In health systems, nurse researchers often partner with quality teams to evaluate clinical initiatives and improve outcomes through rigorous methods. 

Why this role can pay more 

Pay increases with advanced degrees, grant funding responsibilities, publication history, leadership of multi-site projects, and work in high-resource academic medical centers. 

Education and requirements 

While some roles are hired at the MSN level (especially project-based roles), many nurse researcher positions prefer or require doctoral preparation for independent research leadership. 

Helpful certifications 

For nurses working closely with clinical trials operations, certifications such as Certified Clinical Research Coordinator (CCRC) through the Association of Clinical Research Professionals (ACRP) can strengthen research credibility and career options.  

What most effects pay 

Academic rank, grant funding, research scope, specialty area, and employer type (university vs health system). 

Flight nurse 

At a glance 

  • Typical pay (U.S.): $94,830/year average
  • Education: ADN/BSN, but a BSN is often preferred.
  • Experience: Strong critical care/ED background
  • Helpful credential: Certified flight registered nurse (CFRN)
  • Common settings: Air medical transport programs, critical care transport teams 

What flight nurses do 

Flight nurses provide high-acuity care during helicopter or fixed-wing transport. They manage ventilators, vasoactive drips, trauma stabilization, and rapid clinical decision-making in limited-space environments with fewer immediate resources. They work closely with paramedics/RTs and receiving teams to ensure safe transfer. 

Why this role can pay more 

The role requires strong critical care expertise, fast decision-making, and comfort in high-risk environments. Pay may increase with additional responsibilities (education, safety roles), specialized transport programs, or coverage for difficult schedules. 

Education and requirements 

Flight programs often prefer several years of ICU/ED experience. Many require or strongly prefer advanced certifications and excellent clinical competency. 

Helpful certifications 

The CFRN credential through the Board of Certification for Emergency Nursing (BCEN) is a common specialty certification for flight/transport nurses. 

What most effects pay 

Employer type, schedule (on-call/24-hour shifts), region, and transport volume/acuity. 

Clinical research nurse 

At a glance 

What clinical research nurses do 

Clinical research nurses coordinate and deliver care for patients enrolled in clinical trials. They educate patients on trial protocols, administer study medications, monitor for adverse events, ensure protocol adherence, coordinate visits and lab schedules, and collaborate with investigators and sponsors. This role demands strong clinical judgment and meticulous documentation. 

Why this role can pay more 

Pay tends to rise in high-complexity trial environments (oncology, cardiology, neurology), sites with heavy sponsor activity, and roles that include regulatory responsibilities, study startup work, or leadership over multiple protocols. 

Education and requirements 

Strong bedside skills plus a detail-oriented mindset matter. Many nurses transition into research after experience in the same specialty they’ll support (e.g., ICU → critical care trials, oncology unit → cancer trials). 

Helpful certifications 

Credentials like CCRC through the ACRP can help validate research knowledge and support career progression into senior coordinator or research leadership roles. 

What most effects pay 

Therapeutic area, trial complexity, site volume, and whether the job includes regulatory/startup duties. 

Nursing administrator 

At a glance 

  • Typical pay (U.S.): $138,318/year average
  • Education: BSN is required; however, many have an MSN, MHA, or MBA.
  • Experience: Leadership and operations
  • Common settings: Hospitals, long-term care, rehab, ambulatory systems
  • Work style: Leadership + staffing + compliance + budgeting 

What nursing administrators do 

Nursing administrators coordinate operations for nursing units or service lines. That typically includes staffing plans, scheduling oversight, policy implementation, regulatory readiness, workflow improvement, and team performance management. They may also partner with HR, finance, infection prevention, and quality departments to meet organizational goals and maintain safe staffing. 

Why this role can pay more 

Administrator roles pay more when they oversee multiple units, manage large staffing budgets, or work in complex environments with high compliance demands (e.g., acute care hospitals, multi-site organizations). 

Education and requirements 

Most start as RNs, build bedside credibility, then move into charge and management roles before stepping into broader administration. Graduate education in leadership/management is common and often preferred for advancement. 

Helpful credentials 

Leadership certifications and professional development in budgeting, quality improvement, and workforce management are commonly valued, especially in larger systems. 

What most effects pay 

Organization size, number of departments overseen, on-call expectations, and regional labor market pressures. 

ICU nurse 

At a glance 

What ICU nurses do 

ICU nurses manage the most medically complex patients — ventilators, titratable drips, invasive monitoring, sedation/analgesia, CRRT support in some units, and rapid response to instability. ICU nursing is both technical and relational: nurses support families through high-stress decisions while coordinating closely with intensivists and interdisciplinary teams. 

Why this role can pay more 

The ICU requires advanced clinical judgment and constant assessment. Pay can increase with specialty ICUs, night differentials, charge roles, and high-acuity assignments. 

Education and requirements 

ICU nurses often enter via residency programs or transfer from step-down after gaining rhythm recognition and hemodynamic knowledge. 

Helpful certifications 

The CCRN credential from the American Association of Critical-Care Nurses (AACN) is a common certification for experienced critical care RNs. 

What most effects pay 

Unit type, shift differential, staffing ratios, and local demand. 

Operating room (OR) nurse 

At a glance 

What OR nurses do 

OR nurses coordinate safe surgical care, acting as circulators and/or scrub nurses depending on training and facility policy. They manage sterile field integrity, surgical counts, specimen handling, documentation, patient positioning, equipment readiness, and communication across the surgical team. Strong anticipation skills and calm under pressure matter. 

Why this role can pay more 

Pay can rise with specialty ORs (cardiac, neuro, trauma), call requirements, and facilities with high case volumes. Perioperative roles may also pay more when staffing shortages are severe. 

Education and requirements 

Many OR nurses complete perioperative training programs or residencies and build expertise in a specific service line. 

Helpful certifications 

The CNOR credential through the Competency & Credentialing Institute (CCI) is a widely recognized perioperative nursing certification. 

What most effects pay 

Call burden, surgical specialty, facility type, and region. 

Nurse case manager 

At a glance 

  • Typical pay (U.S.): $94,013/year average
  • Education: ADN/BSN; BSN often preferred
  • Licensure: RN
  • Helpful credential: Certified case manager (CCM)
  • Common settings: Hospitals, insurers, outpatient specialty programs, home health 

What nurse case managers do 

Case managers coordinate care across settings, assessing patient needs, arranging services, reducing barriers to discharge, facilitating referrals, and supporting safe transitions (hospital → home/SNF/rehab). In insurance or managed care, case managers focus on care coordination, utilization management, and helping members navigate complex systems. 

Why this role can pay more 

Pay increases in complex patient populations (high-risk chronic disease, transplant, oncology), payer environments, and senior roles that manage large caseloads or oversee teams. 

Education and requirements 

Many nurses move into case management after bedside experience. Strong communication skills, interdisciplinary collaboration, and knowledge of benefits/resources are key. 

Helpful certifications 

The CCM is a widely recognized credential in case management. The Commission for Case Manager Certification (CCMC) describes it as a major credential for case managers. 

What most effects pay 

Payer vs. hospital employer, caseload complexity, region, and whether the role includes utilization management responsibilities. 

Utilization review nurse 

At a glance 

  • Typical pay (U.S.): $90,319/year average
  • Education: ADN/BSN, but a BSN is often preferred.
  • Licensure: RN
  • Common settings: Hospitals, insurers, managed care organizations
  • Work style: Documentation review + medical necessity + coordination 

What utilization review nurses do 

Utilization review (UR) nurses evaluate clinical documentation to support medical necessity, appropriate level of care, and payer requirements. They collaborate with providers and case management to prevent denials, support safe discharge planning, and ensure patients receive care in the right setting at the right time. 

Why this role can pay more 

UR nurses reduce costly denials and help organizations meet compliance and payer requirements, an area with direct financial impact. Pay can increase in roles that span complex service lines (ICU, behavioral health), include denial appeals, or require deep payer policy expertise. 

Education and requirements 

UR roles often prefer experience in acute care, strong documentation knowledge, and comfort communicating with physicians and payers. 

Helpful credentials 

Case management credentials (like CCM) can be helpful when UR work overlaps heavily with care coordination responsibilities. 

What most effects pay 

Employer type (payer vs. hospital), specialty complexity, and responsibility level (front-end review vs appeals). 

Nurse educator 

At a glance 

  • Typical pay (U.S.): $66,083/year average
  • Education: BSN required; MSN commonly preferred/required
  • Licensure: RN
  • Common settings: Hospitals (staff development), colleges/universities, simulation centers
  • Work focus: Teaching, onboarding, competency, professional development 

What nurse educators do 

Nurse educators teach and support nurses and students through onboarding, competency validation, continuing education, simulation training, and evidence-based practice updates. In hospitals, they may build orientation programs, run annual skills days, develop clinical ladders, and support quality initiatives through education. 

Why this role can pay more 

Educator pay increases with scope (system-wide education programs), specialty expertise (ICU/ED/OR educators), and roles that include curriculum design, leadership, or regulatory training responsibilities. 

Education and requirements 

Many educators hold an MSN (education or leadership). Academic faculty roles often require graduate degrees and may prefer doctoral preparation depending on institution. 

Helpful certifications 

Some educators pursue nursing education credentials (varies by setting) and specialty certifications aligned with their clinical focus area. 

What most effects pay 

Academic vs. hospital employer, specialty focus, and whether the role includes leadership/program management. 

Where do nurses make the most? (states, metro areas, and settings) 

These examples focus on RN wage patterns because RN state/metro comparisons are widely published and frequently searched. (APRN pay also varies by location, but role-specific metro rankings are less consistently published in one place.) 

Highest-paying states for RNs (top 5) 

Based on the BLS May 2024 RN wage data summarized by Becker’s, the top-paying states include: 

Highest-paying metro areas for RNs (examples) 

Becker’s (using the BLS May 2024 data) lists top metro areas such as: 

  • San Jose-Sunnyvale-Santa Clara, CA (~$189,880)
  • San Francisco-Oakland-Fremont, CA (~$178,450)
  • Vallejo–Fairfield, CA (~$175,620)
  • Santa Rosa-Petaluma, CA (~$171,490)
  • Sacramento-Roseville-Folsom, CA (~$163,020) 

How to increase your nursing income (practical paths that work) 

Here are realistic ways nurses commonly increase earnings, without guessing or relying on one “magic” move: 

  • Move into higher-acuity specialties (ICU, OR, NICU) where skill intensity and staffing needs often support higher base rates and differentials.
  • Add high-value certifications tied to your specialty (and negotiate using your new scope).
  • Leverage differentials strategically: nights, weekends, charge pay, on-call, and overtime can add up quickly (but watch burnout).
  • Consider travel or per diem for flexibility and higher short-term rates, especially when demand spikes. Vivian, for example, has published pay analyses based on job postings in travel/staff markets.
  • Advance your education into APRN roles (NP, CNM, CRNA) for the largest “step change” in earning potential in clinical practice.
  • Explore leadership tracks (manager → director → executive) if you enjoy systems work, operations, and people leadership.
  • Negotiate smarter: bring market data, highlight outcomes, ask about sign-on bonuses, tuition support, and clinical ladder programs. 

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