By Sam Becker

A career in nursing can be lucrative—although that may not have always been the case. While the COVID-19 pandemic truly did a number on the health care system at large, nurses saw many of their colleagues move on to other jobs or lines of work and that provided them with one key benefit: higher pay.

A labor shortage, paired with employers in the health care industry beefing up their collective hiring incentives, has put nurses at an advantage in the labor market. Registered nurses (RNs) in the U.S. earned a median annual wage of $77,600 as of May 2021, the most-recent data available from the Bureau of Labor Statistics. And the highest earning RNs earn more than $120,000 each year.

But some nurses are pulling in significantly more. In fact, nurses in various advanced practices—such as nurse midwives, nurse anesthetists, and nurse practitioners—earn an average of nearly $124,000 per year, government figures show. And the 2021 nursing trends and salary survey, found that 39% of the more than 4,500 nurses surveyed earned between $80,000 and $139,000 per year.

Even in what’s proving to be a lucrative field in the current labor market, nurses who earn the most typically have advanced degrees, specialize in in-demand practices, and are looking for work in areas that are in dire need of more nurses. Nurses who bounced from hospital to hospital, or city to city, were among the highest earners over the past couple of years.

“We’ve seen a big bump in nurses’ compensation. Our students who were doing travel nursing were telling us that they’re making big money. They were able to pay their tuition while working and attending school,” says Susan Stone, president of Frontier Nursing University, which has a physical campus in Versailles, Ky., but offers digital nursing school programs to students around the country.

With all of this in mind, there are ways that nurses, or prospective nurses, can find high-paying positions—if they play their cards right. Here are some steps to consider if you’re hoping to land a high-earning nursing position.

1. Get an advanced degree (like an MSN)

As mentioned, there’s a big pay discrepancy between registered nurses and nurses working in advanced practice. As such, getting credentialed by earning an advanced nursing degree, like a master of science in nursing (MSN) degree, can give you an edge in salary negotiations. Considering the current supply shortage of nurses, it also may be worth thinking about how an advanced degree could give you an advantage over other, less-credentialed nurses—especially because hospitals may need to find ways to cut costs in the future given these pay increases.

“The increasing cost of nurses will mark an inflection point where hospitals and physicians increasingly adopt more digital technologies to help monitor—with nurse and physician oversight—patients who are increasingly likely to be treated outside the hospital,” says Jason Shafrin, a senior managing director at FTI Consulting in the Center for Healthcare Economics and Policy, and the founder and editor of Healthcare Economist. “Routine nursing care that follows highly standardized, prescribed procedures could be increasingly conducted by machines.”

A more advanced skill set, which can’t easily be automated, may prove to be worth more in the labor market in coming years.

2. Choose an in-demand practice

Not all nurses are the same, and neither are nursing concentrations. The scarcity of nurses working in advanced practices should translate to increased bargaining power.

And not only can the salary be higher for nurses with specialized skills—of which there are many—but so can the incentives to sign with the right employer. Some nurses are fielding signing bonuses up to $40,000, though such incentives are “unsustainable,” says Tiffany McDowell, the principal of people advisory services at Ernst & Young. Rather, the longer-term bargaining power is going to come from simple supply and demand.

“The nursing population last year had low turnover—less than 10%, but this year, it was more than 40%. It was unprecedented, McDowell says. Skilled nurses are at an advantage in the current economic climate, and if they want to boost their pay, this is the time to do it. “The number one thing they’re leaving is for compensation,” she adds.

3. Play the field

Nurses who are truly hoping to maximize their earning potential need to be open and available to different opportunities, especially if that means leaving their current employer, and potentially their current city or state. Registered nurses in South Dakota earn an average salary of around $60,000, for instance, while those in the same roles in California can earn more than double that amount, BLS data shows.

Shopping around for a better offer is likely the only way to ensure nurses can increase their earnings, rather than waiting for an employer—that may already be cash-strapped—to give them a raise.

Add in a sign-on bonus, and it’s possible that some nurses could significantly increase their salaries by job-hopping. McDowell warns, though, that the current labor market won’t last forever. As hospitals become increasingly budget-constrained, they will look to technology or other ways to save money. “Hospitals are mostly nonprofit,” she says. “They’re a low-margin business. They’re not Google or Facebook,” in terms of the salaries they can offer nurses.

One other avenue that nurses may find worthy of exploration: Starting their own practice.

Frontier Nursing University is very involved with nurses in rural areas who go on to start their own practices (which could take the form of independent clinics offering primary care to patients), either out of necessity or because they want to call the shots, according to Stone. “They want to run their own clinics and be able to make their own decisions,” she says, adding that for those nurses who are entrepreneurial, average earnings are around $100,000.

No matter the route, it’s important for prospective nurses to consider how passionate you are about the field, because as a career, nursing can become much more than a full-time job, regardless of earnings, Stone says.

“You’re going to need to put in a minimum of 40 hours per week,” she says of most nursing positions. “But in the end, you’ll be able to make a real change in your community.”