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When Kristopher Short accepted his first job as a nurse practitioner (NP), he expected a pay bump from his years working as a registered nurse (RN). On paper, the salary looked solid, but once Short broke it down hourly, the reality stung: His NP paycheck wasn’t that much higher than what he earned as a staff nurse.
“The salary at my first job was far below what I was expecting,” Short told Medscape Medical News. “Based on my wage from being a nurse practitioner vs being a bedside nurse, there was not that much of a disparity in pay when you broke it down by hour. If you’re wanting to become an NP, it is not for money.”
The latest data from AMN Healthcare shows that the average salary for NPs was $180,000 in 2024/2025 — a 9.5% increase from the previous year — but there are multiple factors that contribute to the number of zeros in an offer letter, which can lead to surprises when new NPs start negotiating their first job offers.
“I did some research [on average NP salaries], but it was limited because my natural inclination was that a NP was going to make more [than a bedside nurse] because that seems like a logical progression,” Short said. “From the respect of benefits and salary, I wish I would have talked to more nurse practitioners.”
About Medscape Data
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Medscape RN/LPN Compensation Report 2025 found that:
- Compensation rose 11% for RNs and 13% for licensed practical nurses over the past 2 years.
- Sadly, many nurses reported that the effort doesn’t equal the compensation.
- Nurses in the West earned significantly more than those in other regions.
Crunching the Numbers
A trend toward team-based healthcare models has led to skyrocketing demand for NPs. In fact, it’s one of the fastest-growing professions, and the number of job openings is expected to increase 35% between 2024 and 2034.
“[Our latest data showed] 68% of the nurse practitioner searches were in primary care and 32% were specialty searches,” Alex Herbison, vice president at AMN Healthcare, said. “If we go back 5 years, we were probably closer to 90% primary care [searches], so we’ve really started to see a shift in how the market is using nurse practitioners.”
Employment arrangements also affect NP salaries. One report found that NPs who are paid hourly earn $6000 more annually than their salaried counterparts because there are more opportunities for hourly workers to take on additional shifts.
As an RN, Ayo Adebiyi boosted her wages by working night shifts in the emergency room, and it was difficult to match that when she was negotiating her starting salary as a family NP in Merced, California.
“I remember sending my pay slip to the recruiter…and saying, ‘I just want to match what I’m making [as an RN],’” she recalls.
Adding It Up
NP salaries are dependent on numerous factors, from geographic location and practice setting to specialization; practice authority also has an impact. In the 28 states and territories where NPs have full practice authority, wages are higher, according to Herbison.
Location matters, too. NPs working in Washington, Oregon, and California earn mean salaries of $170,000, whereas mean salaries for NPs in Mississippi, Alabama, Tennessee, and Kentucky are $143,000.
Adebiyi knows that her salary is lower than that of her counterparts in San Francisco and Los Angeles, but the cost of living in Central California is much lower, too. Short acknowledges that he’d need a higher wage to practice in the Northwest, but his wages cover the basics in the Midwest.
“Looking back, I should have paid more attention to cost of living,” he said. “On its face, the numbers looked good, but what that paycheck really gets you is different depending on where you live.”
Specialization Spikes Salaries
Just as family doctors earn lower salaries than psychiatrists, cardiologists, or surgeons, NPs working in primary care have lower salaries than those who specialize.
Herbison calls neurosurgery, orthopedics, dermatology, gastroenterology, and cardiology “high-revenue specialties,” and having advanced practice providers in a practice to complement the physician’s efforts is driving compensation trends up. AMN Healthcare data found that salaries can reach $338,395 for specialist NPs.
Practice setting is also a factor. In inpatient hospital settings, NPs earn an average of $184,000; salaries drop to $145,000 for NPs in hospital-based outpatient clinics, $133, 000 in nonhospital-based offices and urgent care clinics, and $122,000 in public or community health settings.
The workload in each setting is also a significant factor in compensation. In outpatient settings, on-call responsibilities are often bundled into base salaries, while hospital-based or urgent care roles often offer higher pay to cover nights, weekends, or extended shifts. Herbison noted that a significant portion of the urgent care searches AMN Healthcare conducts are for NPs.
“They’re not necessarily on call, but they may get paid a higher rate to take that seven-to-seven role or even overnight shifts,” he said.
Beyond Base Salaries
During negotiations, starting salary figures alone can be misleading. AMN Healthcare data showed that 74% of open positions offer signing bonuses — that number was just 51% in 2023/2024, and the average signing bonus offered to NPs ranged from $2000 to $70,000.
Herbison calls benefits and incentives a critical piece of the compensation puzzle, adding, “All incentives are on the table for nurse practitioners now. Relocation, [continuing education], coverage for malpractice, flexible scheduling — these are all levers practices use to stay competitive.”
The benefits for NPs are “much better” than for RNs, said Short. His employer offers perks like a continuing education allowance and covers the fees for memberships to the American Association of Nurse Practitioners and other professional organizations.
For Adebiyi, the value of a role comes down to how compensation balances with workload and support. She encourages early-career NPs to look beyond the hourly wage and salary and consider work-life balance, patient workload, administrative time, and benefits packages, and to make decisions that balance financial security with professional growth and quality of life.
“Pay should make sense, but it shouldn’t be the only thing,” said Adebiyi. “Look for a package that supports you as a clinician and as a person; that’s what makes the career sustainable.”
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.
