Best States for Family Nurse Practitioners: Where Should You Work?
Family Nurse Practitioners (FNPs) are in high demand across the U.S., but job opportunities, salary, and autonomy vary significantly by state. Some states allow full practice authority, giving FNPs more independence, while others require physician oversight.
If you’re considering where to work as an FNP, this guide will help you compare the best states based on salary, job growth, and practice authority.
Key Factors to Consider When Choosing a State
Before deciding where to work as an FNP, consider these key factors:
- Salary – How much can you earn as an FNP in a particular state?
- Full Practice Authority – Can FNPs work independently without physician oversight?
- Job Growth – How high is the demand for FNPs in that state?
- Common Employers – Which healthcare systems offer the best job opportunities?
- Alternative Workplaces – Are there opportunities for FNPs outside of hospitals and clinics?
Brief Overview: What Is Practice Authority for FNPs?
Practice authority refers to the level of autonomy that Family Nurse Practitioners have in providing patient care, prescribing medications, and managing treatment plans without physician oversight. The scope of practice for FNPs varies by state and generally falls into three categories:
- Full Practice: FNPs have complete autonomy to assess, diagnose, prescribe medications, and manage patient care without physician supervision. States with full practice authority offer the highest level of independence for FNPs.
- Reduced Practice: FNPs have some restrictions, often requiring a collaborative agreement with a physician for certain aspects of patient care, such as prescribing medications.
- Restricted Practice: FNPs must work under direct supervision of a physician, limiting their ability to practice independently.
Understanding practice authority is crucial when choosing the best state to work in as an FNP, as it directly impacts job flexibility, earning potential, and career growth opportunities.
Top 5 States for Family Nurse Practitioners
Here's a breakdown of the best states for FNPs based on a combination of salary, demand, and practice authority.
1. California – Highest Salary Potential
- Average Salary: $151,830/year
- Practice Authority: Reduced practice (requires physician oversight)
- Job Outlook: High demand, especially in rural and underserved areas
Why Work in California?
California FNPs enjoy the highest salaries in the country, particularly in metro areas like Los Angeles, San Francisco, and San Diego.
Common Employers:
- Kaiser Permanente – One of the largest healthcare providers in the U.S.
- Sutter Health – Operates hospitals and outpatient clinics statewide
- UCLA Health & Stanford Health Care – Top research and teaching hospitals
Alternative Workplaces:
- Telemedicine companies (e.g., Teladoc Health)
- Public health clinics
- Corporate wellness programs (Google, Apple, Facebook all have on-site healthcare)
However, California's cost of living is among the highest in the country, so high salaries may not always translate to more financial freedom. Learn more about NP degree programs in California.
2. Texas – Strong Job Market
- Average Salary: $121,580/year
- Practice Authority: Restricted practice (requires physician supervision)
- Job Outlook: Fast-growing market, especially in rural areas
Why Work in Texas?
Texas has one of the fastest-growing healthcare markets, creating numerous job opportunities for FNPs. The state's rural areas particularly need primary care providers, and FNPs help fill this gap.
Common Employers:
- HCA Healthcare – Operates hospitals across Texas
- Texas Health Resources – Large healthcare system in the Dallas-Fort Worth area
- MD Anderson Cancer Center – Leading cancer treatment and research hospital
Alternative Workplaces:
- Retail clinics (CVS MinuteClinic, Walgreens)
- Mobile healthcare units serving underserved communities
- Military and VA hospitals
While Texas has great job availability, it still requires physician supervision, limiting career flexibility. Learn more about NP degree programs in Texas.
3. New York – High Salaries & Job Demand
- Average Salary: $133,940/year
- Practice Authority: Reduced practice (requires physician collaboration)
- Job Outlook: High demand due to large population and healthcare needs
Why Work in New York?
New York offers high salaries and a strong job market, particularly in urban areas. However, the cost of living is high, especially in New York City.
Common Employers:
- NewYork-Presbyterian Hospital – One of the largest hospital systems in the country
- Mount Sinai Health System – Includes hospitals and outpatient clinics
- Northwell Health – Largest healthcare provider in New York state
Alternative Workplaces:
- School-based health clinics
- Nonprofit organizations serving homeless and immigrant populations
- Telehealth companies (especially in NYC)
New York is a hub for research and innovation, making it a great place for FNPs interested in academia or advanced clinical roles. Learn more about NP degree programs in New York.
4. Washington – Full Practice Authority
- Average Salary: $135,590/year
- Practice Authority: Full practice (FNPs can work independently)
- Job Outlook: Strong demand in both urban and rural areas
Why Work in Washington?
Washington is one of the few states that grant full practice authority, allowing FNPs to diagnose, prescribe, and treat patients independently.
Common Employers:
- University of Washington Medical Center – A leading research hospital
- MultiCare Health System – Offers positions in primary and specialty care
- Providence Health & Services – Serves both urban and rural communities
Alternative Workplaces:
- Independent FNP-run clinics
- Urgent care centers
- Government and tribal healthcare facilities
Washington's full practice authority makes it one of the best states for entrepreneurial FNPs who want to start their own practice. Learn more about NP degree programs in Washington.
5. Arizona – Best for Independence
- Average Salary: $121,410/year
- Practice Authority: Full practice (FNPs can work independently)
- Job Outlook: Growing demand, especially in primary care
Why Work in Arizona?
Arizona offers full practice authority, making it an attractive option for FNPs who want autonomy in their practice. The state also has a lower cost of living compared to California or New York. Learn more about NP degree programs in Arizona.
Common Employers:
- Banner Health – One of the largest employers of FNPs in Arizona
- Dignity Health – Offers primary care and specialty positions
- Phoenix Children's Hospital – Great for FNPs interested in pediatrics
Alternative Workplaces:
- Private clinics (many FNPs open their own)
- Hospice and palliative care
- Rural health clinics serving Native American populations
Arizona's full practice authority makes it a top choice for independent-minded FNPs.
Top FNP States: Tuition vs. Salary
Salary is just one consideration of an FNP career. You may also wish to see how these states stack up compared to the price of tuition for a nurse practitioner program. Learn more about FNP degree programs, and check out the table below for a tuition vs. salary comparison:
| State | Average Tuition (Public) | Average Tuition (Private) | Average NP Salary (Annual) | Salary-to-Tuition Ratio (Public) | Salary-to-Tuition Ratio (Private) |
|---|---|---|---|---|---|
| California | $23,000 | $37,000 | $145,000 | 6.3 | 3.9 |
| Texas | $22,000 | $36,000 | $120,000 | 5.5 | 3.3 |
| New York | $25,000 | $39,000 | $130,000 | 5.2 | 3.3 |
| Washington | $24,000 | $38,000 | $125,000 | 5.2 | 3.3 |
| Arizona | $22,500 | $36,500 | $118,000 | 5.2 | 3.2 |
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Upon completing an ADN from Pacific Union College, Catherine worked in various bedside roles until her career evolved into nursing leadership for a large HMO in Northern California. She then completed a BSN at the University of Phoenix and a Masters in Organizational Leadership at Colorado State University.
In addition to her freelance writing, Catherine is the founder and CEO of Burger Legal Nurse Consulting, is an advanced board-certified nurse executive, and is the CNO & Media Response Specialist for RegisteredNursing.org.
Situated in the beautiful Idaho mountains, Catherine loves traveling and spending time with her husband and their five children.