Health care leaders are taking a strategic approach to nursing compensation this year, a survey by the consulting firm SmithCotter found.
“Organizations are making targeted, strategic investments in nursing pay, prioritizing leaders, critical specialties and hard-to-fill roles as they work to remain competitive in a market that is always evolving,” company principal Steve Meyers said.
Medium-sized health systems, with between $250 million and $750 million in annual net revenue, saw the greatest growth in median base pay during the first half of this year at 3.2%. Those with revenues between $751 million and $1.5 billion reported a 2.9% increase, reflecting continued emphasis on retaining experienced nursing talent.
Registered nurse leaders (3%) and managers (2.7%) received the largest median base pay increases during this period, signaling that organizations are prioritizing compensation for roles with broad supervisory and clinical oversight. Pay movement varied by specialty as well:
- Critical-care RNs recorded the highest six-month median increase at 3.2%, followed closely by those in anesthesiology, oncology and the emergency department.
- Among non-acute care roles, RN case managers (3%) and RN patient navigators (2.3%) experienced the strongest median growth.
- Licensed Practical Nurses had the lowest growth at 1.1%.
Regional variability continues to strongly influence nursing compensation. The West reported the highest median hourly rates for clinical nurse specialists ($96), staff RNs ($61) and LPNs ($36), positioning this region well above the others. The Northeast followed at $69, $50 and $34, respectively, with slightly lower rates across the North Central, South Central and Southeast regions. Specialty pay differences also were notable, particularly in the West. This region showed the widest intraregional variation, from $74 per hour for wound care RNs to $57 for oncology RNs. Even at the low end, specialty pay in the West remains higher than comparable roles in every other region.
Managing nursing turnover remains a significant challenge for health care organizations, given its impact on staffing, cost and continuity of care. Compared to 2024, RN turnover rates have decreased while LPN turnover rates have increased. In the first half of 2025, 62% of organizations reported RN turnover between 11% and 20%. For LPNs, more than one-third of organizations reported turnover above 20%.
For RNs, 5.7% fewer organizations have days-to-fill over 90 days, and 10% fewer organizations have vacancy rates greater than 11%. Year-over-year declines in vacancy rates and time-to-fill metrics indicate that organizations are making progress in addressing staffing gaps and strengthening recruitment pipelines.
“Taken together, these shifts signal that the nursing labor market may be entering a period of greater stability,” Meyers said. “Organizations are not only seeing fewer extended vacancies; they’re also experiencing more predictable hiring activity, an important step toward rebuilding workforce sustainability.”
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