Where you work is the second most important per diem income variable after the platform split. Here's the 2025 ranking of the best states for per diem nurses — with pay rates, demand levels, tax environments, and the nuance that changes the calculation for different nurse profiles.
Article #3 established the full 50-state per diem rate picture. This article goes deeper on the states that matter most — explaining not just what rates look like but why, what demand stability looks like, how the tax environment affects net income, and which states are best for specific nurse profiles rather than as a generic ranking.
The per diem income equation has four state-specific components:
- Gross bill rate — What facilities in that state pay per hour for your specialty
- State income tax — How much the state takes out of your earnings
- Demand depth — How consistently you can fill a full-time schedule without gaps
- Market trajectory — Whether rates and demand are growing, stable, or declining
A state that pays $90/hour but has 9.3% state income tax and thin shift inventory may produce less actual take-home income than a state paying $78/hour with no state income tax and deep consistent demand. This article accounts for all four factors.
States are evaluated on a composite score across four dimensions:
- Rate score (40%): Average per diem RN bill rate for experienced RNs, specialty-adjusted
- Tax score (30%): Effective state income tax rate impact on take-home pay
- Demand score (20%): Consistency and depth of per diem shift availability
- Trajectory score (10%): Whether conditions are improving, stable, or deteriorating
The weighting reflects the practical income impact: gross rates and taxes together determine 70% of what ends up in your account, while demand depth and trajectory affect the sustainability of that income over time.
Composite score: 9.1/10
| Metric | Texas |
|---|---|
| Med/Surg bill rate | $68 – $82/hr |
| ICU bill rate | $88 – $108/hr |
| OR bill rate | $92 – $115/hr |
| State income tax | 0% |
| Demand level | Very High |
| Trajectory | Strongly positive |
Texas is the best overall per diem nursing market in the country for experienced RNs in 2025 — combining strong bill rates, zero state income tax, three of the nation's highest-volume healthcare markets, and a regulatory environment that supports both platform operations and nurse IC classification.
Dallas-Fort Worth: The DFW Metroplex is home to one of the largest concentrations of hospitals, health systems, and specialty facilities in the country. Texas Health Resources, Baylor Scott & White, and Medical City Healthcare operate dozens of hospitals across the metro, creating deep per diem shift inventory across all specialties. ICU and OR bill rates in DFW regularly run $92–$115/hour.
Houston Medical Center: The world's largest medical complex by any measure — 60+ institutions, 160,000+ employees, 10 million annual patient visits. Houston per diem demand is structural and consistent. Specialty nursing demand (cardiovascular, oncology, trauma) is particularly deep given the Medical Center's specialty concentration.
Austin: Fastest-growing metro in Texas and one of the fastest-growing healthcare markets in the country. Dell Seton, St. David's, and expanding hospital networks are creating consistent per diem demand in a market with a large and growing nursing workforce but insufficient permanent staff to cover all supplemental needs.
Net income calculation (Dallas ICU nurse, HealthSquire 85/15):
- Bill rate: $100/hour
- Take-home: $85/hour
- Annual (36 hrs × 50 wks): $153,000 gross
- Federal + self-employment tax (1099, no state): ~$34,000
- Net annual income: ~$119,000
Composite score: 8.8/10
| Metric | Florida |
|---|---|
| Med/Surg bill rate | $65 – $80/hr |
| ICU bill rate | $82 – $102/hr |
| OR bill rate | $88 – $108/hr |
| State income tax | 0% |
| Demand level | Very High |
| Trajectory | Strongly positive |
Florida's per diem market is driven by demographics that don't change: the state has the highest proportion of residents 65+ of any major state, and that cohort consumes more healthcare per capita than any other. Healthcare demand in Florida is not cyclical — it's baked into the population structure for the next 20+ years.
Miami-Fort Lauderdale: One of the most active per diem markets in the Southeast. High cost of living drives higher bill rates; strong international patient volume creates specialty demand (cardiovascular, orthopedics) that competes for credentialed nurses at premium rates.
Tampa Bay: Strong healthcare corridor with BayCare, Tampa General, and AdventHealth driving consistent per diem demand. Tampa bill rates are competitive with Miami at slightly lower cost of living.
Orlando: Rapidly growing metro with major health systems expanding capacity. Per diem demand is growing faster than permanent staff supply can keep pace.
Jacksonville: Developing per diem market with Mayo Clinic Florida, Baptist Health, and UF Health driving specialty demand.
Net income calculation (Miami ICU nurse, HealthSquire 85/15):
- Bill rate: $95/hour
- Take-home: $80.75/hour
- Annual: $145,350 gross
- Federal + SE tax (no state): ~$32,000
- Net annual income: ~$113,350
Composite score: 8.6/10
| Metric | Washington |
|---|---|
| Med/Surg bill rate | $72 – $88/hr |
| ICU bill rate | $88 – $108/hr |
| OR bill rate | $92 – $118/hr |
| State income tax | 0% |
| Demand level | High |
| Trajectory | Stable/positive |
Washington combines Seattle's premium healthcare market — with UW Medicine, Swedish, Providence, and MultiCare — with no state income tax and strong union-influenced base rates that create a high floor for per diem compensation.
The Seattle metro is smaller than Texas's three major corridors, which means demand depth is more concentrated. Nurses who establish preferred worker status at major Seattle health systems find consistent shift availability; those working a broader geographic spread of smaller facilities find more variability.
Washington's compact license status (it joined the NLC in 2023) now allows nurses to hold a Washington multistate license that covers all 41 compact states — significantly expanding the geographic flexibility of nurses based in the Pacific Northwest.
Composite score: 8.2/10
| Metric | California |
|---|---|
| Med/Surg bill rate | $78 – $95/hr |
| ICU bill rate | $96 – $125/hr |
| OR bill rate | $102 – $132/hr |
| State income tax | Up to 13.3% |
| Demand level | Very High |
| Trajectory | Stable |
California has the highest gross per diem rates in the country — driven by mandatory nurse-to-patient ratios that create structural supplemental demand, high cost of living, and strong union contract influence on baseline wages.
The tax headwind is real. California's top marginal state income tax rate of 13.3% is the highest of any state, and nurses earning $150,000+ enter high bracket territory. A California ICU nurse earning $120/hour gross at 85/15 earns $102/hour take-home — but after federal tax (22–24% bracket), California state tax (9.3%+ bracket), and self-employment tax, effective net income is lower than equivalent earnings in Texas despite the higher gross rate.
The California math at $120/hour bill rate:
- Take-home (85%): $102/hour
- Annual gross: $183,600 (36 hrs × 50 wks)
- Federal income tax (~24%): −$44,064
- California state income tax (~10.5% effective): −$19,278
- Self-employment tax (half deductible): −$12,900
- Net annual: ~$107,358
Versus Texas at $100/hour bill rate:
- Take-home: $85/hour
- Annual gross: $153,000
- Federal income tax (~22%): −$33,660
- No state tax
- Self-employment tax: −$10,800
- Net annual: ~$108,540
California's higher gross rate nearly disappears after taxes — making the net income comparison much closer than the bill rate gap suggests. For California-based nurses, this analysis confirms that staying local on a high-split platform is still the right financial choice. For nurses considering relocating to California purely for income, the math is less compelling than advertised.
Composite score: 7.9/10
| Metric | Ohio |
|---|---|
| Med/Surg bill rate | $60 – $74/hr |
| ICU bill rate | $76 – $95/hr |
| OR bill rate | $80 – $100/hr |
| State income tax | 2.75–3.75% (relatively low) |
| Demand level | High |
| Trajectory | Strongly positive |
Ohio is the most underrated per diem nursing market in the country. Three large metropolitan healthcare corridors — Columbus (OhioHealth, Mount Carmel, OSU), Cleveland (Cleveland Clinic, University Hospitals), and Cincinnati (UC Health, Christ Hospital, TriHealth) — create deep, consistent demand across all specialties.
Ohio bill rates are below California and Washington but competitive with Texas when adjusted for Ohio's relatively low state income tax (capped at 3.75%) and lower cost of living. The effective disposable income for a per diem nurse in Columbus is meaningfully higher than a comparable nurse in the Bay Area despite the lower gross rate.
Ohio's strongest advantage is trajectory. Healthcare infrastructure investment in Ohio has accelerated: the Cleveland Clinic continues to expand, OhioHealth has opened multiple new facilities, and Ohio State Medical Center is one of the most active academic health systems in the Midwest. Per diem demand is growing faster than the permanent nursing workforce can accommodate.
Ohio is one of HealthSquire's priority launch markets precisely because it combines strong demand, favorable regulatory environment for platform operations, and current underservice by technology-first per diem platforms.
Composite score: 7.6/10
| Metric | Colorado |
|---|---|
| Med/Surg bill rate | $62 – $76/hr |
| ICU bill rate | $78 – $98/hr |
| State income tax | 4.4% flat |
| Demand level | High |
| Trajectory | Positive |
Denver's rapidly growing population and expanding healthcare infrastructure — UCHealth, SCL Health, HealthONE — are driving increasing per diem demand in a market where the permanent nursing workforce hasn't kept pace with population growth. Colorado's flat 4.4% state income tax is among the most favorable of states with income taxes.
The Rocky Mountain regional concentration of outdoor recreation enthusiasts in the nursing workforce creates a natural per diem preference — nurses who want schedule flexibility for skiing, climbing, and outdoor pursuits are drawn to per diem work, creating a healthier supply-side dynamic than markets where per diem is primarily a career-transition choice.
Rate score: High | Tax score: Low | Overall: 7.0–7.5/10
The Northeast has some of the highest gross nursing rates in the country — New York City RNs command bill rates in the $88–$115/hour range — but state income taxes are punishing. New York's combined state and city tax burden can reach 12–13% for high earners. New Jersey, Massachusetts, and Connecticut all have significant state income tax rates.
For nurses already living in the Northeast who have established housing and cost structures adapted to those markets, local per diem makes excellent financial sense. For nurses considering relocating to the Northeast specifically for per diem income, the tax calculation almost never pencils out versus no-state-tax markets.
The Northeast is also the strongest region for pending ratio mandate legislation — New York and New Jersey are the most likely to pass California-style ratios in the near term, which would significantly increase structural per diem demand and rates in those markets.
Oregon is a compact state with strong healthcare infrastructure in the Portland metro (OHSU, Providence, Legacy Health). Bill rates are competitive ($65–$85/hour for RNs), and the state income tax (9.9% top marginal rate) is the primary headwind. For nurses already living in Oregon, local per diem is financially sound. For relocation decisions, the tax burden makes Washington (no state income tax, similar rates) a materially better choice.
These three states offer a compelling combination of no state income tax (Nevada), low state income tax (Utah: 4.85%, Arizona: 2.5%), and growing healthcare demand driven by population migration from California and the Pacific Coast. Per diem platform penetration in Mountain West markets is lower than in Texas and Florida — creating early-mover advantages for nurses willing to establish relationships before the markets become as competitive.
The best markets for ICU per diem are Texas (DFW and Houston Medical Center for CVICU in particular), California (academic medical center ICU demand), and Ohio (Cleveland Clinic for cardiac and cardiovascular subspecialties). The combination of highest ICU bill rates with no or low state tax points to Texas as the optimal ICU per diem market overall.
California has the highest OR bill rates — particularly for cardiac OR and robotic subspecialties at major academic medical centers. Texas is close behind with lower taxes. OR nurses in Texas, Florida, or Washington will find bill rates within 10–15% of California with significantly lower tax burdens.
Texas and Florida are the premier L&D per diem markets, driven by high birth rates in both states and strong demand for L&D supplemental coverage. Both are no-income-tax states.
For LPNs and CNAs working in LTC and SNF settings, the market dynamics are more similar across states than for RNs — bill rate variation is smaller and demand is more uniformly distributed across states with aging populations. Texas, Florida, and Ohio all provide strong LPN/CNA per diem markets with favorable tax environments.
For nurses who have geographic flexibility, the ranking is clear:
Maximize income: Texas (DFW, Houston), Florida (Miami, Tampa, Orlando), Washington (Seattle) — high rates, no state income tax, deep demand
Best emerging market: Ohio (Columbus, Cleveland, Cincinnati) — strong demand trajectory, low taxes, underserved by technology platforms
Highest gross rates: California — but after-tax income often comparable to Texas and Florida once state income tax is applied
Best Northeast option: Massachusetts or Connecticut for nurses already there; New York only if your specific facility relationships justify the tax burden
The optimal per diem market is the one where your specialty commands premium bill rates, demand is consistent enough to fill your schedule, the state doesn't take back too much of your gross income, and you can be home at night. For most nurses reading this in 2025, that description fits Texas, Florida, or Ohio better than any other three-state combination available.
HealthSquire operates in Texas, Florida, and Ohio — the three markets that rank at the top of this analysis. The 85/15 split means you capture the maximum percentage of those market rates. Browse available shifts in your market →
