As cost of living continues to rise, nurses, like many other professionals, are feeling the strain.
Financial insecurity has a significant impact on every aspect of a person's life, and inadequate compensation can be a major driving factor in employee turnover at an organization.
Nurses are overworked and feeling burnt out, and that plus high cost of living pressures is a recipe for increased turnover rates. CNOs must do what they can to advocate for their nurses and define the value of their work to build more sustainable workforces that benefit the nurse, the patient, and the organization.
Here's what CNOs need to know about nurse compensation in 2025, according to a report by Vivian.
Virtual nursing can provide multiple kinds of support to the bedside nurse that can help with retention, says this nurse leader.
On this episode of HL Shorts, we hear from Emily Warr, system administrator for the Center for Telehealth at MUSC Health, about how virtual nursing can boost nurse retention in health systems. Tune in to hear her insights.
A robust virtual nursing program should be created with long-term goals in mind, says this CNE.
Virtual nursing is rapidly becoming a standard of care in the healthcare industry.
Right now, while many programs are still in their infancy, CNOs have a great opportunity to learn from each other's strategies and outcomes.
For Patty Donley, senior vice president and CNE at WellSpan Health, the original goal of WellSpan's virtual nursing program was twofold. First and foremost, Donley emphasized the workforce shortage and planning for when the baby boomer generation retires.
"We'll likely need more care at the same time that our baby boomer nursing and healthcare professionals are retiring," Donley said.
Donley explained that as nurses retire, the rate at which they will retire is predicted to be greater than the rate of those entering the profession.
"That combined with that increase in the number of aging adults will likely create a supply and demand issue," Donley said. "We're really trying to look ahead and determine how [to] plan for what likely will become an even greater shortage moving forward."
Additionally, WellSpan is considering how to support nurses with their current workload and how to do that in an innovative way that provides greater satisfaction for bedside nurses, Donley said. The health system is also interested in leveraging the knowledge of experienced nurses to help support newer generations of nurses.
Developing the strategy
According to Donley, developing the virtual nursing program, which has been in place since 2023, began by looking at it from a cross-functional perspective.
"We knew what we were looking to accomplish, but doing it in such a way that we pulled in our IT colleagues," Donley said.
WellSpan’s innovation and design teams also got involved with the project. According to Donley, the next step was to create a governance structure that leveraged executive leadership who had the vision, a budget, and a timeline, and a committee of clinical leaders and team members who provided insights on the program’s impact. The technical team also was present to look at all the technical components that needed to be considered.
"I think that's what made us successful and particularly engaging frontline nurses from the beginning was integral to our ability to be where we are today," Donley said. "I think that listening and gaining their insights and input into how we did it initially helped us to build a platform and to create a virtual care model that worked for our nurses."
Donley also emphasized the importance of messaging when starting a virtual nursing program.
"The other thing we started at the very beginning was to message that the virtual care nurse was not meant to replace nurses, but to support them," Donley said.
Looking to the next generation
In terms of looking to the future, while there are no new grads currently working in WellSpan's virtual nursing program, Donley says they have taken Gen Z nurses into consideration for their strategy.
"We're looking to partner with…our colleges and universities to introduce the technology while the nurses are in nursing school so that they can be prepared if potentially that's an area that they're interested in," Donley said.
The goal would be to get new graduate nurses familiar with the technology to equip them for the future of their careers.
"Introducing that technology and the platform and how it's done early on in a person's career might help to eventually move in that direction," Donley said.
In the future, WellSpan plans to continue reducing administrative tasks and unnecessary burdens at the bedside. Donley says they are looking into ambient listening and how to leverage their virtual nursing platform for documentation. The health system is also looking at different efficiencies in sites of care like the operating room and where the virtual care platform and their chosen vendor platform, Artisight, can help capture different documentation pieces.
"That's exactly the position we want to be in as we continue to talk to our frontline nurses and team members, to say, 'how else can we support you?'" Donley said.
Donley recommends having a long-term mindset when strategizing for virtual nursing. Engaging the frontline teams and celebrating milestones and successes are also key for CNOs and other leadership.
"You might start small, you might start with doing admissions or something like that, but think about a platform that's going to take you to the next level and that might be able to solve some future challenges.”
Nurses are overworked and feeling burnt out, and that plus high cost of living pressures is a recipe for increased turnover rates.
As cost of living continues to rise, nurses, like many other professionals, are feeling the strain. Financial insecurity has a significant impact on every aspect of a person's life, and inadequate compensation can be a major driving factor in employee turnover at an organization.
According to Bankrate's 2024 Financial Freedom Survey, Americans report needing to make a six-figure salary of $186,000 on average to live comfortably, which is more than double the $79,000 that the average full-time employee makes annually. Additionally, about 75% of Americans report that they are not completely financially secure.
When thinking about the nursing workforce shortage and why it's happening, it's critical that CNOs take a look at compensation. To get a full picture of nurse compensation in 2025, let's take a look at some facts and figures.
The current state of compensation
As of June 4, 2025, the average RN salary is $43.97 an hour, according to a report by Vivian. If a nurse works the standard 52 weeks at 40 hours per week, this number comes out to be $91,457 annually. According to the Bureau of Labor Statistics (BLS), the median annual wage for RNs was $93,600 in 2024, which translates to $45 an hour.
In 2025, the highest paying state for RNs is California, with an average hourly salary of $73, and a max hourly salary of $91, according to the Vivian report. The next highest paying states are Oregon ($69 average), New York ($62 average), Minnesota ($61 average,) and North Carolina ($56 average). Vivian also reports that the average travel nurse salary is $2,147 per week, and the highest paying state is California, with an average weekly salary of $2,570 and a maximum of $4,491 per week for traveling nurses.
When comparing the average and max hourly rates in each state, it becomes clear that many nurse salaries are hovering below the six-figure salary threshold needed to live comfortably without worry. According to the 2024 National Nursing Workforce Study conducted by the National Council of State Boards of Nursing (NCSBN), one of the top five reasons nurses are leaving the workforce is inadequate salary.
While many health systems are operating on thin margins, it's important to keep in mind that nurse turnover also comes with a price tag. The average cost of turnover for a bedside RN is $61,110, according to the 2025 NSI National Health Care Retention & RN Staffing Report.
Nurses are overworked and feeling burnt out, and that plus high cost of living pressures is a recipe for increased turnover rates. CNOs must do what they can to advocate for their nurses and define the value of their work to build more sustainable workforces that benefit the nurse, the patient, and the organization.
The health system's virtual nursing program has morphed quite a bit in the med surg realm, says this nursing science leader.
While virtual nursing will likely have an impact in all areas of health systems, many organizations are beginning their programs on med surg units and have seen great successes in doing so. As virtual care technology continues to evolve, med surg units will also change and patient care workflows will become more efficient.
Monique Bouvier, corporate director of nursing science at Emory Healthcare and assistant professor at the Nell Hodgson Woodruff School of Nursing, recently gave HealthLeaders an update on the health system's virtual nursing progress over the past year.
Bouvier is part of the HealthLeaders Virtual Nursing Mastermind program, which brings together several health systems to discuss the ins and outs of their virtual nursing programs and what their goals are for now and the future.
What's changed?
Since last year, Bouvier told HealthLeaders that Emory's virtual nursing program has morphed quite a bit in the med surg realm.
"A year ago, we did a pilot to show the value," Bouvier said. "Now, we are hard-wiring bidirectional virtual nursing systems into our patient rooms, and hope to have 1,000 medical-surgical rooms hard-wired for virtual care by the end of the year."
Right now, Emory uses patient care metrics to measure outcomes, including length of stay, readmissions, number of ED visits, patient satisfaction, and quality metrics.
“Additionally, for our nurses we are capturing retention, contract utilization, nurses' perceived workload, work satisfaction, [and] time spent in the EHR," Bouvier said.
In terms of staffing, Bouvier explained that they are on a journey to discover the right model.
"We are really listening to our nurse and patient needs, desires, and critiques to create a staffing strategy that meets the needs of not only our patients, but our nursing staff as well," Bouvier said.
Currently, the health system is working with several vendors for virtual care technology, but the goal is to consolidate as much as possible.
"Our end goal is to have a virtual platform that is a one-stop shop across all sectors of care," Bouvier said.
Overcoming obstacles
As this is a huge financial investment for hospitals to take on, Emory Healthcare is intentionally measuring impact of such a significant investment. Bouvier explained that right now, literature is limited to rely upon for metrics, staffing, and financial benefits, which can make virtual nursing programs a hard sell.
"We are kind of building the ship as we sail because inpatient medical-surgical virtual care is truly a new nursing care delivery model," Bouvier said. "As nurses, we follow evidence-based practices, and because the inpatient virtual landscape is developing, I can understand the hesitancy of investing time and money."
However, Bouvier believes that this technology is not going to go away, and it's the responsibility of partners in the technology space to ensure that the technology is working for providers. Bouvier also pointed out how the virtual care boom is happening concurrently with the rise of AI.
"These huge shifts have revealed a level of unknowns with new technology," Bouvier said. "Hospital organizations need to acknowledge that shift and work with their medical staff to ensure informed, safe, [and] ethical roll outs."
The future is bright
As of right now, Bouvier does not expect much to change on the technological front as the health system is still working on deploying and implementing all of the new technologies for inpatient virtual care, with a current focus on integrating translation services. However, going forward, Bouvier said that Emory plans to expand the virtual care program to outpatient settings.
"We are starting a pilot program for a virtual transition of care platform for our patients from the inpatient to outpatient setting," Bouvier said. "We want our patients to experience uninterrupted care across their care journey."
So far, nurses have reported experiencing benefits from the virtual care program, and have expressed to Bouvier that they appreciate it.
"Hearing nurses who were initially hesitant to be part of the virtual nursing trial transform their thoughts from uncertainty to praise for the platform has been the best part," Bouvier said. "We are taking the time and listening to our nurses via an empathy-based PDSA cycle, [and] that is what has made this great."
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights intoexcelling your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
CNOs need to take a look at their health system's policies and provide guidance to nurses who might have future interactions with ICE or CBP agents.
On Jan. 20, the Trump Administration revoked a policy that protected sensitive locations, including hospitals, from Immigration and Customs Enforcement (ICE) and Customs and Border Patrol (CBP) enforcement actions.
In the wake of these removed protections, preparedness is key. Earlier this year, the ACLU released a fact sheet titled Immigration Enforcement Guidance for Health Centers, which contains several tips for how to prepare for immigration enforcement in health systems.
Here are 8 tips that CNOs should know, according to the ACLU.
Reducing upfront burdens helps nurses take stressors of their plate so they can work on some of the professional pathways they want to pursue, says this nurse leader.
On this episode of HL Shorts, we hear from Abby Rudy, VP of Nursing, Adult Critical Care at Penn State Milton S. Hershey Medical Center, about professional development programs that health systems can offer to improve nurse retention. Tune in to hear her insights.
Nurse leaders must do their best to help maintain patient privacy and be prepared to pivot as regulatory requirements change.
As nurse leaders, it's important to guide the workforce to do their best to safeguard patient rights and privacy.
On June 2, the FBI released a call to action via its official X account stating that they wish for individuals to report tips of any "hospitals, clinics, or practitioners" performing surgical procedures on children "under the guise of gender-affirming care."
This calls into question the issue of patient rights to privacy, and it presents an ethical problem for nurses who want to care for their patients to the best of their ability. CNOs need to understand the current policies regarding the release of patient information to best equip their nurses to care for transgender and gender nonconforming patients.
Current policy
Under the Biden administration, HHS' Office of Civil Rights (OCR) implemented the 2022 HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy (2022 OCR Notice and Guidance), which stated that medical interventions for transgender minors may improve physical and mental health outcomes.
The notice specifically stated that healthcare providers and entities could not disclose protected health information (PHI) about gender-affirming care without patient authorization. This provided transgender patients with protections under HIPAA. The only exception was in circumstances where providers were explicitly required by the law to do so.
However, on Feb. 20, 2025, that guidance was rescinded, in response to Executive Order 14187, "Protecting Children from Chemical and Surgical Mutilation," which was put forth by the Trump administration. HHS stated that their basis for recission was that the 2022 OCR Notice and Guidance lacked legal basis under federal privacy laws, including HIPAA Privacy, Security, and Breach Notification Rules.
What comes next
So, what does this mean for health systems, and, more specifically, for nurse leaders?
As of right now, EO 14187 has been put on hold as two different legal challenges to the EO make their way through the courts. According to analysis from law firm Husch Blackwell, this means that currently providers and health systems do not have to choose between complying with the 2022 OCR Notice and Guidance and EO 14187, pending the outcome of those legal challenges.
For CNOs and other clinical leaders, it's important to remain in compliance with current legal requirements and to be proactive by creating internal policies that can evolve with regulatory updates. CNOs should instruct their nurses to remain in compliance with HIPAA requirements and work to safeguard PHI for transgender patients.
CNOs need to keep tabs on the current state of nursing education so they can adjust accordingly.
In the U.S., industry leaders and experts often discuss the nursing shortage and its impact on the healthcare industry. Shortages can leave the entire workforce feeling burned out, resentful, and angry, and the impact on patient care is even greater.
As CNOs work to recruit and retain nurses, both locally and internationally, it's important to understand that the nursing industry in the U.S. is only one piece of the puzzle. Globally, the situation is incredibly complex and the challenges go beyond just workforce shortages.
Nursing education is just as important for CNOs to keep an eye on, and according to the World Health Organization’s (WHO) State of the world’s nursing 2025 report, the education situation is a mixed bag.
There are several positive and not-so-positive trends that CNOs should pay attention to in the workforce, says this CEO.
On this episode of HL Shorts, we hear from Phil Dickison, CEO of The National Council of State Boards of Nursing (NCSBN), about what the 2024 National Nursing Workforce study reveals about the current state of the nursing workforce. Tune in to hear his insights.
