Med-surg nurses earn approximately $46.40/hour, or about $96,500 per year at 2,080 hours, based on med-surg-specific listing data from Vivian Health (August 2026). That sits about 1% below the BLS OEWS May 2025 median annual wage for all registered nurses of $97,550, which reflects the reality that med-surg is often an entry-level placement before nurses move into higher-paying specialty units. With experience, CMSRN certification, and strategic location choices, med-surg nurses can push past $110,000 annually, and travel med-surg nurses average $2,115 per week.
Quick answer:
- National average:
$46.40/hour ($96,500/year at 2,080 hours) - All-RN benchmark: $97,550 median / $101,420 mean (BLS OEWS May 2025)
- New grad range: $60,000–$75,000 (most states); $85,000+ in California
- Experienced (5+ years): $90,000–$115,000+
- Travel med-surg: ~$2,115/week national average
- Highest-paying state: California (RN median $140,270; $78/hour med-surg specific per Vivian Health)
Med-surg nurse salary overview
Med-surg nurses are compensated within the general RN pay structure – there is no universally separate salary band for med-surg versus other floor nursing specialties at most hospital systems. Pay is determined primarily by:
- Geographic location (state and metro area) – the dominant factor
- Years of RN experience – most systems use step-based pay scales that increase annually
- Employer type – large academic medical centers and union hospitals generally pay more than community hospitals
- Certifications – CMSRN and BSN completion typically unlock pay differentials
- Shift differential – nights and weekends add $3–$8/hour at most facilities
The BLS reports a national median annual wage for registered nurses of $97,550 and a mean of $101,420 (OEWS May 2025). Med-surg-specific listing data from Vivian Health puts the med-surg average at $46.40/hour, which Vivian reports as about 3% below its own all-nursing listing average of $47.77/hour. Against the BLS median of $97,550 the med-surg figure annualizes to roughly $96,500, a gap of about 1%. The two comparisons differ because Vivian measures advertised rates on open listings while OEWS surveys employed wages, so use the BLS figure for the absolute level and the Vivian spread for the specialty-versus-specialty comparison.
Note: BLS does not publish salary breakdowns by nursing specialty. All state and metro figures in this guide are for registered nurses broadly. The note “BLS data reflects all registered nurses, not med-surg-specific, as no specialty breakdown is published” applies to all state and metro tables below.
Med-surg nurse salary by state
All data from BLS OEWS May 2025. Reflects median annual wages for all registered nurses; hourly figures are derived at 2,080 hours. Sorted by annual median wage, descending.
| State | Hourly median | Annual median |
|---|---|---|
| California | $67.44 | $140,270 |
| Hawaii | $65.54 | $136,320 |
| Oregon | $62.02 | $129,010 |
| Washington | $59.71 | $124,200 |
| Alaska | $52.63 | $109,480 |
| New York | $52.62 | $109,440 |
| New Jersey | $51.20 | $106,500 |
| Massachusetts | $50.26 | $104,550 |
| Nevada | $49.84 | $103,670 |
| Connecticut | $49.39 | $102,740 |
| District of Columbia | $49.30 | $102,540 |
| Minnesota | $48.80 | $101,510 |
| Rhode Island | $48.38 | $100,640 |
| Colorado | $48.20 | $100,260 |
| Maryland | $47.98 | $99,790 |
| New Hampshire | $47.93 | $99,700 |
| Delaware | $47.85 | $99,520 |
| Arizona | $47.84 | $99,500 |
| Vermont | $46.86 | $97,460 |
| Pennsylvania | $46.36 | $96,430 |
| Illinois | $46.15 | $95,990 |
| Texas | $46.14 | $95,970 |
| Wisconsin | $45.93 | $95,530 |
| New Mexico | $45.36 | $94,340 |
| Michigan | $45.34 | $94,300 |
| Virginia | $45.00 | $93,600 |
| Georgia | $44.98 | $93,550 |
| Idaho | $44.45 | $92,460 |
| Maine | $41.82 | $86,990 |
| Montana | $41.00 | $85,280 |
| Nebraska | $40.74 | $84,730 |
| Utah | $40.67 | $84,600 |
| North Carolina | $40.55 | $84,350 |
| Florida | $40.48 | $84,190 |
| Wyoming | $40.27 | $83,760 |
| Indiana | $40.14 | $83,500 |
| Oklahoma | $39.87 | $82,920 |
| Ohio | $39.67 | $82,510 |
| South Carolina | $39.60 | $82,360 |
| Missouri | $39.32 | $81,780 |
| Tennessee | $39.18 | $81,500 |
| Kentucky | $38.96 | $81,040 |
| North Dakota | $38.81 | $80,730 |
| Louisiana | $38.57 | $80,230 |
| West Virginia | $38.52 | $80,130 |
| Kansas | $38.13 | $79,320 |
| Arkansas | $37.95 | $78,940 |
| Iowa | $37.80 | $78,630 |
| South Dakota | $37.53 | $78,060 |
| Mississippi | $37.06 | $77,090 |
| Alabama | $37.06 | $77,080 |
Source: BLS OEWS May 2025, SOC 29-1141. Data reflects all registered nurses. No specialty-level breakdown is available for med-surg specifically.
Key observations:
- California’s median ($140,270) is about 1.8 times Alabama’s ($77,080), the lowest state. The geographic spread in nursing compensation is wider than almost any other profession requiring similar education.
- The Pacific Northwest consistently outperforms expectations relative to cost of living. Oregon ($129,010) and Washington ($124,200) are strong alternatives for nurses who want high pay without California’s competition and costs.
- The South and Midwest generally pay $75,000–$90,000, which reads as lower in absolute terms but often corresponds to substantially lower housing costs.
Salary by city and metro area
Metro-level RN wages spread even wider than state-level ones, and California dominates the top of the list – the Bay Area metros pay well over double the national median. The figures below are annual median wages for all RNs from the BLS OEWS May 2025 metropolitan tables, the same statistic and vintage as the state table above, so the two can be read together.
| Metro area | Annual median (OEWS May 2025) |
|---|---|
| San Jose-Sunnyvale-Santa Clara, CA | $216,740 |
| Vallejo, CA | $203,290 |
| San Francisco-Oakland-Fremont, CA | $186,610 |
| Seattle-Tacoma-Bellevue, WA | $128,260 |
| Boston-Cambridge-Newton, MA-NH | $106,180 |
Note: these are metropolitan-area median annual wages for all registered nurses (SOC 29-1141) from BLS OEWS, May 2025, accessed via the O*NET local wage tables. An earlier version of this table carried May 2024 annual mean wages, which understated every metro and could not be compared with the state medians above; the May 2025 metro release supersedes them. Metro figures for Los Angeles, Sacramento, New York, Providence, and Minneapolis previously shown here were approximations rather than published BLS values and have been removed.
For med-surg nurses specifically, the highest-paying metros tracked by Vivian Health are California-based, with advertised staff rates reaching $95/hour in the Bay Area and Southern California. Read those listings against the right benchmark: California’s statewide RN median of $140,270 works out to about $67.44/hour, but the Bay Area metros sit far above the state as a whole, with a San Jose median of $216,740 (roughly $104/hour) and a San Francisco median of $186,610 (roughly $90/hour). A $95/hour Bay Area listing is within the normal local range, while the same rate in a lower-cost metro would be exceptional.
Salary by experience level
Med-surg salaries follow a steep curve in the first 3 years, then a more gradual increase as nurses reach mid-career.
| Experience level | Approximate annual salary range | Notes |
|---|---|---|
| New graduate (0–1 year) | $60,000–$75,000 | Most states; $85,000+ in California |
| Early career (1–3 years) | $70,000–$85,000 | Step increases begin compounding |
| Mid-career (3–5 years) | $80,000–$95,000 | CMSRN eligible; charge nurse potential |
| Experienced (5–10 years) | $90,000–$110,000 | Leadership differentials available |
| Senior (10+ years) | $95,000–$120,000+ | Geographic and employer variation significant |
Ranges are national estimates and can be read against the BLS OEWS May 2025 RN percentiles: 10th $68,940, 25th $80,330, median $97,550, 75th $112,350, 90th $137,470. California runs far above these – its state RN median alone is $140,270, roughly $43,000 above the national median, so equivalent experience levels there sit $30,000–$45,000 higher than the national bands shown.
Most hospital systems use step-based pay scales that automatically increment salary annually for the first 10–15 years. The difference between a year-1 and year-5 nurse at the same facility on the same floor is often $8,000–$15,000 – even without a promotion or specialty transfer.
Salary by employer type
The type of facility significantly affects what med-surg nurses earn. From highest to lowest:
Large academic medical centers and Magnet hospitals – $85,000–$110,000+ nationally. These facilities offer higher base pay, stronger benefits, and more robust certification reimbursement programs. Competition for positions is higher.
Regional hospital systems (HCA, CommonSpirit, Ascension, Tenet) – $80,000–$100,000. Consistent pay scales across facilities. Travel and per diem opportunities often available within the system.
Community hospitals – $75,000–$90,000. May offer strong work-life balance and lower patient census, but base pay is typically below health system rates.
Long-term acute care (LTAC) facilities – $70,000–$85,000. LTAC hospitals serve medically complex patients who need extended acute care but don’t require full hospital resources. Med-surg skills transfer well here, though the patient population is narrower.
Skilled nursing facilities (SNF) with RN positions – $65,000–$80,000. Lower acuity than hospital med-surg, but also lower pay.
Outpatient surgical centers – $70,000–$85,000. Less weekend and holiday coverage, but typically no nights; some nurses accept the pay trade-off for schedule quality.
Union membership also affects compensation. Nurses in states with strong nursing unions (California, Massachusetts, Minnesota, Washington, Oregon, New York) generally earn more than peers in comparable non-union facilities. California’s large union contracts – particularly with National Nurses United member organizations – set wage floors significantly above the national average.
How CMSRN certification affects salary
CMSRN-certified nurses earn a measurable premium over non-certified peers. Analysis of available salary data places the certification salary impact at $5,000–$10,000 annually, though the exact figure varies by employer and whether the facility formally rewards certification with a pay differential.
How certification affects your pay in practice:
Direct pay differential: Many hospitals explicitly offer a certification premium – typically $0.50–$2.00/hour added to base pay when you provide proof of certification. At $1.00/hour, that’s approximately $2,080/year on a full-time 40-hour schedule.
Negotiation leverage: CMSRN certification strengthens your position when negotiating an annual review increase or counter-offering a job offer. Quantified credentials give you a specific, employer-verifiable data point.
Access to higher-level roles: CMSRN-certified nurses are stronger candidates for charge nurse, clinical educator, and preceptor positions – roles that carry pay differentials of $2–$5/hour above staff nurse rates.
Travel nursing premiums: Some travel staffing agencies offer higher weekly rates or more assignment options for CMSRN-certified med-surg nurses.
The total CMSRN salary impact over a career is substantial. The credential is awarded by the Medical-Surgical Nursing Certification Board (MSNCB), the certifying arm of AMSN: members pay $267 for the exam and non-members $394, each inclusive of a $90 non-refundable processing fee. Eligibility requires an unencumbered RN license plus 2,000 med-surg practice hours within the past three years – the frequently quoted “two years of experience” is MSNCB’s recommendation rather than a hard requirement. The certification recoups its cost within weeks to months at any salary premium. Check whether your employer reimburses the exam fee before applying – many do.
For full details on CMSRN eligibility, exam format, and the certification process, see our how to become a med-surg nurse guide.
Travel med-surg nurse salary
Travel med-surg nursing is available to nurses with 1–2 years of solid floor experience. The headline weekly rate looks large against a staff salary, but the comparison needs care: travel packages bundle non-taxable housing and meal stipends into the advertised figure, and few travelers work all 52 weeks. Measured honestly, the gain over a staff role is real but narrower than the weekly number suggests.
Current travel med-surg compensation (2026):
- National average weekly rate: $2,115/week (Vivian Health, August 2026)
- Annualized: approximately $110,000 at 52 continuous weeks, or $95,000–$102,000 at the 45–48 worked weeks most travelers achieve once gaps between contracts are counted
- Top-paying states for travel med-surg (Vivian Health): Alaska ($2,635/week), Rhode Island ($2,619/week), Nevada ($2,529/week), California ($2,442/week), Massachusetts ($2,389/week)
- Med-surg sits about 3% below Vivian’s all-nursing travel average of $2,189/week. Travel med-surg is among the most available travel specialties rather than the highest-paying one.
Weekly rates by experience level (approximate, ZipRecruiter/SkillGigs aggregated data):
| Experience | Typical weekly rate |
|---|---|
| Entry level (0–1 year travel experience) | $1,500–$2,000/week |
| Mid-level (3–5 years RN experience) | $2,000–$2,500/week |
| Experienced (5–7 years RN experience) | $2,400–$2,800/week |
| Senior (7+ years) | $2,800–$3,500+/week |
Travel pay packages include a combination of taxable hourly base pay and non-taxable stipends for housing and meals. The taxable/non-taxable split varies by agency and assignment location. The headline “weekly rate” figures reflect total package value.
Practical considerations for travel med-surg:
Most travel agencies require 1–2 years of recent acute care med-surg experience. A strong float pool background or experience on a high-acuity floor accelerates eligibility. Vivian Health, AMN Healthcare, and Aya Healthcare are among the largest travel nursing platforms; comparing offers across agencies on the same assignment is standard practice.
Med-surg is one of the most consistently available travel specialties – demand is year-round at most health systems. This predictability makes it easier to string together back-to-back 13-week contracts without gaps.
For a full breakdown of the travel nursing path, licensing requirements, and how to evaluate agencies, see our guide on how to become a travel nurse and our travel nurse salary guide.
How to increase your salary as a med-surg nurse
Several concrete strategies can move your pay meaningfully above the baseline:
1. Get CMSRN certified The lowest-cost, highest-return action available to any med-surg nurse with 2+ years of experience. The exam costs under $400. The return is $5,000–$10,000/year in most markets, plus access to higher-level roles. Many employers reimburse the fee.
2. Complete your BSN (if you hold an ADN) Many hospital systems pay an additional $1–$3/hour for BSN-prepared nurses, and BSN completion is a prerequisite for management, education, and advanced practice roles. Online RN-to-BSN programs are available for under $10,000 and can be completed in 12–18 months while working full time.
3. Move to a higher-paying state Geographic arbitrage is the single largest salary lever available to RNs. Tennessee’s RN median is $81,500; Washington’s is $124,200 and Oregon’s $129,010. A mid-career med-surg nurse moving from Tennessee to the Pacific Northwest is looking at roughly $43,000–$48,000 in additional annual pay at the state median, without changing specialty or employer type. Bedside nursing offers no remote option, so physical relocation is the only route to that arbitrage – model it against local housing costs before committing, since a meaningful share of the gain is absorbed by rent in Seattle and Portland.
4. Travel nurse for 1–3 years At $2,115/week, a travel med-surg nurse working 45–48 weeks lands around $95,000–$102,000 in total package value, against roughly $96,500 for a full-year staff role at the national med-surg average. The gain shows up when you target the strongest markets – Alaska, Rhode Island, and Nevada run $2,500–$2,635/week, which is $115,000–$125,000 at the same worked weeks – or when you stack high-rate contracts back to back. After 13–26 weeks of travel, many nurses also return to staff positions with better offers, having demonstrated mobility and negotiating leverage.
5. Transition to a specialty unit ICU, ED, cardiac cath lab, and labor and delivery positions typically pay $2–$8/hour more than general med-surg. The transition requires additional training and sometimes a pay cut during orientation, but the long-term earning ceiling is higher. See our guides on how to become an ICU nurse and ICU nurse salary.
6. Move into charge nurse or clinical educator roles Charge nurses earn shift differentials of $2–$5/hour above staff pay at most facilities. Clinical educators move off the floor but often retain a base comparable to senior staff while gaining schedule control. Both roles require CMSRN or equivalent credentialing and a track record of mentoring peers.
7. Pursue nurse practitioner training NP programs take 2–3 years and require clinical hours, but the salary jump is significant: the BLS OEWS May 2025 median for nurse practitioners (SOC 29-1171) is $132,300, with a mean of $137,300 and a 90th percentile of $174,420. Adult-Gerontology PCNPs, the NP path most aligned with med-surg experience, typically sit in the $115,000–$140,000 range. Med-surg experience is strong preparation for adult-focused NP practice. See our guide on how to become a nurse practitioner.
FAQ
What is the starting salary for a med-surg nurse?
New graduate med-surg nurses typically earn between $60,000 and $75,000 annually in most states, with significant variation by geography. In California, new grads on med-surg floors can start above $85,000 due to the state’s strong union contracts and mandatory staffing laws. The median annual wage for all RNs (the closest BLS proxy for med-surg) was $97,550 as of OEWS May 2025, with a mean of $101,420 – but this blends all experience levels. Entry-level positions skew well below that figure.
Do med-surg nurses make less than ICU nurses?
Generally yes, though the gap is smaller than most nurses expect. ICU nurses earn a modest premium over med-surg nurses at most hospital systems – typically $2–$5 more per hour. The larger differentials come from experience, certifications, and geography rather than from the unit type alone. A CMSRN-certified med-surg nurse with five years of experience will often out-earn a new ICU nurse.
Is CMSRN worth the salary increase?
The data suggests yes. CMSRN-certified nurses typically earn $5,000–$10,000 more annually than non-certified med-surg nurses in comparable roles. The exam is administered by the Medical-Surgical Nursing Certification Board (MSNCB); AMSN members pay $267 and non-members $394, each inclusive of a $90 non-refundable processing fee. Many hospitals reimburse the exam fee entirely. Even without reimbursement, the certification pays for itself within the first month of any salary premium.
What is the highest-paying state for med-surg nurses?
California. BLS OEWS May 2025 data shows California RNs earn a median of $140,270 annually, ahead of Hawaii at $136,320. Vivian Health data specifically for med-surg nurses shows California hourly rates averaging $78/hour, with the highest advertised staff listings reaching $95/hour. The combination of California’s mandatory staffing ratios (which require more nurses per shift), high cost of living, and strong union contracts drives this premium. Note that California’s own RN median works out to about $67.44/hour, so the $78/hour Vivian figure reflects advertised listing rates rather than the typical employed wage.
References
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics (OEWS), Registered Nurses (SOC 29-1141),” May 2025. National median annual wage $97,550; mean $101,420.
- U.S. Bureau of Labor Statistics, “Occupational Outlook Handbook: Registered Nurses,” 2025. Employment projected to grow 5% from 2024 to 2034.
- U.S. Bureau of Labor Statistics, “May 2025 State Occupational Employment and Wage Estimates,” 2026. State-level RN median annual wage tables used for the state table in this guide (California $140,270; Hawaii $136,320; Alabama $77,080).
- U.S. Bureau of Labor Statistics, “May 2025 Metropolitan and Nonmetropolitan Area Occupational Employment and Wage Estimates,” 2026. Metro-area RN annual median wages (San Jose, Vallejo, San Francisco, Seattle, Boston), accessed via the O*NET local wage tables for SOC 29-1141.
- Medical-Surgical Nursing Certification Board (MSNCB), “CMSRN Certification: Eligibility Requirements and Exam Fees,” 2026. AMSN member exam fee $267; non-member $394, each inclusive of a $90 non-refundable processing fee; 2,000 med-surg practice hours within the past three years.
- Vivian Health, “Average Medical Surgical Nurse Salary by State and Nationally,” data updated 5 August 2026. National staff average $46.40/hour against an all-nursing listing average of $47.77/hour; California $78/hour.
- Vivian Health, “Average Travel Medical Surgical Nurse Salary by State and Nationally,” data updated 6 August 2026. National travel average $2,115/week against an all-nursing travel average of $2,189/week; state weekly rates.
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Nurse Practitioners (SOC 29-1171),” May 2025. Median annual wage $132,300; mean $137,300; 90th percentile $174,420.
- American Association of Colleges of Nursing (AACN), “Nursing Fact Sheet,” 2025. BSN pay differentials and RN-to-BSN pathway context.
- American Nurses Credentialing Center (ANCC), Magnet Recognition Program overview, 2025. Context for academic and Magnet facility pay premiums.