Why RN Pay Varies $22,947 by Region in 2026

Registered nurse pay swings by $22,947 between the West and the Midwest in 2026, the widest regional pay gap MGMA found for any of the 18 support-staff roles it tracks. Patient care assistant pay varies by $19,760 between the East and the South in the same report, the second-widest gap MGMA measured.

MGMA published the findings in its 2026 Management and Staffing Compensation Data Report on June 25, 2026, part of its ongoing DataDive series covering front-desk, clinical, and billing pay. The report tracked one-year and five-year pay changes across those 18 roles, alongside regional and tenure comparisons, and found pay moving in different directions depending on the cut. A practice reading only a single national median for a role would miss most of what is actually happening to pay this year.

Regional Pay Gaps Are Wide Enough to Change a Hiring Plan

The $22,947 spread in registered nurse pay between the West and the Midwest is large enough to change which candidates a practice can realistically compete for in either region. Patient care assistants show a similar pattern at $19,760 between the East, the highest-paying region for that role, and the South, the lowest. Both figures describe pay for the same job title inside one national labor market, and MGMA's report lists them among the widest gaps of the 18 roles it tracked for 2026.

A Midwest practice that benchmarks registered nurse pay against a national average risks setting a band nearly $23,000 too high for its own labor market. A Western practice using the same average risks setting one too low to compete. The same logic applies to patient care assistants in the South and the East. Regional benchmarking, not a single blended figure, is what MGMA's own data points to here.

Source: MGMA Management and Staffing Compensation Data Report, June 25, 2026.

Two Decades of Tenure Buy Almost Nothing in Nursing Pay

MGMA's report also compared nursing staff by experience level and found only a $298 gap in 2025 median pay between staff with 21 or more years of experience and those with five years or fewer. That gap comes from the same national data set that produced the $22,947 regional spread, which means location moves nursing pay roughly 77 times more than two decades of tenure does in this data.

For a practice that pays new hires close to the market rate, the $298 figure leaves almost no room to reward a nurse who stays 15 or 20 years longer at the same practice. A retention program built around tenure-based step increases is working against a number that shows almost no separation at the top of the experience scale in MGMA's national data.

Which Roles Actually Got Raises in the Past Year

Pay moved up for 8 of the 18 roles MGMA tracked over the past year and down for the other 10. Licensed practical nurses led the gainers at 6.5%, followed by general accounting staff at 5.7%, medical receptionists at 4.8%, and medical assistants at 4.3%. Those four roles span both clinical support and back-office billing work, so the gains were not limited to one department.

Source: MGMA Management and Staffing Compensation Data Report, June 25, 2026. A dash marks a figure the report did not break out for that role.

The Five-Year Trend Still Favors Staff

Seventeen of the 18 roles MGMA tracked pay more today than they did five years ago, even after a year in which 10 of those roles saw pay fall. Licensed practical nurses gained the most ground over five years at 29.7%, ahead of medical receptionists at 22.0% and medical assistants at 20.6%. Triage nurses, a role MGMA did not break out in the one-year figures, gained 15.3% over the same five-year window.

Reading the one-year and five-year columns together shows a labor market that expanded quickly earlier in the five-year window and has since cooled for several roles, without giving back most of the ground gained. A practice budgeting a flat raise for 2026 based only on this year's slower pace would be working against a five-year trend line that moved much further.

Medical Assistants Are Still Hard to Hire Despite the Raises

Pay gains have not solved the hiring problem for one of the roles seeing real increases. MGMA found 56% of practices reported medical assistant hiring got harder over the past year, against 7% who said it got easier. That split held even with medical assistant pay up 4.3% year over year and 20.6% over five years, evidence that raising pay for this role on its own has not closed the hiring gap practices report.

What the Gaps Mean for 2026 Pay Bands

A practice setting 2026 pay off one national figure is working against data that shows a nearly $23,000 regional swing for registered nurses and a $19,760 swing for patient care assistants. The one-year role data adds a second warning: 8 of 18 tracked roles rose in pay while 10 fell, so a single across-the-board adjustment will overpay the falling roles and underpay the rising ones in the same practice. Checking a role's regional figure and its five-year trend line before setting next year's band is what MGMA's own breakdown supports, role by role rather than as one blended average.

Sources

• GlobeNewswire, "Medical Practice Pay Cools, But Hiring Pressure Holds Firm, New MGMA Report Finds," June 25, 2026
• MGMA, "2026 Management and Staffing Compensation Data Report"