A Tale of Top Cities

With a near crisis-level RN staffing shortage now affecting just about every part of the nation, today it seems like all you have to do to find a city with an urgent demand for nurses is to throw a dart at a map of the U.S.

But choosing the right city in which to live, work and play is a more than just a matter of where the jobs are, or where the salaries are highest. It’s a highly personal choice based on your pace, lifestyle and professional goals. For example, do you prefer bustling, big cities with lots of nightlife or quiet, small-town living? Do you enjoy watching the seasons change or would you rather have sunshine 365 days a year? Are you more comfortable working in a large urban medical center or in isolated, medically underserved rural communities?

In compiling our selection of top cities for minority nurses in 2003, we placed special emphasis on these “personal factors” in order to come up with a list that would truly offer something for everyone. Our choices are also based on such factors as demand for nurses, RN salaries, cost of living, opportunities for educational and professional development and all-around livability (“fun factor”). And, of course, we looked especially hard for cities that lead the nation in racial and ethnic diversity, demand for culturally and linguistically competent nurses and the presence of magnet hospitals and other nursing employers with outstanding reputations as good places for minority nurses to cultivate their careers.

The Biggest: New York City Metro Area

The Big Apple and its boroughs and suburbs form the largest metropolitan area in the U.S., with more than 21 million residents. Not only does more people mean more need for nursing care, but RNs can also make big bucks in New York, earning an average salary of nearly $61,000 a year.1

Of course, living in New York City is not cheap. The median home price in 2000 was $230,200,2 and apartment rents in Manhattan’s trendy areas average $1,800 a month for a studio and $2,500 for a one-bedroom.3

New York has a long and rich history of cultural diversity. From 1892 to 1924, 12 million immigrants entered the U.S. through Ellis Island, and today New York continues to be a vibrant area for residents of all races and ethnicities. The metro area is currently home to more than 5 million recent immigrants, nearly half of them from Latin America.4

According to the Survey of Nurse Staffing in Hospitals in the New York City Region 2002, published by the Greater New York Hospital Association, demand for nursing staff is especially high in critical care, perioperative care and emergency departments. Hospitals in the region experienced an overall vacancy rate of 7.8% for direct patient care RNs, with higher vacancy rates reported in the Bronx (14%), Staten Island (10%), Westchester County (12%) and other counties north of New York City (12%). Nearly 60% of the city’s RN workforce is over age 40.

The New York State Nurses Association is an active lobbyist on behalf of nurses statewide. Thanks to their efforts, in recent years New York has passed laws to prevent needlestick injuries, protect health care whistleblowers and create a statewide peer assistance program for nurses. Bills are currently under consideration that would ban mandatory overtime and establish statewide minimum staffing guidelines.

In October 2002, the 7,000 RNs who work for New York City’s Health and Hospital Corporation reached a tentative agreement on a new 27-month contract. The agreement bolsters “merit pay” for performance and increases wages by 8.4%. The nurses are represented by the New York State Nurses Association and work at the city’s 11 acute care hospitals, four long-term care facilities, six diagnostic and treatment centers and the mayoral health agencies.

Last but not least, New York City’s theaters, restaurants, museums and other cultural attractions are known worldwide. The “city that never sleeps” has something special for everyone, from Central Park and Yankee Stadium to Coney Island and Broadway.

Next Bests–Other Big Cities:

• Chicago

• Dallas-Fort Worth

• Detroit-Ann Arbor

• Philadelphia

• San Antonio

• San Diego

• San Francisco

The Fastest Growing: Las Vegas

Las Vegas’ burgeoning population growth and especially severe RN shortage are creating excellent career opportunities for nurses looking to relocate to this oasis in the desert. The city’s population grew a blistering 83% between 1990 and 2000,4 and is expected to reach 2 million by 2005. This surge in population also increased Las Vegas’ cultural diversity: The percentage of Hispanic residents nearly doubled and the percentage of Asians increased by one-third.

This rapid growth spurt has had its consequences for the local health care industry. A report released in 2001 by the U.S. Department of Health and Human Services revealed that Nevada has the worst nurse-to-population ratio in the U.S., with only 520 nurses per 100,000 people. “And it is going to continue to be the worst as we keep leading the nation in population growth,” said Bill Welsh, president and CEO of the Nevada Hospital Association, at a recent Nevada Business Journal breakfast for local health care organizations. Nevada’s six nursing schools produce a total of 300 to 350 graduates each year, far short of the 767 new nurses a year needed to meet the state’s growth expectations, according to Welsh.

To try to keep up with the growth, Las Vegas is making investments to expand its health care infrastructure. The area is currently serviced by 23 hospitals, with five new ones planned over the next five years. In addition, the 2001 legislature required the state’s university system to develop a plan and budget for doubling its nursing programs. The proposal will be evaluated during the 2003 legislative session.

Las Vegas nurses earn an average of $48,955 a year. Housing costs are reasonable, ranging from a median of $152,000 for existing homes to $183,456 for new ones.5

This city is known for its casino splendor, and the Las Vegas Strip has its own museums, roller coaster rides, theatrical performances and round-the-clock entertainment. Yet the region offers much more than slot machines and bright lights. Lake Mead, Red Rock Canyon and the Hoover Dam are all within a two-hour drive, and the Grand Canyon and Death Valley are close enough for a weekend getaway.

Next Bests–Other Fast-Growing Cities:

• Austin-San Marcos, Texas

• Boise City, Idaho

• Fayetteville-Springdale, Arkansas

• Laredo, Texas

• McAllen-Edinburg, Texas

• Naples, Florida

• Phoenix, Arizona

• Provo-Orem, Utah

• Yuma, Arizona

The Most Diverse: Los Angeles Metro Area

Movie stars, palm trees, sunny 70-degree days and a population that is 45% non-Caucasian. Welcome to Los Angeles, one of the country’s most diverse metro areas!

Los Angeles, the nation’s second largest city, is a tremendously multicultural community. Thirty percent of its population are U.S. immigrants and the city has large numbers of Latino and Asian residents.4 In a recent study examining the impact of immigrant, gay/lesbian and artistic populations on technological innovation, LA was cited as the “most diverse” city in the U.S.6

This huge demand for culturally and linguistically competent health care is just one of many reasons why Los Angeles needs more minority nurses. California’s nurse-to-patient ratio is the second worst in the country (544 nurses per 100,000 people) and its nurses are among the oldest. Half of the RNs working in California were educated in other states or countries. In addition, the state’s population is growing, as is the percentage of residents over age 65.

Recent legislation mandated minimum nurse staffing ratios in the state’s acute care facilities, making nurse recruitment efforts even more aggressive. In July 2002, Tenet Healthcare Foundation, a philanthropic arm of Tenet Healthcare Corp., awarded $1 million to help train Latino nurses in the Los Angeles area. According to Tenet (which operates 30 hospitals in Southern California, including seven in East Los Angeles), more than 40% of the patients served in this market are Latino, yet Latinos account for fewer than 4% of California’s health care professionals.

Salaries for RNs in the Los Angeles metro area are above average–nearly $55,000 a year in the city, but slightly lower in nearby Riverside and Orange County.1 While homes in Los Angeles County sell for a median of $220,000, housing prices can vary dramatically depending on size and location. Tiny fixer-uppers in modest neighborhoods can go for $125,000, while prices in wealthy areas like Malibu, Brentwood and Beverly Hills can reach eight figures. Rentals generally range from $700 to $5,000 a month.3

As for livability and “fun factor,” Los Angeles offers an appealing mix of natural and man-made delights: thriving, culturally rich communities with easy access to some of the most beautiful beaches and mountains in the nation.

Next Bests–Other Culturally Diverse Cities:

• Austin-San Marcos, Texas

• Boston

• New York City

• San Diego

• San Francisco

Most Magnet Hospitals: Houston, Texas

Founded as a riverboat landing in 1836, Houston is now the fourth largest city in the U.S. and the largest in Texas. This thriving city offers a robust economy, racial and ethnic diversity, beautiful tree-lined neighborhoods and all the cultural and recreational attractions of a major urban center.

Houston was selected as one of Minority Nurse’s top cities because it has more magnet hospitals than any city in the U.S. Of the 58 facilities nationwide that have been granted the magnet designation by the American Nurses Credentialing Center for their outstanding commitment to nursing excellence, cultural diversity and career advancement opportunities for RNs, three are located in Houston:

• The Methodist Hospital

• St. Luke’s Episcopal Hospital

• The University of Texas M.D. Anderson Cancer Center.

Houston is also home to the Texas Medical Center, the largest medical complex in the world. Incorporating 11 academic and research institutes and 10 patient care institutions (including the three magnet hospitals), TMC employs 52,000 people and serves 4.8 million patients each year.

Housing in Houston is affordable, with prices averaging 39% lower than those of many comparably sized cities. Nursing salaries range across the region, from an average of $48,452 a year in Houston and $47,277 in nearby Galveston to $43,461 in the northern suburb of Brazoria.1

More than 90 languages are spoken throughout the Houston area, and 90 of its 500 visual and performing arts organizations are devoted to multicultural and minority arts. The metro area’s population grew by more than 25% between 1990 and 2000, with the most significant increase (7.5%) occurring in the Hispanic and Latino population.

While Houston’s notoriously hot summers may take some getting used to, it’s a highly livable city that offers a wide variety of entertainment and sports events. Houston is one of only four U.S. cities that have resident opera, ballet, symphony and theater companies, and there are professional teams representing every major sport. NASA’s Johnson Space Center and the country’s largest Livestock Show and Rodeo are located in the Houston area as well.

Next Bests–Most Magnets:

New Jersey boasts the highest concentration of magnet hospitals in a single state. New Jersey’s 12 magnets are located in the cities of:

• Brick

• Englewood

• Hackensack

• Lakewood

• Morristown

• Neptune

• New Brunswick (2)

• Paterson

• Red Bank

• Trenton (2)

Largest Population Over Age 65: Fort Myers and Cape Coral, Florida

Where do you find resort-style living, beautiful waterfronts and an elderly population facing a severe nursing shortage? Welcome to Fort Myers and Cape Coral, located two hours south of Tampa, on Florida’s southwest coast.

Situated directly across the Caloosahatchee River from each other, Fort Myers and Cape Coral have the largest percentage of residents over age 65 of any city in the U.S.–more than 25%, compared with Florida’s statewide average of 17.6%.4

The two cities, which are connected by four bridges over the river, are very different from each other. Fort Myers is smaller and more historic. It was founded with military roots and grew into a resort community in the early 1900s. Inventor Thomas Edison wintered in Fort Myers and helped the town develop its reputation as “the City of Palms.” Edison’s home, lab and gardens are a major tourist attraction, and the stately royal palms are one of the area’s most photographed scenes.

Other attractions include the Gulf of Mexico (about 20 miles away), the Boston Red Sox spring training stadium, and Imaginarium, a hands-on children’s museum.

Fort Myers is also one of the region’s most racially and ethnically diverse cities. Its population of 48,000 includes almost 7,000 Hispanics–the fastest-growing minority group–and 16,100 black or African-American residents.

Cape Coral, which is much newer than its riverfront neighbor, is the region’s largest city, offering residents 400 miles of canals and many waterfront living opportunities. Single-family homes can range from less than $100,000 to more than $1 million, but the median price is $130,000. Registered nurses in the area earn an average of $38,754 annually,1 so the relatively low cost of housing compared to many other parts of the country is a big plus.

Like most Florida communities, Fort Myers and Cape Coral need nurses to serve their growing elderly population. Lee Memorial Health System is the regional health network, offering a full range of medical specialties. Cape Coral Hospital, a 281-bed facility, has the area’s largest emergency room, along with strong specialties in rehabilitation, pediatrics, obstetrics, oncology, general surgery, urology, endocrinology and gastroenterology.

Florida is struggling with a growing nursing shortfall that is predicted to reach a need for 34,000 more RNs by 2006. In an effort to combat this pending crisis, the state has put forth a plan to allow eligible nurses to apply for affordable home and education loans. Funds are targeted to full-time licensed nurses–RNs, LPNs or LVNs–but may also be available to full-time nursing assistants certified by the Florida Board of Nursing and/or to nurses who have completed board-approved training.

Next Bests–Other Large 65+ Communities:

• Clearwater, Florida

• Hollywood, Florida

• Honolulu

• Philadelphia

• Scottsdale, Arizona

• Tampa-St. Petersburg, Florida

• Warren, Michigan

Data Sources
1. SalaryExpert
2. The National Association of REALTORS®
3. Homestore
4. U.S. Census Bureau
5. Home Builders Research, Inc.
6. The Brookings Institution