RN Salary in Missouri (2026): The Complete BLS-Anchored Guide
Last verified: April 23, 2026 — all pay figures anchored to U.S. Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) 29-1141 Registered Nurses, May 2024 release; NLC compact membership per NCSBN records (Missouri is an original compact member; enhanced NLC effective January 19, 2018); union context from Missouri Nurses Association (MONA).
Missouri is a two-metro state from an RN-market perspective — Kansas City (MO portion, straddling the KS line) and St. Louis (straddling the IL line) together account for approximately 65% of Missouri RN employment. Springfield (CoxHealth + Mercy Springfield), Columbia (University of Missouri Health — the state academic center), Joplin, Jefferson City, Cape Girardeau, and rural Missouri fill the remainder. BLS OEWS 29-1141 May 2024 reports a Missouri state RN median annual wage of $72,9401 — approximately 15% below the national RN median of $86,070, one of the lower nominal-wage state markets in the country. Missouri is a long-standing NLC compact member (original compact early 2000s; enhanced NLC effective January 19, 2018), right-to-work / low-union-density, with substantial non-profit Catholic and academic system scale. This guide is the complete Missouri RN salary picture in 2026.
The Headline — Missouri RN Pay in One Chart
BLS OEWS 29-1141 Registered Nurses, Missouri state, May 2024 release:1
| Metric | Missouri | U.S. median | Delta |
|---|---|---|---|
| Median (50th percentile) annual | $72,940 | $86,070 | -15% |
| Mean annual | $76,800 | $94,480 | -19% |
| 10th percentile annual | $53,270 | $61,250 | -13% |
| 25th percentile annual | $62,560 | $72,800 | -14% |
| 75th percentile annual | $88,650 | $107,380 | -17% |
| 90th percentile annual | $102,620 | $132,680 | -23% |
| Median hourly | $35.07 | $41.38 | -15% |
| Employment | ~75,000 | ~3.3M | — |
Missouri pay sits meaningfully below the national median across the distribution. Missouri's nominal wage structure has not kept pace with post-2020 inflation-adjusted RN wage trends in other states. Cost of living context is important — Missouri housing is substantially below national average, and net real RN purchasing power is often stronger than nominal pay indicates, particularly outside the two major metros.
Why Missouri Pays What It Does — The Structural Drivers
1. Two-metro concentration: Kansas City + St. Louis. Roughly 65% of Missouri RN employment concentrates in the Kansas City (MO portion) and St. Louis metros. Springfield (~8%), Columbia (~4%), Joplin (~3%), Jefferson City (~2%), Cape Girardeau (~2%) and rural Missouri account for the remainder.
2. St. Louis academic medical center density.
- BJC HealthCare (St. Louis + regional) — the largest Missouri health system. 14 hospitals including Barnes-Jewish Hospital (flagship, academic partner of Washington University School of Medicine), St. Louis Children's Hospital (part of BJC, pediatric academic), Missouri Baptist Medical Center, Christian Hospital, Alton Memorial Hospital (IL), Progress West (O'Fallon), Boone Hospital Center (Columbia — joint venture with BJC), Memorial Hospital Belleville (IL).2 BJC employs approximately 14,000 RNs across the network — one of the largest RN employer concentrations in the U.S. Midwest.
- SSM Health (St. Louis-headquartered multi-state) — 23 hospitals across MO/IL/OK/WI. In Missouri: SSM Health Cardinal Glennon Children's Hospital, SSM Health Saint Louis University Hospital (post-2015 partnership with Saint Louis University), SSM Health St. Clare Hospital (Fenton), SSM Health St. Joseph Hospital (St. Charles + Lake St. Louis), SSM Health DePaul Hospital (Bridgeton), SSM Health St. Mary's Hospital (Richmond Heights), and regional.
- Mercy Health / Mercy (Chesterfield HQ) — 40+ hospitals across MO/AR/OK/KS. In Missouri: Mercy Hospital St. Louis (Creve Coeur), Mercy Hospital Washington, Mercy Hospital Jefferson (Festus), Mercy Hospital South (Kansas City MO), Mercy Springfield (flagship Mercy), Mercy Cassville, Mercy Lebanon, Mercy Aurora, Mercy Joplin, Mercy Cassville. Largest Missouri-based system by operations footprint.
- Saint Luke's Health System (Kansas City MO) — 15+ hospitals; Saint Luke's Hospital of Kansas City (flagship), Saint Luke's East (Lee's Summit), Saint Luke's North (Smithville + Barry Road), Saint Luke's South (KS), Saint Luke's Surgicenter, and regional.
3. Kansas City metro complexity — MO-KS state line. Kansas City metro spans Missouri and Kansas. Missouri-side (Jackson / Clay / Platte / Cass counties) includes Saint Luke's Health System HQ + University Health / Truman Medical Centers + Children's Mercy Kansas City + Research Medical Center (HCA). Kansas-side (Johnson / Wyandotte counties) hosts University of Kansas Health System (KU Med). The state-line metro creates interesting commuter dynamics — Missouri RNs can work in Kansas facilities and vice versa.
4. University of Missouri Health Care (Columbia) — the state academic medical center; University Hospital + Women's and Children's Hospital + Missouri Orthopaedic Institute + Ellis Fischel Cancer Center. State-employer; pension access (MOSERS).
5. CoxHealth (Springfield) — southern Missouri flagship. Cox Medical Center South + Cox Medical Center North + Cox Branson + Cox Monett + Cox Barton County.
6. Long-standing NLC compact membership. Missouri has been an NLC compact member continuously since the compact's early years, joining in the original NLC era. Missouri transitioned to the enhanced NLC (eNLC) effective January 19, 2018 per NCSBN records.3 This structural advantage has historically supported travel-nurse pipeline into Missouri.
7. Right-to-work reality and low union density. Missouri passed right-to-work legislation (SB 19) in 2017, which was overturned by referendum (Proposition A) in August 2018 — preserving private-sector organizing options but without strong union-organizing momentum in the RN labor market. The Missouri Nurses Association (MONA) functions primarily as a professional association.4 Net effect on pay: Missouri lacks the union-driven pay-floor lift that CA / NY / WA / IL / MI / MN / NJ show.
8. Cost of living. Missouri has one of the more favorable cost-of-living-to-nominal-wage ratios in the U.S. Kansas City and St. Louis housing is substantially below coastal metros; Springfield, Columbia, Joplin housing is very affordable. Net real RN purchasing power is typically stronger than nominal pay indicates.
Metro Breakdown — All BLS-Reported Missouri Areas
Missouri metros with BLS OEWS 29-1141 published data (May 2024):1
| Metro | Median hourly | Median annual | Employment | Notes |
|---|---|---|---|---|
| St. Louis (MO–IL, MO portion) | $35.94 | $74,760 | ~27,000 | BJC + SSM + Mercy St. Louis + Ascension (former St. John's / DePaul via SSM merger). |
| Kansas City (MO–KS, MO portion) | $35.19 | $73,200 | ~21,000 | Saint Luke's Health System + University Health / Truman Medical Centers + Children's Mercy + Research Medical Center (HCA) + North Kansas City Hospital. |
| Columbia | $37.97 | $78,980 | ~4,500 | University of Missouri Health Care + Boone Hospital Center (BJC JV). Highest Missouri metro median due to state academic concentration. |
| Springfield | $34.14 | $71,010 | ~8,500 | Mercy Springfield (flagship Mercy facility) + CoxHealth Cox Medical Center South + Cox Medical Center North. |
| Jefferson City | $34.22 | $71,170 | ~1,500 | SSM Health St. Mary's Jefferson City + Capital Region Medical Center (MU Health). |
| Joplin (MO portion) | $33.14 | $68,930 | ~3,500 | Mercy Hospital Joplin + Freeman Health System. |
| St. Joseph | $33.31 | $69,270 | ~2,000 | Mosaic Life Care (formerly Heartland Health). |
| Cape Girardeau (MO–IL, MO portion) | $32.69 | $68,000 | ~2,000 | SoutheastHEALTH + Saint Francis Healthcare System. |
| Columbia (separate from the Columbia listed above depending on metro / cluster definitions) | — | — | — | See above. |
St. Louis and Kansas City metros dominate Missouri RN employment. Columbia has the highest metro median due to University of Missouri Health Care's academic pay structure. Springfield and Joplin run modestly below the state median.
Missouri Pay by Care Setting
Base pay varies by care setting on top of the state BLS median. Typical 2026 Missouri base ranges (before differentials), Kansas City / St. Louis metros:
| Care setting | Typical 2026 MO base (major metros) | Source link |
|---|---|---|
| Acute care med-surg / stepdown | $62,000–$88,000 | Hub F acute |
| ICU | $72,000–$105,000 | Hub F ICU |
| ED | $68,000–$100,000 | Hub F ED |
| OR / perioperative | $70,000–$98,000 | Hub F OR |
| L&D | $70,000–$100,000 | Hub F L&D |
| Pediatric specialty | $72,000–$108,000 | Hub F pediatric |
| Ambulatory | $58,000–$82,000 | Hub F ambulatory |
| Home health | $62,000–$85,000 | Hub F home health |
| Hospice | $58,000–$82,000 | Hub F hospice |
| School nursing | $42,000–$66,000 (10-month contract) | Hub F school |
Shift differentials typical at Missouri hospital systems: night +$3–$6/hour, weekend +$2–$4/hour, charge +$1–$3/hour, specialty-cert stipend varies by employer. Springfield / Joplin / Cape Girardeau typically pay 5–12% below Kansas City / St. Louis metros; Columbia pay runs modestly above the state median due to MU Health academic structure.
Top Missouri Employers — 2026 Pay Landscape
BJC HealthCare (St. Louis + regional) — largest Missouri system. Barnes-Jewish Hospital (flagship, WashU School of Medicine academic partner), St. Louis Children's Hospital (academic pediatric), Missouri Baptist Medical Center, Christian Hospital, Alton Memorial (IL), Progress West (O'Fallon), Boone Hospital Center (Columbia JV), Memorial Hospital Belleville (IL), Missouri Baptist Sullivan, Parkland Health Center (Farmington + Bonne Terre).
SSM Health (St. Louis-headquartered, multi-state) — 23 hospitals across MO/IL/OK/WI. Missouri facilities: SSM Health Cardinal Glennon Children's Hospital, SSM Health Saint Louis University Hospital (SLU academic partnership), SSM Health St. Clare Hospital (Fenton), SSM Health St. Joseph Hospital (St. Charles + Lake St. Louis), SSM Health DePaul Hospital (Bridgeton), SSM Health St. Mary's Hospital (Richmond Heights + Jefferson City), SSM Health St. Francis Hospital (Maryville), and more.
Mercy Health / Mercy (Chesterfield MO-headquartered, 40+ hospitals across MO/AR/OK/KS) — Mercy Hospital St. Louis (Creve Coeur), Mercy Hospital Washington, Mercy Hospital Jefferson (Festus), Mercy Hospital South (Kansas City MO), Mercy Springfield (flagship Mercy facility — largest Mercy hospital by operations), Mercy Cassville, Mercy Lebanon, Mercy Aurora, Mercy Joplin, Mercy Cassville.
Saint Luke's Health System (Kansas City MO) — 15+ hospitals. Saint Luke's Hospital of Kansas City (flagship), Saint Luke's East (Lee's Summit), Saint Luke's North (Smithville + Barry Road), Saint Luke's South (KS), and regional.
University Health / Truman Medical Centers (Kansas City MO) — public safety-net hospital; Jackson County-affiliated. Pension access (Jackson County + MO state).
Children's Mercy Kansas City — pediatric academic; one of the largest freestanding pediatric hospitals in the Midwest.
Research Medical Center (Kansas City MO — HCA) — for-profit HCA hospital; tertiary care.
North Kansas City Hospital — Kansas City MO secondary.
University of Missouri Health Care (Columbia) — state academic medical center; University Hospital + Women's and Children's Hospital + Missouri Orthopaedic Institute + Ellis Fischel Cancer Center. State-employer pension access (MOSERS).
CoxHealth (Springfield) — Cox Medical Center South + Cox Medical Center North + Cox Branson + Cox Monett + Cox Barton County.
Freeman Health System (Joplin) — Freeman Hospital West + Freeman Neosho + Freeman Ozark.
Mosaic Life Care (St. Joseph) — formerly Heartland Health; flagship northern Missouri system.
SoutheastHEALTH (Cape Girardeau) — SoutheastHEALTH Cape Girardeau.
Saint Francis Healthcare System (Cape Girardeau) — Saint Francis Medical Center.
VA Medical Centers (St. Louis VA, Kansas City VA, Columbia Truman VA, Poplar Bluff VA) — federal pay scale + federal pension.
Compare specific facilities at Hospital Pay Band Comparator.
Specialty Certifications — What They Stack on Missouri Base
Missouri's non-union employer landscape means specialty-cert differentials are set by employer policy. Magnet-designated hospitals (Barnes-Jewish, St. Louis Children's, Missouri Baptist, Mercy Hospital St. Louis, Mercy Springfield, Saint Luke's Hospital of Kansas City, Children's Mercy, University of Missouri Health) are most likely to pay differentials.
- CCRN — AACN; MO differential typically $0.75–$1.75/hour + clinical-ladder step at Magnet facilities.
- CEN — BCEN; MO differential typically $0.75–$1.50/hour.
- OCN — ONCC; MO differential typically $0.75–$1.75/hour at Siteman Cancer Center (BJC/WashU, NCI-designated Comprehensive Cancer Center) / Ellis Fischel (MU Health) / Mercy Cancer Center programs.
- CNOR — CCI; MO differential typically $0.75–$1.75/hour + RNFA pathway.
- PCCN — AACN; MO differential typically $0.50–$1.25/hour.
- CMSRN — MSNCB; MO differential typically $0.50–$1.25/hour.
- RNC-OB / C-EFM / RNC-NIC / CPN / TCRN / CPEN — common at Cardinal Glennon, St. Louis Children's, Children's Mercy, MU Women's and Children's programs.
Model at Specialty Cert Worth-It.
Travel Nurse Baseline — Missouri Comparison
Missouri is a mid-to-lower-rate travel market. NLC compact membership dates back to the compact's early years; enhanced NLC since 2018.
Typical 2026 weekly gross for experienced travelers on Missouri contracts (Kansas City / St. Louis):
| Specialty | Weekly gross (typical) | Weekly gross (crisis rate) |
|---|---|---|
| Med-surg | $1,500–$2,000 | $2,200–$2,600 |
| Telemetry/PCU | $1,700–$2,100 | $2,400–$2,800 |
| ED | $1,800–$2,300 | $2,600–$3,000 |
| ICU | $1,900–$2,400 | $2,700–$3,100 |
| CVICU/NICU/PICU | $2,100–$2,700 | $2,900–$3,300 |
| L&D | $1,800–$2,300 | $2,500–$2,900 |
| OR | $1,900–$2,400 | $2,700–$3,100 |
Springfield / Columbia / Joplin metros typically run 5–15% below Kansas City / St. Louis rates.
Important: Missouri is a long-standing NLC compact member; enhanced NLC effective January 19, 2018 per NCSBN.3 RNs with NLC compact multistate licenses from other NLC states can practice in Missouri without additional licensure. Out-of-state RNs with single-state licenses (from non-NLC states) still need Missouri license by endorsement — typically 3–6 weeks processing.
Real take-home after IRS Publication 463 tax-home compliance, Missouri housing (very affordable — among the best value in the Midwest), Missouri state income tax (graduated up to 4.8% as of 2024, reducing over phased-in tax reform), and contract-specific terms typically runs 10–20% below headline. The narrow gap reflects low Missouri housing and tax costs. Run at Travel Nurse Contract Analyzer.
Missouri RN Licensing — Long-Standing NLC Compact Member
Missouri has been an NLC compact member continuously since the compact's early years. Missouri transitioned to the enhanced NLC (eNLC) effective January 19, 2018 per NCSBN records.3 The Missouri State Board of Nursing issues RN licenses including multistate compact options.5 Practical implications:
- RNs with NLC compact multistate licenses from other NLC states can practice in Missouri without separate state licensure.
- Missouri RNs with Missouri-issued multistate compact licenses can practice in any of 40+ other NLC member states.
- Out-of-state RNs with single-state licenses (from non-NLC states like California, New York, Oregon, Hawaii, Nevada, Massachusetts, Illinois, Pennsylvania, New Jersey, Minnesota) still need Missouri license by endorsement — typically 3–6 weeks.
Full Missouri licensing detail: Missouri Nurse Licensing Guide.
Career Lattice — How Missouri RNs Grow Pay
Clinical ladder (typical Magnet hospital structure): Clinical Nurse I → II → III → IV → V. BSN + specialty cert + professional activity required for ladder advancement. Missouri Magnet hospitals (Barnes-Jewish, St. Louis Children's, Missouri Baptist, Mercy Hospital St. Louis, Mercy Springfield, Saint Luke's KC, Children's Mercy, University of Missouri Health) have competitive ladder structures.
Public-sector ladder — University of Missouri Health Care (state, MOSERS pension), University Health Truman Medical Centers (Jackson County), VA offer pension access.
APRN track — MSN/DNP → FNP / AGPCNP / AGACNP / PMHNP / CNM / CRNA / PNP. Missouri grants APRN prescriptive authority under a collaborative agreement framework. Full practice authority has been proposed but not enacted as of 2026.
Two-metro career patterns — Missouri RNs frequently progress between Kansas City and St. Louis metros as well as into Kansas (KU Med) and Illinois (Alton Memorial / Memorial Belleville) border markets. NLC compact licensure simplifies multi-state movement.
Model educational investment ROI at BSN-to-MSN ROI.
Regional Realities — Cost-of-Living Adjustment
Missouri has one of the strongest cost-of-living-to-RN-pay ratios among all U.S. states:
- St. Louis metro: Competitive pay ($75K median); housing among most affordable of any large Midwest metro. Net purchasing power strong.
- Kansas City metro (MO portion): Competitive pay ($73K median); housing very affordable. Net purchasing power strong.
- Columbia: Highest MO metro pay ($79K); housing moderate (MU student demand). Net purchasing power strong for academic / MU Health employment.
- Springfield: Pay $71K; housing very affordable. Strong net purchasing power.
- Joplin / Cape Girardeau / Jefferson City / St. Joseph / rural Missouri: Pay $68K–$72K; housing very affordable. Net purchasing power often strongest in these markets.
Model net purchasing power at RN Salary by State with a Missouri cost-of-living overlay.
FAQ
What's the median RN salary in Missouri in 2026? BLS OEWS 29-1141 May 2024 release: $72,940 median Missouri RN annual wage.1 Mean: $76,800. 90th percentile: $102,620.
Which Missouri metro pays the most? Columbia: $78,980 median annual (MU Health-driven, highest MO metro). St. Louis: $74,760. Kansas City: $73,200. Springfield: $71,010.
Is Missouri in the Nurse Licensure Compact? Yes — Missouri has been an NLC compact member continuously since the compact's early years. Enhanced NLC effective January 19, 2018 per NCSBN records.3 RNs with compact licenses from other NLC states can practice in Missouri without additional licensure.
Why is Missouri RN pay below the national median? Combination of low union density, low cost of living (wage-to-COL equilibrium), lack of statutory ratios, two-metro concentration without a single dominant high-wage anchor metro, and lower 90th-percentile ceiling. Net real purchasing power is typically strong despite nominal pay 15% below national median.
Are there unions in Missouri nursing? Minimal. Missouri's right-to-work law (SB 19 of 2017) was overturned by Proposition A in August 2018; private-sector organizing is legally allowed but RN unionization is minimal. MONA functions primarily as a professional association.
How much do Missouri travel nurses earn? Kansas City / St. Louis weekly gross (2026): $1,500 (med-surg) to $2,700 (CVICU/NICU crisis). Springfield / Columbia 5–15% below. Real take-home typically 10–20% below headline — narrow gap reflects low Missouri housing and tax costs.
Is specialty certification worth it in Missouri? Yes at Magnet facilities. Barnes-Jewish, St. Louis Children's, Missouri Baptist, Mercy Hospital St. Louis, Mercy Springfield, Saint Luke's KC, Children's Mercy, MU Health tie certification to clinical-ladder advancement.
Are public-sector Missouri RN jobs competitive? Yes. University of Missouri Health Care (state, MOSERS pension), University Health Truman Medical Centers (Jackson County), VA (St. Louis, KC, Columbia, Poplar Bluff) offer pay + pension + strong benefits.
What's the two-metro career dynamic? Missouri RNs frequently move between Kansas City and St. Louis, and can easily cross into Kansas (KU Med) and Illinois (Alton Memorial / Memorial Belleville via BJC) border markets. NLC compact licensure simplifies multi-state career patterns — a meaningful advantage vs non-compact peer states.
What about CRNA pay in Missouri? CRNAs in Missouri typically earn $185,000–$275,000 base in 2026; top academic and private-practice settings reach $320,000+. Missouri CRNAs practice under physician supervision (Missouri has not adopted full practice authority for CRNAs as of 2026).
Sources
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U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics (OEWS), "29-1141 Registered Nurses," May 2024 data release, Missouri state and metro tables. https://www.bls.gov/oes/current/oes_mo.htm and https://www.bls.gov/oes/current/oes291141.htm ↩↩↩↩
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BJC HealthCare — Organizational Facts and Hospital Network. https://www.bjc.org/about ↩
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NCSBN Nurse Licensure Compact — Missouri (enhanced NLC effective January 19, 2018). https://www.ncsbn.org/nurse-licensure-compact.htm ↩↩↩↩
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Missouri Nurses Association (MONA). https://missourinurses.org/ ↩
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Missouri State Board of Nursing — RN Licensure including Compact Multistate Licensure. https://pr.mo.gov/nursing.asp ↩
