Nursing Salary: What You Actually Take Home

What's your salary?

My base rate is $34.13 an hour. I work nights, so I get a $5 night differential. That brings me to $39.13 for the hours between 7 PM and 7 AM. On paper, working three twelve-hour shifts a week at $39.13, I should gross about $73,300 a year. In practice, I grossed $71,400 last year. The difference is because I took PTO for two weeks and PTO pays at base rate, not with the differential. So those two weeks I was technically "off," I was also earning $5 less per hour for 24 shifts I'd already banked. That's about $1,900 I lost by taking a vacation. Nobody explains that when you sign up for night shift.

Walk me through the deductions.

OK. So, $71,400 gross. Federal taxes took about $10,700. Arizona state taxes, $1,800. Social Security and Medicare, about $5,460. Health insurance premium, my share, is $186 per biweekly paycheck, so $4,836 a year. That's a single plan. If I had a family plan it would be $412 per paycheck, which is, I did the math once, $10,712 a year. Dental is $23 per paycheck. Vision is $8. My 403(b) contribution is 4% of gross because the hospital matches up to 4%, so that's $2,856 going to retirement, which I'll get matching on, so that's actually the one deduction I don't resent.

After all of that, my take-home last year was about $43,600. Divided by 12, that's roughly $3,633 a month. My rent is $1,450 for a one-bedroom in Tempe, which is, by the way, not a nice one-bedroom. It's a perfectly fine one-bedroom. My car payment is $380. Car insurance, $165. Phone, $85. Utilities, $140 in summer because Phoenix in July means the AC runs all day while I'm sleeping and I need the apartment to be cold enough to actually sleep during daylight hours because, again, night shift. Groceries, $350 to $400. Student loans, $280 a month on an income-driven plan. I still owe $34,000 on a BSN.

After fixed expenses I have about $300 to $400 a month. That's my life. Gas, clothes, if I go out with friends, that $300 is it. I'm 32 years old, I have a bachelor's degree and a professional license that required passing a national board exam, and my disposable income is $300 a month.

You mentioned calculating your true hourly rate.

Right. So. I'm scheduled for 36 hours a week. Three twelves. But I don't actually work 36 hours. I arrive at 6:40 for a 7 PM shift to pull up the board in Epic, see what's in the waiting room, get a sense of what I'm walking into. That's 20 minutes I'm never paid for. And I almost never leave at 7 AM. If I have a patient who's mid-workup, or a trauma that came in at 6:30, or charting I haven't finished, I'm staying. I tracked it for four weeks. My average was 13.2 hours per shift, not 12. Over three shifts, that's 39.6 hours per week, not 36. The extra 3.6 hours per week are uncompensated. Over 50 weeks, that's 180 hours of unpaid work. At my base rate, that's about $6,100 I donated to the hospital.

So when I did the napkin math, I took my actual take-home, $43,600, and divided it by my actual hours worked, which was about 1,980, not the scheduled 1,872. My real hourly take-home rate is $22.02. Not $34.13. Not even $39.13 with the differential. $22.02 is what hits my bank account for every hour I'm physically in that emergency department. The barista at the coffee shop near my apartment makes $18 an hour plus tips. She does not start IVs on combative patients at 2 AM.

Do you pick up overtime?

Sometimes. OT is time and a half, so $51.20 an hour at base, or $56.20 with the night differential. A single overtime shift grosses me about $674. After taxes, that's maybe $470 in my pocket. Which is meaningful. That $470 is the difference between making my student loan payment comfortably and checking my bank balance three times before I pay it. But overtime also means a fourth twelve-hour night shift in a week, which means my body gets one day to recover instead of two, and by Friday I'm useless. My roommate Alejandra, she's a respiratory therapist, she works overtime every other week and she says the money is worth it. I think the money is necessary and the cost is my knees and my sleep and eventually my health, and I'm just choosing not to look at that math yet.

What's the money thing nobody tells you about nursing?

The hidden costs. Not student loans, everybody knows about those. I mean the costs the job itself creates. Compression socks, $15 a pair, I go through six pairs a year. Shoes, good ones that don't destroy your feet on twelve hours of concrete, $130 every eight months. Scrubs, because my hospital doesn't provide them for ER nurses, we're expected to buy our own. That's about $200 a year. My license renewal is $150 every two years. CEUs, continuing education units, are technically required to maintain my license, and while some are free online, the good ones cost $50 to $200 each. BLS recertification is $65. ACLS recertification is $175. TNCC, which is a trauma certification my ER expects, is $400 and has to be renewed every four years.

Then there's what I'll call the body tax. I've spent $840 on physical therapy for my lower back this year because my insurance covers 20 visits but my copay is $35 per visit and I've been 24 times. My back hurts because I lift and turn patients for 13 hours a shift. The job injured me and then I paid out of pocket to fix the injury the job caused. Nobody puts that in the salary comparison charts. "Average nursing salary: $86,000. Average cost of repairing what the job does to your body: not tracked."

What's your salary?

$58,200 base. I've been a nurse for 18 years. I started at the hospital in Greenville making $38,500 in 2008. Eighteen years and $19,700 in raises. That averages out to about a $1,094 raise per year, which, adjusting for inflation, is essentially flat. Some years were 3%. Some years were 1.5%. One year, during a budget freeze, it was zero. The zero percent year was the year I seriously looked at travel nursing, but Hannah was seven and my wife Terri said she didn't want to move around, and Terri was right, so I stayed.

Outpatient oncology pays less than hospital inpatient. I knew that going in. At the hospital I was making about $63,000 before I switched. I took a $5,000 pay cut to move to the cancer center. The trade was: no nights, no weekends, no holidays, and patients I see repeatedly over months or years instead of for two days during an admission. For my mental health, the trade was worth it. For my bank account, it means I'm 44 years old with nearly two decades of experience making less than a new grad in California.

Walk me through your budget.

Gross $58,200. Take-home after federal and state taxes, Social Security, Medicare, health insurance for a family of four, dental, vision, and my 3% retirement contribution is about $3,400 a month. That's for a family. Me, Terri, Hannah who's 13, and my son Luke who's 10.

Mortgage is $1,050. We bought in 2014 when Kinston prices were lower than they are now. I'd consider that our best financial decision. Car payments, $320 for the minivan and $280 for my truck. Insurance on both is $210. Utilities run about $180 in summer, $140 in winter. Groceries for four people is $650 to $700. Terri's a substitute teacher, which is technically income but it's unpredictable. She made $14,200 last year. When she subs, she makes $85 a day. When she doesn't, we live on mine. Hannah's braces are $5,400 total, and the orthodontist lets us do $225 a month for two years. Luke needs glasses. The pediatric ophthalmologist copay was $40, the lenses were covered, the frames Terri picked out at LensCrafters were $180 after insurance.

After all of it, we're tight. Not broke. Tight. I describe it to Terri as "we're one transmission away from a problem." If the minivan needs a $2,000 repair, that's a credit card. And credit card interest on $2,000 at our rate would be about $40 a month, which compounds, and suddenly a car repair becomes a six-month financial event.

You mentioned picking up agency shifts on Saturdays.

Yeah. I work for a PRN staffing agency. I do one Saturday shift at the hospital in Greenville, usually every other week, sometimes every week depending on what bills are coming. The agency pays $42 an hour for an experienced RN. A twelve-hour shift is $504 before taxes. After taxes, it's maybe $370 in my pocket. That's Hannah's braces payment plus $145 for whatever else comes up. I've been doing it for about eight months. On the Saturdays I work, I leave at 5:30 AM, drive 40 minutes to Greenville, work a floor shift that I haven't done in six years so I'm slower than I used to be, drive home, eat dinner at 8 PM, and fall asleep on the couch by 9.

Luke asked me once why I work on Saturdays when other dads don't. I said some dads do, he just doesn't see them. Which is true but also a deflection. The real answer is that I work on Saturdays because my primary job, where I administer chemotherapy and monitor patients for anaphylactic reactions to immunotherapy agents and hold people's hands during infusions that determine whether they live or die, pays $58,200, and that isn't enough for braces and glasses and a $1,050 mortgage in one of the cheapest housing markets in North Carolina.

Do you ever think about what you'd earn somewhere else?

All the time. California median for an oncology nurse with my experience is north of $110,000. Even Charlotte or Raleigh would probably be $72,000 to $78,000. But then the mortgage is $1,800 instead of $1,050 and the schools are bigger and Terri's family is here and the kids are settled. The financial calculation doesn't exist in a vacuum. My mother-in-law watches the kids when Terri subs and I work Saturdays. That's free childcare from someone who loves them. Monetize that and it's probably worth $15,000 a year. So we stay. And I drive to Greenville on Saturdays and I don't resent it, exactly. But I notice it. I notice that 18 years of showing up didn't get me far enough that I can pay for braces without a second job.

What's the money thing nobody tells you?

I don't go to the dentist. I'm an oncology nurse. I administer medication to preserve human bodies. I know what untreated health issues become. And I skipped my last two dental cleanings because the copay is $25 and I'd rather put that $25 toward Luke's shoes because he's growing a half-size every four months and shoes in kids' size 5 cost more than you'd think. Terri doesn't know I've skipped the dentist. She thinks my appointment is coming up. It is not coming up. I de-prioritized my own preventive care to maintain cash flow. I'm a healthcare professional who doesn't access healthcare because the healthcare I provide doesn't pay enough for the healthcare I need. If I think about that for too long, I have to laugh because the alternative is something else.

What did you make last year?

Gross, $156,200. That's across four contracts. January through March I was in Denver, med-surg, $2,450 per week. April through June in Portland, Oregon, step-down unit, $2,800 per week. I took three weeks off in July, which is zero income. August through October in Las Vegas, telemetry, $2,600 per week. November through mid-January I've been in Sacramento, med-surg again, $2,700 per week. The weekly rates include the taxable hourly wage plus a non-taxable housing stipend. The housing stipend is the big lever. Mine ranges from $1,200 to $1,600 per week depending on the city, and it's tax-free as long as I maintain a "tax home," which is my parents' house in Omaha where I pay $400 a month in rent to maintain the IRS requirement.

$156,000 is a lot more than the staff nurses we've been talking to. What's the catch?

The catch is everything the number doesn't show. Let me walk you through the actual expenses. Housing: I rented furnished apartments in every city. Denver was $2,100 per month. Portland was $2,350. Las Vegas was $1,700, which was the cheapest, but the apartment had roaches and I didn't find out until week two. Sacramento is $2,200. Total housing for the year was about $24,800. Remember, my stipend covered most of that tax-free, but the stipend was calculated based on GSA per diem rates, and actual rents in these cities often exceeded the stipend. Portland cost me about $300 out of pocket per month above the stipend.

Health insurance: I don't get employer-sponsored insurance. The agency offers a plan but it's $580 a month and the coverage is thin. I bought a marketplace plan for $420 a month with a $4,000 deductible. That's $5,040 in premiums, and when I sprained my ankle in Denver stepping off a curb at the end of a 13-hour shift, I paid $1,200 out of pocket because I hadn't hit my deductible. Total health costs for the year: about $6,240.

Retirement: no employer match. Zero. Staff nurses at hospitals typically get 3 to 6 percent matching on their 401(k) or 403(b). I contribute to a solo IRA, but there's no free money. If I were staff making $80,000 with a 4% match, the employer would be putting $3,200 into my retirement every year. Over a 30-year career, that's, well, it's a lot.

Travel: driving between contracts, gas, wear on my car. I put 23,000 miles on my Civic last year. Not all of it was contract travel, but most of it was. Gas was about $3,800. I'll need new tires and probably brakes before summer.

Licensing: California required a separate RN license. $300 application fee plus about $200 in document processing. Oregon was $195. Colorado recognized my compact license, so that was free. Nevada was compact too. But every time a non-compact state comes up, there's a fee and a 6 to 12 week processing time during which I can't work there. I spent $695 on licensing last year.

When I add it all up, my true net after taxes, housing, insurance, licensing, travel, and the $4,800 I pay my parents, was about $89,000. That's real money. It's more than I'd make as staff almost anywhere. But it's not $156,000. And the gap between $156,000 and $89,000 is where my stability lives. No employer retirement match. No PTO. When I took three weeks off in July, I earned nothing. A staff nurse taking three weeks of PTO still gets a paycheck.

Do you feel rich?

No. I feel solvent. I feel like I have margin. I saved $22,000 last year, which is the most I've ever saved, and that feels good. But rich? I live in furnished apartments with other people's furniture. I don't have a couch that's mine. I have two suitcases and a plastic bin of kitchen stuff in my trunk. My friend from nursing school, Dana, she's staff at Nebraska Medicine making $74,000, and she has a house with a yard and a dog and a bookshelf with actual books and a coffee table she picked out. When I visit her, which I do every July during my break, I sit on her couch and I think, this is what $74,000 buys if you stay in one place. It buys a life. What $156,000 buys if you move every 13 weeks is a number in a spreadsheet and a very organized suitcase.

I'm 29. I can do this for another few years. My plan is to save aggressively, build a down payment, and go back to staff when I'm ready to stop living out of a car. But I also said that last year. The money is, it's hard to walk away from. Every time a contract ends and I think "maybe I'll apply for staff positions," I get an email from the agency offering $2,800 a week in San Diego and my brain does the math before my heart has a chance to vote.

What's the money thing nobody tells you about travel nursing?

The taxes are terrifying. Travel nursing tax law is complicated. The housing stipend is only non-taxable if you maintain a legitimate tax home, which means you have to prove you have a permanent residence you return to and pay for. My parents' house in Omaha is real. I have a room there. I pay rent. I go back between contracts, sometimes. But the IRS audits travel nurses because the tax-free stipend structure is exactly the kind of thing people game. I know nurses who claimed a tax home they hadn't visited in a year. I know nurses who claimed the stipend while also renting out the "tax home" on Airbnb. If the IRS catches that, they reclassify all the stipend income as taxable and you owe back taxes plus penalties. I've heard figures of $15,000 to $25,000 owed.

I pay a CPA who specializes in travel nursing. Her name is Brenda, she's in Kansas City, she charges me $600 for my annual return. That sounds expensive until you realize that one wrong stipend classification could cost me $20,000. So I pay Brenda $600 and I sleep at night. Most of my travel nurse friends don't have a Brenda. Most of them use TurboTax and hope for the best. That's a bet I'm not willing to make with $156,000 in reported income and a housing structure the IRS considers inherently suspicious.