How Nurse Pay Works: Base Rate, Differentials & Overtime

Nurse pay starts with a base hourly rate set by your employer, usually tied to your experience, specialty and location. Shift differentials, certification pay, overtime and bonuses are added on top of that rate. Most staff nurses are paid hourly, so how your hours are counted directly affects what you take home.

How does nurse pay work?

Your total pay is your base rate multiplied by your hours, plus any differentials, overtime and bonuses you earn. The details differ by employer, state and union contract, so read your offer letter and the hospital's pay policy before you sign.

How hospitals set your base hourly rate

Most hospitals use a pay grid or range for each role. Where you land on it usually depends on:

• Years of licensed nursing experience, and sometimes whether that experience is in the same specialty
• Your education (some employers pay more for a BSN or MSN)
• The unit or specialty you're hired into
• Local labor market conditions and the cost of living in the area

Base rates vary widely by state and experience. To see typical rates for your area, check our nurse pay data.

Hourly vs salaried nurse pay

Most bedside RNs, LPNs and CNAs are paid hourly and are non-exempt under the federal Fair Labor Standards Act (FLSA), which means they're owed overtime. The U.S. Department of Labor has stated that registered nurses paid on an hourly basis are entitled to overtime.

Salaried roles are more common in nurse management, education and some administrative positions. These can be classified as exempt, meaning no overtime pay. Before you accept a salaried role, compare it with what the hours would earn you at an hourly rate.

What shows up on a typical nurse paycheck

A nurse pay stub often has more line items than people expect. Common entries include:

• Regular hours at your base rate
• Differential hours, listed separately for nights, weekends or other qualifying shifts
• Overtime hours, usually at 1.5 times your regular rate
• Holiday, on-call or call-back pay
• PTO used
• Deductions: federal and state taxes, retirement contributions (often a 403(b) at nonprofit hospitals), health insurance premiums and union dues if applicable

What is a shift differential in nursing?

A shift differential is extra pay for working less desirable hours or taking on added responsibility. Differentials exist so hospitals can staff nights, weekends and specialized roles. Amounts are set by employer policy or union contract. There is no federal requirement to pay them.

Night, evening and weekend differentials

Night differentials are usually the largest because night shifts are the hardest to staff. Evening differentials tend to be smaller. Weekend differentials may stack with night pay, so a Saturday night shift can earn both.

Check how your employer defines each shift. Some pay the night differential only for hours worked within a set window, such as after 7 p.m. Others pay it for the entire shift if most of it falls at night.

Holiday pay rates

No federal law requires holiday pay for private employers. Hospitals set their own policies, and many pay a premium for working recognized holidays, often time and a half. Some also give holiday credit to nurses who are scheduled off. The list of recognized holidays and the premium rate vary by employer and contract.

Charge nurse, certification and specialty differentials

Many employers pay extra for added responsibility or credentials:

• Charge nurse pay for shifts where you're in charge of the unit
• Preceptor pay for orienting new staff
• Certification pay for specialty credentials such as CCRN (AACN), CEN (BCEN), CPN (PNCB), OCN (ONCC), CNOR (CCI) or PMHN-BC (ANCC)
• Specialty or unit differentials for hard-to-staff areas

Certification pay may be an hourly add-on or an annual lump sum. Some employers also reimburse exam fees.

Flat-dollar vs percentage differentials

Differentials are paid in one of two ways. A flat-dollar differential adds a fixed amount per hour, no matter what your base rate is. A percentage differential adds a percentage of your base rate, so it grows as you get raises.

Percentage differentials work out better for experienced nurses with higher base rates. Flat-dollar differentials give the same amount to everyone.

How does overtime work for nurses?

Under the FLSA, non-exempt employees must be paid at least 1.5 times their regular rate for overtime hours. Hospitals can choose between two methods to calculate it, and state law can add more protections.

The 40-hour rule vs the 8/80 rule

The standard rule pays overtime for hours over 40 in a fixed workweek. A nurse working three 12-hour shifts (36 hours) earns no overtime. A fourth shift in the same week pushes them past 40.

Hospitals and residential care facilities can instead use the 8/80 system. It requires an agreement with the employee before the work is performed. Under 8/80, overtime is owed for:

1. Any hours over 8 in a single workday, and
2. Any hours over 80 in a 14-day period.

Some states, such as California, also have daily overtime laws. California allows healthcare employers to adopt alternative workweek schedules for 12-hour shifts. Your employer's policy and your state's law determine which rules apply to you.

Do differentials count toward your overtime rate?

Generally, yes. Under the FLSA, shift differentials and nondiscretionary bonuses must be included in your "regular rate," which is the figure overtime is calculated from. If you work overtime on a night shift, your 1.5x rate should reflect your base rate plus the differential.

If your overtime looks like it's calculated only on your base rate, ask payroll how they figured it.

Mandatory overtime and state limits

Federal law does not limit how many hours an adult nurse can be required to work. Many states, including New York and Washington, restrict mandatory overtime for nurses. These laws usually include exceptions for emergencies.

The rules differ a lot from state to state. Check your state's labor department or board of nursing, and your union contract if you have one.

Incentive and extra-shift bonus pay

When units are short-staffed, hospitals often offer incentive pay for picking up extra shifts. This may be a flat bonus per shift or a higher hourly rate. These incentives are usually nondiscretionary, so they generally must be factored into your overtime rate under the FLSA.

How does per diem nurse pay compare with staff pay?

Per diem nurses work as needed, filling open shifts without a set schedule. The trade-off is simple: a higher hourly rate in exchange for fewer benefits and less certainty about hours.

Why per diem hourly rates run higher

Per diem rates are higher partly to make up for the lack of benefits and partly because hospitals need flexible staff who can fill gaps on short notice. Some employers offer different per diem tiers. A higher tier pays more in exchange for a bigger availability commitment.

What you give up: benefits and guaranteed hours

Per diem nurses usually don't get employer health insurance, paid time off or the same retirement contributions. Shifts may also be canceled when the census drops, often with little notice. If you rely on per diem work, plan for health coverage and uneven income. You can browse per diem nurse jobs to compare how employers structure these roles.

On-call and call-back pay

On-call pay is a reduced hourly rate for being available to come in. Common in the OR, cath lab and other procedural areas, it's paid even if you're never called. Call-back pay applies once you're actually called in, often at a premium rate. Many employers also guarantee a minimum number of paid hours per call-back.

Under the FLSA, on-call time may count as hours worked if you're restricted enough that you can't use the time for yourself. Employer policies and state law vary, so check the details.

How do nurse sign-on bonuses work?

Sign-on bonuses are one-time payments offered to attract nurses, especially to hard-to-fill specialties and locations. They almost always come with conditions.

How bonuses are paid out

Bonuses are often split into installments, such as part after orientation and the rest after a set number of months. Some are paid as a lump sum. Bonuses are taxable income and are withheld as supplemental wages, so the amount you receive will be less than the advertised figure.

Commitment periods and repayment clauses

Most bonuses require you to stay for a set period, commonly one to two years. If you leave early, you may have to repay part or all of the bonus. Before you sign, check:

• How long the commitment period lasts
• Whether repayment is prorated or the full amount
• Whether it applies if you're terminated, not just if you resign
• Whether you must keep a specific FTE or stay on a specific unit

Sign-on bonus vs a higher base rate

A bonus is paid once. A higher base rate pays off on every hour you work, and differentials, overtime and future percentage raises are often built on it. If you plan to stay long-term, a higher base rate usually adds up to more. If you're unsure how long you'll stay, a bonus with a repayment clause carries more risk.

How to negotiate a nursing salary

Many nurses accept the first offer, but there's often room to negotiate, especially for experienced nurses in high-demand specialties.

What is actually negotiable

Depending on the employer, you may be able to negotiate:

• Your placement on the pay scale (step or experience level)
• Sign-on bonus amount or terms
• Relocation assistance
• Start date and orientation length
• Schedule, such as a set shift or weekend requirements
• Tuition or certification reimbursement

Differential amounts are usually fixed by policy and rarely negotiable for individual nurses.

Getting credit for years of experience and certifications

Make sure the employer counts all of your relevant licensed experience. Some count only acute care or only same-specialty years. Ask how they calculated your placement, and give documentation if they've missed something. Mention your certifications, since they may qualify you for a higher step as well as certification pay.

Using local pay data to back your ask

A specific request backed by data is stronger than a vague one. Follow these steps:

1. Look up typical rates for your role and area using our pay data.
2. Compare postings from similar employers nearby.
3. Make a specific counteroffer tied to your experience and credentials.
4. Get the final terms in writing before you accept.

Union contracts and fixed pay scales

At unionized hospitals, base rates, differentials, overtime rules and step increases are set by the collective bargaining agreement. Individual nurses usually can't negotiate their rate. What you can do is make sure you're placed on the correct step for your experience. Ask for a copy of the contract before you accept.

Frequently asked questions

How much is a typical night shift differential for nurses?

It varies by employer, state and contract. Some hospitals pay a flat dollar amount per hour, and others pay a percentage of base. Check job postings and our pay data to see what's typical where you live.

Do nurses get paid overtime on 12-hour shifts?

Not automatically. Under the federal 40-hour rule, three 12-hour shifts (36 hours) don't trigger overtime, but under the 8/80 system or some state laws, hours past 8 in a day can. Your employer's overtime method and your state's law decide which applies.

Is per diem nursing worth it without benefits?

It can be if you already have health coverage, such as through a spouse or another job, and value flexibility. The higher hourly rate has to cover insurance, retirement savings and the risk of canceled shifts. Run the numbers for your situation before switching.

Do you have to pay back a sign-on bonus if you quit?

Usually, if you leave before the commitment period ends. The repayment terms are in your bonus agreement. Some require a prorated amount and others the full bonus, so read them before signing.

Can new grad nurses negotiate salary?

Often the new grad rate is fixed, especially at unionized hospitals or in residency programs. You may still have room on start date, unit choice or relocation help. Prior healthcare experience, such as working as a CNA or tech, sometimes counts toward placement, so ask.

Ready to compare offers? Browse per diem nurse jobs on NurseTide.