How to Read Your Nurse Pay Stub: Every Line Explained

Your pay stub has dozens of line items, and most nurses have never been taught what half of them mean. Here is a complete walkthrough of every section, what to expect, and what to question.

Why Nurses Need to Read Their Pay Stubs

A typical office worker has a simple pay stub: salary, federal tax, state tax, insurance, done. A nurse's pay stub is different. Between base hours, shift differentials, overtime at a weighted regular rate, holiday premiums, charge nurse pay, and a half-dozen deductions, there are many places where errors can hide.

Payroll systems are configured by humans, and they make mistakes. A wrong differential rate, a missing premium, overtime calculated on base-only instead of the regular rate - these errors happen, and they tend to repeat every pay period until someone catches them. That someone needs to be you.

Section 1: Earnings (the Top Half)

The earnings section is where your gross pay is built. Each line typically shows a pay type, the number of hours, the rate, and the total for that line. Here is what each common line means:

Regular Hours

This is your base hourly rate multiplied by your non-overtime hours. If you earn $35.00/hr and worked 36 hours of regular time, this line should show 36.00 hours at $35.00 for a total of $1,260.00.

Shift Differential

Night and weekend differentials usually appear as separate line items. You might see "EVE DIFF" or "NIGHT PREM" or "WKND DIFF." Each line should show the number of qualifying hours multiplied by the differential rate. If you worked 36 night-shift hours with a $5.00/hr differential, this line should show $180.00. If you see fewer hours than you actually worked on nights, that is a red flag.

Overtime

Overtime lines can be confusing because of how the math works. Under FLSA, overtime is paid at 1.5 times your regular rate, not your base rate. The regular rate includes differentials and premiums earned during the week, so it changes from week to week.

Some pay stubs show OT as a single line at the full 1.5x rate. Others break it into two components: regular-rate pay for the OT hours (already included in the regular hours line) plus a separate "OT premium" line at 0.5x the regular rate. Both approaches arrive at the same total, but they look very different on the stub.

Holiday Premium

Holiday pay varies widely by facility. Some hospitals pay time-and-a-half for the holiday shift. Others pay a flat bonus per holiday hour (e.g., an extra $10/hr). Some pay double time. Check your contract or employee handbook to know which method your facility uses, then verify the line matches.

Charge Nurse and Preceptor Pay

If you took charge or precepted a new nurse, look for a separate line item. Charge pay is typically $1.50-$5.00/hr added to every hour of that shift. Preceptor pay is similar, usually $1.00-$3.00/hr. If you worked charge for a 12-hour shift at $3.00/hr, the line should show 12.00 hours at $3.00 for $36.00.

The Difference Between "Hours" and "Earnings" Columns

Some stubs show an "Hours" column and a separate "Earnings" column. The hours column is informational - it tells you how many hours were coded to each pay type. The earnings column is the actual dollar amount. These should always be consistent (hours times rate equals earnings), but verify that they are. Rounding or system errors occasionally cause mismatches.

Section 2: Deductions (the Bottom Half)

Deductions reduce your gross pay to arrive at your net (take-home) pay. Here are the standard deductions on a nurse's stub:

Federal Income Tax Withholding

This is the largest variable deduction. The amount withheld depends on your W-4 elections (filing status, dependents, additional withholding). This is not the tax you actually owe - it is an estimate. If you consistently get large refunds, your W-4 is over-withholding.

State Income Tax Withholding

If your state has an income tax, this line shows the state withholding. Rates and methods vary by state. Some states have flat rates; others have brackets like the federal system. A few states (Texas, Florida, Nevada, and others) have no state income tax at all.

Social Security (OASDI)

This is a flat 6.2% of your gross pay, up to the annual wage cap ($168,600 in 2025, typically adjusted annually). Once your year-to-date earnings hit the cap, this deduction drops to zero for the rest of the year. If you are a high-earning nurse or work heavy overtime, watch for this mid-year - your take-home pay will jump when you hit the cap.

Medicare

A flat 1.45% of your gross pay with no cap. If your annual earnings exceed $200,000 (single filer), an additional 0.9% Medicare surtax applies to earnings above that threshold.

Health Insurance

Your share of health, dental, and vision insurance premiums. These are usually pre-tax deductions, meaning they reduce your taxable income. Check that the amount matches what you elected during open enrollment.

Retirement Contributions (401k/403b)

If you contribute to a 401(k) or 403(b), this line shows your per-paycheck contribution. It may be shown as a dollar amount or a percentage of gross. Traditional contributions are pre-tax; Roth contributions are post-tax. Verify the amount matches your election, especially after any changes.

Union Dues

If you are in a union, dues are typically deducted per pay period. This is a fixed amount defined by your union contract.

Section 3: Year-to-Date (YTD) Totals

The YTD column shows cumulative totals for the calendar year. This section matters for two reasons:

Tax planning. Your YTD gross earnings tell you which tax bracket you are in and whether your withholding is on track. If your YTD federal withholding is significantly higher than your estimated tax liability, you may want to adjust your W-4.
Social Security wage cap. Once your YTD earnings hit the Social Security cap, you stop paying the 6.2% OASDI tax. For nurses earning $70,000-$90,000 per year, this typically does not apply. But if you work heavy overtime or have a high base rate, you could hit it late in the year.

Common Red Flags to Watch For

After understanding what each line means, here are the specific things that most frequently go wrong on nurse pay stubs:

Missing differential line. You worked nights but there is no night differential line item at all. This means those hours were not coded correctly in the system.
Overtime calculated on base rate only. Your OT rate should be higher than 1.5x your base rate if you earned any differentials that week. If the OT line shows exactly $52.50 for a $35.00 base rate, the regular-rate calculation may be wrong.
Wrong hours count. Add up all the hours across all earnings lines. Do they match the hours you actually worked? Short-staffed scheduling changes sometimes result in hours being lost between the timekeeper and payroll.
Deductions that changed without notice. If your health insurance deduction jumped or your 401(k) percentage changed and you did not make a change, contact HR immediately.

What to Do If Something Looks Wrong

First, compare your pay stub against your own records. If you track your shifts in an app or on paper, line up each shift against the corresponding earnings line. Identify the specific line that does not match.

Then contact payroll with specifics: "My pay stub shows 24 night differential hours, but I worked 36 night-shift hours this pay period. Here are the dates and shifts." Specific, documented discrepancies get resolved faster than "I think my pay is wrong."

How ShiftWorth Helps

ShiftWorth calculates what each line on your pay stub should be. You enter your shifts throughout the pay period - base hours, differentials, premiums, overtime - and the app builds an expected pay breakdown using your saved facility rules. When your paycheck arrives, you can compare line by line: expected versus actual.

If there is a discrepancy, you know exactly which component is off and by how much. That turns a confusing pay stub into a clear, actionable conversation with payroll.