Pay for nurses under Title 38 starts with a national base rate, then gets adjusted upward at each VA medical center based on what nearby hospitals pay for comparable nursing work. On top of that locally-set base, you can earn premium pay for nights, weekends, holidays, and on-call hours, plus recruitment, retention, and certification bonuses. The result is that two VA nurses with the same credentials can earn very different salaries depending on where they work and what shifts they pick up.
Your Grade and Step Set the Starting Number
VA nursing positions fall into five grades: Nurse I, Nurse II, Nurse III, Nurse IV, and Nurse V.1Office of the Law Revision Counsel. Title 38 USC Part V, Chapter 74, Subchapter I – Appointments Each grade contains multiple steps that mark incremental raises within it. New graduates typically start at Nurse I. Experienced nurses or those with advanced certifications and leadership backgrounds may be brought in at Nurse II or III. Nurse IV requires leading programs that cross service or discipline lines, and Nurse V is an executive role setting strategic direction across an organization or enterprise, with demonstrated business acumen in technology, data analytics, and resource management.2Department of Veterans Affairs. Nurse Qualification Standard VN/AD-0610
Your selecting official (usually a hiring manager or nurse executive) recommends your initial step, and an approving official authorizes it.3Department of Veterans Affairs. VA Handbook 5007/63 Pay Administration When a step above the grade minimum is recommended, the Office of Nursing Services Above Entry Pay Tool documents the justification. Prior nursing experience, specialized skills, or the facility’s recruiting needs can push your starting step up. Previous federal civilian service may let your step be set based on your highest previous rate of pay. For Nurse IV and V, the approving official can set the initial rate at any step within the grade.
When you move up, federal law requires that your new rate exceed what you earned before the promotion.4Office of the Law Revision Counsel. 38 U.S. Code 7452 – Nurses and Other Health-Care Personnel: Administration of Pay A promotion within the same grade brings at least a one-step increase. Within-grade step increases follow from performance and tenure.
Locality Adjustment Is Usually the Biggest Factor
Federal law directs each VA medical center director to run an annual locality pay survey comparing the facility’s nursing pay to what non-VA employers pay in the same labor market.5Office of the Law Revision Counsel. Title 38 USC 7451 – Nurses and Other Health-Care Personnel: Competitive Pay The survey draws on Bureau of Labor Statistics industry-wage data for the facility’s area. The director sets the minimum rate for each grade to match the starting compensation for comparable private-sector nursing positions, then adjusts the remaining steps in proportion.
The size of these adjustments swings widely. A facility in a market with modest health care wages might apply a locality adjustment around 17%. A facility competing with high-paying urban hospital systems can go past 30%. This is not a cost-of-living bump. A city with a low cost of living but a nursing shortage can still carry a high locality adjustment because of the competition for staff. When you compare two VA job postings, the grade and step tell you less about the paycheck than the labor market does.
Premium Pay for Nights, Weekends, Holidays, and On-Call
Title 38 fixes premium pay rates by statute, so they don’t vary from facility to facility.
- Night differential: an additional 10% of your hourly base pay for shifts where at least four hours fall between 6 p.m. and 6 a.m. If fewer than four hours fall in that window, you get the differential only for the hours actually worked in it.6Office of the Law Revision Counsel. Title 38 USC 7453 – Nurses: Additional Pay
- Weekend premium: an additional 25% of your hourly base pay for any service between midnight Friday and midnight Sunday.6Office of the Law Revision Counsel. Title 38 USC 7453 – Nurses: Additional Pay
- Holiday pay: your regular hourly rate plus an equal additional amount for each hour worked on a federal holiday. Holiday service counts as a minimum of two hours even if you work less.6Office of the Law Revision Counsel. Title 38 USC 7453 – Nurses: Additional Pay
- On-call pay: 10% of the overtime hourly rate (1.5 times your base hourly rate) for each hour of scheduled on-call duty, excluding any time you’re actually called back to work.6Office of the Law Revision Counsel. Title 38 USC 7453 – Nurses: Additional Pay
These premiums stack. A Saturday night shift earns the 25% weekend premium and the 10% night differential together, both computed against your hourly base. Holiday nights carry more. For a nurse who regularly works off-shifts, premium pay adds thousands of dollars a year.
Bonuses and Loan Repayment
Recruitment and Retention Bonuses
At facilities designated as having a significant nursing shortage, the VA Secretary can authorize recruitment and retention bonus agreements. The agreements run two to four years and pay annual bonuses up to $2,000 per year for a two-year agreement, $3,000 per year for three years, or $4,000 per year for four years.7Office of the Law Revision Counsel. Title 38 USC 7458 – Recruitment and Retention Bonus Pay The Secretary reviews at least annually which facilities and clinical services qualify. These bonuses come with a service commitment, and leaving early can trigger repayment.
Certification Bonuses
A facility director can award a cash bonus of up to $2,000 when a nurse earns certification in a VA-recognized specialty.4Office of the Law Revision Counsel. 38 U.S. Code 7452 – Nurses and Other Health-Care Personnel: Administration of Pay The same provision authorizes bonuses for exemplary job performance and achievement. Specialty certifications also feed into grade and step decisions, so the long-term pay effect often exceeds the one-time payment.
Education Debt Reduction
The Education Debt Reduction Program reimburses qualifying education loan payments up to $40,000 per year, with a lifetime cap of $200,000 over five years of participation.8Office of the Law Revision Counsel. Title 38 USC 7683 – Education Debt Reduction For positions where there’s a shortage of qualified employees due to location or job requirements, the Secretary can waive these caps and cover the full principal and interest on qualifying loans. That waiver authority makes the program especially valuable at rural or underserved VA facilities.
Health Professional Scholarship Program
Nursing students can receive tuition funding through the VA Health Professional Scholarship Program in exchange for post-graduation service. Full-time students owe one year of full-time VA clinical service for each scholarship year, with a two-year minimum.9eCFR. VA Health Professional Scholarship Program Part-time students serve a proportionally reduced obligation, but never less than one year. Combined with debt reduction after graduation, the two programs can eliminate most or all education-related debt for a nurse who commits to VA service.
The Aggregate Pay Cap
Total compensation for Title 38 nurses is subject to an annual aggregate pay limitation. For 2026, that cap is $253,100, matching Executive Level I.10OPM (Office of Personnel Management). January 2026 Pay Adjustments The ceiling covers the combined total of base pay, locality adjustments, premium pay, and bonuses in a calendar year. Most staff nurses will never come close. It can matter for Nurse IV and Nurse V roles in high-locality areas who also earn substantial premium and bonus pay.
Benefits That Round Out Total Compensation
Leave
Full-time Title 38 nurses earn 8 hours of annual leave per pay period from day one, or 208 hours (26 days) per year. Title 5 federal employees, by contrast, start at 4 hours per pay period and don’t reach the 8-hour rate until 15 years of service. Sick leave accrues at 4 hours per pay period (13 days per year) and carries over indefinitely with no cap.
Retirement
VA nurses participate in the Federal Employees Retirement System. FERS has three parts: a defined-benefit annuity that vests after five years of creditable civilian service, Social Security, and the Thrift Savings Plan. The government automatically contributes 1% of your basic pay to your TSP regardless of whether you contribute anything. If you contribute up to 5% yourself, the government matches dollar-for-dollar on the first 3% and 50 cents per dollar on the next 2%.11The Thrift Savings Plan (TSP). Contribution Types A nurse contributing 5% receives a 5% total government contribution.
Health Insurance
Coverage runs through the Federal Employees Health Benefits program, which offers a wide selection of plans and pays a substantial share of the premium. FEHB coverage continues into retirement for anyone who maintained enrollment for at least five years before retiring.
Why Title 38 Exists Separately From the GS Scale
Most federal workers are paid under Title 5 of the U.S. Code, which uses the General Schedule and its GS-1 through GS-15 grades. VA nurses fall instead under Title 38, Chapter 74, which was built specifically for health care professionals.1Office of the Law Revision Counsel. Title 38 USC Part V, Chapter 74, Subchapter I – Appointments The Secretary of Veterans Affairs sets pay rates independently, and facility directors adjust them to stay competitive locally. That flexibility is why the same grade and step can pay one figure in rural Mississippi and another in San Francisco, and why the pay conversation always comes back to the local labor market.