Starting a nursing career in the United States is an exciting journey, and with it comes the responsibility of understanding how U.S. taxes work. As an international nurse, it’s important to know how taxes are structured, how they’re paid, and what you can expect to see deducted from your paycheck. Having a basic understanding of the U.S. tax system will help you budget wisely and avoid surprises when tax season comes around.
In the U.S., taxes are collected at two main levels of government: federal and state. The federal government collects income taxes from everyone who earns a wage, regardless of immigration status or where they live in the United States. In addition, most U.S. states also collect their own state income taxes, though a few (like Florida, Texas, and Nevada) do not charge state income tax. The amount you pay in state tax depends on which state you live in, and sometimes how much you earn. Each state has its own rates and rules, which means your take-home pay can vary depending on your location. We encourage you to reach out to our team if you have questions!
When you start working, taxes are automatically withheld (subtracted) from your paycheck by your employer. These withholdings typically include federal income tax, state income tax (if applicable), Social Security, and Medicare taxes. Social Security and Medicare are part of a federal benefits program that supports retirees, people with disabilities, and healthcare for older adults.
There is no exemption from paying taxes—even as an international worker or visa holder. Together, these deductions usually total around 20–30% of your gross pay, depending on your income level and the state you’re in. This means you can expect each paycheck to be about 20–30% less than your gross pay. If you’re curious about what your paycheck might look like, the ADP salary calculator is a great resource!
Hours × pay rate = gross pay – ~20–30% = take-home pay after taxes.
While these deductions may seem high at first, they ensure you’re contributing to essential programs and staying compliant with U.S. tax laws. Additionally, all U.S. salaries take these tax rates into account, and Interstaff especially considers tax rates when determining your salary and annual cost-of-living reviews.
Each year, you’ll also need to file a tax return, usually by April 15. This process allows you to report your income and withholdings and determine if you owe additional taxes or are due a refund. Refunds happen when you have paid more taxes throughout the year than you actually ended up owing. Many nurses choose to work with a tax preparer or use online software to help with filing, especially in their first year. Don’t hesitate to reach out to the Interstaff team for help preparing your taxes!
Getting comfortable with U.S. taxes takes time, but you won’t be alone. Interstaff will help guide you to resources that explain your paystubs, tax documents (like your W-2), and filing responsibilities. With the right support, managing your taxes will become just another step in building your new life and career in the US.
